Sağlık Bilimleri Fakültesi / Faculty of Health Sciences

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A novel dorsal trimline approach for passive-dynamic ankle-foot orthoses
(Assoc Mechanical Engineers Technicians Slovenia, Po Box 197-Iv, Ljubljana 61001, Slovenia, 2018) Sürmen, Hasan Kemal; Fetvacı, Mahmut Cüneyt; Arslan, Yunus Ziya; AKALAN, NAZİF EKİN; 123435; 176320; 19199; 110120
An ankle-foot orthosis (AFO) is an externally applied assistive device that encompasses the lower leg, ankle, and foot of the human body. In the current one-piece passive-dynamic AFO design, the trimming process is performed from lateral and medial parts of the ankle to ensure desired rotational displacement (hereafter referred to as Design I). In most cases, stress concentrations occurring over the trimmed regions during walking can cause permanent damage to the AFO. In this study, to reduce the stress concentration and ensure a homogeneous stress distribution, a new trimming approach is presented, in which the trim zones were transferred from lateral and medial to dorsal (hereafter referred to as Design II). Finite element analyses of the Designs I and II models were carried out. Displacement and von Mises stress values for both models under the same loading and boundary conditions were obtained. Maximum displacement values were 8.51 mm and 9.05 mm for Design I and Design II, respectively. Maximum stress values were 15.19 MPa and 6.70 MPa for Design I and Design II, respectively. For the similar range of motion of ankle joint, the novel design produced less stress and more homogeneous stress distribution than the currently used design, thus indicating that Design II would be more resistant to plastic deformation than Design I.
Open Access
Active Child, Healthy Child Project: The Effects on Dynamic Balance of an Increase in Femoral Anteversion in Healthy Developing Children
(AVES, 2024) APTİ, ADNAN; AKALAN, NAZİF EKİN; AKEL, BURCU SEMİN; EVRENDİLEK, HALENUR; ÖNERGE, KÜBRA; NAS, İMGE
Objective: Increased femoral anteversion (IFA) is defined as the anterior rotation of the femoral head in relation to the transcondylar axis of the knee. The aim of this study was to determine the frequency of IFA in healthy developing children and to investigate the effects of IFA on dynamic balance. Methods: School screening was conducted on 315 school-age children (6-14 years old, mean 9.9 ± 2 years), and IFA was determined in 26 children. From the same sample, 36 children with no IFA were selected as the control group. Data obtained from the Y balance test, handgrip strength with a digital dynamometer, IFA according to the Craig’s test, and joint hypermobility according to the Beighton score were compared between the groups. Independent sample t-test and Pearson’s correlation test were used in the statistical analysis. Results: This study was carried out on a narrow universe of children mean aged 9.9 ± 2 years, and the incidence of IFA was determined as 8.3%. The Y balance scores were found to be higher in the IFA group than in the controls (P=.049 right, P=.027 left). There was no correlation between Craig’s test and the Y balance test results (r=0.04). No difference was found between the groups for muscle strength and joint hypermobility scores associated with balance. Conclusion: Balance may not be one of the causes of frequent falls in children with IFA. Further studies are needed to further examine the biomechanical causes of falls, as studies to improve balance may not provide sufficient benefit to prevent fall-related trauma and injury in children with IFA. © 2024 AVES. All rights reserved.
Open Access
Correction to: Residual Gait Deviations in Children Treated by Medial Open Reduction for Developmental Dysplasia of the Hip at Long-Term Follow-up: A Comparison With Healthy Controls (International Orthopaedics, (2024), 48, 10, (2661-2671), 10.1007/s00264-024-06263-9)
(Springer Nature, 2024) Demirel, Mehmet; EVRENDİLEK, HALENUR; AKALAN, NAZİF EKİN; Bilgili, Fuat; Meriç, Emre; Kuchimov, Shavkat; ÖNERGE, KÜBRA
The correct affiliation of Kübra Önerge should be affiliation 2: Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, İstanbul Kültür University, Istanbul, Turkey. and not affiliation 3. The original article has been corrected. © The Author(s) 2024.
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Determining the Relationship Between the Impairment of Selective Voluntary Motor Control and Gait Deviations in Children With Cerebral Palsy Using Simple Video-Based Analyses
(Elsevier Ireland Ltd., 2021) Sardogan, Cansu; Muammer, Rasmi; AKALAN, NAZİF EKİN; Sert, Rukiye; Bilgili, Fuat
Background: The impairment of selective voluntary motor control (SVMC) in children with cerebral palsy (CP) has been shown to correlate with their gait characteristics using complex 3D gait analysis systems (3DGA); however, this relationship has not been investigated using simple video-based observational gait analysis (VBOGA). The aim of this study was to determine the relationship between VBOGA and SVMC of the lower extremities in children with CP. Methods: Forty-two CP children 10.9 +/- 5.7 years old with Gross Motor Function Classification System (GMFCS) levels I-III participated in the study. Their gait characteristics were assessed using the Edinburgh Visual Gait Score (EVGS), and selective voluntary motor control was tested using the Selective Control Assessment of the Lower Extremity (SCALE). Spearman's rho correlation test with Cohen's classification were used in the statistical analyses. Results: The GMFCS levels (r = 0.604, p < 0.001), foot clearance (r = -0.584. p < 0.001), and maximum ankle dorsiflexion (r = -0.567, p < 0.001) during the swing phase had strong correlations with total SCALE scores. There was also a moderate correlation between total SCALE scores and total EVGS (r = -0.494, p < 0.001), knee extension in the terminal swing phase (r = -0.353, p < 0.001), peak sagittal trunk position (r = -0.316, p < 0.005), and maximum lateral shift (r = -0.37, p < 0.001). Conclusion: Impaired lower extremity SVMC was noticeably related to the foot and ankle movements in the swing phase and initial stance during walking as well as the total EVGS scores and sagittal and frontal trunk movements. The SCALE correlations with VBOGA were similar those observed in the complex 3DGA in the literature; therefore, we suggest that SVMC impairment of gait could be evaluated using simple VBOGA. These findings may help to tailor physical therapy programs for CP children to increase their motor control and walking quality.
Open Access
Does Increased Femoral Anteversion Can Cause Hip Abductor Muscle Weakness?
(MDPI, 2023) APTİ, ADNAN; AKALAN, NAZİF EKİN
Background: Increased femoral anteversion (IFA) causes functional problems (i.e., tripping, frequently falling, and fatigue) by affecting the pelvis and lower extremity biomechanics. In the frontal plane, increased contralateral pelvic drop and ipsilateral hip adduction, which are mainly considered deteriorated hip abductor muscle mechanisms, are associated with hip and knee injuries. Aims: The aim of this study was to examine the effects of femoral anteversion on hip abductor weakness and frontal plane pelvis-hip biomechanics during walking. Methods: The study included nine subjects with increased femoral anteversion and a control group of eleven subjects. Maximum isometric voluntary contraction (MIVC) values of the hip abductor muscles were measured with a handheld dynamometer. Three-dimensional gait analysis was performed for kinetic, kinematic, and temporo-spatial gait parameters. Non-parametric tests were used for statistical analysis (p < 0.05). Results: There was no significant difference found between the MIVC values of the IFA and control groups (p = 0.14). Moreover, no significant difference was determined between the ipsilateral peak hip adduction (p = 0.088) and contralateral pelvic drop (p = 0.149) in the stance phase. Additionally, there was no correlation between the peak hip adduction angle in the stance phase and normalized MIVC values in the IFA group (r = -0.198, p = 0.44), or in the control group (r = -0.174, p = 0.55). The deviations of pelvic rotation (p = 0.022), hip internal rotation (p = 0.003), and internal foot progression (p = 0.022), were found to be higher in the IFA group than in the controls. Conclusions: IFA may not be associated with hip abductor muscle weakness, and it may not lead to the hip adduction and pelvic depression that can be seen in hip abductor weakness. Increased pelvic rotation and internal hip rotation during walking might be considered as a compensation for the femoral head-acetabulum alignment mechanism in the frontal plane.
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The Effect of Wearing High Heels on Lower Extremity Kinematics During Walking for Female with Hypermobility
(Elsevier Ireland Ltd., 2023) AYAN, BUSE; AKALAN, NAZİF EKİN; ÖNERGE, KÜBRA; KUCHIMOV, SHAVKAT; EVRENDİLEK, HALENUR
Open Access
Effects of Arm Swing on Plantar Pressure Behavior During Walking
(İstanbul Üniversitesi-Cerrahpaşa Sağlık Bilimleri Fakültesi, 2023) Leblebici, Gökçe; AKALAN, NAZİF EKİN; ÖNERGE, KÜBRA; KUCHIMOV, SHAVKAT; Ören, Meryem
Objective: This study aimed to investigate the influence of different arm swing conditions on plantar pressure behavior during walking in healthy individuals. Methods: The study included 29 healthy (22.55 ± 1.02 years) volunteers. The foot pressure was analyzed under 3 conditions: both arms should be freely swinging and the dominant arm should be restricted and should be held. Time and magnitudes of peak forces, gait velocity, duration of stance subphases, peak forces for 5 different areas in foot-sole, accelerations of the center of pressure, and mediolateral displacements of center of pressure were the interesting parameters. Results: When the arm swing was held, the onset of terminal stance was earlier and the anterior-posterior center of pressure acceleration decreased at the midfoot on the affected side (0.32 ± 0.04 seconds, 2.96 ± 0.27 m/ms 2) than on the contralateral side (0.34 ± 0.05 seconds, 3.12 ± 0.28 m/ms 2) (P = .04, P = .02). The differ- ences in anterior-posterior center of pressure acceleration between heel and forefoot and the mediolateral displacements of center of pressure were lower on the affected side at held (3.75 ± 0.31 m/ms 2, 0.06 ± 0.02 m, respectively) compared to the free swing (3.82 ± 0.30 m/ms 2, 0.07 ± 0.02 m) (P = .02, P = .01), while the peak force at the medial forefoot was lower on the contralateral side when the arm was held (28.87 ± 6.22 N) compared to the free swing (30.54 ± 5.86 N) (P= .01). Conclusion: The lack of arm swing may interact with ipsilateral early onset and longer late stance phase during walking in healthy individuals. The foot pressure behaviors during walking should be investigated for unilaterally affected patients.
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The Effects of Improvement in Upper Extremity Function on Gait and Balance in Children With Upper Extremity Affected
(Elsevier Ireland Ltd., 2024) Leblebici, Gökçe; Tarakcı, Ela; Kısa, Eylül Pınar; AKALAN, NAZİF EKİN; Kasapçopur, Özgür
Background: This study aimed to investigate the effects of functional improvement in the upper extremity on gait and balance in children with upper extremity affected. Research question: What are the effects of functional improvement in the upper extremity on gait and balance in children with upper extremity affected? Methods: Eighteen children with a diagnosis of rheumatologic diseases and 15 healthy children were evaluated with Shriners Hospital Upper Extremity Assessment, Jebsen-Taylor Hand Function Test, Abilhand Rheumatoid Arthritis Scale, 10-meter walk test and Childhood Health Assessment Questionnaire. For static balance assessment, the Biodex Balance was used. Ground reaction forces (peak forces (heel strike and push-off) and minimum force (loading response), single-limb support duration, Center-of-Force displacement and walking speed were evaluated with the Sensor Medica. Arm swing was evaluated with the Kinovea 2D motion analysis. Results: Before treatment, single-limb support duration and push-off force was higher and center-of-force displacement was lower on affected side compared to unaffected side in rheumatologic group. After the 6week rehabilitation program, upper extremity function, quality of life and functional gait score improved. Single-limb support duration decreased on affected side and increased on unaffected side. On affected side, pushoff force decreased. The arm swing parameters were similar before and after treatment. Significance: Improving upper extremity function can help with gait balance by decreasing the difference in walking and balance parameters between the affected and unaffected sides and providing for more symmetrical weight transfer.
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ESMAC 2021 Abstracts
(Elsevier Ireland Ltd., 2021) AKALAN, NAZİF EKİN; GÖRGÜLÜ, M.; AYDIN, B.; Sert. R.; Bilgili F.
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Femoral Anteversiyon Artışı Olan Çocuklarda Hipermobilite, Kas Kuvveti ve 3 Boyutlu Yürüme Analizi Parametreleri Arasındaki İlişki
(2019-10-18) EVRENDILEK, HALENUR; Karaca, Gülşah; Ertürk, Gamze; Bilgili, Fuat; AKALAN, NAZİF EKİN; ÖNERGE, KÜBRA
AMAÇ Çalışmanın amacı; femoral anteversiyon artışı (FAA) olan çocuklarda hipermobilite, kas kuvveti ve 3 boyutlu yürüme analizi parametreleri arasındaki ilişkiyi araştırmaktır. YÖNTEM FAA olan 7 çocuk (14 bacak, ort.yaş:9.14 ± 0.3, trokanter prominens açı testi(TPAT):28 ± 6.2°) çalışmaya dahil edildi. Çocukların femoral anteversiyon açıları, eklem mobiliteleri ve maksimal izometrik kas kuvvetleri sırasıyla TPAT, Beighton testi ve el dinamometresiyle (Lafayette Instruments,USA) değerlendirildi. Tüm katılımcılara normal hızlarında yürürken 3 boyutlu yürüme analizleri yapılarak pelvis, kalça ve diz kinematik parametreleri incelendi. Parametreler arasındaki ilişkiler, verilerin normal dağılımlarına göre Pearson ve Spearman korelasyon testleri kullanılarak değerlendirildi. Verilerin istatistiksel olarak anlamlılık düzeyi (p<0.05) olarak kabul edildi ve sonuçlar Cohen sınıflamasına göre yorumlandı. BULGULAR Beighton testi skoru ile kalça ekstansör(r: -.70) ve diz ekstansör(r: -.91) kas kuvvetleri, minimum diz fleksiyon açısı(r: -.83) arasında yüksek korelasyon bulundu. TPAT değerleri ise kalça abduktör kas kuvveti(r: -.77) ve ortalama kalça rotasyon açısıyla yüksek korelasyon gösterdi(r: .60). TARTIŞMA Literatürde, FAA olan çocukların yürüme sırasında ortalama kalça iç rotasyon, pelvik oblikite ve duruş fazında diz ekstansiyon parametrelerinin arttığı gösterilmiştir. Bu çalışma, zayıf kalça ekstansör ve abduktür, diz fleksör ve ekstansör kaslarındaki zayıflığın kinematik değişimlerle ilişkili olabildiğini göstermiştir. Ayrıca, literatürle uyumlu olarak ortalama kalça internal rotasyon parametresiyle kalça abdüktör kas kuvvetinin TPAT açısıyla anlamlı olarak ilişkili olduğu bulumuştur. FAA olan çocuklarda sıkça görülebilen hipermobilitenin, kalça ve diz ekstansör kas zayıflığı ile duruş fazında hiperekstansiyon artışında rolü olabilir. Sonuç olarak, kalça abdüktör ve ekstansör, diz fleksör ve ekstansör kas kuvvetlerinin arttırılması, FAA olan hipermobil çocuklarda alt ekstremite fonksiyonun iyileştirilmesi için önemlidir.
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Functional Bandaging in Children with Idiopathic Toe-Walking
(NLM (Medline), 2023) Tuncer, Deniz; AKALAN, NAZİF EKİN; Çalışkan, M. Mine; Temelli, Yener; Yiğit, Pakize
Background: Idiopathic toe-walking (ITW) is a persistent gait pattern with no known etiology characterized as premature heel rise or no heel contact. We investigated the effects of functional bandaging in children with ITW on heel contact during stance phase and on gait quality. Methods: Nineteen children aged 4 to 16 years with ITW and ten age-matched healthy children were included in the study. Elastic adhesive bandages were applied to children with ITW to assist with dorsiflexion. Before bandaging (T0) and immediately (T1) and 1 week (T2) after initial bandaging, the initial contact, loading response, and midstance subphases of gait were analyzed using light pressure sensors and the Edinburgh Visual Gait Score (EVGS). Ten age-matched children with typical gait participated for comparison in T0. The data were analyzed with Friedman and Wilcoxon signed rank tests for within-group comparisons and Mann-Whitney U tests for between-group comparisons. Results: In T0, for the ITW group, no heel contact was observed during stance. In T1, all of the participants achieved heel contact at initial contact and loading response and 56.8% at midstance. In T2, all of the heels continued contact at initial contact and loading response and 54.3% at midstance. The EVGS significantly improved. The Friedman test showed that there were noteworthy improvements between T0-T1 and T0-T2 in video-based observational gait analysis and EVGSs (P < .001), although no difference was found between T1-T2 in video-based observational gait analysis (P = .913) and EVGSs (P = .450). Conclusions: In children with ITW, dorsiflexion assistive functional bandaging was an effective tool to help achieve heel contact on the ground and improve walking quality for a short period after application. Further studies with longer follow-up and larger sample sizes are required to confirm the long-term therapeutic effects of this promising functional bandaging.
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Gait analysis of patients subjected to the atrophic mandible augmentation with Iliac bone graft
(HINDAWI LTD, ADAM HOUSE, 3RD FLR, 1 FITZROY SQ, LONDON, W1T 5HF, ENGLAND, 2019) Temelli, Yener; Arslan, Yunus Ziya; Cansız, Erol; Karabulut, Derya; Doğru, Suzan Cansel; AKALAN, NAZİF EKİN; 190878; 110120; 42880; 249199; 181247; 176320
In this study, we aimed to quantitatively monitor and describe the gait functions of patients, who underwent iliac crest bone grafting in atrophic jaw augmentation operation, by taking into account the alterations of gait parameters and muscle forces in the early recovery course. To do so, temporospatial and kinematic gait parameters of ten patients during pre- and postoperative periods were recorded, and forces of the gluteus medius, gluteus maximus, and iliacus muscles were calculated. Three postoperative periods were specified as one week (post-op1), two weeks (post-op2), and three weeks (post-op3) after the surgery. Restoring process of the gait patterns was comparatively evaluated by analyzing the gait parameters and muscle forces for pre- and postoperative periods. Temporospatial and kinematic parameters of post-op3 were closer to those obtained in pre-op than those in post-op1 and post-op2 (p<0.05). Muscle forces calculated in post-op3 showed the best agreement with those in pre-op among the postoperative periods in terms of both magnitude and correlation (p<0.05). In conclusion, the patients began to regain their preoperative gait characteristics from the second week after surgery, but complete recovery in gait was observed three weeks after the surgery.
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Increased Femoral Anteversion May Not Cause Hip Abductor Muscle Weakness During Walking
(Elsevier Ireland Ltd., 2023) APTİ, ADNAN; AKALAN, NAZİF EKİN; KUCHIMOV, SHAVKAT; Temelli, Yener
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Intraoperative Testing of Passive and Active State Mechanics of Spastic Semitendinosus in Conditions Involving Intermuscular Mechanical Interactions and Gait Relevant Joint Positions
(Elsevier, 2020) Kaya, Cemre S.; Bilgili, Fuat; AKALAN, NAZİF EKİN; Yücesoy, Can A.
In cerebral palsy (CP) patients suffering pathological knee joint motion, spastic muscle's passive state forces have not been quantified intraoperatively. Besides, assessment of spastic muscle's active state forces in conditions involving intermuscular mechanical interactions and gait relevant joint positions is lacking. Therefore, the source of flexor forces limiting joint motion remains unclear. The aim was to test the following hypotheses: (i) in both passive and active states, spastic semitendinosus (ST) per se shows its highest forces within gait relevant knee angle (KA) range and (ii) due to intermuscular mechanical interactions, the active state forces elevate. Isometric forces (seven children with CP, GMFCS-II) were measured during surgery over a range of KA from flexion to full extension, at hip angle (HA) = 45 degrees and 20 degrees, in four conditions: (I) passive state, (II) individual stimulation of the ST, simultaneous stimulation of the ST (III) with its synergists, and (IV) also with an antagonist. Gait analyses: intraoperative data for KA = 17-61 degrees (HA = 45 degrees) and KA = 0-33 degrees (HA = 20 degrees) represent the loading response and terminal swing, and mid/terminal stance phases of gait, respectively. Intraoperative tests: Passive forces maximally approximated half of peak force in condition II (HA = 45 degrees). Added muscle activations did increase muscle forces significantly (HA = 45 degrees: on average by 42.0% and 72.5%; HA = 20 degrees: maximally by 131.8% and 123.7%, respectively in conditions III and IV, p < 0.01). In conclusion, intermuscular mechanical interactions yield elevated active state forces, which are well above passive state forces. This indicates that intermuscular mechanical interactions may be a source of high flexor forces in CP. (C) 2020 Elsevier Ltd. All rights reserved.
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Kinematic Analysis of Walking of Hypermobile and Non-Hypermobile Individuals with Heavy Backpack
(Elsevier Ireland Ltd., 2023) OPAN, İREM; Uzunoğlu, Gamze Ertürk; AKALAN, NAZİF EKİN; ÖNERGE, KÜBRA; KUCHIMOV, SHAVKAT; EVRENDİLEK, HALENUR
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Kinesiology of the Human Gait
(Elsevier, 2020) AKALAN, NAZİF EKİN; Angın, Salih
Gait is one of the most complex functional activity which takes 7 years in average to learn and there are many factors such as music that is listened to, momentary psychogenic state, exhaustion, happiness, anger, etc. may affect the gait characteristics. Gait is a common activity in our daily lives. People who experience pain in only one phase of gait do not feel it only once a day. This situation is unacceptable for the human body and, thus, causes automatic, compensatory changes in a short time. In this section, the fundamentals of normal gait, its sub-phases, and the biomechanical events under these phases are explained.
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O 043 – Mechanics of spastic semitendinosus altered by intermuscular interactions elevate its contribution to pathological resistance against knee extension during gait
(2018-09) Kaya, C.S.; Bilgili, Fuat; Temelli, Yener; Ateş, Filiz; Yücesoy, Can A.; AKALAN, NAZİF EKİN
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Pilot Study on Obstetric Brachial Plexus Paralysis: Docs Arm Swing Asymmetry Affect Foot Plantar Pressure Behavior?
(2019-09) Kuchimov, Shavkat Nadir; AKALAN, NAZİF EKİN; 176320
Introduction Brachial plexus palsy, as one of the most common congenital injuries affected by arm swing, is characterized by muscle weakness at different levels in the upper extremity (1). As the weakness of the upper extremity muscles can affect the trunk muscles and the postural development, these children may have some gait deviations (2,3). Previous studies have shown that walking parameters are also influenced by clinical conditions such as stroke and cerebral palsy (2-6). There is a lack of literature on determining the biomechanical influences of arm swing asymmetry on foot pressure behavior for OBBP children. Therefore, the aim of the study was determining arm-swing asymmetry related foot pressure behavioral alterations on OBBP. Research Question Does arm swing asymmetry affect foot plantar pressure behavior on OBBP patients? Methods Thirteen children with OBPP (7 females, 6 males) (mean age:9.37±2.68 years) participated in the study. For all individuals, a digital plantar-pressure analysis system (Win-track, Balma, France) was utilized to analyze the foot pressure behavior during standing and walking with self-selected velocity. The magnitude of the first and the second peak forces divided to an invidual’s weight (Fl, F2), total stance duration (Ts), time of Fl (Tl), time of min force between F1-F2 (T2), time o f F2 (T3), step length were calculated. Each stance phase was divided into five sub-phases: Loading response (Tl/Ts), mid-stance (T2-Tl/Ts), terminal stance (T3-T2/Ts) and pre-swing (Ts-T3/Ts), single limb support (T3-Tl/Ts) (7). In addition, arm swing ranges were recorded and analyzed using Kinovea software (8). Paired t-test was used for the compared between affected side and non-affected side (p < 0.05). Results Fl, pre-swing duration and step length were higher in affected side than in non-affected side(p<0.05). Single limb support duration lower in affected side than in non-affected side (p<0.05). The maximum arm flexion and extension angle and arm swing range were significantly reduced on the affected side (p<0.05). No significant difference was found in F2, loading response duration, mid-stance duration and terminal stance duration between affected side and non-affected side (Table 1). Discussion The reduced arm swing may alter the foot pressure behavior during walking on affected side as well as the non-affected side in children with OBBP. Reduced single limb support duration ((T3-Tl)/Ts) on the affected side indicate the stability problem in stance on affected side. Increase the first vertical peak force (Fl) on the affected side is probably related to the decreased arm extension range at the affected side, which absorbs the first peak of vertical force in early stance during walking. Increased step length on the affected side may due to the enhanced single limb duration on the non-affected side.
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The Relationship of One Leg Standing Duration to GMFM Scores and to Stance Phase of Walking in Children with Hemiplegic Cerebral Palsy
(Taylor & Francis, 2021) UZUNOĞLU, GAMZE ERTÜRK; AKALAN, NAZİF EKİN; EVRENDİLEK, HALENUR; YILMAZ, GÜLŞAH KARACA; Bilgili, Fuat
Background: Lack of stability during stance negatively impacts gait and motor function for children with unilateral cerebral palsy. Improving stability and balance are the focus for gait rehabilitation). The One-Leg-Standing-Test may give valuable information about motor function and stability of stance for patients with unilateral cerebral palsy. Objective: This study aimed to investigate the relationship between the One-Leg-Standing-Test and the gross-motor-function-measurement and single-limb support time. Methods: The study included 18 patients with unilateral cerebral palsy (age 11.08 [SD 2.84] years old). The One-Leg-Standing-Test and pedobarographic evaluation were performed. Sections D and E of the gross-motor-function-measurement were assessed, and in pedobarographic evaluation, the single-limb support time (the total duration of mid-stance and terminal-stance during walking) was calculated to describe stability during stance. Results: For patients, the One-Leg-Standing-Test scores and single-limb support time values were lower on the affected side than on the unaffected side. The One-Leg-Standing-Test was correlated with single-limb support time (p = .02, r = 0.60) and section E (p < .01, r = 0.59) values. The One-Leg-Standing-Test was also correlated to total stance phase and section D. Conclusion: The One-Leg-Standing-Test gives valuable information about gross-motor-function but cannot be substituted for motor function tests. The single-limb support time value may be used to describe stability in stance during walking.
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Residual Gait Deviations in Children Treated by Medial Open Reduction for Developmental Dysplasia of the Hip at Long-Term Follow-up: A Comparison With Healthy Controls
(Springer, 2024) Demirel, Mehmet; EVRENDİLEK, HALENUR; AKALAN, NAZİF EKİN; Bilgili, Fuat; Meric, Emre; Kuchimov, Shavkat; ÖNERGE, KÜBRA
Purpose This study aimed to analyze and compare gait patterns and deviations at long-term follow-up in children who received medial open reduction (MOR) before 18 months for unilateral or bilateral hip developmental dysplasia (DDH). Methods A retrospective chart review was conducted on children who underwent MOR. The study population was divided into two groups: the unilateral group, including unilateral (five children with unilateral) and bilateral (five children with bilateral DDH). Ten healthy children were recruited for the control group. Spatiotemporal, kinematic, stiff-knee gait (SKG), and kinetic gait characteristics were analyzed. Results Stance time was significantly shorter in both the unilateral (median [IQR]; 590 ms, [560.0-612.5] and bilateral (575 ms, [550-637.5]) groups than in the control group (650, [602.5-677.5]) (p < 0.001), whereas swing time did not differ substantially (p = 0.065) There was no considerable difference in the mean knee flexion at swing between the unilateral (31.6 degrees, [30-36]) and control (30.11 degrees, [27.8-33.6] groups (p > 0.05), but the bilateral group (28.5 degrees, [24.9-32.1]) showed the lower values than the other groups (p < 0.001 for bilateral vs unilateral group; p = 0.008 bilateral vs unilateral group). All the SKG parameters significantly differed among the groups in multi-group comparisons (p < 0.001 for each parameter). Three children had borderline SKG, and two had not-stiff limbs in the unilateral group. In the bilateral group, four children had stiff limbs, and one had borderline SKG. Most kinetic gait parameters were not statistically different between groups (p > 0.05). Conclusion This study has revealed notable deviations in gait patterns of children with DDH treated by MOR at long-term follow-up compared to healthy children's gait. MOR could negatively affect pelvic motion during gait due to impaired functions of the iliopsoas and adductor muscles, and SKG can be encountered secondary to iliopsoas weakness.

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