Medial opening-wedge has gained popularity in comparison to other techniques of high tibial osteotomy. This technique involves the creation of a gap in the tibia. Filling the gap with autologous iliac bone graft was recommended in the classic description, to prevent complications such as correction loss or delayed bone union. No previous reports have compared grafted and nongrafted osteotomies. This study hypothesized that the use of autologous bone graft in medial opening-wedge high tibial osteotomy (MOWHTO) less than 12.5 mm is unnecessary. A prospective randomized clinical trial was conducted. Forty-six opening-wedge high tibial osteotomies were carried out between April 2007 and December 2008. All had fixation with a type of Puddu stainless steel plate and screws. Patients were randomly divided by software analysis into two groups: group A had osteotomies that were filled with autologous bone graft and group B had osteotomies that were unfilled. Autologous iliac bone graft was harvested in both groups. Clinical and radiographic evaluations were performed twice monthly by blinded investigators. The rates of complications were compared between the groups. There was no difference in demographic data. Mean time to clinical bone union in group A was 12.4 weeks (confidence interval [CI] 11.2-13.6) and in group B was 13.7 weeks (CI 12.5-14.9), but this difference was not significant (P = 0.13). Signals of correction loss occurred in one patient (4.35%) in group A, and in two patients (8.70%) in group B. All osteotomies had achieved bone union. It was concluded that time to bone union was not statistically different between the group with bone graft and the group without graft.

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There is a lack of studies comparing the kinematics data of idiopathic Parkinson's disease (IPD) patients with healthy elder (HE) subjects, and when there is such research, it is not correlated to clinical measures. Objective: To compare the spatio-temporal and kinematic parameters of Parkinsonian gait with the HE subjects group and measure the relation between these parameters and clinical instruments. Method: Twelve patients with IPD and fifteen HE subjects were recruited and evaluated for clinical instruments and gait analysis. Results: There were statistically significant differences between HE group and the IPD group, in stride velocity, in stride length (SL), and in the hip joint kinematic data: on initial contact, on maximum extension during terminal contact and on maximum flexion during mid-swing. Regarding the clinical instruments there were significant correlated with in stride velocity and SL. Conclusion: Clinical instruments used did not present proper psychometric parameters to measure the IPD patient's gait, while the 3D system characterized it better. Key words: Parkinson's disease, gait assessment, kinematics.Comparação da doença de Parkinson com idosos saudáveis através da análise da marcha RESUMO Poucos estudos comparam os dados cinemáticos de pacientes com doença de Parkinson idiopática (DPI) com indivíduos idosos saudáveis, e quando realizam não correlacionam com medidas clínicas. Objetivo: Comparar os parâmetros espaço-temporais e cinemáticos da marcha na DP com os de idosos saudáveis (IS) e avaliar a relação entre estes parâmetros com os instrumentos clínicos. Método: Doze pacientes com DPI e quinze IS foram recrutados e avaliados por instrumentos clínicos e de análise de marcha. Resultados: Houve diferenças estatísticas significantes entre o grupo de IS e o de DPI na velocidade da marcha e no comprimento do passo (CP), nos dados cinemáticos das articulações do quadril: no contato inicial, na máxima extensão no apoio e na máxima flexão na oscilação. No que diz respeito aos instrumentos clínicos houve significativa correlação com a velocidade da marcha e SL. Conclusão: Os instrumentos clínicos utilizados não apresentaram adequados parâmetros psicométricos para a avaliação da marcha dos indivíduos com DPI, enquanto uma avaliação em 3D caracteriza melhor a marcha destes indivíduos. Palavras-chave: doença de Parkinson, avaliação da marcha, cinemática.

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Study design: Determination of differences in the cardiorespiratory responses of tetraplegic subjects with incomplete and complete lesions during treadmill gait and endurance exercise provided by neuromuscular electrical stimulation (NMES). Differences between rest and exercise phases were also examined. Objectives: To compare the cardiorespiratory responses in tetraplegic individuals during endurance exercise in the sitting position and treadmill gait with 30-50% body weight relief, both provided by NMES. Setting: Rehabilitation Ambulatory at University Hospital, Brazil. Methods: A total of 31 tetraplegic subjects were evaluated. Individuals were separated into two groups: gait group and endurance exercise group. In the gait group (n ¼ 17), the exercise protocol consisted of three different phases: 8 min of rest, 10 min of treadmill walking using NMES and 10 min of recovery. In the endurance exercise group (n ¼ 14), the cardiorespiratory test consisted of 8 min of rest, 15 min of quadriceps endurance exercise in the sitting position by NMES and 10 min of recovery. Oxygen uptake (VO 2 ), carbon dioxide production (VCO 2 ), respiratory exchange ratio (RER), pulmonary ventilation (V E ) and heart rate (HR) were measured. Results: All parameters increased considerably in the gait group from rest to the walking phase, although individuals with incomplete lesions presented a more pronounced increase than those with complete lesion. In the gait group, for incomplete tetraplegics, the mean VO 2 peak was 0.81670.314 l/min, corresponding to 11.4173.11 ml/kg/min; the mean value for VCO 2 was 0.66070.24 l/min, mean HR was 124.54728.72 bpm and mean V E was 28.3876.28 l/min. In the endurance exercise group, for incomplete tetraplegics, the mean VO 2 peak was 0.24670.07 l/ min, corresponding to 3.8470.92 ml/kg/min; the mean value for VCO 2 was 0.20570.06 l/min, mean HR was 71.45715.51 bpm and mean V E was 11.8372.72 l/min. In the endurance exercise group, smaller differences were observed in all variables from rest to the exercise phase, compared with the large increases observed in the gait group. Conclusions: These preliminary results have shown that gait training probably improves physical capacity in tetraplegic individuals more than the endurance exercise. www.nature.com/sc injured subjects, increases the ability to perform daily activities and reduces medical complications. Neuromuscular electrical stimulation (NMES) in spinal cord injured subjects allows the activation of paralyzed muscles through electrical stimulation of intact periphery motoneurons. 3 Thus, NMES has been used extensively in order to provide walking function 4 and to study the action of the spinal cord in the control of movement, using the concept of task-oriented training, which suggests that sensory input can produce the basic motor pattern. 5 Gait training on the treadmill provides a constant rate of movement and rhythm, which stimulates the reciprocal coordination of the lower limbs. 6 Moreover, NMES activates the large muscle mass, increases str...

Regular physical activity is associated with improved LV diastolic function in SCI subjects and might exert distinct cardiac structural effects in tetraplegic and paraplegic subjects.

Study design: Cross-sectional. Objectives: Individuals with spinal cord injury (SCI) exhibit increased carotid intima-media thickness (IMT) and are reported to be exposed to higher circulating levels of inflammatory mediators. This study evaluated the relationship between inflammatory markers and carotid surrogates of cardiovascular risk in subjects with SCI. Setting: São Paulo, Brazil. Methods: A total of 65 nondiabetic, nonhypertensive, sedentary, nonsmoker men (34 with SCI; 31 healthy subjects) were evaluated by medical history, anthropometry, routine laboratory tests, analysis of hemodynamic, inflammatory parameters and ultrasound examination of carotid arteries. Results: Subjects with SCI (18 tetraplegic and 16 paraplegic) had lower systolic blood pressure (P ¼ 0.009), higher serum C-reactive protein (P ¼ 0.001), tumor necrosis factor (TNF) receptor-II (P ¼ 0.02) and TNF receptor-I (P ¼ 0.04) levels and increased in vitro production of interleukin-6 by mononuclear cells (P ¼ 0.04), compared to able-bodied individuals. No differences in serum interleukin-6, e-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and transforming growth factor-b levels, or in vitro release of interleukin-10, interleukin-17 and interferon-g by mononuclear cells, were detected between the studied groups. Common carotid IMT, but not internal carotid resistive index, was significantly higher in subjects with SCI (Po0.0001 adjusted for C-reactive protein and TNF receptor-II levels). In addition, tetraplegic subjects exhibited increased IMT (P ¼ 0.002 adjusted for systolic blood pressure and body mass index), but similar levels of inflammatory mediators compared to paraplegic ones. Conclusions: Individuals with SCI exhibit a clustering of vascular and inflammatory surrogates of increased cardiovascular risk. Nevertheless, subclinical carotid atherosclerosis is related to injury level but not to increased inflammatory status in these subjects.

Quadriplegic subjects present extensive muscle mass paralysis which is responsible for the dramatic decrease in bone mass, increasing the risk of bone fractures. There has been much effort to find an efficient treatment to prevent or reverse this significant bone loss. We used 21 male subjects, mean age 31.95 ± 8.01 years, with chronic quadriplegia, between C4 and C8, to evaluate the effect of treadmill gait training using neuromuscular electrical stimulation, with 30-50% weight relief, on bone mass, comparing individual dual-energy X-ray absorptiometry responses and biochemical markers of bone metabolism. Subjects were divided into gait (N = 11) and control (N = 10) groups. The gait group underwent gait training for 6 months, twice a week, for 20 min, while the control group did not perform gait. Bone mineral density (BMD) of lumbar spine, femoral neck, trochanteric area, and total femur, and biochemical markers (osteocalcin, bone alkaline phosphatase, pyridinoline, and deoxypyridinoline) were measured at the beginning of the study and 6 months later. In the gait group, 81.8% of the subjects presented a significant increase in bone formation and 66.7% also presented a significant decrease of bone resorption markers, whereas 30% of the controls did not present any change in markers and 20% presented an increase in bone formation. Marker results did not always agree with BMD data. Indeed, many individuals with increased bone formation presented a decrease in BMD. Most individuals in the gait group presented an increase in bone formation markers and a decrease in bone resorption markers, suggesting that gait training, even with 30-50% body weight support, was efficient in improving the bone mass of chronic quadriplegics. Correspondence