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Bazancir Z, Talu B, Korkmaz MF. Postoperative rehabilitation versus early mobilization following scoliosis surgery: A single-blind randomized clinical trial. J Orthop Sci 2023; 28:308-314. [PMID: 34922807 DOI: 10.1016/j.jos.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND To compare the effect of five days of intensive postoperative rehabilitation and early mobilization following scoliosis surgery. METHODS Forty adolescent patients who had undergone scoliosis surgery were randomly allocated into a rehabilitation group (RG, n = 20) and a mobilization group (MG, n = 20). The RG received five days of intensive exercise program and early ambulation, the MG received five days of a standard gait training and early ambulation. The patients were evaluated for severity of pain using a visual analog scale, thorax mobility with the thoracic mobility index, balance with the functional reach test, walking distance with the 2-min walk test, and quality of life with the Scoliosis Research Society-22 questionnaire. The length of hospital stay was recorded. RESULTS The RG was favored over the MG for improvements from 0 to 1 week for pain. Improvements from 0 to 1 week were significantly better in the RG than the MG group for thorax mobility, balance, and walking distance. Quality of life scores improvements from 0 to 1 week were significantly better in the RG group than in the MG group. The length of hospital stay was significantly shorter in the RG group. CONCLUSION Five days of intensive postoperative rehabilitation were superior to early mobilization in reducing the length of hospital stay, and in improving physical and functional outcomes following scoliosis surgery.
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Affiliation(s)
- Zilan Bazancir
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Burcu Talu
- Inonu University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Malatya, Turkey.
| | - Mehmet Fatih Korkmaz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
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Osuka S, Sudo H, Yamada K, Tachi H, Watanabe K, Sentoku F, Chiba T, Iwasaki N, Mukaino M, Tohyama H. Effects of Posterior Spinal Correction and Fusion on Postural Stability in Patients with Adolescent Idiopathic Scoliosis. J Clin Med 2022; 12:jcm12010270. [PMID: 36615069 PMCID: PMC9821153 DOI: 10.3390/jcm12010270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
The present study aimed to assess the effects of posterior spinal correction and fusion on postural stability in patients with adolescent idiopathic scoliosis (AIS). The study included 41 female patients with AIS at our institution. All patients performed three 10 s single-leg standing trials on a force plate. The center of pressure (COP) was measured preoperatively, and at 1 week and 6 months postoperatively. The postural stability parameters were absolute minimum time-to-boundary (TTB), mean of the minimum TTB, mean COP velocity, standard deviation, range, and 95% confidence ellipse area. One-way repeated analysis of variance or Friedman test was applied to the postural stability parameters. Multiple comparisons were performed using the Bonferroni correction. The absolute minimum TTB and the mean minimum TTB showed a significant increase 6 months post-operation as compared to preoperatively and 1 week postoperatively. The COP velocity significantly decreased at 6 months post-operation compared to preoperatively and 1 week postoperatively. These changes in postural stability indicate that spinal correction and fusion can be considered to improve postural stability during single-leg standing tests in the postoperative period.
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Affiliation(s)
- Satoshi Osuka
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Hokkaido, Japan
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8638, Hokkaido, Japan
- Correspondence:
| | - Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8638, Hokkaido, Japan
| | - Hiroyuki Tachi
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8638, Hokkaido, Japan
- Department of Orthopaedic Surgery, Eniwa Hospital, Eniwa 061-1449, Hokkaido, Japan
| | - Kentaro Watanabe
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
| | - Fuma Sentoku
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
| | - Takeshi Chiba
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo 060-8638, Hokkaido, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Hokkaido, Japan
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
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Larni Y, Mohsenifar H, Ghandhari H, Salehi R. The effectiveness of Schroth exercises added to the brace on the postural control of adolescents with idiopathic scoliosis: Case series. Ann Med Surg (Lond) 2022; 84:104893. [DOI: 10.1016/j.amsu.2022.104893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
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St-Georges M, Teles AR, Rabau O, Saran N, Ouellet JA, Ferland CE. Adolescent idiopathic scoliosis: evaluating perioperative back pain through a simultaneous morphological and biomechanical approach. BMC Musculoskelet Disord 2020; 21:466. [PMID: 32677928 PMCID: PMC7367237 DOI: 10.1186/s12891-020-03462-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) has been associated with diminished postural stability and a greater prevalence of back pain. Currently, the literature is lacking information on the effect of spinal fusion on both postural stability and its association with back pain. Our objectives were to evaluate the postsurgical effect of spinal morphological changes on static standing balance and assess the influence of these alterations on reported pain throughout the perioperative period. Methods Twenty consecutive AIS patients schedule to undergo spinal fusion surgery were recruited and followed prospectively at the Shriners Hospitals for Children-Canada. Data was collected at the preoperative, 6 weeks and 6 months postoperative visits. Spinal morphology data was collected through 3D reconstructed simultaneous standing biplanar radiographs using the SterEOS software. Postural balance was assessed through Moticon© sensor insoles and analyzed through their software. The data was simultaneously collected as part of the Global Biomechanical and morphological Assessment. Pain was evaluated through self-reported questionnaires. Results Morphological curve parameters were significantly reduced after surgery. Balance parameters did not change significantly throughout the perioperative period with the exception of the Center of Pressure of the left foot medial/lateral transient shift (P = 0.017) at 6 weeks. Of note, preoperative balance parameters were associated with the degree of right thoracic Cobb angles (P = 0.029 R = 0.528). Pain scores significantly improved 6 weeks and 6 months after the surgery. Pain intensity diminished in the thoracic and lumbar spine but worsen in the neck region at the 6 weeks and 6 months postoperative time points (P = 0.044). Greater residual Cobb angle difference between Mid thoracic and Thoracolumbar/Lumbar curves was associated with greater pain severity at 6 weeks postop (P < 0.005). In addition, greater residual thoracic deformity was associated with significant pain severity 6 months after surgery (P < 0.05). Conclusions Improved spinal morphology of postsurgical AIS patients has no significant impact on their static standing balance. Suggesting that other factors apart from the spinal morphology may contribute to AIS patients’ balance during stance. Although balance did not influence pain severity, spinal morphology and its correction appear to have influenced the intensity and location of back pain.
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Affiliation(s)
- Maxime St-Georges
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Alisson R Teles
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Integrated Program in Neurosciences, McGill University, Montreal, Canada
| | - Oded Rabau
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Surgery, Division of Orthopedics, McGill University, Montreal, Canada
| | - Neil Saran
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Surgery, Division of Orthopedics, McGill University, Montreal, Canada
| | - Jean A Ouellet
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Experimental Surgery, McGill University, Montreal, Canada.,Department of Surgery, Division of Orthopedics, McGill University, Montreal, Canada
| | - Catherine E Ferland
- McGill Scoliosis and Spine Research Group, Montreal, Canada. .,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada. .,Department of Experimental Surgery, McGill University, Montreal, Canada. .,Integrated Program in Neurosciences, McGill University, Montreal, Canada. .,Department of Anesthesia, McGill University, Montreal, Canada.
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Postural adjustments in adolescent idiopathic thoracic scoliosis during walking. Gait Posture 2019; 68:423-429. [PMID: 30594870 DOI: 10.1016/j.gaitpost.2018.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Adolescent idiopathic scoliosis (AIS) is the most common type of three-dimensional spinal deformity. Identifying the postural adjustments or changes for different phases and events is needed for developing programs to improve the AIS gait, but such information has been limited. The current study aimed to fill the gap via three-dimensional motion analysis of quiet standing and level walking in patients with severe thoracic AIS. MATERIALS AND METHODS Sixteen female adolescents with AIS (Lenke 1 or 2, age: 14.9 ± 1.7 years, height: 154.7 ± 5.0 cm, mass: 41.7 ± 7.2 kg) and sixteen sex-, age- and BMI-matched healthy controls (age: 14.8 ± 2.7 years, height: 154.9 ± 5.6 cm, mass: 44.7 ± 6.3 kg) participated in the current study with informed written consent. The kinematic and kinetic changes between the trunk, pelvis, and lower limb segments, and at the lumbosacral level at different gait events were measured during quiet standing and level walking. RESULTS The homogeneity of the current patient group helped reduce the effects of the level and severity of spinal deformity on inter-subject variability that has been associated with controversies over reported gait variables in AIS. The current results support the hypothesis that postural adjustments involving the trunk, pelvis and lower limb segments were needed in severe thoracic AIS during both quiet standing and level walking, and differed between concave and convex sides at different key gait events during level walking. CONCLUSIONS Although scoliotic spinal deformity occurred mainly in the frontal plane, postural adjustments in all three planes were present at key events during level walking with associated joint loading changes in patients with severe thoracic AIS. Monitoring of such adjustments and the associated joint kinetic changes will be helpful for assessing the disease and treatment outcomes.
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Postural control of individuals with spinal fusion for adolescent idiopathic scoliosis. Clin Biomech (Bristol, Avon) 2019; 61:46-51. [PMID: 30465967 DOI: 10.1016/j.clinbiomech.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the study was to assess the postural stability and complexity of postural control for moderately physically active individuals with spinal fusion for adolescent idiopathic scoliosis at two years post-operation. METHODS Limit of stability test and sensory organization test were conducted for 10 moderately physically-active participants with spinal fusion and 10 controls pair-matched for mass, height and physical activity level. During the limit of stability test, participants were instructed to lean the center of gravity as far as possible toward 8 predetermined directions and the maximum excursion and direction control were analyzed. During the sensory organization test, participants were instructed to maintain as still as possible in six test conditions and equilibrium scores and sway area of center of pressure were analyzed. Multi-scale entropy of center of pressure was calculated to quantify sway complexity. FINDINGS Most postural stability outcomes of spinal fusion participants were comparable to controls except for significantly reduced equilibrium scores (p = 0.039, partial η2 = 0.217). Moreover, spinal fusion participants exhibited tendencies of reduced direction control (p = 0.053) during the limit of stability test and greater sway area (p = 0.052) during the sensory organization test. INTERPRETATION Although the center of gravity control might be affected, spinal fusion individuals who were moderately physically active likely progressively learned to adapt postoperatively to their fused spine to meet the postural demands required when performing physical movements. We suggest that spinal fusion is a satisfactory treatment in regard to the recovery of postural stability.
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Dynamic Fluctuation of Truncal Shift Parameters During Quiet Standing in Healthy Young Individuals. Spine (Phila Pa 1976) 2018; 43:E746-E751. [PMID: 29215505 DOI: 10.1097/brs.0000000000002521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To describe the dynamic fluctuation of truncal shift parameters during quiet standing in healthy young individuals using biomechanical analyses. SUMMARY OF BACKGROUND DATA Coronal decompensation (CD) and sagittal vertical axis (SVA) are the key radiographic parameters to assess static truncal stability, with the known cut-off value of 4 cm for SVA in determining severity of spinal deformity. These values are obtained at a specific moment during quiet standing, when the posture innately changes. Thus, unassessed truncal sway could potentially compromise the reliability of these measurements. METHODS Previously obtained biomechanical data with 11 male, healthy participants aged 16 to 29 were used to quantify the dynamic sway of standing posture. The participants were instructed to quietly stand with surface reflective markers for 130 seconds. The midpoint of bilateral acromia was used as a surrogate for C7 vertebral body. The time series of coronal and sagittal shifts of C7 to sacrum were measured as quasi-coronal decompensation (CD) and quasi-sagittal vertical axis (SVA) to simulate CD and SVA on radiographs. A force platform was also used to measure the center of pressure (COP) displacement. RESULTS The group averages of the dynamic sway range were 20.2 ± 4.1 mm (range: 15.1-28.6) in the sagittal plane (quasi-SVA) and 9.8 ± 3.2 mm (range: 5.5-15.2) in the coronal plane (quasi-CD). There were significant correlations between quasi-CD sway and medial-lateral COP velocity (Pearson r = 0.65, P = 0.03), as well as between quasi-SVA sway and COP sway area (r = 0.65, P = 0.03). CONCLUSION Given the considerable fluctuation of quasi-SVA and quasi-CD during quiet standing, the reliability of radiographic measurement using CD and SVA at a specific moment can be substantially compromised. The assessment based on the currently proposed cut-off values should be interpreted with caution, and repeat examinations are warranted. LEVEL OF EVIDENCE 4.
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Sim T, Yoo H, Lee D, Suh SW, Yang JH, Kim H, Mun JH. Analysis of sensory system aspects of postural stability during quiet standing in adolescent idiopathic scoliosis patients. J Neuroeng Rehabil 2018; 15:54. [PMID: 29929530 PMCID: PMC6013903 DOI: 10.1186/s12984-018-0395-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/11/2018] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to quantitatively analyze quite standing postural stability of adolescent idiopathic scoliosis (AIS) patients in respect to three sensory systems (visual, vestibular, and somatosensory). Method In this study, we analyzed the anterior-posterior center of pressure (CoP) signal using discrete wavelet transform (DWT) between AIS patients (n = 32) and normal controls (n = 25) during quiet standing. Result The energy rate (∆EEYE%) of the CoP signal was significantly higher in the AIS group than that in the control group at levels corresponding to vestibular and somatosensory systems (p < 0.01). Conclusions This implies that AIS patients use strategies to compensate for possible head position changes and spinal asymmetry caused by morphological deformations of the spine through vestibular and somatosensory systems. This could be interpreted that such compensation could help them maintain postural stability during quiet standing. The interpretation of CoP signal during quiet standing in AIS patients will improve our understanding of changes in physical exercise ability due to morphological deformity of the spine. This result is useful for evaluating postural stability before and after treatments (spinal fusion, bracing, rehabilitation, and so on).
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Affiliation(s)
- Taeyong Sim
- Department of Bio-Mechatronic Engineering, College of Biotechnology and Bioengineering, Sungkyunkwan University, Natural Sciences Campus, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Hakje Yoo
- Department of Bio-Mechatronic Engineering, College of Biotechnology and Bioengineering, Sungkyunkwan University, Natural Sciences Campus, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Dongjun Lee
- Department of Bio-Mechatronic Engineering, College of Biotechnology and Bioengineering, Sungkyunkwan University, Natural Sciences Campus, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Seung-Woo Suh
- Department of Orthopedics, Scoliosis Research Institute, Korea University Medical College, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Jae Hyuk Yang
- Department of Orthopedics, Scoliosis Research Institute, Korea University Medical College, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Hyunggun Kim
- Department of Bio-Mechatronic Engineering, College of Biotechnology and Bioengineering, Sungkyunkwan University, Natural Sciences Campus, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea.
| | - Joung Hwan Mun
- Department of Bio-Mechatronic Engineering, College of Biotechnology and Bioengineering, Sungkyunkwan University, Natural Sciences Campus, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea.
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Gait in patients with adolescent idiopathic scoliosis. Effect of surgery at 10 years of follow-up. Gait Posture 2018; 61:141-148. [PMID: 29353740 DOI: 10.1016/j.gaitpost.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/22/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess radiological and gait biomechanical changes before, at one and 10 years after surgery in AIS patients. METHODS This clinical prospective study included fifteen adult women (mean[SD] age: 26 [1] years) diagnosed with thoraco-lumbar/lumbar AIS and operated 10 years ago. Clinical, radiological and gait variables, including kinematics, electromyography (EMG), mechanics and energetics were compared between presurgery (S0), 1 year (S1) and 10 years (S2) postsurgery period using a one way repeated measure ANOVA. RESULTS The Cobb angle of the scoliosis curve was reduced by 55% at 1 year postsugery but only by 37% at 10 years postsurgery suggesting a loss of 32% over time. Frontal plumb line C7-S1 distance was significantly improved by surgery (-44%) and remained stable at 10 years postsurgery. Lower limb kinematics was not affected by the surgery at long term. Excessive bilateral activation of lombo-pelvic muscles, observed before surgery, decreased significantly at S1 and S2 period. Mechanical energy increased significantly between S0, S1 and S2 session, without any change for the energetic variables. CONCLUSIONS Between 1 and 10 years post-surgery, thoraco-lumbar/lumbar AIS women showed a few decompensation of the curve without any change of the improved frontal body balance. Lower limbs and pelvic motion, during gait, was not affected by the surgery. But presurgical excessive EMG activity of the lumbo-pelvic muscle and reduced mechanical energy produced to walk get similar to normal patterns. Only the oxygen consumption remained excessive probably due to physical deconditioning or postural instability.
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Intratrunk Coordination During High-Effort Treadmill Running in Individuals With Spinal Fusion for Adolescent Idiopathic Scoliosis. J Appl Biomech 2017; 33:437-445. [DOI: 10.1123/jab.2017-0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to determine if the intratrunk coordination of axial rotation exhibited by individuals with spinal fusion for adolescent idiopathic scoliosis (SF-AIS) during running varies from healthy individuals and how the coordination differs among adjacent trunk-segment pairs. Axial rotations of trunk segments (upper, middle, lower trunk) and pelvis were collected for 11 SF-AIS participants and 11 matched controls during running. Cross-correlation determined the phase lag between the adjacent segment motions. The coupling angle was generated using the vector coding method and classified into 1 of the 4 major, modified coordination patterns: in-phase, anti-phase, superior, and inferior phase. Two-way, mixed-model ANCOVA was employed to test phase lag, cross-correlation r, and time spent in each major coordination pattern. A significantly lower phase lag for SF-AIS was observed compared with controls. Qualitatively, there was a tendency that SF-AIS participants spent less time in anti-phase for middle-lower trunk and lower trunk-pelvis coordinations compared to controls. Phase lag and anti-phase time was significantly increased from cephalic to caudal segment pairs, regardless of group. In conclusion, SF-AIS participants and controls displayed similar patterns of intra-trunk coordination; however, the spinal fusion hindered decoupling of intra-trunk motions particularly between the lower trunk-pelvic motion.
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Postural Balance Parameters as Objective Surgical Assessments in Low Back Disorders: A Systematic Review. J Appl Biomech 2015; 32:316-23. [PMID: 26695763 DOI: 10.1123/jab.2015-0246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Balance assessments could render useful objective performance measures to evaluate the efficacy of low back surgeries, yet these assessments have not been collectively examined to determine longitudinal sensitivity across surgical interventions. The purpose of this review was to determine sensitivity of balance measurements for disparate spinal disorders after surgical intervention. We searched PubMed, Embase, Scopus, the Cochrane Library, Web of Science, and CINAHL. Articles were selected based on: (1) sample consisted of low back disorder individuals and (2) balance measurements were obtained both pre- and postsurgery. Most of the articles addressed 2 specific low back disorders: (1) adolescent idiopathic scoliosis/spinal fusion and (2) disc herniation/decompression surgery. For scoliosis patients, body sway increased (14-97%) immediately following surgery but gradually reduced (1-33%) approaching the 1-year post spinal fusion assessment. For patients with disc herniation, sway range, sway velocity, sway area, and sway variability all decreased (19-42%) immediately postsurgery. Balance assessments for adolescents with idiopathic scoliosis who underwent surgical intervention should be performed with visual occlusion, focus on time domain parameters, and evaluated with longer follow-up times. Patients with disc herniation who underwent decompression surgery should have balance assessments with visual deprivation, test conditions specifically addressing hip strategy, and correlation with pain.
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Crétual A. Which biomechanical models are currently used in standing posture analysis? Neurophysiol Clin 2015; 45:285-95. [PMID: 26388359 DOI: 10.1016/j.neucli.2015.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/23/2015] [Indexed: 12/22/2022] Open
Abstract
In 1995, David Winter concluded that postural analysis of upright stance was often restricted to studying the trajectory of the center of pressure (CoP). However, postural control means regulation of the center of mass (CoM) with respect to CoP. As CoM is only accessible by using a biomechanical model of the human body, the present article proposes to determine which models are actually used in postural analysis, twenty years after Winter's observation. To do so, a selection of 252 representative articles dealing with upright posture and published during the four last years has been checked. It appears that the CoP model largely remains the most common one (accounting for nearly two thirds of the selection). Other models, CoP/CoM and segmental models (with one, two or more segments) are much less used. The choice of the model does not appear to be guided by the population studied. Conversely, while some confusion remains between postural control and the associated concepts of stability or strategy, this choice is better justified for real methodological concerns when dealing with such high-level parameters. Finally, the computation of the CoM continues to be a limitation in achieving a more complete postural analysis. This unfortunately implies that the model is chosen for technological reasons in many cases (choice being a euphemism here). Some effort still has to be made so that bioengineering developments allow us to go beyond this limit.
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Affiliation(s)
- A Crétual
- M2S lab (Mouvement Sport Santé), University Rennes 2 - ENS Rennes - UEB, avenue Robert-Schuman, campus de Ker Lann, 35170 Bruz, France; MimeTIC team, INRIA Rennes, campus universitaire de Beaulieu, 35042 Rennes, France.
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Tanaka EH, Santos PF, Reis JG, Rodrigues NC, Moraes R, Abreu DCC. Is there a relationship between complaints of impaired balance and postural control disorder in community-dwelling elderly women? A cross-sectional study with the use of posturography. Braz J Phys Ther 2015; 19:186-93. [PMID: 26083602 PMCID: PMC4518571 DOI: 10.1590/bjpt-rbf.2014.0086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/18/2014] [Indexed: 12/12/2022] Open
Abstract
Background: Risk of falls increases as age advances. Complaints of impaired balance are very
common in the elderly age group. Objectives: The objective of this study was to investigate whether the subjective perception
of impaired balance was associated with deficits in postural control (objective
analysis) in elderly community-dwelling women. Method: Static posturography was used in two groups: elderly women with (WC group) and
without (NC group) complaints of impaired balance. The area, mean sway amplitude
and mean speed of the center of pressure (COP) in the anterior-posterior (AP) and
medial-lateral (ML) directions were analyzed in three stances: single-leg stance,
double-leg stance and tandem stance, with eyes open or closed on two different
surfaces: stable (firm) and unstable (foam). A digital chronometer was activated
to measure the time limit (Tlimit) in the single-leg stance. Kruskal-Wallis tests
followed by Mann-Whitney tests, Friedman analyses followed by post hoc Wilcoxon
tests and Bonferroni corrections, and Spearman statistical tests were used in the
data analysis. Differences of p<0.05 were considered statistically significant.
Results: The results of posturography variables revealed no differences between groups. The
timed single-leg stance test revealed a shorter Tlimit in the left single-leg
stance (p=0.01) in WC group compared to NC group. A negative correlation between
posturography variables and Tlimit was detected. Conclusions: Posturography did not show any differences between the groups; however, the timed
single-leg stance allowed the authors to observe differences in postural control
performance between elderly women with and those without complaints of impaired
balance.
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Affiliation(s)
- Erika H Tanaka
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo F Santos
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Júlia G Reis
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Natalia C Rodrigues
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Renato Moraes
- Escola de Educação Física e Esporte de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniela C C Abreu
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Schimmel JJ, Groen BE, Weerdesteyn V, de Kleuver M. Adolescent idiopathic scoliosis and spinal fusion do not substantially impact on postural balance. SCOLIOSIS 2015; 10:18. [PMID: 26056528 PMCID: PMC4459442 DOI: 10.1186/s13013-015-0042-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/27/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The spinal curvature in patients with Adolescent Idiopathic Scoliosis (AIS) causes an asymmetry of upper body postural alignment, which might affect postural balance. However, the currently available studies on balance in AIS patients are not consistent. Furthermore, it is not known whether potential deficits are similar between patients with single and double curves. Finally, the effects of a corrective posterior spinal fusion on postural balance have not yet been well established. METHODS Postural balance was tested on a force plate, in 26 female subjects with AIS (12-18 years old; preoperative Cobb-angle: 42-71°; single curve n = 18, double curve n = 6) preoperatively, at 3 months and 1 year postoperatively. We also conducted a balance assessment in 18 healthy age-matched female subjects. Subjects were tested during quiet double-leg standing in four conditions (eyes open/closed; foam/solid surface), while standing on one leg, while performing a dynamic balance (weight shifting) task and while performing a reaching task in four directions. RESULTS AIS subjects did not demonstrate greater COP velocities than controls during the double-leg standing tasks. In the reaching task, however, they achieved smaller COP displacements than healthy controls, except in the anterior direction. AIS patients with double curves had significantly greater COP velocities in all test conditions compared to those with a single curve (p < 0.05). For the AIS group, a slight increase in COP velocities was observed in the foam eyes closed and right leg standing condition at 3 months post surgery. At 1-year post surgery, however, there were no significant differences in any of the outcome measures compared to the pre-surgery assessment, irrespective of the curve type. CONCLUSIONS Postural balance in AIS patients scheduled for surgery was similar to healthy age matched controls, except for a poorer reaching capacity. The latter finding may be related to their reduced range of motion of the spine. Patients with double curves demonstrated poorer balance than those with a single curve, despite the fact that they have a more symmetrical trunk posture. Postural balance one year after surgery did not improve as a result of the better spinal alignment, neither did the reduced range of trunk motion inherent to fusion negatively affect postural balance.
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Affiliation(s)
- Janneke Jp Schimmel
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O box 9011, Nijmegen, GM The Netherlands 6500
| | - Brenda E Groen
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O box 9011, Nijmegen, GM The Netherlands 6500
| | - Vivian Weerdesteyn
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O box 9011, Nijmegen, GM The Netherlands 6500 ; Radboud University Medical Centre, Donders Institute for Neuroscience, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands ; Department of Orthopaedic Surgery, VU university medical centre, Amsterdam, The Netherlands
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15
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Torres SF, Reis JG, Abreu DCCD. Influence of gender and physical exercise on balance of healthy young adults. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.003.ao10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To verify the effects of gender and physical activity on postural sway. Method A cross-sectional study was conducted to analyze upright balance of young men and women between the ages of 20-30, both active and sedentary. Study participants were 60 individuals, who were divided into: active women (n = 15), sedentary women (n = 15), active men (n = 15) and sedentary men (n = 15). The International Physical Activity Questionnaire (IPAQ) short form, was used to evaluate each participant’s level of physical activity. According to the questionnaire, active individuals are those who carry out moderate activity, with an energy expenditure between 3.5 and 6 METs (1 MET: 3.5 ml/kg/min), or vigorous activity, with an energy expenditure above 6 METs, at least three days a week for 20 minutes. To assess control of postural sway, we measured the amplitude and velocity of anteroposterior (AP) and mediolateral (ML) sway in standing position, with their eyes open and closed, with and without foam, on a force platform. Results Comparison between genders revealed that, when compared to sedentary women, sedentary men displayed poorer performance in velocity and amplitude of AP postural control sway with their eyes closed, with and without foam. There were no differences in the amplitude and velocity of ML sway, both with open and closed eyes among groups (p < 0.05). There were no differences when comparing physically active men and women either. Conclusion Sedentary men seem to rely more on vision for maintaining postural control in quiet standing situations with respect to women.
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de Santiago HAR, Reis JG, Gomes MM, da Silva Herrero CFP, Defino HLA, de Abreu DCC. The influence of vision and support base on balance during quiet standing in patients with adolescent idiopathic scoliosis before and after posterior spinal fusion. Spine J 2013; 13:1470-6. [PMID: 23623510 DOI: 10.1016/j.spinee.2013.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 12/05/2012] [Accepted: 03/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Scoliosis is the most common postural alteration in adolescence and is characterized by deviations of the spine in three planes. Surgical treatment based on arthrodesis has been developed, but the effects of such restructuring on the systems involved in postural control need to be better understood. PURPOSE To assess the influence of vision and the support base on balance in the quiet standing position in adolescents awaiting surgical treatment for idiopathic scoliosis. STUDY DESIGN/SETTING Longitudinal study/Ribeirão Preto Clinics Hospital (HC-FMRP-USP) and Laboratory of Assessment and Rehabilitation of Equilibrium at the FMRP-USP. PATIENT SAMPLE Adolescent idiopathic scoliosis patients and controls. OUTCOME MEASURES Center of pressure (CoP) sway area of the 95% confidence ellipse. METHODS Thirty female adolescents were divided into two groups according to their spinal alignment: control (n=15) and scoliosis groups (SGs) (n=15). The subjects with scoliosis were evaluated before and 7, 30, 60, and 90 days after surgery; the controls were evaluated once. The area of CoP oscillation was measured with the eyes open and closed and with two different support bases (feet apart or together). The force platform was purchased with funding support (US $8,375.00) provided by the Research Foundation of São Paulo (FAPESP). The study sponsors had no involvement in the study. Data were collected from the force platform and then statistically assessed through a linear model analysis of mixed effects. RESULTS Data reveal that subjects in the SG oscillated more than controls, and postsurgery subjects had more oscillation than presurgery subjects. The results also indicated that both groups (control and scoliosis) showed more oscillation among those subjects with feet apart and eyes closed, but subjects with scoliosis were more affected by vision deprivation than by a reduced support base. CONCLUSIONS Our results indicate that adolescents with idiopathic scoliosis are more dependent on visual information and that surgical correction does not change this relationship.
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Affiliation(s)
- Hildemberg A R de Santiago
- Department of Biomechanics, Medicine, and Rehabilitation of Locomotor System, Ribeirão Preto School of Medicine, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, São Paulo 14049-900, Brazil
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