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Morphofunctional aspects of lower limb in multiple sclerosis - Rjme.ro

Morphofunctional aspects of lower limb in multiple sclerosis - Rjme.ro

Morphofunctional aspects of lower limb in multiple sclerosis -

Rom J Morphol Embryol 2012, 53(1):117–120 ORIGINAL PAPER R J M E Romanian Journal rong>ofrong> Morphology & Embryology http://www.rjme.ro/ rong>Morphrong>ofrong>unctionalrong> rong>aspectsrong> rong>ofrong> rong>lowerrong> rong>limbrong> rong>inrong> rong>multiplerong> rong>sclerosisrong> M. C. NEAMŢU 1) , LIGIA RUSU 2) , M. MARIN 3) , TAINA AVRAMESCU 2) , P. F. RUSU 3) , OANA MARIA NEAMŢU 2) , MARIA IANCĂU 4) 1) Department rong>ofrong> Pathologic Physiology, University rong>ofrong> Medicrong>inrong>e and Pharmacy rong>ofrong> Craiova 2) Department rong>ofrong> Sports Medicrong>inrong>e and Krong>inrong>esiology 3) Department rong>ofrong> Applied Mechanics University rong>ofrong> Craiova 4) Department rong>ofrong> Physiology, University rong>ofrong> Medicrong>inrong>e and Pharmacy rong>ofrong> Craiova Abstract Gait, as an expression rong>ofrong> the locomotive system, needs a complex biomechanical analysis, which allows the description rong>ofrong> rong>multiplerong> rong>sclerosisrong> (MS) specific patterns, MS patients havrong>inrong>g a polymorphism rong>ofrong> motion patterns. The studied group consisted rong>ofrong> 13 MS patients with gait disorders, average age rong>ofrong> the group was rong>ofrong> 36 years. The evaluation rong>ofrong> the subjects comprises: clrong>inrong>ical evaluation (anamnesis, neurological examrong>inrong>ation), paraclrong>inrong>ical evaluation (MRI), functional evaluation, neuro-physiologic evaluation and biomechanical evaluation. Biomechanical examrong>inrong>ation was completed usrong>inrong>g the force and pressure-measurrong>inrong>g platform rong>ofrong> plantar pressure distribution Footscan Scientific Version, RSscan. The studied parameters were: contact area, active contact area, heel rotation, foot balance, foot angle. The evaluated zones durrong>inrong>g a gait cycle were: the heel, medial foot, antefoot. Although the analysis rong>ofrong> contact area rong>inrong> the lateral foot did not show any significant differences between the right and the left foot, it nonetheless underlrong>inrong>ed a major difference rong>inrong> the expression rong>ofrong> maximum and mrong>inrong>imum values, which meant that MS patients with clrong>inrong>ically detectable gait disorders had a tendency to rong>inrong>crease contact area to marong>inrong>tarong>inrong> balance. Examrong>inrong>rong>inrong>g the foot positions rong>inrong> relation to the movement direction and to the foot vertical axis, we noticed the existence rong>ofrong> certarong>inrong> elements rong>inrong>dicatrong>inrong>g an orientation tendency rong>ofrong> the foot. This tendency had to be related to neutral position (correspondrong>inrong>g to anatomical position) rong>ofrong> the foot. We also noticed a foot deviation rong>inrong> abduction, associated with visible pronation and decrease rong>ofrong> the contact area correspondrong>inrong>g to medial plantar zone. Keywords: gait, morphrong>ofrong>unctional parameters, biomechanical parameters, evaluation. Introduction Each patient with rong>multiplerong> rong>sclerosisrong> (MS) presents a wide range rong>ofrong> lesion types [1], which rong>inrong>volves a polymorphism rong>ofrong> the gait patterns due to many pathologic mechanisms and etiologies. This demonstrates the existence rong>ofrong> heterogeneous syndromes with consequences on the therapeutic approach. Gait, as an expression rong>ofrong> the locomotor system, needs a complex biomechanical assessment [2, 3], which allows the description rong>ofrong> MS specific patterns and facilitates certarong>inrong> programmes rong>ofrong> gait disorders prophylaxis and rehabilitation [4] at MS patients [5]. The gait cycle is comprised rong>ofrong> stance (approximately 60%) and swrong>inrong>g phases (approximately 40%). The stance phase is divided rong>inrong>to more stages: loadrong>inrong>g, median stance and heel risrong>inrong>g while the swrong>inrong>g phase comprises rong>inrong>itial and termrong>inrong>al swrong>inrong>g. There are two short moments rong>ofrong> double stance when both feet contact the ground, allowrong>inrong>g weight transfer from the rear foot to the front foot. The body weight is sustarong>inrong>ed by a srong>inrong>gle rong>limbrong> approximately 80% rong>ofrong> the gait cycle. Krong>inrong>etic variables are highly important rong>inrong> gait analysis; they are calculated usrong>inrong>g force plates and krong>inrong>ematic data. These are: vertical and horizontal ground reaction forces (GRF) (Newtons per kilogram), the moment rong>ofrong> force produced at the jorong>inrong>t level (Newton-meters per kilogram), the power transferred between the body segments (watt) and mechanic energy rong>ofrong> the body segments (Jouli). The moments rong>ofrong> force represent the frong>inrong>al product rong>ofrong> the forces rong>inrong> the ligaments and rong>ofrong> friction forces, which modify the rotation angle at the jorong>inrong>t level. The moments can be rong>inrong>terpreted as resultants rong>ofrong> muscle forces. Patients and Methods The purpose rong>ofrong> this paper is to present morphrong>ofrong>unctional rong>limbrong> rong>aspectsrong> durrong>inrong>g gait at MS patients. The research was carried out rong>inrong> compliance with the prrong>inrong>ciples rong>ofrong> ethics, the Declaration rong>ofrong> Helsrong>inrong>ki and the Law No. 206/2004. The studied group consisted rong>ofrong> 13 MS patients with clrong>inrong>ically detectable gait disorders, out rong>ofrong> whom seven men and six women. Average age rong>ofrong> the group was rong>ofrong> 36 years. From the clrong>inrong>ical porong>inrong>t rong>ofrong> view, the patients had two flares: positive MS diagnosis and gait capacity. There were excluded both the patients with spasticity level above 2 on Ashworth scale, who presented severe ISSN (prrong>inrong>t) 1220–0522 ISSN (on-lrong>inrong>e) 2066-8279

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