Begell House Inc.
Critical Reviews™ in Physical and Rehabilitation Medicine
CRP
0896-2960
13
1
2001
Determinants, Limiting Factors, and Compensatory Strategies in Gait
26
10.1615/CritRevPhysRehabilMed.v13.i1.10
Sylvie
Nadeau
School of Rehabilitation, Faculty of Medicine, University of Montreal, and CRIR, Montreal Rehabilitation Institute, Montreal, Quebec, Canada
Denis
Gravel
School of Rehabilitation, Faculty of Medicine, University of Montreal, and CRIR, Montreal Rehabilitation Institute, Montreal, Quebec, Canada
Sandra Jean
Olney
School of Rehabilitation Therapy, Queen's University Kingston, Ontario, Canada
In the field of rehabilitation, gait evaluation and training is an everyday task confronted by the therapist. To correct gait problems in an efficient manner, an understanding of the relevant gait concepts are essential. It is the purpose of this review to describe and discuss particular biomechanical issues that have consequences on gait training. This article reviews the determinants of gait, with special focus placed on the strength and range of motion (ROM) factors. General considerations are presented, followed by a summary of the specific roles of the sagittal muscle groups in gait. The literature about the associations between muscle weakness, ROM, and normal gait is reviewed, and findings are discussed in relation to the gait pattern. In the second part of the article, descriptions and concepts around the limiting factors and compensatory strategies are presented and discussed. This article is based on relevant literature and our understanding as physical therapists of what is important for rehabilitation specialists to know about the determinants, the limiting factors, and the compensatory strategies in gait.
Fibromyalgia Syndrome: Toward an Integration of the Literature
28
10.1615/CritRevPhysRehabilMed.v13.i1.20
Akiko
Okifuji
Associate Professor, Department of Anesthesiology, Pain Research and Management Center, University of Utah, UT 84108 University of Washington, Seattle, WA 98195
Michael A.
Ashburn
Professor of Anesthesiology and Director of Pain Management Center, University of Utah, UT 84108
Fibromyalgia syndrome (FMS) is a generalized musculoskeletal pain disorder with multiple functional and psychological problems. Despite extensive efforts during the last 30 years to uncover the etiology, the mechanisms underlying FMS remain elusive. Similarly, no single treatment has proven to be universally effective for FMS. FMS is considered to be a medical enigma, and millions of patients continue to suffer from debilitating pain and disability. The primary objective of this article is to present a thorough review of the current FMS literature. We discuss three primary hypotheses on the pathophysiologic mechanisms: peripheral, psychological, and central. We attempt to integrate the findings and suggest a heuristic model of FMS, integrating the physiological and psychological variables with the predispositional, stress, and time factors associated with FMS. This article also includes a review of clinical trials testing various therapy modalities for FMS. The review emphasizes the importance of understanding the multifactorial nature of FMS; different modalities seem to target different areas of the disorder. We suggest that clinical decisions need to reflect the diversity of the FMS symptom profiles. Interdisciplinary treatments tailored to target a patient's specific needs are likely to improve the clinical efficacy and cost-effectiveness of the therapy.
Leg-Length Discrepancy: Clinical Implication for Gait
12
10.1615/CritRevPhysRehabilMed.v13.i1.30
D. Casey
Kerrigan
Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
Edwin
Hanada
Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Leg-length discrepancy (LLD) is a common disorder, with important clinical implications, including for gait. There are many controversial clinical issues involving LLD that can make it challenging for the clinician. The extent of LLD that is clinically significant is up for debate, although this is now more commonly expressed as a percentage of the longer limb leading to, for example, compensatory strategies in gait. There is some evidence to suggest that LLD has an association with low back pain, and is linked with degenerative arthritis of the longer-leg hip and knee, although the strength of these associations are a contentious issue. Evaluation of LLD should involve a thorough history and physical examination, including clinical measurement through the "iliac crest palpation book correction" technique, and quantitative gait analysis. Finally, treatment should involve stretching, and strengthening exercises for the hip abductors/adductors, and extensors, as well as for the back. For LLD between 20 and 5O mm, conservative management should involve a trial of a heel with or without a shoe lift. Larger LLD should be managed by prostheses if surgical management is not being considered. Leg-length discrepancy remains a fascinating clinical entity and an important one, with which clinicians should be familiar, and be able to manage effectively.
Carpal Tunnel Syndrome: A Critical Review
12
10.1615/CritRevPhysRehabilMed.v13.i1.40
David E.
Kipp
U.S.Healthworks, Inc., 3151 East Center Street, Warsaw, IN 46580
Julie K.
Wilson
Department of Performance Dynamics, 22021 North Glenwood Avenue, Muncie, IN 47304
Carpal tunnel syndrome: can we scientifically substantiate and improve upon current examination, evaluation, intervention, and patient management techniques? In recent decades, carpal tunnel syndrome (CTS) has been one of the most reported cumulative trauma disorders. Clinically, physicians used different provocative tests to diagnose CTS. Some of those tests include Tinel's sign, Phalen's test, and Semmes-Weinsten Monofilament testing. In addition, some physicians use grip strength and electromyography or nerve conduction» velocities to confirm clinical diagnosis. Depending on diagnosis and severity, there are different treatment approaches to consider implementing. Treatment options include surgery, physical therapy, occupational rehabilitation, drug therapy, and biobehavioral interventions. Although surgery is an available option, conservative therapy should not be ruled out as a first line of treatment. The purposes of this article are to review literature, draw a consensus among the investigators regarding the basic scientific evidence substantiating effective techniques of examination, evaluation, diagnosis, interventions, and care management of patients with CTS synthesized into an integrated, clinically relevant and applicable format, thereby enhancing clinical practice.
Expectations, Prognostic Factors, and Outcome After Lumbar Disc Surgery
11
10.1615/CritRevPhysRehabilMed.v13.i1.50
C.
Woertgen
Department of Neurosurgery, University of Regensburg, Germany
R. D.
Rothoerl
Department of Neurosurgery, University of Regensburg, Germany
In this review we give a critical overview of some problems related to the surgical treatment of lumbar disc herniations. The following points and questions are discussed: Pathogenic and pathophysiological factors. Diagnostic tools: Which are the best? What do patients expect from surgery? What are the risk factors? Physical therapy versus surgery or both? What is a favorable result after lumbar disc surgery? Current scientific problems. To investigate the effectiveness of lumbar disc surgery, the starting conditions, the aim, and the follow-up period have to be taken into account. Unfortunately, these points are still under discussion and the instrument to evaluate effectiveness has not been found.