Resumo Objetivo Avaliar a correlação entre dados do exame físico relativos à rotação do quadril e torção tibial com a cinemática do plano transverso em crianças com paralisia cerebral; e determinar quais pontos no tempo e eventos do ciclo de marcha apresentam maior correlação com achados do exame físico. Métodos Um total de 195 crianças com paralisia cerebral vistas em dois laboratórios de marcha, de 2008 a 2016, foi incluído neste estudo. As medidas do exame físico incluíram rotação interna do quadril, rotação externa do quadril, ponto médio da rotação do quadril e ângulo do eixo transmaleolar. Foram selecionados seis parâmetros cinemáticos para cada segmento, para avaliar a rotação do quadril e a do pé em relação à perna durante a marcha. As correlações entre exame físico e medidas cinemáticas foram analisadas por coeficientes de correlação de Spearman, e considerou-se um nível de significância de 5%. Resultados Comparando as medidas da rotação do quadril e da cinemática do quadril, encontramos correlações moderadas a fortes para todas as variáveis (p<0,001). Os coeficientes mais altos foram observados entre o ponto médio da rotação do quadril no exame físico e a rotação do quadril na cinemática (rho range: 0,48-0,61). Correlações moderadas também foram encontradas entre a medição do ângulo do eixo transmaleolar no exame físico e a rotação do pé em relação à perna na cinemática (faixa rho: 0,44-0,56; p<0,001). Conclusão Estes achados podem ter implicações clínicas na avaliação e no tratamento de desvios da marcha do plano transverso em crianças com paralisia cerebral.

Abstract Objective To evaluate the correlation between physical examination data concerning hip rotation and tibial torsion with transverse plane kinematics in children with cerebral palsy; and to determine which time points and events of the gait cycle present higher correlation with physical examination findings. Methods A total of 195 children with cerebral palsy seen at two gait laboratories from 2008 and 2016 were included in this study. Physical examination measurements included internal hip rotation, external hip rotation, mid-point hip rotation and the transmalleolar axis angle. Six kinematic parameters were selected for each segment to assess hip rotation and shank-based foot rotation. Correlations between physical examination and kinematic measures were analyzed by Spearman correlation coefficients, and a significance level of 5% was considered. Results Comparing physical examination measurements of hip rotation and hip kinematics, we found moderate to strong correlations for all variables (p<0.001). The highest coefficients were seen between the mid-point hip rotation on physical examination and hip rotation kinematics (rho range: 0.48-0.61). Moderate correlations were also found between the transmalleolar axis angle measurement on physical examination and foot rotation kinematics (rho range 0.44-0.56; p<0.001). Conclusion These findings may have clinical implications in the assessment and management of transverse plane gait deviations in children with cerebral palsy.

ABSTRACT Objective: To evaluate whether distal rectus femoris transfer (DRFT) is related to postoperative increase of knee flexion during the stance phase in cerebral palsy (CP). Methods: The inclusion criteria were Gross Motor Function Classification System (GMFCS) levels I-III, kinematic criteria for stiff-knee gait at baseline, and individuals who underwent orthopaedic surgery and had gait analyses performed before and after intervention. The patients included were divided into the following two groups: NO-DRFT (133 patients), which included patients who underwent orthopaedic surgery without DRFT, and DRFT (83 patients), which included patients who underwent orthopaedic surgery that included DRFT. The primary outcome was to evaluate in each group if minimum knee flexion in stance phase (FMJFA) changed after treatment. Results: The mean FMJFA increased from 13.19° to 16.74° (p=0.003) and from 10.60° to 14.80° (p=0.001) in Groups NO-DRFT and DRFT, respectively. The post-operative FMJFA was similar between groups NO-DRFT and DRFT (p=0.534). The increase of FMJFA during the second exam (from 13.01° to 22.51°) was higher among the GMFCS III patients in the DRFT group (p<0.001). Conclusion: In this study, DRFT did not generate additional increase of knee flexion during stance phase when compared to the control group. Level of Evidence III, Retrospective Comparative Study.

OBJECTIVE: To identify gait patterns in a large group of children with diplegic cerebral palsy and to characterize each group according to age, Gross Motor Function Classification System (GMFCS) level, Gait Deviation Index (GDI) and previous surgical procedures. METHODS: One thousand eight hundred and five patients were divided in seven groups regarding observed gait patterns: jump knee, crouch knee, recurvatum knee, stiff knee, asymmetric, mixed and non-classified. RESULTS: The asymmetric group was the most prevalent (48.8%). The jump knee (9.6 years old) and recurvatum (9.4 years old) groups had mean age lower than the other groups. The lowest GDI (43.58) was found in the crouch group. There were more children classified within GMFCS level III in the crouch and mixed groups. Previous surgical procedures on the triceps surae were more frequent in stiff knee and mixed groups. The jump knee group received less and the stiff-knee group more surgical procedures at hamstrings than others. CONCLUSIONS: The asymmetrical cases were the most frequent within a group of diplegic patients. Individuals with crouch gait pattern were characterized by the lowest GDI and the highest prevalence of GMFCS III, while patients with stiff knee exhibited a higher percentage of previous hamstring lengthening in comparison to the other groups. Level of Evidence III, Retrospective Comparative Study.

CONTEXTO E OBJETIVO: A lesão mais comum no basquetebol é a entorse de tornozelo. Assim, os atletas freqüentemente utilizam suportes externos como medidas profiláticas. O objetivo deste estudo é avaliar as respostas da força de reação do solo (FRS) durante a execução do movimento de cutting do basquetebol com e sem acessórios de tornozelo. TIPO DE ESTUDO E LOCAL: Estudo comparativo. Delineamento experimental de grupo único com medidas repetidas; Divisão de Medicina de Reabilitação, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil. MÉTODOS: Foram colhidas as forças vertical (Fy) e médio-lateral (Fz) em três condições (bandagem, Aircast e calçado esportivo) e analisados os picos de força e de propulsão no contato com o solo (Fymax1, Fzmax1, Fymax2 e Fzmax2), o gradiente de crescimento (pico/tempo) (GC Fymax1, GC Fzmax1, GC Fymax2 e GC Fzmax2) e o impulso após o contato. RESULTADOS: Os acessórios reduziram significativamente Fymax2 e GC Fymax2. GC FZmax1 foi maior na situação com tênis quando comparado com bandagem. No momento do impacto, a bandagem aumentou a Fy em relação ao calçado, mas em um intervalo de tempo maior, não aumentando a carga articular. Fz atingiu um pico em menor tempo, podendo gerar maior carga eversora/inversora. O Aircast exerceu um melhor efeito de absorção de impacto, pois gera menor Fy em um maior intervalo de tempo. CONCLUSÕES: Apesar do uso freqüente deste tipo de recurso pelos atletas, seu mecanismo de ação ainda é confuso. Mais estudos são necessários para esclarecer seus efeitos nas atividades esportivas a longo prazo.

CONTEXT AND OBJECTIVE: In basketball, the most common injuries are ankle sprains. For this reason, players frequently use external ankle devices or taping as prophylactic and rehabilitation measures. The purpose of this study was to evaluate ground reaction force (GRF) responses in basketball players while performing typical cutting maneuvers with and without ankle bracing and ankle taping. DESIGN AND SETTING: Comparative study with experimental design of single-group repeated measurements, at Medical Rehabilitation Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. METHODS: Vertical (Fy) and medial-lateral (Fz) GRF measurements were made under three conditions (taping, Aircast-type orthosis and basketball shoes alone), with analysis of peak forces at foot contact (Fymax1, Fzmax1, Fymax2 and Fzmax2), growth gradient (peak/time) (GG Fymax1, GG Fzmax1, GG Fymax2 and GG Fzmax2) and impulse after foot contact. RESULTS: Bracing significantly reduced Fymax2 and GG Fymax2. GG Fzmax1 was significantly higher for the sport shoe condition than for the taping condition. Taping increased Fy in relation to the sport shoe at foot contact, but over a longer time interval, without increasing excessive ankle loading. Fz reached a peak in less time, which might generate greater inversion/eversion loading on a player's foot. The Aircast exerted better shock-absorbing effect than did the other two conditions, since it generated less vertical force over longer time intervals and smaller medial-lateral forces in relation to taping. CONCLUSIONS: Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities.

FUNDAMENTOS E OBJETIVO: O segmento mais freqüentemente lesado no basquetebol é o tornozelo, sendo a entorse por inversão a lesão mais comum. Para evitá-la, é comum o uso de implementos. O objetivo deste estudo foi avaliar a força reação do solo (FRS) em jogadores de basquete durante execução do salto em três situações: uso de tênis, bandagem e tênis, e tênis e órtese tipo Aircast. MÉTODOS: Oito atletas foram analisados durante o salto, através de uma plataforma de força, nas três situações citadas, para análise das componentes vertical e horizontal médio-lateral da FRS. RESULTADOS E CONCLUSÃO: Não houve diferença estatística significativa entre as três situações na componente vertical da FRS durante o salto, embora o uso de bandagem tenda a apresentar, na impulsão, maiores valores do pico de força vertical (3,10 ± 0,46PC; 3,01 ± 0,39PC; 3,03 ± 0,41PC) e do gradiente de crescimento (GC) (12,33 ± 12,21PC; 8,16 ± 3,89PC; 8,46 ± 3,85PC), e durante a aterrissagem, menores valores de pico de força vertical (5,18 ± 1,35PC; 5,56 ± 1,31PC; 5,49 ± 1,44PC) e do GC (88,83 ± 33,85PC; 95,63 ± 42,64PC; 94,53 ± 31,69PC). Durante a impulsão, a força medial do salto com Aircast foi significativamente menor que com tênis (p = 0,0249) e apresentou valor semelhante ao do uso da bandagem, enquanto a força lateral foi significativamente maior com a bandagem do que com tênis (p = 0,0485) e tendeu a ser maior do que o Aircast. Na aterrissagem o componente médio-lateral da FRS ficou inalterado nas três situações. Concluiu-se que a bandagem potencializou a força direcionada ao salto vertical durante a impulsão, porém não estabilizou tanto quanto o Aircast os movimentos de inversão e eversão do pé. Durante a aterrissagem, os implementos não foram efetivos para reduzir a força médio-lateral, mas com a bandagem, houve um tempo maior para absorção do impacto.

BASES AND OBJECTIVE: The segment most frequently injured in basketball is the ankle, being the inversion sprain the most common lesion. In order to avoid it, ankle devices are frequently used. The objective of this study was to evaluate the ground reaction force (GRF) in basketball players during jump performance in three situations: use of basketball sport shoes, sport shoes with bracing and sport shoes with Aircast-type orthosis. METHODS: Eight athletes were analyzed during jump through a force platform in the three situations mentioned for the analysis of the medial-lateral vertical and horizontal components of the ground reaction force. RESULTS AND CONCLUSION: No significant statistical differences between the three situations were verified in the vertical ground reaction force during jump, although the use of bracing trends to present, during impulsion, higher peak values of the vertical force (3.10 ± 0.46PC; 3.01 ± 0.39PC; 3.03 ± 0.41PC) and the growth gradient (GC) (12.33 ± 12.21PC; 8.16 ± 3.89PC; 8.46 ± 3.85PC), and during landing, lower peak values of the vertical force (5.18 ± 1.35PC; 5.56 ± 1.31PC; 5.49 ± 1.44PC) and the GC (88.83 ± 33.85PC; 95.63 ± 42.64PC; 94.53 ± 31.69PC). During impulsion, the jump medial force with Aircast was significantly lower than with sport shoes (p = 0.0249) and presented values similar to values obtained with the use of bracing, while the lateral force was significantly higher with bracing than with the use of the sport shoes (p = 0.0485) and trended to be higher than with the use of the Aircast. In the landing, the medial-lateral component of the ground reaction force remained unchanged in the three situations. One concludes that the use of bracing has potentialized the force towards the vertical jump during impulsion, however, it did not stabilize the foot inversion and eversion movements as much as the Aircast. During landing, the devices were not effective to reduce the medial-lateral force, however, with the use of the bracing, a longer time for the impact absorption was verified.

FUNDAMENTOS Y OBJETIVO: EL segmento mas frecuentemente lesionado en el basquetbol es el tobillo, siendo la torsión por inversión interna la lesión mas común, para evitarla, es común el uso de ciertos implementos. El objetivo de este estudio fue el de evaluar la fuerza de reacción del suelo (frs) en jugadores de basquetbol durante la ejecución del salto en tres situaciones: uso de calzado deportivo, uso de vendaje y calzado deportivo, uso de calzado deportivo y ortesis Aircast. MÉTODOS: Ocho atletas fueron analizados durante el salto, a través de la plataforma de fuerza en las tres situaciones citadas para el análisis de los componentes vertical y horizontal medio lateral de la FRS. RESULTADOS Y CONCLUSIÓN: No hubo diferencia estadística significativa entre las tres situaciones en la componente vertical de la FRS durante el salto, ahora el uso del vendaje tiende a presentar en la impulsión mayores valores del pico de fuerza vertical. (3,10 ± 0,46PC; 3,01 ± 0,39PC; 3,03 ± 0,41PC) y del gradiente de crecimiento (GC) (12,33 ± 12,21PC; 8,16 ± 3,89PC; 8,46 ± 3,85PC), y durante el aterrizaje, menores valores del pico de fuerza vertical (5,18 ± 1,35PC; 5,56 ± 1,31PC; 5,49 ± 1,44PC) e do GC (88,83 ± 33,85PC; 95,63 ± 42,64PC; 94,53 ± 31,69PC). Durante la impulsión, la fuerza medial del salto con Aircast fue significativamente menor que con el calzado deportivo (p = 0,0249), y presentó un valor semejante al uso del vendaje, en cuanto a la fuerza lateral fue significativamente mayor con el vendaje que con el calzado deportivo (p = 0,0485) y tendió a ser mayor que con el Aircast. En el aterrizaje el componente medio-lateral de la FRS quedó inalterado en las tres situaciones. Se concluye que el vendaje potencializó la fuerza direccionada al salto vertical durante la impulsión, porque no estabilizó tanto como con el Aircast los movimientos de inversión y eversión del pie. Durante el aterrizaje, los implementos no fueron efectivos para reducir la fuerza medio-lateral, más que con el vendaje, hubo un tiempo mayor para absorción del impacto.