Open Versus Closed Kinetic Chain Exercises in Tibial Distraction Osteogenesis by Ilizarov's METHOD
The Ilizarov external fixator is an external skeletal fixator that is used to stabilize or lengthen the limb bones. Bone lengthen bone occurs through mechanical distraction on the long axis of the bone, thus the method of lengthening is called distraction osteogenesis. This method has been shown successful. Unfortunately, it has also been associated with a substantial number of complications.
Muscle shortening and persistent weakness are among the most common complications seen in this procedure. Muscle shortening usually occurs in strong muscle groups such as the planter flexor muscles, as a result of strength imbalance between the opposing muscle groups. Shortening may persist for more than a year after the removal of the fixator and may require surgical intervention. Fortunately, muscular shortening can be prevented by splinting and physiotherapy in the form of stretching and strengthening exercise and functional training.
The use of different exercises in rehabilitation can help accomplishing different therapeutic goals. Thus, the choice to use one or the other should depend on the desired treatment goals. Weight bearing (CKC) and non weight bearing (OKC) exercise has been incorporated into rehabilitation; however, the effects of these two types of exercises particularly on muscle flexibility and mechanics have never been studied systematically.
Therefore, the purpose of this is to compare the effects of OKC and the CKC exercise on muscle strength, architecture and flexibility.
The use of open kinetic or closed kinetic chain exercises will have no different effects on muscle function or internal organization during tibial distraction osteogenesis by Ilizarov's method Specific hypotheses
- There will be no difference between the effects of OKC and CKC on muscle flexibility.
- There will be no difference between the effect of OKC and CKC exercises on muscle strength.
- There will be no difference between the effect of OKC and CKC on the internal organization of muscle specifically the pennation angle, muscle thickness and fiber length.
- There will be no difference between the overall of OKC and CKC exercise on the functional performance of patients.
|Limb Length Discrepancy Bone Deformity||Other: Open Kinetic Chain exercise Other: Closed kinetic chain exercise||Phase 2|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Open Versus Closed Kinetic Chain Exercises in Tibial Distraction Osteogenesis by Ilizarov's METHOD|
- peak isometric strength of the ankle plantar flexors [ Time Frame: september 2013 (10 months) ]Then Isometric strength of the ankle plantar flexors will be measured using an isometric test in which the patients push maximally against the plate and the piston of the hand-held dynamometer for four to five seconds. Three measurements will be taken, with only maximum value used for statistical analysis
- Ultrasonography for measuring internal muscle structure [ Time Frame: September 2013 (10 months) ]For each patient, images of medial gastrocnemius will be taken bilaterally with the ankle joint at neutral position and at maximum plantar flexion, while the subtalar position is neutral. Imaging will be repeated while the muscle is relaxed and contracting by the same radiologist. The recorded scans will be used to measure Pennation angle, muscle thickness and fiber length using computer software
- Ankle plantar flexors flexibility [ Time Frame: September 2013 (10 months) ]The flexibility of the gastrocnemius and the soleus muscles will be assessed passively with the knee extended and flexed, respectively. Patient will assume the supine lying position during the testing. The investigator will measure the range of ankle dorsiflexion achieved using a digital inclinometer
|Study Start Date:||July 2014|
|Study Completion Date:||December 2014|
|Primary Completion Date:||December 2014 (Final data collection date for primary outcome measure)|
Experimental: open kinetic chain exercise
Open kinetic chain exercise
Other: Open Kinetic Chain exercise
Experimental: Closed Kinetic chain exercise
Closed kinetic chain exercise
Other: Closed kinetic chain exercise
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01738113
|The University of Benha|
|Principal Investigator:||Aliaa Rehan Youssef, PhD||Cairo University|
|Principal Investigator:||Khaled Ayad, PhD||Cairo University|
|Study Director:||Gamal A hosny, PhD||Benha University|