Sam Khamis - Academia.edu (original) (raw)

Papers by Sam Khamis

Research paper thumbnail of Detecting Anatomical Leg Length Discrepancy Using the Plug-in-Gait Model

Applied Sciences

Leg length discrepancy (LLD) is a significant factor influencing several pathological conditions.... more Leg length discrepancy (LLD) is a significant factor influencing several pathological conditions. Gait analysis is based on biomechanical gait models calculating joint kinematics; however, no previous study has validated its ability to detect anatomical LLD. The aim of the present study was to compare the validity of the Vicon ® Plug-in-Gait-model (PGM) in measuring femur and tibia segmental length discrepancy with measurements attained by X-ray. Fifteen participants with suspected leg length discrepancies underwent a lower limb X-ray and a standing calibration trial using a motion analysis system (Vicon ® , Oxford Metrics, UK). Femur and tibia segment lengths were deducted from both measurements. No differences were found when measuring the discrepancies between sides for the femur (p = 0.3) and tibia (p = 0.45) segmental length. A high correlation was found between methods (r = 0.808-0.962, p < 0.001), however, a significant difference was observed when measuring the femur and tibia length (p < 0.0001). PGM was found to be a valid model in detecting segmental length discrepancy when based on the location of the joint centers compared to X-ray. A variance was noted in the femur and tibial segmental length. The impact of this inconsistency in segmental length on kinematics and kinetics should be further evaluated.

Research paper thumbnail of Measuring Dynamic Leg Length during Normal Gait

Sensors

Dynamic leg length [DLL] is a resultant factor of anatomic leg length and lower limb movement tha... more Dynamic leg length [DLL] is a resultant factor of anatomic leg length and lower limb movement that is measured by the distance from the hip to the heel, ankle, and forefoot during the gait cycle. The aim of this study was to present DLL measurement during normal gait. Forty healthy participants underwent a gait evaluation using a motion analysis system. The average DLLs were compared between sides during the gait cycle using the paired t-test at 51 sample points. Time of maximal and minimal DLLs and the ratio between maximal and minimal DLLs during the gait cycle were calculated. DLLs were found to be consistent, indicated by a within standard deviation of <6.65 mm and by being symmetrical with no significant differences between sides [p > 0.103]. DLL patterns and time of maximal and minimal DLLs were established. The ratio between maximal DLLs during the stance phase and minimal DLLs during the swing phase was also defined and found to be symmetrical. Normative data of DLL me...

Research paper thumbnail of Detecting the presence of leg length discrepancy based on gait deviations and dynamic measurement of leg length during walking

British Medical Journal, Case Reports, 2017

Leg length discrepancy (LLD) is associated with many musculoskeletal disorders. Its clinical sign... more Leg length discrepancy (LLD) is associated with many musculoskeletal disorders. Its clinical significance is unclear mainly due to limited functional measurement capacity. An integrated approach measuring true LLD, gait deviations and functional leg length during the gait cycle, based on location of joint centre and anatomical landmarks using a three-dimensional motion analysis system was performed on two patients. In one case, strong agreement was found between all measurements thus, leading to the same treatment intervention. However, in another case, true LLD was not correlated with functional LLD or gait deviations, which led to contradictory results. Functional LLD was found to be correlated with gait deviations in both cases. Our results indicate the effectiveness of integrating into the diagnostic regimen, a dynamic method of measuring LLD, together with the functional outcome of gait deviations as a basis for decision-making regarding the presence and clinical significance of LLD in musculoskeletal disorders.

Research paper thumbnail of Sacroiliac joint fusion and the implications for manual therapy diagnosis and treatment

The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac j... more The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac joint (SIJ) with age. SIJs of 287 patients (159 males and 128 females), aged 22–93 years, were examined for fusion, using 3-D CT images. Presence, side and location of the fusion along the joint borders were recorded. Fusion of the SIJ was found to be gender and age dependent; present in 27.7% of all males in contrast to only 3.0% in females (po0.001). The phenomenon increased with age in the male population from 5.8% in the 20–39 age cohorts to 46.7% in the 80+ cohort. As mobilization and/or manipulation of a dysfunctional SIJ are common procedures used by manual therapists, the effect that aging has on SIJ mobility requires therapists to alter or change their method with advancing age.

Research paper thumbnail of Influence of Orthosis on the Foot Progression Angle in Children with Spastic Cerebral Palsy

Gait & Posture, 2015

We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle... more We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle (FPA) of 97 children with spastic cerebral palsy (CP) who had undergone comprehensive computer-based gait analysis both barefoot and with their orthosis, during the same session. The physical examination results and the gait study temporal and kinematic parameters comprise the study data. We focused on the peak FPA reached during stance and swing phases and at mid-stance and mid-swing, and also measured the transverse rotations of the pelvis, the femur and the tibia. AFOs improved gait, as reflected by improved temporal parameters, but they also increased internal rotation of the feet in diplegic CP children by 4.29 degrees for mid-stance, and by 3.72 degrees for mid-swing. The correlation between components of the rotational profile and FPA was significant for the diplegic group. AFOs did not produce any noteworthy differences between walking barefoot and walking with the brace in the hemiplegic group in what concerns FPA. Children with diplegic CP who use AFOs walk with increased internal FPAs in their orthoses. These findings might be explained by anatomical attributes as well as dynamic features during gait.

Research paper thumbnail of Influence of Orthosis on the Foot Progression Angle in Children with Spastic Cerebral Palsy

Gait & Posture, 2015

We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle... more We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle (FPA) of 97 children with spastic cerebral palsy (CP) who had undergone comprehensive computer-based gait analysis both barefoot and with their orthosis, during the same session. The physical examination results and the gait study temporal and kinematic parameters comprise the study data. We focused on the peak FPA reached during stance and swing phases and at mid-stance and mid-swing, and also measured the transverse rotations of the pelvis, the femur and the tibia. AFOs improved gait, as reflected by improved temporal parameters, but they also increased internal rotation of the feet in diplegic CP children by 4.29 degrees for mid-stance, and by 3.72 degrees for mid-swing. The correlation between components of the rotational profile and FPA was significant for the diplegic group. AFOs did not produce any noteworthy differences between walking barefoot and walking with the brace in the hemiplegic group in what concerns FPA. Children with diplegic CP who use AFOs walk with increased internal FPAs in their orthoses. These findings might be explained by anatomical attributes as well as dynamic features during gait.

Research paper thumbnail of The Relationship Between Foot and Pelvic Alignment While Standing

Journal of human kinetics, Jan 27, 2015

A normal motion and segmental interrelationship has been determined as a significant factor in no... more A normal motion and segmental interrelationship has been determined as a significant factor in normal function. Yet, the relationship between distal segments and pelvic alignment needs further investigation. The aim of this study was to investigate the interrelationship between distal and proximal lower extremity segments while standing and during induced feet hyperpronation. Changes in alignment of the pelvis and lower extremities were measured at a gait laboratory using the VICON 612 computerized motion analysis system. Thirty-five healthy volunteer subjects were recruited. Four randomized repeated-measure standing modes were used: standing directly on the floor and then on three wedges angled at 10°, 15° and 20° to induce bilateral hyperpronation for 20 seconds. A significant (p<0.05) bi-variate relationship was found between the anterior pelvic tilt and thigh internal rotation, in all four standing positions (.41≤r≤.46, in all p<0.014). A combined effect of rotational alig...

Research paper thumbnail of Improved ankle and knee control with a dual-channel functional electrical stimulation system in chronic hemiplegia A case report

European journal of physical and rehabilitation medicine

The aim of this report is to describe the effects of a dual-channel functional electrical stimula... more The aim of this report is to describe the effects of a dual-channel functional electrical stimulation (FES) system applied daily as an orthotic device to the dorsiflexors and hamstrings muscles in a subject with chronic hemiparesis. Prior to the application of FES, the patient's gait was characterized by a footdrop and knee hyperextension during stance. Measurements of gait performance were collected before FES application, after a conditioning period of six weeks, and following ten months of daily use. Outcomes included lower limb kinematics and temporal gait measures. The kinematic assessments indicated significant benefits for gait with the dorsiflexors and hamstrings FES, as compared to no stimulation and peroneal FES alone. In addition to improved ankle control, knee hyperextension was reduced during stance, and the self-selected comfortable gait velocity increased following ten months of daily use. The results of this report suggest that dual-channel FES for the dorsiflexo...

Research paper thumbnail of A functional electrical stimulation system improves knee control in crouch gait

Journal of children's orthopaedics, Jan 19, 2015

Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). I... more Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300(®) Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground rea...

Research paper thumbnail of Are Gait Indices Sensitive Enough to Reflect the Effect of Ankle Foot Orthosis on Gait Impairment in Cerebral Palsy Diplegic Patients?

Journal of pediatric orthopedics, Jan 6, 2015

Neuromuscular impairments may compromise gait function in patients with cerebral palsy (CP). As s... more Neuromuscular impairments may compromise gait function in patients with cerebral palsy (CP). As such, ambulatory children with CP often use ankle foot orthosis (AFO) to facilitate and optimize their ability to walk.The aim of this study was to evaluate whether the different gait indices, the Gillette Gait Index (GGI), the Gait Deviation Index (GDI), and the Gait Profile Score (GPS), reflect the improved gait that was previously shown using AFO. A retrospective analysis of 53 studies on children with spastic diplegic CP. All had undergone a comprehensive gait study and were analyzed while walking, both barefoot and with their braces, in the same session.Kinematic and temporal spatial data were determined and summarized by 3 methods: GPS, GDI, and GGI. Significant differences were found between the barefoot condition and the AFO conditions for temporal and kinematic parameters: changes in GGI, GDI, and GPS were not statistically significant, with an improvement of 9.33% in GGI (P=0.44...

Research paper thumbnail of Sacroiliac joint fusion and the implications for manual therapy diagnosis and treatment

Manual Therapy, 2008

The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac j... more The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac joint (SIJ) with age. SIJs of 287 patients (159 males and 128 females), aged 22-93 years, were examined for fusion, using 3-D CT images. Presence, side and location of the fusion along the joint borders were recorded. Fusion of the SIJ was found to be gender and age dependent; present in 27.7% of all males in contrast to only 3.0% in females (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The phenomenon increased with age in the male population from 5.8% in the 20-39 age cohorts to 46.7% in the 80+ cohort. As mobilization and/or manipulation of a dysfunctional SIJ are common procedures used by manual therapists, the effect that aging has on SIJ mobility requires therapists to alter or change their method with advancing age.

Research paper thumbnail of Effect of feet hyperpronation on pelvic alignment in a standing position

Gait & Posture, 2007

Hyperpronation may cause malalignment of the lower extremity, frequently leading to structural an... more Hyperpronation may cause malalignment of the lower extremity, frequently leading to structural and functional deficits both in standing and walking. Our aim was to study the effect of induced foot hyperpronation on pelvic and lower limb alignment while standing. Thirty-five healthy subjects were requested to remain in a natural standing position for 20 s in four different modes: feet flat on the floor, and on wedges angled at 108, 158 and 208, designed to induce hyperpronation. Sequencing was random, repeated three times and captured by eight computerized cameras using the VICON 1 three-dimensional motion analysis system. We found that standing on the wedges at various angles, induced hyperpronation, with 41% to 90% of the changes attributable to the intervention. In addition, a statistically significant increase (paired t-test) in internal shank rotation ( p < 0.0001), internal hip rotation ( p < 0.0001) and anterior pelvic tilt ( p < 0.0001) was identified. A strong correlation was found between segmental alignment in every two consecutive modes at all levels (r = 0.612-0.985; p < 0.0001). These findings suggest that alignment of the lower extremity up to the pelvic girdle, can be altered, due to forces acting on the foot. Interaction between the foot and pelvis occurs in a kinematic chain reaction manner. Although this study was limited to healthy subjects, clinicians should be aware that when addressing pelvis and lower back dysfunction, foot alignment should be examined as a contributing factor. #

Research paper thumbnail of Utilization of the foot load monitor for evaluating deep plantar tissue stresses in patients with diabetes: Proof-of-concept studies

Gait & Posture, 2009

The purposes of the present study were to (1) determine the internal plantar mechanical stresses ... more The purposes of the present study were to (1) determine the internal plantar mechanical stresses in diabetic and healthy subjects during everyday activities, and (2) identify stress parameters potentially capable of distinguishing between diabetic and healthy subjects. A self-designed, portable, real-time and subject-specific foot load monitor which employs the Hertz contact theory was utilized to determine the internal dynamic plantar tissue stresses in 10 diabetic patients and 6 healthy subjects during free walking and outdoors stair climbing. Internal stress parameters and average stress-doses were evaluated, and the results obtained from the two groups were compared. Internal plantar stresses and averaged stress-doses during free walking and outdoors stairs climbing in the diabetic group were 2.5-5.5-fold higher than in the healthy group (p < 0.001; stair climbing comparisons incorporated data from five diabetic patients). The interfacial pressures measured during free walking were slightly higher ($1.5-fold) in the diabetic group (p < 0.05), but there was no significant difference between the two groups during stairs climbing. We conclude that during walking and stair climbing, internal plantar tissue stresses are considerably higher than foot-shoe interface pressures, and in diabetic patients, internal stresses substantially exceed the levels in healthy. The proposed method can be used for rating performances or design of footwear for protecting sub-dermal plantar tissues in patients who are at risk for developing foot ulcers. It may also be helpful in providing biofeedback to neuropathic diabetic patients. ß

Research paper thumbnail of Prevalence of Bowlegs Among Child and Adolescent Soccer Players

Clinical Journal of Sport Medicine, 2006

Little is known about the interactions of sports-related demands and human body, in particular on... more Little is known about the interactions of sports-related demands and human body, in particular on musculoskeletal features, during growth. Focusing on the relationship between soccer and lower limb alignment, we examined the hypothesis that varus knee deviation is more prevalent among high-performance pediatric and adolescent soccer players. Cross-sectional study with focused sampling. First league sports clubs. 106 male child/adolescent soccer players aged 10 to 21 years and 68 age-matched tennis players. All athletes completed a demographic questionnaire and underwent physical examinations, which included height, weight, generalized laxity, knee, ankle, foot and spine axis, hip range of motion, tibial torsion, Q angle, foot navicular height, and progression angle. Varus/valgus axis was determined by the intercondylar intermalleolar distance while standing. Soccer and tennis players were compared on knee axis and other outcome variables by analysis of covariance, adjusting for age and by t-tests within age groups. A significantly higher prevalence of knee varus was found among the soccer players compared to that among the tennis players. The difference in intracondylar distance was statistically significant after the age of 13 years (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In addition, compared to tennis players, soccer players had higher foot arches, decreased hip external rotation and increased external tibial torsion. Varus knee axis deviation was more common among children and adolescent soccer players than among tennis players. The prevalence was more pronounced among players aged 13 years or older. Further research is needed to explore the rationale of this phenomenon.

Research paper thumbnail of The efficacy of neuroprosthesis in young hemiplegic patients, measured by three different gait indices: early results

Journal of Children's Orthopaedics, 2013

To evaluate functional electrical stimulation (FES) neuroprothesis as a method to improve gait in... more To evaluate functional electrical stimulation (FES) neuroprothesis as a method to improve gait in hemiplegic patients, using three different gait scoring methods as measures. Five hemiplegic patients (four with cerebral palsy at GMFCS I, one with diffuse pontine glioma) with a mean age of 16.5 years were given a FES neuroprosthesis (NESS(®) L300™) that was applied and calibrated individually. After an adaptation period during which the participants increased their daily use of the neuroprosthesis, gait was assessed with the stimulation off and with the FES on. Kinematic, kinetic, and temporal spatial data were determined using motion analysis and summarized by three scoring methods: Gait Profile Score (GPS), Gait Deviation Index (GDI), and Gillette Gait Index (GGI). Indices were calculated using the Gaitabase program available online. Patients were followed for a minimum of 1 year. When comparing gait with and without stimulation, all scoring methods showed improvement. GPS and GDI of the affected leg were significantly improved: 12.23-10.23° (p = 0.017) and 72.36-78.08 (p = 0.002), respectively. By applying the movement analysis profile, the decomposed GPS score, we found that only the ankle dorsiflexion and the foot progression angle were significantly changed. GGI of the affected leg showed improvement, but without statistical significance: 168.88-131.64 (p = 0.221). Total GPS of legs and the GPS, GDI, and GGI of the nonaffected leg showed improvement without statistical significance. At the 1-year follow-up, all patients expressed high satisfaction and continued to use the device. Dorsiflexion functional electrical stimulation improves gait in hemiplegic patients, as reflected by GPS, GDI, and GGI.

Research paper thumbnail of Detecting Anatomical Leg Length Discrepancy Using the Plug-in-Gait Model

Applied Sciences

Leg length discrepancy (LLD) is a significant factor influencing several pathological conditions.... more Leg length discrepancy (LLD) is a significant factor influencing several pathological conditions. Gait analysis is based on biomechanical gait models calculating joint kinematics; however, no previous study has validated its ability to detect anatomical LLD. The aim of the present study was to compare the validity of the Vicon ® Plug-in-Gait-model (PGM) in measuring femur and tibia segmental length discrepancy with measurements attained by X-ray. Fifteen participants with suspected leg length discrepancies underwent a lower limb X-ray and a standing calibration trial using a motion analysis system (Vicon ® , Oxford Metrics, UK). Femur and tibia segment lengths were deducted from both measurements. No differences were found when measuring the discrepancies between sides for the femur (p = 0.3) and tibia (p = 0.45) segmental length. A high correlation was found between methods (r = 0.808-0.962, p < 0.001), however, a significant difference was observed when measuring the femur and tibia length (p < 0.0001). PGM was found to be a valid model in detecting segmental length discrepancy when based on the location of the joint centers compared to X-ray. A variance was noted in the femur and tibial segmental length. The impact of this inconsistency in segmental length on kinematics and kinetics should be further evaluated.

Research paper thumbnail of Measuring Dynamic Leg Length during Normal Gait

Sensors

Dynamic leg length [DLL] is a resultant factor of anatomic leg length and lower limb movement tha... more Dynamic leg length [DLL] is a resultant factor of anatomic leg length and lower limb movement that is measured by the distance from the hip to the heel, ankle, and forefoot during the gait cycle. The aim of this study was to present DLL measurement during normal gait. Forty healthy participants underwent a gait evaluation using a motion analysis system. The average DLLs were compared between sides during the gait cycle using the paired t-test at 51 sample points. Time of maximal and minimal DLLs and the ratio between maximal and minimal DLLs during the gait cycle were calculated. DLLs were found to be consistent, indicated by a within standard deviation of <6.65 mm and by being symmetrical with no significant differences between sides [p > 0.103]. DLL patterns and time of maximal and minimal DLLs were established. The ratio between maximal DLLs during the stance phase and minimal DLLs during the swing phase was also defined and found to be symmetrical. Normative data of DLL me...

Research paper thumbnail of Detecting the presence of leg length discrepancy based on gait deviations and dynamic measurement of leg length during walking

British Medical Journal, Case Reports, 2017

Leg length discrepancy (LLD) is associated with many musculoskeletal disorders. Its clinical sign... more Leg length discrepancy (LLD) is associated with many musculoskeletal disorders. Its clinical significance is unclear mainly due to limited functional measurement capacity. An integrated approach measuring true LLD, gait deviations and functional leg length during the gait cycle, based on location of joint centre and anatomical landmarks using a three-dimensional motion analysis system was performed on two patients. In one case, strong agreement was found between all measurements thus, leading to the same treatment intervention. However, in another case, true LLD was not correlated with functional LLD or gait deviations, which led to contradictory results. Functional LLD was found to be correlated with gait deviations in both cases. Our results indicate the effectiveness of integrating into the diagnostic regimen, a dynamic method of measuring LLD, together with the functional outcome of gait deviations as a basis for decision-making regarding the presence and clinical significance of LLD in musculoskeletal disorders.

Research paper thumbnail of Sacroiliac joint fusion and the implications for manual therapy diagnosis and treatment

The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac j... more The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac joint (SIJ) with age. SIJs of 287 patients (159 males and 128 females), aged 22–93 years, were examined for fusion, using 3-D CT images. Presence, side and location of the fusion along the joint borders were recorded. Fusion of the SIJ was found to be gender and age dependent; present in 27.7% of all males in contrast to only 3.0% in females (po0.001). The phenomenon increased with age in the male population from 5.8% in the 20–39 age cohorts to 46.7% in the 80+ cohort. As mobilization and/or manipulation of a dysfunctional SIJ are common procedures used by manual therapists, the effect that aging has on SIJ mobility requires therapists to alter or change their method with advancing age.

Research paper thumbnail of Influence of Orthosis on the Foot Progression Angle in Children with Spastic Cerebral Palsy

Gait & Posture, 2015

We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle... more We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle (FPA) of 97 children with spastic cerebral palsy (CP) who had undergone comprehensive computer-based gait analysis both barefoot and with their orthosis, during the same session. The physical examination results and the gait study temporal and kinematic parameters comprise the study data. We focused on the peak FPA reached during stance and swing phases and at mid-stance and mid-swing, and also measured the transverse rotations of the pelvis, the femur and the tibia. AFOs improved gait, as reflected by improved temporal parameters, but they also increased internal rotation of the feet in diplegic CP children by 4.29 degrees for mid-stance, and by 3.72 degrees for mid-swing. The correlation between components of the rotational profile and FPA was significant for the diplegic group. AFOs did not produce any noteworthy differences between walking barefoot and walking with the brace in the hemiplegic group in what concerns FPA. Children with diplegic CP who use AFOs walk with increased internal FPAs in their orthoses. These findings might be explained by anatomical attributes as well as dynamic features during gait.

Research paper thumbnail of Influence of Orthosis on the Foot Progression Angle in Children with Spastic Cerebral Palsy

Gait & Posture, 2015

We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle... more We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle (FPA) of 97 children with spastic cerebral palsy (CP) who had undergone comprehensive computer-based gait analysis both barefoot and with their orthosis, during the same session. The physical examination results and the gait study temporal and kinematic parameters comprise the study data. We focused on the peak FPA reached during stance and swing phases and at mid-stance and mid-swing, and also measured the transverse rotations of the pelvis, the femur and the tibia. AFOs improved gait, as reflected by improved temporal parameters, but they also increased internal rotation of the feet in diplegic CP children by 4.29 degrees for mid-stance, and by 3.72 degrees for mid-swing. The correlation between components of the rotational profile and FPA was significant for the diplegic group. AFOs did not produce any noteworthy differences between walking barefoot and walking with the brace in the hemiplegic group in what concerns FPA. Children with diplegic CP who use AFOs walk with increased internal FPAs in their orthoses. These findings might be explained by anatomical attributes as well as dynamic features during gait.

Research paper thumbnail of The Relationship Between Foot and Pelvic Alignment While Standing

Journal of human kinetics, Jan 27, 2015

A normal motion and segmental interrelationship has been determined as a significant factor in no... more A normal motion and segmental interrelationship has been determined as a significant factor in normal function. Yet, the relationship between distal segments and pelvic alignment needs further investigation. The aim of this study was to investigate the interrelationship between distal and proximal lower extremity segments while standing and during induced feet hyperpronation. Changes in alignment of the pelvis and lower extremities were measured at a gait laboratory using the VICON 612 computerized motion analysis system. Thirty-five healthy volunteer subjects were recruited. Four randomized repeated-measure standing modes were used: standing directly on the floor and then on three wedges angled at 10°, 15° and 20° to induce bilateral hyperpronation for 20 seconds. A significant (p<0.05) bi-variate relationship was found between the anterior pelvic tilt and thigh internal rotation, in all four standing positions (.41≤r≤.46, in all p<0.014). A combined effect of rotational alig...

Research paper thumbnail of Improved ankle and knee control with a dual-channel functional electrical stimulation system in chronic hemiplegia A case report

European journal of physical and rehabilitation medicine

The aim of this report is to describe the effects of a dual-channel functional electrical stimula... more The aim of this report is to describe the effects of a dual-channel functional electrical stimulation (FES) system applied daily as an orthotic device to the dorsiflexors and hamstrings muscles in a subject with chronic hemiparesis. Prior to the application of FES, the patient's gait was characterized by a footdrop and knee hyperextension during stance. Measurements of gait performance were collected before FES application, after a conditioning period of six weeks, and following ten months of daily use. Outcomes included lower limb kinematics and temporal gait measures. The kinematic assessments indicated significant benefits for gait with the dorsiflexors and hamstrings FES, as compared to no stimulation and peroneal FES alone. In addition to improved ankle control, knee hyperextension was reduced during stance, and the self-selected comfortable gait velocity increased following ten months of daily use. The results of this report suggest that dual-channel FES for the dorsiflexo...

Research paper thumbnail of A functional electrical stimulation system improves knee control in crouch gait

Journal of children's orthopaedics, Jan 19, 2015

Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). I... more Crouch gait is a major sagittal plane deviation in children diagnosed with cerebral palsy (CP). It is defined as a combination of excessive ankle dorsiflexion and knee and hip flexion throughout the stance phase. To the best of our knowledge, functional electrical stimulation (FES) has not been used to decrease the severity of crouch gait in CP subjects and assist in achieving lower limb extension. To evaluate the short- and long-term effects of FES to the quadriceps muscles in preventing crouch gait and achieving ankle plantar flexion, knee and hip extension at the stance phase. An 18-year-old boy diagnosed with CP diplegia [Gross Motor Function Classification System (GMFCS) level II] was evaluated. The NESS L300(®) Plus neuroprosthesis system provided electrical stimulation of the quadriceps muscle. A three-dimensional gait analysis was performed using an eight-camera system measuring gait kinematics and spatiotemporal parameters while the subject walked shod only, with ground rea...

Research paper thumbnail of Are Gait Indices Sensitive Enough to Reflect the Effect of Ankle Foot Orthosis on Gait Impairment in Cerebral Palsy Diplegic Patients?

Journal of pediatric orthopedics, Jan 6, 2015

Neuromuscular impairments may compromise gait function in patients with cerebral palsy (CP). As s... more Neuromuscular impairments may compromise gait function in patients with cerebral palsy (CP). As such, ambulatory children with CP often use ankle foot orthosis (AFO) to facilitate and optimize their ability to walk.The aim of this study was to evaluate whether the different gait indices, the Gillette Gait Index (GGI), the Gait Deviation Index (GDI), and the Gait Profile Score (GPS), reflect the improved gait that was previously shown using AFO. A retrospective analysis of 53 studies on children with spastic diplegic CP. All had undergone a comprehensive gait study and were analyzed while walking, both barefoot and with their braces, in the same session.Kinematic and temporal spatial data were determined and summarized by 3 methods: GPS, GDI, and GGI. Significant differences were found between the barefoot condition and the AFO conditions for temporal and kinematic parameters: changes in GGI, GDI, and GPS were not statistically significant, with an improvement of 9.33% in GGI (P=0.44...

Research paper thumbnail of Sacroiliac joint fusion and the implications for manual therapy diagnosis and treatment

Manual Therapy, 2008

The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac j... more The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac joint (SIJ) with age. SIJs of 287 patients (159 males and 128 females), aged 22-93 years, were examined for fusion, using 3-D CT images. Presence, side and location of the fusion along the joint borders were recorded. Fusion of the SIJ was found to be gender and age dependent; present in 27.7% of all males in contrast to only 3.0% in females (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The phenomenon increased with age in the male population from 5.8% in the 20-39 age cohorts to 46.7% in the 80+ cohort. As mobilization and/or manipulation of a dysfunctional SIJ are common procedures used by manual therapists, the effect that aging has on SIJ mobility requires therapists to alter or change their method with advancing age.

Research paper thumbnail of Effect of feet hyperpronation on pelvic alignment in a standing position

Gait & Posture, 2007

Hyperpronation may cause malalignment of the lower extremity, frequently leading to structural an... more Hyperpronation may cause malalignment of the lower extremity, frequently leading to structural and functional deficits both in standing and walking. Our aim was to study the effect of induced foot hyperpronation on pelvic and lower limb alignment while standing. Thirty-five healthy subjects were requested to remain in a natural standing position for 20 s in four different modes: feet flat on the floor, and on wedges angled at 108, 158 and 208, designed to induce hyperpronation. Sequencing was random, repeated three times and captured by eight computerized cameras using the VICON 1 three-dimensional motion analysis system. We found that standing on the wedges at various angles, induced hyperpronation, with 41% to 90% of the changes attributable to the intervention. In addition, a statistically significant increase (paired t-test) in internal shank rotation ( p < 0.0001), internal hip rotation ( p < 0.0001) and anterior pelvic tilt ( p < 0.0001) was identified. A strong correlation was found between segmental alignment in every two consecutive modes at all levels (r = 0.612-0.985; p < 0.0001). These findings suggest that alignment of the lower extremity up to the pelvic girdle, can be altered, due to forces acting on the foot. Interaction between the foot and pelvis occurs in a kinematic chain reaction manner. Although this study was limited to healthy subjects, clinicians should be aware that when addressing pelvis and lower back dysfunction, foot alignment should be examined as a contributing factor. #

Research paper thumbnail of Utilization of the foot load monitor for evaluating deep plantar tissue stresses in patients with diabetes: Proof-of-concept studies

Gait & Posture, 2009

The purposes of the present study were to (1) determine the internal plantar mechanical stresses ... more The purposes of the present study were to (1) determine the internal plantar mechanical stresses in diabetic and healthy subjects during everyday activities, and (2) identify stress parameters potentially capable of distinguishing between diabetic and healthy subjects. A self-designed, portable, real-time and subject-specific foot load monitor which employs the Hertz contact theory was utilized to determine the internal dynamic plantar tissue stresses in 10 diabetic patients and 6 healthy subjects during free walking and outdoors stair climbing. Internal stress parameters and average stress-doses were evaluated, and the results obtained from the two groups were compared. Internal plantar stresses and averaged stress-doses during free walking and outdoors stairs climbing in the diabetic group were 2.5-5.5-fold higher than in the healthy group (p < 0.001; stair climbing comparisons incorporated data from five diabetic patients). The interfacial pressures measured during free walking were slightly higher ($1.5-fold) in the diabetic group (p < 0.05), but there was no significant difference between the two groups during stairs climbing. We conclude that during walking and stair climbing, internal plantar tissue stresses are considerably higher than foot-shoe interface pressures, and in diabetic patients, internal stresses substantially exceed the levels in healthy. The proposed method can be used for rating performances or design of footwear for protecting sub-dermal plantar tissues in patients who are at risk for developing foot ulcers. It may also be helpful in providing biofeedback to neuropathic diabetic patients. ß

Research paper thumbnail of Prevalence of Bowlegs Among Child and Adolescent Soccer Players

Clinical Journal of Sport Medicine, 2006

Little is known about the interactions of sports-related demands and human body, in particular on... more Little is known about the interactions of sports-related demands and human body, in particular on musculoskeletal features, during growth. Focusing on the relationship between soccer and lower limb alignment, we examined the hypothesis that varus knee deviation is more prevalent among high-performance pediatric and adolescent soccer players. Cross-sectional study with focused sampling. First league sports clubs. 106 male child/adolescent soccer players aged 10 to 21 years and 68 age-matched tennis players. All athletes completed a demographic questionnaire and underwent physical examinations, which included height, weight, generalized laxity, knee, ankle, foot and spine axis, hip range of motion, tibial torsion, Q angle, foot navicular height, and progression angle. Varus/valgus axis was determined by the intercondylar intermalleolar distance while standing. Soccer and tennis players were compared on knee axis and other outcome variables by analysis of covariance, adjusting for age and by t-tests within age groups. A significantly higher prevalence of knee varus was found among the soccer players compared to that among the tennis players. The difference in intracondylar distance was statistically significant after the age of 13 years (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In addition, compared to tennis players, soccer players had higher foot arches, decreased hip external rotation and increased external tibial torsion. Varus knee axis deviation was more common among children and adolescent soccer players than among tennis players. The prevalence was more pronounced among players aged 13 years or older. Further research is needed to explore the rationale of this phenomenon.

Research paper thumbnail of The efficacy of neuroprosthesis in young hemiplegic patients, measured by three different gait indices: early results

Journal of Children's Orthopaedics, 2013

To evaluate functional electrical stimulation (FES) neuroprothesis as a method to improve gait in... more To evaluate functional electrical stimulation (FES) neuroprothesis as a method to improve gait in hemiplegic patients, using three different gait scoring methods as measures. Five hemiplegic patients (four with cerebral palsy at GMFCS I, one with diffuse pontine glioma) with a mean age of 16.5 years were given a FES neuroprosthesis (NESS(®) L300™) that was applied and calibrated individually. After an adaptation period during which the participants increased their daily use of the neuroprosthesis, gait was assessed with the stimulation off and with the FES on. Kinematic, kinetic, and temporal spatial data were determined using motion analysis and summarized by three scoring methods: Gait Profile Score (GPS), Gait Deviation Index (GDI), and Gillette Gait Index (GGI). Indices were calculated using the Gaitabase program available online. Patients were followed for a minimum of 1 year. When comparing gait with and without stimulation, all scoring methods showed improvement. GPS and GDI of the affected leg were significantly improved: 12.23-10.23° (p = 0.017) and 72.36-78.08 (p = 0.002), respectively. By applying the movement analysis profile, the decomposed GPS score, we found that only the ankle dorsiflexion and the foot progression angle were significantly changed. GGI of the affected leg showed improvement, but without statistical significance: 168.88-131.64 (p = 0.221). Total GPS of legs and the GPS, GDI, and GGI of the nonaffected leg showed improvement without statistical significance. At the 1-year follow-up, all patients expressed high satisfaction and continued to use the device. Dorsiflexion functional electrical stimulation improves gait in hemiplegic patients, as reflected by GPS, GDI, and GGI.