The Effect of Improvement in Function on Foot Pressure, Balance and Gait in Children With Upper Extremity Affected
Condition: Upper Extremity Dysfunction; Gait, Unsteady; Juvenile Idiopathic Arthritis; Balance
MeSH terms: Arthritis, Juvenile; Gait Disorders, Neurologic
Study type: Interventional

Summary: 
      It has been shown that movements of the upper extremity during walking are associated with
      lower extremity mobility. For example, when walking at a slow pace, the swing frequency of
      the arms is 2: 1 compared to the legs, while the limb frequency decreases to 1: 1 as the
      walking speed increases. That is, in order to walk fast, the lower extremity takes advantage
      of the acceleration of the upper extremity [1]. It is known that the muscles of the shoulder
      girdle also support this oscillating movement in the upper extremity during walking. Thus, it
      is thought that blocking or restricting shoulder girdle and arm movements during walking
      increases energy expenditure and heart rate, decreases gait stability, and decreases stride
      length and walking speed [2,3]. However, the possible effects that the upper limb can aid in
      movement include decreasing vertical displacement of the center of mass, decreasing angular
      momentum or decreasing ground reaction moment, and increasing walking stability [2-4]. In
      these studies that restrict arm swing, methods such as crossing the arms on the chest [5],
      holding the arm in a sling or pocket [6], or fixing the arms to the trunk with a bandage [7]
      were used. Studies have generally been conducted on healthy individuals or on the
      biomechanical model, and arm swing during walking has not been investigated in pathologies
      with only upper extremity involvement (upper extremity fractures, Juvenile Idiopathic
      Arthritis) without any problems with lower extremity and/or walking.

      This study is aimed to reveal the effects of decreased upper extremity functionality on
      walking and balance.
    

Detailed description: 
      It has been shown that movements of the upper extremity during walking are associated with
      lower extremity mobility. For example, when walking at a slow pace, the swing frequency of
      the arms is 2: 1 compared to the legs, while the limb frequency decreases to 1: 1 as the
      walking speed increases. That is, in order to walk fast, the lower extremity takes advantage
      of the acceleration of the upper extremity [1]. It is known that the muscles of the shoulder
      girdle also support this oscillating movement in the upper extremity during walking. Thus, it
      is thought that blocking or restricting shoulder girdle and arm movements during walking
      increases energy expenditure and heart rate, decreases gait stability, and decreases stride
      length and walking speed [2,3]. However, the possible effects that the upper limb can aid in
      the movement include decreasing vertical displacement of the center of mass, decreasing
      angular momentum or decreasing ground reaction moment, and increasing walking stability
      [2-4]. In these studies that restrict arm swing, methods such as crossing the arms on the
      chest [5], holding the arm in a sling or pocket [6], or fixing the arms to the trunk with a
      bandage [7] were used. Studies have generally been conducted on healthy individuals or on the
      biomechanical model, and arm swing during walking has not been investigated in pathologies
      with only upper extremity involvement (upper extremity fractures, Juvenile Idiopathic
      Arthritis) without any problems with lower extremity and/or walking.

      Studies performed in pathologies where upper extremity mobility and arm swing are affected
      have shown that the kinetic and kinematic parameters of walking are also affected [8-11].
      This change in walking dynamics also changes foot pressure behavior. In a study investigating
      the effect of arm swing on the affected side on walking in hemiplegic individuals, ground
      reaction forces on the affected and unaffected sides by foot pressure analysis were examined
      and it was found that the maximum forces applied during the first contact and toe-off on both
      sides decreased [12]. In addition, the stance phase duration was higher in hemiplegic
      patients compared to healthy controls in both lower extremities [12]. This suggests that the
      affected upper extremity may change the time to transfer weight while walking. In a study
      investigating the changes in gait parameters in patients with brachial plexus [13] in which
      ground reaction forces were examined, different gait phase durations and maximum ground
      reaction force times were found in the affected lower extremity compared to the unaffected
      side. In a study examining whether the degree of upper extremity functionality has an effect
      on walking in patients with hemiparetic cerebral palsy; Patients were included in the
      exercise program aimed at increasing upper extremity function, and as a result, it was found
      that while upper extremity function increased, patients improved walking parameters and
      walking distance [14]. Zhou et al. investigated the effects of an active upper extremity
      exercise program in patients with spinal cord injuries and demonstrated the usefulness of
      active upper extremity participation in walking [15].

      With these results in the literature, the effect of reduced upper extremity function on gait
      and balance in disease groups (such as rheumatic diseases with only upper extremity
      involvement, upper extremity fractures) without affecting walking or any
      neurological/orthopedic diagnosis that may affect walking was not investigated.

      The aim of this study is to reveal the effects of decreased upper extremity functionality on
      walking and balance.
    

Intervention name(s): Exercise protocol
Intervention type(s): Other
Intervention description(s): a combination of stretching, range of motion, and strengthening exercise.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Upper Extremity; Physiotherapy; Exercise; Gait; Balance