BACKGROUND: In patients with rheumatoid arthritis (RA), the pathological progression of lower limb biomechanics is established. Although specific aspects of RA gait patterns have been studied and described, we are aware of no studies of gait pattern compensations over the entire disease course. This study aimed to describe a model that could predict the evolution of lower limb pathomechanics in patients with RA.
METHODS: A literature review was conducted of electronic databases (MEDLINE, PEDro, Trip Database, DOAJ, BioMed Central, PLOS clinical trial, ScienceDirect, and CRD York University, AHRQ, NICE, Cochrane Library) to October 3, 2023.
RESULTS: A theory was developed that all people with RA induce or augment gait evolution syndromes following the same biomechanical course. Specifically, we postulate the \"rheumatoid equinus syndrome,\" the \"rheumatoid abnormal pronation syndrome\" and the \"rheumatoid shuffle syndrome,\" which have never been described before.
CONCLUSIONS: A new model of the evolution of gait compensation in RA is proposed. An important challenge of RA is that it increases the risk of ulcerative lesions, falls, pain, fractures, and healthcare costs. The proposed model can be used to reduce morbidity in this patient group by helping to explain and reduce the pain, deformity, and ankylosis of foot RA.

OBJECTIVE: To investigate the relationship between oral muscle pressure and malocclusion in the mixed dentition.
METHODS: Maximum tongue, lip and cheek pressure was measured using the Iowa Oral Performance Instrument (IOPI) in 3 patient cohorts: patients with (1) posterior crossbite, (2) class II relationship and (3) a control group of patients without malocclusion. Linear models were used to compare the mean differences in muscle pressure between groups, with correction for age and gender. The imbalance between lips and tongue and between lips and cheeks was calculated by the Delta z-scores of each group.
RESULTS: A total of 146 participants were included, 46 (mean age 8.71±0.85), 41 (mean age 11.74±1.17) and 35 (mean age 10.71±1.92) in groups 1, 2 and 3 respectively. Patients with malocclusion showed significantly higher lip and lower cheek pressure and imbalance favouring the lips over the tongue compared to controls. Class II,1 patients showed significantly higher tongue pressure than Class II,2. No differences were found in muscle pressure or imbalance between crossbite and Class II nor between crossbite types.
CONCLUSIONS: These findings suggest that oral muscle pressure may be associated with malocclusion. This highlights the importance of functional diagnosis and its implications on the prevention and treatment of malocclusion, as well as on orthodontic stability.

The aim of the present study was to develop and design software-based \"virtual patient\" for learning functional diagnosis with clinical reasoning of respiratory dysfunction based on need analysis and perception of faculty and student on utility in the undergraduate physiotherapy curriculum. The objective of the study was to design a framework of a respiratory case scenario that includes personal details, history taking, physical examination, differential diagnosis, investigations, functional impairment, and diagnosis, design a prototype of the virtual patient case scenario using software in a virtual environment created in oculus quest, obtain faculty and student feedback, and analyze the feedback. The result of the study obtained on feedback analysis suggests that the virtual patient case scenario (prototype) contains the relevant information in an organized and sequenced manner. The virtual patient case scenario on the virtual reality platform will be helpful as a teaching and learning modality. The study concluded that the present virtual simulated case scenario (prototype) with more cases helps to develop functional diagnosis and clinical reasoning skills as a part of the undergraduate physiotherapy curriculum.

Manual therapy is a cornerstone of physical therapy and canine physical rehabilitation. Although veterinary literature has tackled the topic of manual therapy treatments in animal patients, less attention has been paid to the assessment techniques and clinical reasoning skills that guide a practitioner toward determining if, when, and where manual therapies will be most effective. This article tackles the topics of clinical reasoning, the functional diagnosis, observational skills, and physical evaluation techniques that serve as prerequisites to the use of manual therapeutics.

The ability to communicate is one of the fundamental factors underlying human relationships. Severe brain damage and disorders of consciousness may indispose a person to participate in everyday social and family life. In spite of this fact, however, the issue of holistic approach to communication in the context of severe traumatic brain injury is still not well explained and described. The goal of this article is to introduce a profile of nonverbal behavior of children with disorders of consciousness.
The study included 30 children with minimal conscious state after severe brain trauma, aged between 7 and 16 years old. Research was conducted using the Coma Recovery Scale-Revised and the Bykova-Lukyanov Scale of Communication Activity.
Significant differences in communication level between investigated groups were demonstrated, both in Body Function (F = 9.184; p < 0.001) and Activity and Participation (F = 13.100; p < 0.001).
It is possible to map and classify communication ability of children with minimal conscious state by using International Classification of Functioning, Disability and Health (ICF) protocol and the Bykova-Lukyanov Scale of Communication Activity, with specific consideration of Activities and Participation factors. This approach reveals differences in communication and disability level between children with minimal conscious state plus (MSC+) and minimal conscious state minus (MSC-).

The back of the foot is a standard region for measuring transcutaneous oxygen tension (tcpO2) with a reliably determined threshold of ischaemia, but such measurement reflects blood supply of only a portion of angiosomes of the foot. Determining the reference values of tcpO2 in other regions of the lower extremity is of current importance. However, measuring the tcpO2 level on the plantar surface and in some other regions not uncommonly reveal a phenomenon of its steady decrease instead of formation of a plateau. The purpose of the present study was to analyse the frequency of the phenomenon of a steady decrease in ptcO2 level while performing transcutaneous oximetry in various zones of the lower extremity. We retrospectively analysed the results of a total of 160 measurements of tcpO2 in 35 patients with diabetes mellitus. The patients\' mean age amounted to 68 (47-87) years, with the duration of diabetes mellitus averaging 14 (1-24) years. The male-to-female ratio was 60:40. Seventy-seven percent of patients had foot ulcers/wounds, 34% of patients had a history of previously endured revascularization. The examination was carried out in the dorsal, plantar, medial plantar regions of the foot, on the medial surface of the crus and in the subclavian region, using the TCM 400 monitoring device (Radiometer, Denmark). The measurements were performed by an experienced operator in strict accordance with the manufacturer\'s recommendations. We evaluated the average value of tcpO2 between the 15th and 19th minutes of measurement and the peculiarities of the tpcO2 curve (plateau/increase/decrease of the value) within this time interval. The mean tcpO2 value in the medial plantar region was significantly higher than that on the back of the foot: 34 (3-70) versus 22 (1-59) mm Hg, p=0.003. A portion of measurements demonstrated a steady decrease in the tpcO2 during the measurement up to the 40th minute. Complying with the stable plateau phase criteria we had developed were 92% of measurements in the subclavian region, 100% - in the middle third of the crus, 76% - on the back of the foot, 77% - in the medial plantar region and 43% - on the plantar surface of the foot. CONCLUSIONS: 1) the revealed phenomenon of a steady decrease of tcpO2 in some patients needs to be taken into consideration in clinical practice and deserves further study; 2) the nature of this phenomenon is unclear, with a possible effect of skin creams on the results of the measurements; 3) it is advisable to include into the functions of the devices for transcutaneous oximetry an algorithm for confirmation of the true phase of the plateau and calculation of the mean tcpO2 value for a chosen period; 4) despite the need for measurement of tcpO2 in the \'alternative zones\' it is necessary to thoroughly study the reliability of the data in these zones and to determine the normal values of the parameter separately for each of them.
Тыл стопы - стандартная область для измерения чрескожного напряжения кислорода (tcpO2) с достоверно установленным порогом ишемии, но такое измерение отражает кровоснабжение лишь части ангиосомов стопы. Актуальным является определение референсных значений tcpO2 в других областях нижней конечности. Однако при измерении уровня tcpO2 на подошвенной поверхности и в некоторых других областях нередко выявляется феномен его неуклонного снижения вместо формирования плато. Целью исследования послужил анализ частоты феномена неуклонного снижения уровня tcpO2 при проведении транскутанной оксиметрии в различных зонах нижней конечности. Проведен ретроспективный анализ результатов 160 измерений tcpO2 у 35 больных с сахарным диабетом. Средний возраст пациентов составил 68 (47-87) лет, давность сахарного диабета в среднем - 14 (1-24) лет. Доля мужчин - 60%. У 77% имели место язвы/раны стоп, 34% ранее перенесли реваскуляризацию. Исследование проводилось в дорсальной, плантарной, медиальной пяточной областях стопы, на медиальной поверхности голени и в подключичной области. Использовался аппарат TCM 400 (Radiometer, Дания). Измерения выполнялись опытным оператором в строгом соответствии с рекомендациями производителя устройства. Оценивалось среднее значение tcpO2 между 15 и 19 минутами измерения и особенности кривой tcpO2 (плато/нарастание/снижение показателя) в этот период времени. Среднее значение tcpO2 в медиальной пяточной области было значительно выше, чем на тыле стопы: 34 (3-70) против 22 (1-59) мм рт. ст., p=0,003. В части измерений выявлено непрерывное снижение tcpO2 за время измерения, вплоть до 40 минуты. Разработанным нами критериям стабильной фазы плато соответствовали 92% измерений в подключичной области, 100% - в средней трети голени, 76% - на тыле стопы, 77% - в медиальной пяточной области и 43% - на подошвенной поверхности стопы. Выводы: 1) выявленный феномен неуклонного снижения tcpO2 у части больных требует учета в клинической практике и заслуживает дальнейшего изучения; 2) природа этого феномена не ясна, возможно влияние кремов для кожи на результаты измерений; 3) в функции аппаратов для транскутанной оксиметрии целесообразно включение алгоритма подтверждения истинной фазы плато и расчета среднего значения tcpO2 для выбранного периода; 4) несмотря на потребность в измерении tcpO2 в \'альтернативных зонах\', необходимо тщательно изучить достоверность данных в этих зонах и определять нормальные значения показателя отдельно для каждой из них.

BACKGROUND: We aimed to delineate if unanticipated jump-landing assessments delivers complementary information to those of commonly used hop and jump tests after anterior cruciate ligament reconstruction.
METHODS: Eleven participants (5 males) performed a series of unanticipated jump-landings and traditional hop and jump performance tests (single leg hops for distance, triple crossover hops for distance and drop jumps). The number of mistrials, time to stabilization and peak ground reaction force (pGRF) at landing and jump/hop distance were measured. Pearson correlations to find potential associations between the unanticipated jump-landing-values and the traditional jump/hop performance tests were calculated twice: once for the affected and once for the unaffected legs. t-Tests for dependent samples were used to detect differences between affected and unaffected leg within each test condition.
RESULTS: The pGRF at unanticipated landing significantly correlated to the pGRF at drop jump landing (r = 0.68) and the hopping distance after the triple crossover hops (r = 0.71, each p < .05). No other significant correlation occurred (p > .05). Hopping distance after single leg hops (mean: 110.2 cm vs. 95.5 cm) and triple crossover hops for distance (mean: 315.3 cm vs. 294.2 cm) showed significant differences between the unaffected and the reconstructed leg (p < .05). Other parameters showed no significant between-legs differences (p > .05).
CONCLUSIONS: Both, the reconstructed and the contralateral leg seems to be affected. Unanticipated jump landing tasks deliver information beyond those of commonly used jump and hop tests, the thereby assessed abilities may thus be a complementary aspect of dynamic knee function than those assessed with classic tests.