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      Effect of Unilateral Shoulder Disorder on the Stance Phase of Human Gait

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          Abstract

          Background

          Gait analysis systems serve as important tools for assessing disturbed gait patterns. Amongst other factors, functional limitations of the shoulder joint may relate to such disturbances. Patient-reported outcome measures, assessment of pain, and active range of motion are commonly used to describe shoulder impairment.

          Purpose

          The aim of this cohort study was to evaluate the impact of unilateral limitations of shoulder mobility and pain on gait patterns and to detect correlations between pain, shoulder mobility, and particular phases of human gait using a Zebris gait analysis system.

          Methods

          20 subjects with unilaterally restricted mobility and pain of the affected shoulder and a control group of 10 healthy subjects underwent a gait analysis. Various gait parameters, the DASH score, pain at rest and movement of the affected shoulder, and the active range of motion (aROM) for shoulder flexion and abduction were recorded.

          Results

          We determined significant differences of the duration of the loading response ( p = 0.021), midstance ( p = 0.033), and the terminal stance phase ( p = 0.019) between the shoulder group and the control group, with a shorter loading response phase and a longer terminal stance phase of the affected side in the shoulder group. In the shoulder group, we found significant correlations between the DASH and the duration of the midstance phase ( p = 0.023) and the terminal stance phase ( p = 0.038). In addition, there was a significant correlation between shoulder flexion and the duration of the midstance phase ( p = 0.047).

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          Most cited references38

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          Validity of four pain intensity rating scales.

          The Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and the Faces Pain Scale-Revised (FPS-R) are among the most commonly used measures of pain intensity in clinical and research settings. Although evidence supports their validity as measures of pain intensity, few studies have compared them with respect to the critical validity criteria of responsivity, and no experiment has directly compared all 4 measures in the same study. The current study compared the relative validity of VAS, NRS, VRS, and FPS-R for detecting differences in painful stimulus intensity and differences between men and women in response to experimentally induced pain. One hundred twenty-seven subjects underwent four 20-second cold pressor trials with temperature order counterbalanced across 1°C, 3°C, 5°C, and 7°C and rated pain intensity using all 4 scales. Results showed statistically significant differences in pain intensity between temperatures for each scale, with lower temperatures resulting in higher pain intensity. The order of responsivity was as follows: NRS, VAS, VRS, and FPS-R. However, there were relatively small differences in the responsivity between scales. A statistically significant sex main effect was also found for the NRS, VRS, and FPS-R. The findings are consistent with previous studies supporting the validity of each scale. The most support emerged for the NRS as being both (1) most responsive and (2) able to detect sex differences in pain intensity. The results also provide support for the validity of the scales for use in Portuguese samples. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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            Assessment of pain.

            Valid and reliable assessment of pain is essential for both clinical trials and effective pain management. The nature of pain makes objective measurement impossible. Acute pain can be reliably assessed, both at rest (important for comfort) and during movement (important for function and risk of postoperative complications), with one-dimensional tools such as numeric rating scales or visual analogue scales. Both these are more powerful in detecting changes in pain intensity than a verbal categorical rating scale. In acute pain trials, assessment of baseline pain must ensure sufficient pain intensity for the trial to detect meaningful treatment effects. Chronic pain assessment and its impact on physical, emotional, and social functions require multidimensional qualitative tools and health-related quality of life instruments. Several disease- and patient-specific functional scales are useful, such as the Western Ontario and MacMaster Universities for osteoarthritis, and several neuropathic pain screening tools. The Initiative on Measurement, and Pain Assessment in Clinical Trials recommendations for outcome measurements of chronic pain trials are also useful for routine assessment. Cancer pain assessment is complicated by a number of other bodily and mental symptoms such as fatigue and depression, all affecting quality of life. It is noteworthy that quality of life reported by chronic pain patients can be as much affected as that of terminal cancer patients. Any assessment of pain must take into account other factors, such as cognitive impairment or dementia, and assessment tools validated in the specific patient groups being studied.
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              Gait disorders in adults and the elderly

              Summary Human gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems. The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives. The prevalence of gait disorders increases from 10 % in people aged 60–69 years to more than 60 % in community dwelling subjects aged over 80 years. Sensory ataxia due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait disorders. With advancing age the proportion of patients with multiple causes or combinations of neurological and non-neurological gait disorders increases. Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions. This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.
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                Author and article information

                Contributors
                Journal
                ScientificWorldJournal
                ScientificWorldJournal
                tswj
                The Scientific World Journal
                Hindawi
                2356-6140
                1537-744X
                2022
                25 April 2022
                : 2022
                : 8205879
                Affiliations
                1Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
                2Austrian Workers' Compensation Board (AUVA), Innsbruck, Austria
                3VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
                4Piz-Therapie, Saalfelden, Austria
                5Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
                6Hannover Medical School MHH, Clinic for Rehabilitation Medicine, Hannover, Germany
                Author notes

                Academic Editor: Noureddin Nakhostin Ansari

                Author information
                https://orcid.org/0000-0003-2111-8772
                https://orcid.org/0000-0002-4421-2449
                https://orcid.org/0000-0002-6345-0813
                Article
                10.1155/2022/8205879
                9061043
                35509375
                5c88dfb5-a6d9-4fab-a37c-18d3bd10bf6f
                Copyright © 2022 Martin Missmann et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 December 2021
                : 14 March 2022
                : 13 April 2022
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