RESUMEN
The relationship between structural changes in the cerebral gray matter and diminished balance control performance in patients with chronic ankle instability (CAI) has remained unclear. This paper aimed to assess the difference in gray matter volume (GMV) between participants with CAI and healthy controls (HC) and to characterize the role of GMV in the relationship between disease duration and balance performance in CAI. 42 participants with CAI and 33 HC completed the structural brain MRI scans, one-legged standing test, and Y-balance test. Regional GMV was measured by applying voxel-based morphometry methods. The result showed that, compared with HC, participants with CAI exhibited lower GMV in multiple brain regions (familywise error [FWE] corrected p < 0.021). Within CAI only, but not in HC, lower GMV in the thalamus (ß = -0.53, p = 0.003) and hippocampus (ß = -0.57, p = 0.001) was associated with faster sway velocity of the center of pressure (CoP) in eyes closed condition (i.e., worse balance control performance). The GMV in the thalamus (percentage mediated [PM] = 32.02%; indirect effect ß = 0.119, 95% CI = 0.003 to 0.282) and hippocampus (PM = 33.71%; indirect effect ß = 0.122, 95% CI = 0.005 to 0.278) significantly mediated the association between the disease duration and balance performance. These findings suggest that the structural characteristics of the supraspinal elements is critical to the maintenance of balance control performance in individuals suffering from CAI, which deserve careful consideration in the management and rehabilitation programs in this population.
Asunto(s)
Articulación del Tobillo , Sustancia Gris , Inestabilidad de la Articulación , Imagen por Resonancia Magnética , Equilibrio Postural , Humanos , Equilibrio Postural/fisiología , Masculino , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/diagnóstico por imagen , Femenino , Adulto Joven , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Articulación del Tobillo/patología , Estudios de Casos y Controles , Adulto , Enfermedad Crónica , Tálamo/diagnóstico por imagen , Tálamo/patología , Tálamo/fisiopatología , Hipocampo/diagnóstico por imagen , Hipocampo/patología , Factores de TiempoRESUMEN
Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.
Asunto(s)
Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Osteoartritis/cirugía , Osteoartritis/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Falla de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/etiología , Prótesis Articulares/efectos adversosRESUMEN
Weight-bearing computed tomography has multiple advantages in evaluating the hindfoot and ankle. It can assess hindfoot and ankle alignment, pathology in ankle arthritis, and complications related to total ankle replacements. It is an essential tool in ankle osteoarthritis diagnostic, preoperative planning, and total ankle replacement outcomes. It allows for better accuracy and reproducibility of alignment and implant size. In addition, it has the potential to more assertively detect complications related to weight bearing.
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Articulación del Tobillo , Artroplastia de Reemplazo de Tobillo , Tomografía Computarizada de Haz Cónico , Osteoartritis , Soporte de Peso , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugíaRESUMEN
Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications.
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Artroplastia de Reemplazo de Tobillo , Prótesis Articulares , Imagen por Resonancia Magnética , Humanos , Artroplastia de Reemplazo de Tobillo/efectos adversos , Imagen por Resonancia Magnética/métodos , Prótesis Articulares/efectos adversos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Dolor Postoperatorio/etiología , Diseño de Prótesis , Masculino , Artefactos , Femenino , Falla de PrótesisRESUMEN
The gold standard diagnostic imaging tool for ankle OCLs is magnetic resonance imaging, which allows precise evaluation of the articular cartilage and assessment of the surrounding soft tissue structures. Post-operative morphologic MRI assessment via MOCART scores provide semi-quantitative analysis of the repair tissue, but mixed evidence exists regarding its association with post-operative outcomes. Post-operative biochemical MRIs allow assessment of the collagen network of the articular cartilage via T2-mapping and T2∗ mapping, and assessment of the articular glycosaminoglycan content via delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho mapping and sodium imaging.
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Cartílago Articular , Imagen por Resonancia Magnética , Humanos , Imagen por Resonancia Magnética/métodos , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/cirugía , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Cuidados Preoperatorios/métodos , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico por imagen , Cuidados Posoperatorios/métodos , Osteocondritis/cirugía , Osteocondritis/diagnóstico por imagen , Traumatismos de los Pies/cirugía , Traumatismos de los Pies/diagnóstico por imagenRESUMEN
Radiography is considered the first-line screening exam for clinically suspected osteomyelitis. However, additional evaluation is generally needed. MRI is the definitive diagnostic exam with high sensitivity and specificity combined with excellent anatomic definition. Gadolinium contrast can be useful to detect areas of devitalization before surgery. Bone marrow edema on fluid-sensitive images and low signal intensity on T1-weighted images in the presence of secondary MRI findings, including ulcer, sinus tract, and cellulitis with or without abscess are typical findings of osteomyelitis. If MRI is contraindicated, three phase bone scan can be used. Early diagnosis and treatment is essential.
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Artritis Infecciosa , Imagen por Resonancia Magnética , Osteomielitis , Humanos , Osteomielitis/diagnóstico por imagen , Osteomielitis/diagnóstico , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/terapia , Articulación del Tobillo/diagnóstico por imagenRESUMEN
Weight-bearing computed tomography (WBCT) was introduced in 2012 for foot and ankle applications as a breakthrough technology that enables full weight-bearing, three-dimensional imaging unaffected by x-ray beam projections or foot orientation. The literature describing the use of WBCT in the treatment of foot and ankle disorders is growing, and this article provides an overview of what can be measured with WBCT.
Asunto(s)
Pie , Tomografía Computarizada por Rayos X , Soporte de Peso , Humanos , Pie/diagnóstico por imagen , Articulación del Tobillo/diagnóstico por imagen , Imagenología Tridimensional , Tobillo/diagnóstico por imagenRESUMEN
Ultrasound is a high-resolution, real-time imaging modality that is frequently used for image-guided procedures. Due to the highly complex anatomy of the foot and ankle, ultrasound should be considered a first-line imaging modality for injections and procedures in this region.
Asunto(s)
Pie , Ultrasonografía Intervencional , Humanos , Pie/diagnóstico por imagen , Tobillo/diagnóstico por imagen , Inyecciones Intraarticulares/métodos , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/cirugíaRESUMEN
MRI is a valuable tool for diagnosing a broad spectrum of acute and chronic ankle disorders, including ligament tears, tendinopathy, and osteochondral lesions. Traditional two-dimensional (2D) MRI provides a high image signal and contrast of anatomic structures for accurately characterizing articular cartilage, bone marrow, synovium, ligaments, tendons, and nerves. However, 2D MRI limitations are thick slices and fixed slice orientations. In clinical practice, 2D MRI is limited to 2 to 3 mm slice thickness, which can cause blurred contours of oblique structures due to volume averaging effects within the image slice. In addition, image plane orientations are fixated and cannot be changed after the scan, resulting in 2D MRI lacking multiplanar and multiaxial reformation abilities for individualized image plane orientations along oblique and curved anatomic structures, such as ankle ligaments and tendons. In contrast, three-dimensional (3D) MRI is a newer, clinically available MRI technique capable of acquiring high-resolution ankle MRI data sets with isotropic voxel size. The inherently high spatial resolution of 3D MRI permits up to five times thinner (0.5 mm) image slices. In addition, 3D MRI can be acquired image voxel with the same edge length in all three space dimensions (isotropism), permitting unrestricted multiplanar and multiaxial image reformation and postprocessing after the MRI scan. Clinical 3D MRI of the ankle with 0.5 to 0.7 mm isotropic voxel size resolves the smallest anatomic ankle structures and abnormalities of ligament and tendon fibers, osteochondral lesions, and nerves. After acquiring the images, operators can align image planes individually along any anatomic structure of interest, such as ligaments and tendons segments. In addition, curved multiplanar image reformations can unfold the entire course of multiaxially curved structures, such as perimalleolar tendons, into one image plane. We recommend adding 3D MRI pulse sequences to traditional 2D MRI protocols to visualize small and curved ankle structures to better advantage. This article provides an overview of the clinical application of 3D MRI of the ankle, compares diagnostic performances of 2D and 3D MRI for diagnosing ankle abnormalities, and illustrates clinical 3D ankle MRI applications.
Asunto(s)
Articulación del Tobillo , Cartílago Articular , Imagenología Tridimensional , Imagen por Resonancia Magnética , Tendones , Humanos , Imagen por Resonancia Magnética/métodos , Articulación del Tobillo/diagnóstico por imagen , Cartílago Articular/diagnóstico por imagen , Tendones/diagnóstico por imagen , Tendones/anatomía & histología , Traumatismos del Tobillo/diagnóstico por imagen , Ligamentos Articulares/diagnóstico por imagen , Ligamentos/diagnóstico por imagenRESUMEN
During vertical jump evaluations in which jump height is estimated from flight time (FT), the jumper must maintain the same body posture between vertical takeoff and landing. As maintaining identical posture is rare during takeoff and landing between different jump attempts and in different individuals, we simulated the effect of changes in ankle position from takeoff to landing in vertical jumping to determine the range of errors that might occur in real-life scenarios. Our simulations account for changes in center of mass position during takeoff and landing, changes in ankle position, different subject statures (1.44-1.98 m), and poor to above-average jump heights. Our results show that using FT to estimate jump height without controlling for ankle position (allowing dorsiflexion) during the landing phase of the vertical jump can overestimate jump height by 18% in individuals of average stature and performing an average 30 cm jump or may overestimate by ≤60% for tall individuals performing a poor 10 cm jump, which is common for individuals jumping with added load. Nevertheless, as assessing jump heights based on FT is common practice, we offer a correction equation that can be used to reduce error, improving jump height measurement validity using the FT method allowing between-subject fair comparisons.
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Postura , Humanos , Fenómenos Biomecánicos/fisiología , Postura/fisiología , Masculino , Tobillo/fisiología , Adulto , Articulación del Tobillo/fisiología , Femenino , Simulación por Computador , Adulto Joven , Movimiento/fisiologíaRESUMEN
BACKGROUND: Acute ankle sprains represent one of the most common traumatic injuries to the musculoskeletal system. Many individuals with these injuries experience unresolved symptoms such as instability and recurrent sprains, leading to chronic ankle instability (CAI), which affects their ability to maintain an active lifestyle. While rehabilitation programs focusing on sensorimotor, neuromuscular, strength and balance training are primary treatments, some patients require surgery when rehabilitation fails. A critical analysis of the patient-reported outcome tools (PROs) used to assess CAI surgical outcomes raises some concerns about their measurement properties in CAI patients, which may ultimately affect the quality of evidence supporting current surgical practice. The aim of this research is to develop and validate a new PRO for the assessment of ankle instability and CAI treatment outcomes, following recent methodological guidelines, with the implicit aim of contributing to the generation of scientifically meaningful evidence for clinical practice in patients with ankle instability. METHODS: Following the COnsensus-based Standards for the selection of Health Measurement Instruments (COSMIN), an Ankle Instability Treatment Index (AITI) will be developed and validated. The process begins with qualitative research based on faceâtoâface interviews with CAI individuals to explore the subjective experience of living with ankle instability. The data from the interviews will be coded following an inductive approach and used to develop the AITI content. The preliminary version of the scale will be refined through an additional round of faceâtoâface interviews with a new set of CAI subjects to define the AITI content coverage, relevance and clarity. Once content validity has been examined, the AITI will be subjected to quantitative analysis of different measurement properties: construct validity, reliability and responsiveness. DISCUSSION: The development of AITI aims to address the limitations of existing instruments for evaluating surgical outcomes in patients with CAI. By incorporating patient input and adhering to contemporary standards for validity and reliability, this tool seeks to provide a reliable and meaningful assessment of treatment effects. TRIAL REGISTRATION: Not applicable.
Asunto(s)
Traumatismos del Tobillo , Inestabilidad de la Articulación , Medición de Resultados Informados por el Paciente , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/terapia , Articulación del Tobillo/fisiopatología , Articulación del Tobillo/cirugía , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: Compared with open surgery, arthroscopic anterior talofibular ligament (ATFL) repair has many advantages and good clinical outcome. Inferior extensor retinaculum (IER) reinforcement is a supplement procedure that increase the strength of the ATFL. There is still no gold standard for arthroscopic ATFL repair. The purposes of this study were to describe a simplified technique for arthroscopic ATFL repair with IER reinforcement and to analyze its preliminary clinical results. METHODS: Twenty-seven patients with chronic lateral ankle instability (CLAI) who underwent this simplified surgery were analyzed in this retrospective study. The patients' characteristics and operative times were evaluated. Intraoperative photos, radiographs from the anterior drawer test and talar tilt test and postoperative MR images were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) score were also recorded. With the assistance of a needle, we performed ATFL repair and IER reinforcement with one Pushlock anchor and nonabsorbable sutures. RESULTS: No complications namely skin necrosis, superficial fibular nerve injury or wound infection, were reported. The AOFAS score and VAS score improved from 64.74 ± 9.47 and 6.00 ± 1.56 to 90.74 ± 6.46 and 1.07 ± 1.09, respectively. The talar advancement and talar tilt angle were improved after surgery. One year after the operation, the ATFL appeared to be continuous on MR images. CONCLUSION: In this study, we proposed a simple and effective arthroscopic ATFL repair with IER reinforcement technique. The short-term follow-up examination revealed satisfactory clinical outcomes. Our technique might be a new surgical option for the treatment of CLAI.
Asunto(s)
Artroscopía , Inestabilidad de la Articulación , Ligamentos Laterales del Tobillo , Humanos , Masculino , Femenino , Artroscopía/métodos , Adulto , Ligamentos Laterales del Tobillo/cirugía , Ligamentos Laterales del Tobillo/lesiones , Ligamentos Laterales del Tobillo/diagnóstico por imagen , Estudios Retrospectivos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/diagnóstico por imagen , Adulto Joven , Persona de Mediana Edad , Resultado del Tratamiento , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , AdolescenteRESUMEN
BACKGROUND: Proprioceptive disorders may occur when thick fibers are affected in diabetic neuropathy. This can lead to impaired joint stabilization and increased risk of falls and fractures. We evaluated joint position sense (JPS) in diabetic patients to detect those at risk for neuropathy earlier. METHODS: Sixty diabetic patients and 30 healthy individuals aged 30 to 60 years were included in the study and divided into three groups: 30 diabetic patients with peripheral neuropathy, 30 diabetic patients without peripheral neuropathy, and 30 nondiabetic control patients. Presence of neuropathy was determined electrophysiologically. Passive ankle JPS was evaluated by an isokinetic system in all three groups. Both 10° and 30° plantarflexion and 10° dorsiflexion were determined as target angles. The mean absolute angular error (MAAE) values for three trials with each angle were assessed by Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The MAAEs with all of the angles were significantly higher in diabetic patients with peripheral neuropathy compared with diabetic patients without peripheral neuropathy and the control group (P < .001 for all of the comparisons). The MAAEs with right ankle 10° plantarflexion (P = .004) and 10° dorsiflexion (P = .007) and left ankle 10° plantarflexion (P = .008) were significantly higher in diabetic patients without peripheral neuropathy than in the control group. CONCLUSIONS: According to these results, ankle JPS may be deteriorated before determination of neuropathy electrophysiologically.Therefore, we believe that prophylactic programs in terms of the risk of falls and fractures by evaluating JPS need to be developed in the early stages of diabetes.
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Articulación del Tobillo , Diabetes Mellitus Tipo 2 , Neuropatías Diabéticas , Propiocepción , Humanos , Persona de Mediana Edad , Masculino , Femenino , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/fisiopatología , Adulto , Articulación del Tobillo/fisiopatología , Neuropatías Diabéticas/fisiopatología , Propiocepción/fisiología , Estudios de Casos y Controles , Dinamómetro de Fuerza Muscular , Rango del Movimiento Articular/fisiologíaRESUMEN
An abundance of degrees of freedom (DOF) exist when executing a countermovement jump (CMJ). This research aims to simplify the understanding of this complex system by comparing jump performance and independent functional DOF (fDOF) present in CMJs without (CMJNoArms) and with (CMJArms) an arm swing. Principal component analysis was used on 39 muscle forces and 15 3-dimensional joint contact forces obtained from kinematic and kinetic data, analyzed in FreeBody (a segment-based musculoskeletal model). Jump performance was greater in CMJArms with the increased ground contact time resulting in higher external (p = 0.012), hip (p < 0.001) and ankle (p = 0.009) vertical impulses, and slower hip extension enhancing the proximal-to-distal joint extension strategy. This allowed the hip muscles to generate higher forces and greater time-normalized hip vertical impulse (p = 0.006). Three fDOF were found for the muscle forces and 3-dimensional joint contact forces during CMJNoArms, while four fDOF were present for CMJArms. This suggests that the underlying anatomy provides mechanical constraints during a CMJ, reducing the demand on the control system. The additional fDOF present in CMJArms suggests that the arms are not mechanically coupled with the lower extremity, resulting in additional variation within individual motor strategies.
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Brazo , Músculo Esquelético , Humanos , Fenómenos Biomecánicos , Brazo/fisiología , Masculino , Músculo Esquelético/fisiología , Adulto , Adulto Joven , Articulación de la Cadera/fisiología , Articulación del Tobillo/fisiología , Movimiento/fisiología , Rango del Movimiento Articular/fisiología , FemeninoRESUMEN
BACKGROUND: Individuals with subacute severe hemiplegia often undergo alternate gait training to overcome challenges in achieving walking independence. However, the ankle joint setting in a knee-ankle-foot orthosis (KAFO) depends on trunk function or paralysis stage for alternate gait training with a KAFO. The optimal degree of ankle joint freedom in a KAFO and the specific ankle joint conditions for effective rehabilitation remain unclear. Therefore, this study aimed to investigate the effects of different degrees of freedom of the ankle joint on center-of-pressure (CoP) parameters and muscle activity on the paretic side using a KAFO and to investigate the recommended setting of ankle joint angle in a KAFO depending on physical function. METHODS: This study included 14 participants with subacute stroke (67.4 ± 13.3 years). The CoP parameters and muscle activity of the gastrocnemius lateralis (GCL) and soleus muscles were compared using a linear mixed model (LMM) under two ankle joint conditions in the KAFO: fixed at 0° and free ankle dorsiflexion. We confirmed the relationship between changes in CoP parameters or muscle activity under different conditions and physical functional characteristics such as the Fugl-Meyer Assessment of Lower Extremity Synergy Score (FMAs) and Trunk Impairment Scale (TIS) using LMM. RESULTS: Anterior-posterior displacement of CoP (AP_CoP) (p = 0.011) and muscle activity of the GCL (p = 0.043) increased in the free condition of ankle dorsiflexion compared with that in the fixed condition. The FMAs (p = 0.004) and TIS (p = 0.008) demonstrated a positive relationship with AP_CoP. A positive relationship was also found between TIS and the percentage of medial forefoot loading time in the CoP (p < 0.001). CONCLUSIONS: For individuals with severe subacute hemiplegia, the ankle dorsiflexion induction in the KAFO, which did not impede the forward tilt of the shank, promotes anterior movement in the CoP and muscle activity of the GCL. This study suggests that adjusting the dorsiflexion mobility of the ankle joint in the KAFO according to improvement in physical function promotes loading of the CoP to the medial forefoot.
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Articulación del Tobillo , Ortesis del Pié , Hemiplejía , Músculo Esquelético , Humanos , Hemiplejía/rehabilitación , Hemiplejía/etiología , Hemiplejía/fisiopatología , Masculino , Femenino , Anciano , Músculo Esquelético/fisiopatología , Articulación del Tobillo/fisiopatología , Estudios Retrospectivos , Persona de Mediana Edad , Rehabilitación de Accidente Cerebrovascular/métodos , Rehabilitación de Accidente Cerebrovascular/instrumentación , Anciano de 80 o más Años , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiologíaRESUMEN
We aimed to implement strength and balance training for elite adolescent male soccer players with functional ankle instability (FAI) to assess kinesiophobia, ankle instability, ankle function, and performance. This cluster randomized controlled trial comprised 51 elite adolescent male soccer players with FAI recruited from six different teams, divided into strength, balance, and control groups (SG, n = 17; BG, n = 17; and CG, n = 17, respectively). The SG and BG underwent strength and balance training sessions three times per week for 6 weeks. Primary outcomes were the Tampa scale for kinesiophobia-17 (TSK) and Cumberland ankle instability tool (CAIT) scores to assess kinesiophobia and FAI, respectively. Secondary outcomes were ankle strength (four directions), dynamic balance, static balance (ellipse, displacement, velocity), and performance (figure 8 and side-hop tests). A significant interaction effect was observed for both TSK and CAIT post-intervention (both, P < 0.01). In post hoc analyses, the BG had significantly better outcomes in reducing TSK. The SG and BG showed greater improvements in CAIT scores. Regression analysis indicated that CAIT severity correlated significantly with TSK (P = 0.039, R = 0.289). For secondary outcomes, the SG and BG were superior in terms of ankle dorsiflexion/inversion strength, static balance displacement, and figure-8 and side-hop tests (all, P < 0.05). The BG showed significantly better static balance ellipse results (P < 0.05). The 6-week intervention significantly enhanced kinesiophobia management, ankle stability, and performance. Balance training effectively mitigated kinesiophobia and improved balance, compared with strength training alone. Even small variations in CAIT severity can influence kinesiophobia, highlighting the potential benefits of balance training. Integrating balance training into training programs can address both physical and psychological aspects of ankle instability. Research is recommended to explore the longitudinal effects of these interventions and their potential to prevent injury recurrence.
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Inestabilidad de la Articulación , Trastornos Fóbicos , Equilibrio Postural , Entrenamiento de Fuerza , Fútbol , Humanos , Fútbol/psicología , Fútbol/fisiología , Masculino , Adolescente , Equilibrio Postural/fisiología , Inestabilidad de la Articulación/psicología , Inestabilidad de la Articulación/fisiopatología , Estudios Prospectivos , Entrenamiento de Fuerza/métodos , Trastornos Fóbicos/psicología , Trastornos Fóbicos/terapia , Rendimiento Atlético/psicología , Rendimiento Atlético/fisiología , Articulación del Tobillo/fisiopatología , Traumatismos del Tobillo/psicología , Fuerza Muscular/fisiología , Miedo , KinesiofobiaRESUMEN
Gait analysis systems are critical for assessing motor function in rehabilitation and elderly care. This study aimed to develop and optimize an abnormal gait classification algorithm considering joint impairments using inertial measurement units (IMUs) and walkway systems. Ten healthy male participants simulated normal walking, walking with knee impairment, and walking with ankle impairment under three conditions: without joint braces, with a knee brace, and with an ankle brace. Based on these simulated gaits, we developed classification models: distinguishing abnormal gait due to joint impairments, identifying specific joint disorders, and a combined model for both tasks. Recursive Feature Elimination with Cross-Validation (RFECV) was used for feature extraction, and models were fine-tuned using support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGB). The IMU-based system achieved over 91% accuracy in classifying the three types of gait. In contrast, the walkway system achieved less than 77% accuracy in classifying the three types of gait, primarily due to high misclassification rates between knee and ankle joint impairments. The IMU-based system shows promise for accurate gait assessment in patients with joint impairments, suggesting future research for clinical application improvements in rehabilitation and patient management.
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Marcha , Aprendizaje Automático , Humanos , Masculino , Marcha/fisiología , Adulto , Máquina de Vectores de Soporte , Algoritmos , Caminata/fisiología , Articulación del Tobillo/fisiopatología , Articulación de la Rodilla/fisiopatología , Análisis de la Marcha/métodos , Adulto JovenRESUMEN
A common challenge for exoskeleton control is discerning operator intent to provide seamless actuation of the device with the operator. One way to accomplish this is with joint angle estimation algorithms and multiple sensors on the human-machine system. However, the question remains of what can be accomplished with just one sensor. The objective of this study was to deploy a modular testing approach to test the performance of two joint angle estimation models-a kinematic extrapolation algorithm and a Random Forest machine learning algorithm-when each was informed solely with kinematic gait data from a single potentiometer on an ankle exoskeleton mock-up. This study demonstrates (i) the feasibility of implementing a modular approach to exoskeleton mock-up evaluation to promote continuity between testing configurations and (ii) that a Random Forest algorithm yielded lower realized errors of estimated joint angles and a decreased actuation time than the kinematic model when deployed on the physical device.
Asunto(s)
Algoritmos , Dispositivo Exoesqueleto , Humanos , Fenómenos Biomecánicos/fisiología , Aprendizaje Automático , Marcha/fisiología , Articulación del Tobillo/fisiología , Articulaciones/fisiologíaRESUMEN
INTRODUCTION: Ankle-foot orthoses (AFOs) are commonly prescribed for people with Charcot-Marie-Tooth disease (CMT) to improve gait efficiency and reduce the occurrence of tripping and falls. The aim of this study was to systematically review evidence on the effects of AFOs on gait kinematics and kinetics and postural stability/balance in people with CMT. METHODS: Studies were identified from electronic databases and screened for inclusion online using Rayyan. Data from all eligible studies were extracted into a standardised Excel spreadsheet. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Where available, continuous outcomes were pooled to estimate standardised mean differences in random-effects meta-analyses. RESULTS: A total of 15 studies were included with variable methodological quality. Sample sizes ranged from 1 to 32 with significant variability in participant characteristics, AFO designs and testing procedures. Data from eight studies were available for meta-analysis. Although AFOs impacted walking velocity, stride length, step length, cadence, ankle dorsiflexion, plantarflexion, knee and hip flexion and ankle plantarflexion and dorsiflexion moments, the effect sizes were small-to-moderate and non-significant. There were insufficient data available for pooled analyses of outcomes related to postural stability/balance. CONCLUSION: Although AFOs positively affect a number of gait and balance parameters, the small participant numbers, variability in participant characteristics, AFO designs and testing procedures adopted by the available studies resulted in the absence of statistically significant effects when data were pooled. The results from this review also highlight the importance of device customisation based on the individual needs of people with CMT and their degree of gait impairment.
Asunto(s)
Enfermedad de Charcot-Marie-Tooth , Ortesis del Pié , Marcha , Humanos , Enfermedad de Charcot-Marie-Tooth/fisiopatología , Enfermedad de Charcot-Marie-Tooth/complicaciones , Enfermedad de Charcot-Marie-Tooth/rehabilitación , Fenómenos Biomecánicos , Marcha/fisiología , Equilibrio Postural/fisiología , Articulación del Tobillo/fisiopatología , Masculino , Femenino , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/rehabilitación , Adulto , Persona de Mediana Edad , Tobillo/fisiopatologíaRESUMEN
Purpose: Multiple loose bodies (LBs) are often found in patients with varus ankle osteoarthritis (OA). This study aimed to investigate the characteristics of extra-articular posterior ankle LBs in patients with varus ankle OA. We also sought to determine whether there were variations in the characteristics of LBs according to the degree of ankle OA. Methods: We retrospectively reviewed 50 patients who had appeared posterior extraarticular LBs on preoperative ankle imaging among the patients who underwent operative treatment for varus ankle OA from March 2011 to February 2023. We categorized the entire patient cohort into four groups according to the degree of ankle arthritis (Takakura stage II, IIIA, IIIB, and IV). Size, number, and location of LBs were evaluated using preoperative computed tomography and magnetic resonance imaging. Results: 142 LBs were identified (mean size: 11.5 mm); 76.8% were located within the flexor hallucis longus (FHL) tendon sheath, 20.4% in the posterior recess, and 2.8% in the flexor digitorum longus tendon sheath. Average LB size was significantly larger in Takakura stage IIIB and IV patients (p < .05), and the LB number was significantly lower in stage II patients (p = .013). Conclusion: Extra-articular posterior LBs in varus ankle OA are predominantly located within the FHL tendon sheath and were larger in Takakura stages IIIB and IV patients.Level of Evidence: Level III. Retrospective comparative study.