PubMed · 13596115
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G PARMEGGIANI. 1958. [Closed free talocrural dislocation].. https://pubmed.ncbi.nlm.nih.gov/13596115/
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This study investigates the importance of ankle muscular force and foot shape on body equilibrium at the end of a first step by means of a comparison between healthy children and children with unilateral clubfoot who showed Triceps surae atrophy. Subjects were asked to initiate gait at different velocities and to perform a few forward-oriented steps. In healthy children, there was a significant increase in the number of positive values of the centre of gravity vertical acceleration at foot contact (Z"HC) as velocity increased without any difference between the preferred and non-preferred stepping foot. These results indicated that ankle muscular forces from the leg of support intervene in braking the downfall of the body, as velocity and step length increase, and that this function does not depend on the subject's lateralization. In comparison with healthy children, clubfoot subjects showed a greater occurrence of low or negative Z"HC values when gait was initiated at a velocity greater than 0.8 m/s. However, except for two of them, there was no difference in Z"HC control between the steps initiated with the sound leg and those initiated with the affected leg. These results indicate that in unilateral clubfoot children, residual musculoskeletal impairment of one leg induces a deficit in equilibrium control as soon as step length needs a significant braking of the body's vertical fall. It is also shown that equilibrium is not limited to the gait period where the affected leg is the body's supporting leg but also when it is the stepping one. This could reflect a global alteration of the body scheme preserving symmetry in the control of both legs.
This study examined whether ankle-movement tracking training could improve ankle function and brain reorganization, evidenced with functional magnetic resonance imagery (fMRI), in a single subject with stroke. Test measurements included self-ratings of functional activities, 15.24 m (50 feet) walk time, ankle range of motion, ankle tracking accuracy, and peak dorsiflexion movement during dorsiflexion phases of tracking. Cortical activation in the frontal and parietal lobes was measured during fMRI with an active voxel count. Additionally, a signal intensity index was determined for the gyrus precentralis (GPrC). Training consisted of 16 sessions of tracking waveforms on a computer screen with ankle motion. Four pretest, four posttest and two follow-up measurements occurred. Data were analyzed by visual inspection and by statistical analysis that examined whether posttest measurements exceeded the pretest mean by at least two standard deviations on at least two consecutive posttest measurements. Posttest results showed that the subject's self report of paretic ankle "catches" (failure of toes to clear floor during swing phase) during gait were eliminated and that peak dorsiflexion movement improved visually but not statistically. Multiple cortical areas showed increased voxel count statistically, as did the intensity index for GPrC. Follow-up results showed that the ankle "catches", peak dorsiflexion movement, and the intensity index remained at the same levels as posttest. Voxel counts returned toward pretest values. We concluded that tracking training produced training effects in both ankle function and brain reorganization.
BACKGROUND: Endothelial dysfunction plays a key role in atherogenesis. We prospectively investigated the impact of noninvasive measurement of endothelial function on cardiovascular risk in peripheral arterial disease (PAD). The study was specially aimed at assessing whether brachial artery flow-mediated dilation (FMD) added to the predictive value of ankle-brachial pressure index (ABPI). METHODS AND RESULTS: Of 131 patients monitored for a mean of 23+/-10 months, 18 had a coronary event, 12 a cerebrovascular event, and 9 a peripheral event. The median FMD was lower in patients with an event than in those without (5.8% versus 7.6%, P<0.05), whereas vasodilation to nitroglycerin was similar in the two groups. The cardiovascular event rate was higher in patients with FMD below the median versus those with FMD above the median (P<0.001 by log-rank test). In a Cox proportion hazard model, independent predictors of events were FMD below the median (P<0.01), ABPI below the median (P<0.01), and previous stroke (P<0.02). Similar results were obtained when peripheral events were excluded from the analysis. Below-median ABPI and FMD combined was more accurate in predicting risk (relative risk [RR] 13.0; 95% CI, 3.0 to 56.2; P<0.01) than ABPI (RR, 6.4; 95% CI, 1.4 to 29.1; P<0.02) and FMD (RR, 4.8; 95% CI, 1.1 to 23.3; P<0.05) alone. CONCLUSIONS: A low brachial artery FMD is an independent predictor of cardiovascular risk in patients with PAD and adds to the prognostic value of ABPI, which is currently the most powerful prognostic indicator in PAD.