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Purpose Age-related decreases in cervical mobility and proprioception have previously been demonstrated. Potential associations of these deteriorations with fall risk have not been investigated so far. This study aims to compare cervical mobility and proprioception between fallers and non-fallers and prospectively assess the contribution of these parameters in fall risk identification among healthy older adults. Methods 95 community-dwelling older adults underwent a cervical screening. Active cervical range of motion (aCROM) was measured using a digital inclinometer and cervical proprioception was assessed by determining joint position error (JPE). Fear of falling was identified through the Iconographical Falls Efficacy Scale (iconFES). Falls were prospectively recorded during a 1-year follow-up period using monthly calendars. Univariate and multivariate logistic regression analyses were conducted to examine the association between these parameters and falls occurrence. Results Baseline measurements revealed reduced cervical performance (i.e., smaller aCROM and larger JPE) among individuals who reported at least one fall during the following year (“fallers”). The multivariate logistic regression model contained eight independent variables (age, sex, walking aid, fall history, iconFES, aCROM F, aCROM E and JPE) and correctly classified 77.8% of cases. Conclusion Although the contribution of cervical parameters to fall risk identification seems to be rather small compared to well-known (though often unmodifiable) major risk factors, further research is needed to elucidate underlying mechanisms of cervical functions in relation to falls. Second, it would be interesting to develop a targeted fall preventive cervical exercise program and assess its effectiveness in terms of falls occurrence.

Background: During the COVID-19 pandemic, mandatory containment measures led to lockdowns and severely diminished social interaction, with older adults being one vulnerable group. Socially assistive robots (SARs) could prove to be an effective intervention. Objectives: To explore the experiences of older adults with mild cognitive impairment (MCI) with a SAR during the first lockdown in Belgium. Methods: Inductive thematic analysis was used. After a two-week interaction period with robot James, semi-structured interviews were conducted. Results: Four people were interviewed (median: 86 years; range: 70–90 years; 2 men, 2 women). Four themes were identified. The first theme described the robot as a companion, alleviating feelings of loneliness and social isolation. The second theme explored the robot in light of meaningful activity. The third theme detailed the technical aspects of the robot and the fourth theme described notable barriers and areas of improvement. Conclusion: The study demonstrated the potential of SARs during the first lockdown period in Belgium. The robot proved to be promising in terms of alleviating feelings of loneliness and social isolation. It was found to be both motivating and facilitating in terms of meaningful activity. Significance: The study provided valuable insights for the care of lonely and occupationally deprived older adults.

Background: Early-onset dementia (EOD) defines all dementia related conditions with an onset before the age of 65 years. EOD places a large and distressing psychological, emotional and financial burden on the individuals themselves and their caregivers. For various reasons, diagnostic and treatment strategies for EOD are very challenging. There is a general agreement that not only the human body but also the mind benefits from physical activity and/or exercise. Especially aerobic exercise has shown to have favorable effects on cognitive functions in healthy older adults, as well as in patients with MCI and dementia. However, there are major differences in age, physical fitness level and clinical presentation between EOD and late-onset dementia. Therefore, one cannot just assume that the same type and intensity of exercise will lead to similar effects in the former population. By conducting this scoping review, the authors aimed to identify the evidence on the effectiveness of aerobic exercise on physical and mental health outcomes in individuals with EOD, display gaps in this context, and formulate related directions for future research. Summary: There are a number of reasons to assume that aerobic exercise might be extremely valuable within individuals with EOD. However, this scoping review led to the surprising and striking finding that not a single study so far has investigated the effects of physical exercise on cognition, physical performance and feelings of well-being and quality of life in EOD. Although nowadays the disease is increasingly recognized, coping and (non-pharmacological) treatment strategies for EOD are virtually non-existent. Key Messages: Exercise intervention studies in EOD are lacking. With this scoping review the authors hope to inspire researchers in the field for related directions for future research. The potential beneficial effects of aerobic exercise in individuals with EOD should be explored and assessed extensively. Secondarily, decent guidelines for non-pharmacological treatment and coping strategies should be developed, with the aim of supporting people with EOD and their caregivers.

Background: Performing a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce. Objectives: A randomised multiple treatment trial was conducted to compare the effects of different mobilisation techniques on shoulder PROM. Method: Eleven participants with upper limb paresis in the subacute phase after stroke underwent three different mobilisation techniques (3 x 4 weeks):(1) combined soft-tissue mobilisation in the scapular plane, (2) scapular mobilisation without glenohumeral movement, (3) angular glenohumeral mobilisation in the frontal plane. Depending on the randomisation, the order of the techniques changed. Differences in outcome measures (PROM shoulder, shoulder pain, spasticity of shoulder muscles and biceps, trunk impairment scale and Fugl-Meyer assessment) were calculated between the beginning and end of each intervention period. Results: Using combined soft-tissue mobilisation in patients in the subacute phase after stroke with persistent arm paresis resulted in an increased passive shoulder external rotation (p = 0.006). An average increase of 6.82 degrees (+/- 9.20 degrees) for shoulder external rotation was noted, whilst after the two other techniques, passive external rotation decreased (scapular mobilisation -7.27 degrees +/- 10.81 degrees; angular mobilisation -5.45 degrees +/- 11.72 degrees). Conclusion: These preliminary findings, suggest that combined soft-tissue mobilisation technique might improve the PROM for external shoulder rotation in subacute stroke patients with persistent arm paresis. Clinical implications: Performing a specific mobilisation technique might have positive effects on shoulder PROM. Research including larger sample sizes is necessary to confirm these findings and define the underlying mechanisms.

Paratonia, a form of hypertonia typically seen in dementia, is often associated with difficulties in positioning and daily care. No evidence-based therapy or clinical guideline for management is available. In this study, the short-term effect of harmonic techniques (HT) and supporting cushions (SC) on paratonia was explored.This was a multicenter interventional clinical trial with AB/BA crossover design. Each intervention (SC or HT) was subsequently implemented over 1 week in each of the participants.The study included 22 participants with moderate to severe paratonia from 9 different nursing homes in Flanders, Belgium.Measurements of biceps brachii and rectus femoris muscle tone (MyotonPRO), maximal elbow and knee extension (goniometer), and pain (Pain Assessment Checklist for Seniors With Limited Ability to Communicate) were performed on 3 different days within 1 week. The effect of HT on nursing care was evaluated with the Pain Assessment Checklist for Seniors With Limited Ability to Communicate and visual analog scale ratings of discomfort items.After 30 minutes of positioning with SC, participants had lower biceps brachii muscle tone (P = .041) and higher maximal elbow extension (P = .006) than without SC. After a 30-minute session of HT, a significant increase in biceps brachii muscle tone (P = .032) and maximal extension of elbow (P .001) and knee (P = .028) was found. Pain (P = .003) and discomfort (P = .001 to P = .019) during morning care were significantly lower when care was preceded by 30 minutes of HT.This explorative study revealed beneficial short-term effects on range of motion for both SC and HT and a positive effect of SC on upper limb muscle tone. Beneficial effects of HT were found on resident's pain and caregiver's discomfort during care. The results of the present study are encouraging and can contribute to the development of evidence-based interventions for paratonia.

Background: Using self-paced treadmills for gait analysis requires less space compared to overground gait labs while a more natural walking pattern could be preserved compared to fixed speed treadmill walking. Although self-paced treadmills have been used in stroke related intervention studies, studies comparing self-paced to fixed-speed treadmill walking in this population are scarce. Methods: Twenty-five persons after stroke (10 males/15 females; 53 ± 12.05 years; 40.72 ± 42.94 months post stroke) walked on a treadmill in a virtual environment (GRAIL, Motek) in two conditions (self-paced and fixed-speed). After familiarization, all participants completed two trials (3 min) at comfortable walking velocity in randomized order. A paired-sample t-test or Wilcoxon Signed Rank test was used to calculate differences between both conditions for spatiotemporal parameters. Statistical Parametric mapping was conducted using the t-tests (SPM (t)), to statistically compare the kinematic and kinetic curves. Results: The self-selected walking velocity on the treadmill was higher in the self-paced condition compared to the fixed-speed condition (p < 0.001). However, most variability and symmetry measures were similar in both conditions. Only the standard deviation of the step length at the paretic side was significant higher (p = 0.007) and step length symmetry was significantly better (p = 0.032) in the self-paced condition. Detected kinematic and kinetic differences were small (< 3◦, < 0.1 Nm/kg) and stride to stride variability was comparable in both conditions. Conclusion: Based on the results of the current study, self-paced walking can be used as an equivalent to fixed-speed treadmill walking in persons after stroke. Accordingly, this justifies the use of this more functional mode in clinical gait assessment and rehabilitation trials.

INTRODUCTION: Since there is no clear conclusion concerning the use of arm slings in the prevention or reduction of shoulder subluxation or shoulder pain in stroke patients, it seems important to explore other potentially beneficial effects. Earlier research already suggested that the upper limb might play a considerable role in efficient balance and gait in stroke patients. Therefore, the aim of this systematic review was to investigate the effects of wearing an arm sling on balance and/or gait in stroke patients. This information could support the decision-making concerning the use of shoulder orthoses after stroke. EVIDENCE ACQUISITION: Four electronic databases (Pubmed/MEDLINE, Embase, Web of Science and CINAHL/EBSCO) were searched until April 8th, 2019. Search alerts were set and followed until January 2020 to assure no new eligible articles were published. Reference lists of included studies were hand searched. All studies examining the effect of wearing an upper limb orthosis on balance and gait in stroke patients were included. Two reviewers independently identified eligible studies and extracted data. The methodological quality of included trials was assessed using the QualSyst assessment tool for quantitative studies. Prospero registration number: CRD42019130282. EVIDENCE SYNTHESIS: Ten studies, examining 283 stroke patients with moderate to low level of upper limb impairment, were included in the quantitative synthesis of the results. The pooled mean time since stroke was 21.88 +/- 9.03 months. Only minor effects on balance or gait related outcome parameters could be detected in favor of wearing an arm sling. However, these changes did not exceed the minimal clinical important difference (MCID). CONCLUSIONS: So far no strong evidence is available regarding a potential benefit of wearing an arm sling on balance and gait for stroke patients. However, further research with longer intervention periods, can be useful to determine if stroke patients in the early phases after stroke or with persistent UL paresis might possibly benefit from wearing an arm sling.

The purpose of this study was to investigate the impact of diabetic neuropathy (dNP) on lower limb endurance, explosive and maximal muscle strength in patients with Type 2 Diabetes Mellitus (T2DM).Fifty-four participants, aged between 55 and 85, were enrolled in this observational comparative study. The patients with T2DM had an average HbA1c of 7.4% (±1.03) and diabetes duration of 13 years. Participants were classified by means of electroneuromyography as T2DM without dNP (dNP-; n = 8), T2DM with sensory dNP (dNPs; n = 13), T2DM with sensorimotor dNP (dNPsm; n = 14), and healthy controls without neuropathy (C; n = 19). Maximal muscle strength and muscle endurance of the dominant knee and ankle were measured by dynamometry, while explosive muscle strength was evaluated by mechanography.Muscle endurance "total work" in knee extension and ankle plantar flexion was higher in the healthy controls compared to dNP-, dNPs and dNPsm, in knee flexion compared to dNPs and dNPsm, and in ankle dorsiflexion compared to dNPsm only (p0.05). Furthermore, relative explosive muscle strength "total power/body weight" and relative maximal muscle strength "peak torque/lean body mass of the dominant leg" considering knee flexion, ankle plantar flexion and dorsiflexion, were higher in healthy controls compared to the dNPsm group, and for maximal muscle strength ankle dorsiflexion even between dNP- and dNPsm (p 0.05).Muscle endurance is impaired in patients with T2DM, independent of the presence of dNP. Explosive and maximal muscle strength are more likely affected by the presence and severity of dNP.

Background: Dementia is associated with impairment in gait, balance, and fine motor function. Paratonia, a form of hypertonia, is often present in severe dementia. However, little is known about muscle tone in early dementia, and the eventual relation between muscle tone abnormalities and changes in fine and gross motor function. Methods: Three groups of participants were included in the study: healthy controls (n=60), participants with mild dementia (MiD) (n=31), and participants with moderate dementia (n=31). Measurements of fine motricity (Purdue pegboard test), balance and gait (Dynaport Hybrid), the presence of paratonia (PAI), and muscle tone measurements (MyotonPRO) were performed. Results: Paratonia was present in 42% of participants with MiD and in 58% of participants with moderate dementia. Participants with paratonia had lower Purdue Pegboard scores (P

Background and Purpose: Although shoe type may influence gait performance and is considered to be an extrinsic fall risk factor, little or no attention is paid to it when conducting research in this field. Therefore, this study aimed to assess the effect of various types of footwear under single-and dual-task conditions on spatiotemporal gait characteristics in older women. Methods: Fifty-seven community-dwelling women (68.0 +/- 4.6 years) were enrolled in this study. Spatiotemporal gait analysis using the GAITRite walkway was performed under 4 footwear conditions (barefoot, slippers, high heels, and standard shoes) and 3 task conditions (single-task, motor dual-task, and cognitive dual-task). Two-factor repeated-measures analysis of variance was conducted. Primary outcomes were velocity, cadence, stride time, stride length, and stride length variability. Results: Irrespective of task condition, walking barefoot resulted in a significantly slower gait pattern with decreased cadence and stride length and increased stride time and stride length variability compared with walking with the standard shoe. These significant gait alterations were also observed when adding a cognitive task to normal walking. The effects of footwear were most obvious during the cognitive dual-task condition and for the spatiotemporal parameters velocity and stride length. Conclusions: Footwear matters when analyzing gait in older women. It should be described in greater detail by gait researchers. Footwear should also be considered by clinicians in light of the study findings and its effects on gait. Older women are strongly discouraged to walk barefoot because barefoot walking adversely affects gait patterns. A well-fitting standard shoe with laces, a low and wide heel, firm heel collar and a grooved, moderately hard sole is recommended in research, rehabilitation, and daily use.

OBJECTIVES: To determine characteristics and effectiveness of prevention programs on fall-related outcomes in a defined setting. DESIGN: Systematic review and meta-analysis. SETTING: A clearly described subgroup of nursing homes defined as residential facilities that provide 24-hour-a-day surveillance, personal care, and limited clinical care for persons who are typically elderly and infirm. PARTICIPANTS: Nursing home residents (N = 22,915). MEASUREMENTS: The primary outcomes were number of falls, fallers, and recurrent fallers. RESULTS: Thirteen studies met the inclusion criteria. Six fall prevention programs were single (one intervention component provided to the residents), one was multiple (two or more intervention components not customized to individual fall risk), and six were multifactorial (two or more intervention components customized to each resident's fall risk). Meta-analysis found significantly fewer recurrent fallers in the intervention groups (4 studies, relative risk (RR) = 0.79, 95% confidence interval (CI) = 0.65-0.97) but no significant effect of the intervention on fallers (6 studies, RR = 0.97, 95% CI = 0.84-1.11) or falls (10 studies, RR = 0.93, 95% CI = 0.76-1.13). Multifactorial interventions significantly reduced falls (4 studies, RR = 0.67, 95% CI = 0.55-0.82) and the number of recurrent fallers (4 studies, RR = 0.79, CI = 0.65-0.97), whereas single or multiple interventions did not. Training and education showed a significant harmful effect in the intervention groups on the number of falls (2 studies, RR = 1.29, 95% CI = 1.23-1.36). CONCLUSION: This meta-analysis failed to reveal a significant effect of fall prevention interventions on falls or fallers but, for the first time, showed that fall prevention interventions significantly reduced the number of recurrent fallers by 21%. Language: en

BACKGROUND: Arm slings are often used in clinical practice to support the hemiplegic arm aiming to prevent or treat glenohumeral subluxation. Evidence supporting the corrective effect of slings on subluxation is scarce and long-term studies are lacking. AIM: The aim of this study was to determine both the immediate and long-term effect on acromiohumeral distance using the Actimove (R) sling and Shoulderlift and to determine the effect of slings on pain and passive range of motion of the shoulder in stroke patients with glenohumeral subluxation. DESIGN: Randomized control trial. SETTING: Hospital inpatients. POPULATION : Stroke patients. METHODS: Twenty-eight stroke patients, with severe upper limb impairments, were randomly allocated to 3 groups (Actimove, Shoulderlift, No sling). Patients wore their supportive device for 6 weeks and no sling in the control group. Immediate and postinterventional effect on acromiohumeral distance was measured using sonography. Pain (VAS), ROM (goniometry), spasticity (Modified Ashworth Scale), Fugl-Meyer Assessment and trunk stability (TIS) were also assessed before and after the intervention. RESULTS: The level of immediate correction of both slings was different at baseline and after 6 weeks (0 weeks: Shoulderlift 63%, Actimove 36%; 6 weeks: Shoulderlift 28%, Actimove 24%). Comparing the level of subluxation over time shows a distinct decrease in subluxation but only for the control group (-37.59% or 3.30 mm). Subluxation remained the same in the Actimove group (-2.77% or 0.27 mm) but increased in the Shoulderlift group (+ 12.44% or 1.03 mm). After 6 weeks, the Actimove group reported more pain at rest (P=0.036). ROM for abduction and external rotation decreased in 2 groups and remained un-altered in the Shoulderlift group. CONCLUSIONS : Results of immediate correction varied. Subluxation seemed to reduce in patients that did not wear a sling. CLINICAL REHABILITATION IMPACT: The (assumed) presence of subluxation may not benefit from wearing an arm sling which may itself inhibit active correction. If a sling is indicated the Shoulderlift may be preferable to the Actimove sling.

Background Shoulder range of motion (ROM) and strength measurements are imperative in the clinical assessment of the patient's status and progression over time. The method and type of assessment varies among clinicians and institutions. No comprehensive study to date has examined the reliability of a variety of procedures based on different testing equipment and specific patient or shoulder position. The purpose of this study was to establish absolute and relative reliability for several procedures measuring the rotational shoulder ROM and strength into internal (IR) and external (ER) rotation strength. Methods Thirty healthy individuals (15 male, 15 female), with a mean age of 22.1 ± 1.4 years, were examined by 2 examiners who measured ROM with a goniometer and inclinometer and isometric strength with a hand-held dynamometer (HHD) in different patient and shoulder positions. Relative reliability was determined by intraclass correlation coefficients (ICC). Absolute reliability was quantified by standard error of measurement (SEM) and minimal detectable change (MDC). Systematic differences across trials or between testers, as well as differences among similar measurements under different testing circumstances, were analyzed with dependent t tests or repeated-measures analysis of variance in case of 2 or more than 2 conditions, respectively. Results Reliability was good to excellent for IR and ER ROM and isometric strength measurements, regardless of patient or shoulder position or equipment used (ICC, 0.85-0.99). For some of the measurements, systematic differences were found across trials or between testers. The patient's position and the equipment used resulted in different outcome measures. Conclusions All procedures examined showed acceptable reliability for clinical use. However, patient position and equipment might influence the results.

This study investigates (i) the potential discriminative role of a clinical measure of peripheral neuropathy (PN) in assessing postural performance and fall risk and (ii) whether the integration of a simple screening vibration perception threshold (VPT) for PN in any physical (fall risk) assessment among elderly should be recommended, even if they do not suffer from DM.One hundred and ninety-five elderly were entered in a four-group model: DM with PN (D+; n = 75), DM without PN (D-; n = 28), non-diabetic elderly with idiopathic PN (C+; n = 31) and non-diabetic elderly without PN (C-; n = 61). Posturographic sway parameters were captured during different static balance conditions (AMTI AccuGait, Watertown, MA). VPT, fall data, Mini-Mental State Examination and Clock Drawing Test were registered. Two-factor repeated-measures ANOVA was used to compare between groups and across balance conditions.The groups with PN demonstrated a strikingly comparable, though bigger sway, and a higher prospective fall incidence than their peers without PN.The indication of PN, irrespective of its cause, interferes with postural control and fall incidence. The integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. Implications for Rehabilitation The indication of peripheral neuropathy (PN), irrespective of its cause, interferes with postural control and fall incidence. Therefore, the integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. It might be useful to integrate somatosensory stimulation in rehabilitation programs designed for fall prevention.

Dit boek geeft fysio- en kinesitherapeuten een actueel overzicht van kennis en vaardigheden om (kwetsbare) ouderen adequaat te onderzoeken en behandelen met oog voor de fysieke aspecten én voor de psychische, sociale en omgevingsfactoren. Deze tweede, geheel herziene editie van Geriatrie in de fysiotherapie en kinesitherapie bestaat uit twee delen: een boek en een online beschikbaar deel. In het eerste deel komt de kennis aan bod over de reguliere veroudering, de rol en kracht van de therapeut, en het klinisch redeneren. Ook worden de veranderingen in de grofmotorische eigenschappen beschreven (spierfunctie,­ mobiliteit, posturale controle en uithoudingsvermogen) en een twaalftal bijzondere aandachtsgebieden zoals onder andere dementie, vallen, hulpmiddelen en farmacotherapie. Online volgen in het tweede deel de vaardigheden op het gebied van onderzoek en behandeling. Daarin staat veelvoorkomende casuïstiek op cardiovasculair, respiratoir, orthopedisch, neurologisch en oncologisch vlak. Dit digitale deel is een heus ‘groeiboek’. Aan de basiscasuïstiek­ worden de komende jaren telkens nieuwe casussen toegevoegd. Het boek richt zich op fysio- en kinesitherapeuten, oefentherapeuten, ergotherapeuten en alle andere zorgprofessionals die betrokken zijn bij de zorg voor ouderen.

Background Glenohumeral internal rotation deficit (GIRD) and posterior shoulder stiffness have been associated with impingement symptoms in the overhead athlete. Stretching of the posterior shoulder is advised in injury prevention as well as rehabilitation programs. The purpose of the present study was to determine if stretching of the posterior shoulder improves ROM and reduces symptoms, and to compare angular with non-angular stretching techniques. Methods 60 overhead athletes with GIRD (age 25 ± 7.2 years, height 176 ± 8 cm, weight 69.8 ± 10.2 kg) participated to the study. Thirty athletes had no shoulder pain, 30 had impingement symptoms on the dominant shoulder. The subjects were randomly assigned into an “angular” or a “non-angular” treatment group. They were treated for 3 weeks (9 sessions) and followed for another period of 3 weeks after completion of the treatment. Treatment outcome variables were glenohumeral internal rotation range of motion, and, in the patient group, pain (VAS) scores and functional performance (ROWE-score). Results Statistical analysis showed a significant increase in ROM ( p < .05) in both treatment groups, in the patient as well as in the healthy control group. In addition, patients showed a significant improvement in pain assessment scores, and a significant increase in the Modified Rowe Score. There were no significant differences between both treatment techniques. Discussion Stretching, angular as well as non-angular techniques, increases internal rotation ROM in overhead athletes, and may decrease sport specific shoulder pain in overhead athletes with impingement symptoms.

The single-item question on self-rated health has been widely used in surveys. This study aims to explore which frames of reference are used by respondents when answering this question, to describe differences in the used frame of reference according to gender, educational background and age, and to determine whether subgroup differences can be explained by differences in prior health experiences. Face-to-face interviews were conducted in a sample of 310 adults who were asked to rate their health using a single-item question with closed-ended answering categories and to explain the reasons for the rating they gave with open-ended probes. Different indicators of prior health experiences were taken into account. Physical health problems were the most utilized referents. However, participants also mentioned reasons that go beyond the physical dimension of health. Subgroup differences were found. Prior health experiences partly explained subgroup differences for some referents, but not for others. Investigators using the single question on self-rated health for comparing health across different population groups should be aware that the meaning of the question varies across different socio-demographic groups.

There is mounting evidence of an association between chronic neck pain and impaired cervical flexor muscle performance. It is likely that the deep cervical flexors demonstrate changes very early after the onset of pain, but evidence is currently lacking. This study investigated the effect of experimental neck muscle pain on the activation of the cervical flexor muscles during the performance of craniocervical flexion (CCF) by use of muscle functional magnetic resonance imaging. Activity of the longus colli (Lco), longus capitis (Lca) and sternocleidomastoid (SCM) muscles were investigated bilaterally and at three cervical levels (C0-C1, C2-C3 and C6-C7) in 14 healthy subjects. Measurements were performed at rest and after the performance of CCF without and with induced pain of the upper trapezius (intramuscular injection of hypertonic saline). In the non-pain condition, the Lca (p = 0.005) and Lco (p = 0.029) were significantly more active during CCF compared to SCM. In the pain condition, the activity of the Lco and Lca was reduced bilaterally and at multiple levels (p ≤ 0.009), whereas the left SCM showed increased activity at only the C6-C7 level (p ≤ 0.001). The results suggest that local excitation of nociceptive afferents causes an immediate reorganization of the cervical flexor muscle activity similar to that identified in clinical populations.

Background Early identification of children with developmental co-ordination disorder is important. Teachers may be very useful in this identification process. The objective of this study was to develop a motor skill checklist (MSC) for 3- to 5-year-old children to be completed by teachers, and to establish the psychometric properties of this new instrument. Methods An MSC of 28 functional items was constructed in close consideration with clinical experts and teachers. In regular schools, 366 pre-school children were rated with the MSC by their teachers (n= 111). To determine test–retest reliability, each teacher completed 4 weeks later the MSC again for one randomly selected child. In 22 classes with two teachers sharing the job, both teachers were asked to fill in the questionnaire. A subgroup of children was also tested with the Movement Assessment Battery for Children (M-ABC; n= 122). All teachers were invited to complete a questionnaire to evaluate the MSC. Results The internal consistency of the MSC was high. The test–retest reliability was good. Inter-rater reliability was adequate except in the 5-year-old children. There was a strong correlation between the checklist and the M-ABC, establishing concurrent validity. Most teachers judged the MSC as easy or rather easy to complete. Conclusions The MSC is a reliable, valid and useful instrument to identify and assess young children with motor difficulties.

OBJECTIVE: To identify risk factors and predict falling in stroke patients. To determine the strength of general vs mobility screening for this prediction. DESIGN: Prospective study. SUBJECTS: Patients in the first 6 months after stroke. METHODS: The following assessments were carried out: an interview concerning civil state and fall history, Mini-Mental State Examination, Geriatric Depression Scale, Falls Efficacy Scale (FES), Star Cancellation Task (SCT), Stroop test, Berg Balance Scale, Functional Ambulation Categories (FAC), Motricity Index, grip and quadriceps strength, Modified Ashworth Scale, Katz scale, and a 6-month fall follow-up. RESULTS: Sixty-five patients were included for analysis. Thirty -eight (58.5%) reported falling. Risk factors were: being single (odds ratio (OR) 4.7; 95% confidence interval (95% CI) 1.2-18.3), SCT-time (OR 1.2; 95% CI 1.0-1.3), grip strength on unaffected side (US) (OR 0.1; 95% CI 0.0-0.8), FAC 3 vs FAC 4-5 (OR 8.1; 95% CI 1.5-43.2), and walking aid vs none (OR 5.1; 95% CI 1.4-17.8). These parameters were included in predictive models, which finally implied a general model (I) with inclusion of SCT-time, FAC category and use of walking aid. A mobility model (II) included: FAC category and strength (US). These models showed a sensitivity of 94.1% and 76.3%, respectively. CONCLUSION: Several assessments and both prediction models showed acceptable accuracy in identifying fall-prone patients. A purely physical model can be used; however, looking beyond mobility aspects adds value. Further validation of these results is required. Language: en

Background Children with hearing impairments have a higher risk for deficits in balance and gross motor skills compared with children who are developing typically. As balance is a fundamental ability for the motor development of children, a valid and reliable assessment to identify weaknesses in balance is crucial. Objective The purpose of this study was to investigate the construct validity of posturography and clinical balance tests in children with hearing impairments and in children who are developing typically. Methods The study involved 53 children with typical development and 23 children with hearing impairments who were between 6 and 12 years of age and without neuromotor or orthopedic disorders. All participants completed 3 posturography tests (modified Clinical Test of Sensory Interaction of Balance [mCTSIB], unilateral stance, and tandem stance) and 4 clinical balance tests (one-leg stance with eyes open and with eyes closed, balance beam walking, and one-leg hopping). Results Three conditions of the mCTSIB, unilateral stance, and 2 clinical balance tests were able to distinguish significantly between the 2 groups. Children with hearing impairments showed more difficulties in balance tasks compared with children who were developing typically when 1 or 2 types of sensory information were eliminated or disturbed. The study showed only low to moderate correlations among the different methods of evaluating balance. Conclusions Clinical balance tests and posturography offer different but complementary information. An assessment protocol for balance consisting of posturography and clinical balance tasks is proposed. Static and dynamic balance abilities could not be differentiated and seem not to be a valid dichotomy.

Study design Descriptive study, cross-sectional design. Background Tennis requires repetitive overhead movement patterns that can lead to upper extremity injury. The scapula plays a vital role in injury-free playing. Scapular dysfunction has been associated with shoulder injury in the overhead athlete. Objectives The purpose of this study was to describe variables regarding scapular position, muscle strength and flexibility in young elite tennis players. Methods Thirty-five adolescent Swedish elite tennis players (19 boys, aged 13.6 (+/-1.4) years, 16 girls, aged 12.6 (+/-1.3) years), selected on the basis of their national ranking, underwent a clinical screening protocol consisting of: scapular upward rotation at several angles of arm elevation; isometric scapular muscle strength; and anthropometric measurement of pectoralis minor (PM) length. Results The players showed significantly more scapular upward rotation on their dominant side (p

Objective: Evidence suggests that the deep cervical flexors (DCFs) are important for the control of the cervical spine. The craniocervical flexion (CCF) test is a clinical test developed for patients with neck pain disorders based on the action of the DCFs. Because these muscles are deeply situated, it is difficult to reach the DCFs with surface electromyography. Magnetic resonance imaging (MRI) can be used to measure these muscles in cross section. The objective of this study was (1) to determine the reliability of MRI for measuring cross-sectional area (CSA) of the longus colli (Lco) and longus capitis (Lca) and (2) to evaluate the changes in CSA during contraction. Methods: Thirty healthy subjects aged 29 ± 9.3 years were imaged using MRI. The CSA of the Lco and Lca was evaluated at 4 different levels (C0-C1, C2-C3, C4-C5, and C6-C7) at rest and during CCF. Results: The intraclass correlation coefficients for the CSA of the Lco and Lca showed good to excellent reliability (0.73-0.92), except at the C4-C5 level. There was a significant increase in CSA of both Lco (F = 6.79, P = .015) and Lca (F = 19.20, P ≤ .001) due to CCF, and this was at different levels. The highest increases in CSA occurred at the C0-C1 level for the Lca (11.1%) and at the C2-C3 level for the Lco (17.4%). Conclusions: This study demonstrated that the action of CCF resulted in a contraction of the Lco and Lca at different levels. The results indicate that MRI is a promising technique to evaluate changes in CSA during contraction. (J Manipulative Physiol Ther 2010;33:286-291) Key Indexing Terms: Neck Muscles; Magnetic Resonance Imaging; Muscle Contraction

This study prospectively investigates whether catastrophizing thinking is associated with length of hospital stay after total knee arthroplasty. Forty-three patients who underwent primary total knee arthroplasty were included in this study. Prior to their operation all patients were asked to complete the pain catastrophizing scale, and a Western Ontario McMaster Universities Osteoarthritis index. A multiple regression analysis identified pain catastrophizing thinking and age as predictors of hospital stay after total knee arthroplasty. Patients with a higher degree of pain catastrophizing prior to the total knee arthroplasty and those with a higher age have a significantly greater risk for a longer hospital stay. Therefore, the results of this study indicate that the pre-operative level of pain catastrophizing in patients determine, in combination with other variables, the length and inter-individual variation in hospital stay after total knee arthroplasty. Reducing catastrophizing thinking about pain through cognitive-behavioral techniques is likely to reduce levels of fear after total knee arthroplasty. As a result, pain and function immediately post-operative might improve, leading to a decrease in length of hospital stay. Although during the last decades the duration of hospital stay is significantly reduced, this study shows that this can be improved when taking into account the contribution of psychological factors such as pain catastrophizing.

All muscles of the neck have a role in motion and postural control of the cervical region. The aim of this study was to investigate the difference in muscle/fat index between (1) cervical flexors and extensors and (2) deep and superficial neck muscles. Twenty-six healthy subjects participated in the study. Magnetic resonance imaging (MRI) was used to quantify muscle fat indices in different cervical flexor and extensor muscles at the C4-C5 level. Overall, the ventral muscles had a significantly lower fat content compared with the dorsal muscles (Por = 0.001). For the cervical extensors, significant differences between the muscle/fat index of the deep and superficial muscles were found (Por = 0.001). For the cervical flexors, there were no significant differences between the different muscles. The higher fat content in the dorsal muscles can be explained by a discrepancy in function between the spine extensors and flexors, reflected in a different muscle fiber distribution. The rather small differences between superficial and deep neck muscles are in line with recent findings that have demonstrated that both muscles groups exhibit phasic activity during isometric muscles contractions and the presumption that there is no difference in fiber type distribution between superficial and deep neck muscles.

The aims of the present study were (1) to investigate the differences in median frequency characteristics between back and hip muscles of healthy subjects during a Biering-Sørensen test, (2) to determine if the Biering-Sørensen test is a valid test for measuring back muscle fatigue, and (3) to standardise the Biering-Sørensen test by using objective movement analysis when defining endurance time, and compare this to the original method based on tactile feedback. Twenty healthy subjects participated in this experiment. The electromyographic activity of eight back and hip muscles was bilaterally measured. In addition three-dimensional data of the lumbar region were collected with an ultrasound movement analysis system. Median frequencies were computed from the EMG power spectra. Two methods of determining the endurance time of the Biering-Sørensen test yielded highly correlated but significantly different normalized median frequency slope values (NMF(slope)). Significant differences in NMF(slope) values between several back and hip muscles could be demonstrated. Low to moderate correlation coefficients were shown between NMF(slope) values and endurance time. Multiple stepwise linear regression analyses revealed that only NMF(slope) of the thoracic part of the iliocostalis lumborum muscle could significantly predict the test endurance time. The findings of the present study support the validity of the Biering-Sørensen test for measuring back muscle fatigue.

The present study aimed at assessing the test-retest reliability of wavelet - and Fourier derived (instantaneous) median frequencies of surface electromyographic (EMG) measurements of back and hip muscles during isometric back extensions. Twenty healthy subjects (10 males and 10 females) performed a modified Biering-Sørensen test on two separate days, with a 1-week interval between the two tests. Surface EMG measurements were bilaterally performed from the latissimus dorsi, the thoracic and lumbar parts of the longissimus thoracis, the thoracic and lumbar parts of the iliocostalis lumborum, the multifidus, the gluteus maximus and the biceps femoris. In addition, three-dimensional kinematic data were recorded of the subjects' lumbar vertebrae. The (instantaneous) median frequencies were calculated from the EMG signals using continuous wavelet (IMDF) - and short-time Fourier transforms (MDF). Linear regressions performed on the IMDF and MDF data as a function of time yielded slopes (IMDF(slope) and MDF(slope)) and intercepts (IMDF(init) and MDF(init)) of the regression lines. Test-retest reliability was assessed on the normalized slopes and intercept parameters by means of intraclass correlation coefficients (ICC) and standard errors of measurements expressed as percentages of the mean values (% SEM). The results of IMDF(slope) and MDF(slope) parameters indicated ICCs for back and hip muscles between .443 and .727 for IMDF(slope), values between .273 and .734 for MDF(slope), % SEM between 7.6% and 58.9% for IMDF(slope) and % SEM between 8.2% and 25.3% for MDF(slope), respectively. The ICCs for IMDF(init) and MDF(init) parameters varied between .376 and .907 for IMDF(init) and between .383 and .883 for MDF(init), and % SEM ranged from 2.7% to 6.3% for IMDF(init) and from 2.6% to 4.7% for MDF(init), respectively. These results indicate that both wavelet - and Fourier based (instantaneous) median frequency parameters generally are reliable in the analysis of back and hip muscle fatigue during a modified Biering-Sørensen test.

The aims of the current study were to examine the stationarities of surface electromyographic (EMG) signals obtained from eight bilateral back and hip muscles during a modified Biering-Sorensen test, and to investigate whether short-time Fourier (STFT) and continuous wavelet transforms (CWT) provided similar information with regard to EMG spectral parameters in the analysis of localized muscle fatigue. Twenty healthy subjects participated in the study after giving their informed consent. Reverse arrangement tests showed that 91.6% of the EMG signal epochs demonstrated no significant trends (all p > 0.05), meaning 91.6% of the EMG signal epochs could be considered as stationary signals. Pearson correlation coefficients showed that STFT and CWT in general provide similar information with respect to the EMG spectral variables during isometric back extensions, and as a consequence STFT can still be used.

The cranio-cervical flexion test (CCF-T) is used as a clinical evaluation tool for the deep cervical flexors (DCF). The influence of breathing type, expiration and cervical posture on the performance of the test is evaluated in asymptomatic subjects. Thirty volunteers participated in the study and were classified according to their breathing type: costo-diaphragmatic breathing type and upper costal breathing type. Sternocleidomastoid (SCM) electromyographic (EMG) activity was recorded during five incremental levels of CCF during normal breathing as well as during expiration. The cranio-vertebral angle of each subject was measured to quantify cervical posture. During normal inspiration, higher EMG activity of the SCM muscles was observed in subjects with an upper costal breathing pattern compared to costo-diaphragmatic breathing subjects. This difference was statistically significant (P< 0.05) at the three lowest stages of the test. In the upper costal breathing group a significantly lower EMG activity of the SCM muscles was observed while performing the CCF-T during slow expiration compared to normal breathing. No significant correlation was found between the cranio-vertebral angle and the EMG activity of the SCM muscles. Performing the CCF-T during slow expiration diminishes the activity of the SCM muscles in subjects with a predominantly upper costal breathing pattern. Using a costo-diaphragmatic breathing pattern while performing the test will optimize the performance. Studies on neck pain patients are required to further clarify this issue.

Work related neck disorders are common problems in office workers, especially among those who are intensive computer users. It is generally agreed that the etiology of work related neck disorders is multidimensional which is associated with, and influenced by, a complex array of individual, physical and psychosocial factors. The aim of the current study was to estimate the one-year prevalence of neck pain among office workers and to determine which physical, psychological and individual factors are associated with these prevalences. Five hundred and twelve office workers were studied. Information was collected by an online questionnaire. Self-reported neck pain during the preceding 12 months was regarded as a dependent variable, whereas different individual, work-related physical and psychosocial factors were studied as independent variables. The 12 month prevalences of neck pain in office workers was 45.5%. Multivariate analysis revealed that women had an almost two-fold risk compared with men (OR = 1.95, 95% CI 1.22–3.13). The odds ratio for age indicates that persons older than 30 years have 2.61 times more chance of having neck pain than younger individuals (OR = 2.61, 95% CI 1.32–3.47). Being physically active decreases the likelihood of having neck pain (OR = 1.85, 95% CI 1.14–2.99). Significant associations were found between neck pain and often holding the neck in a forward bent posture for a prolonged time (OR = 2.01, 95% CI 1.20–3.38), often sitting for a prolonged time (OR = 2.06, 95% CI 1.17–3.62) and often making the same movements per minute (OR = 1.63, 95% CI 1.02–2.60). Mental tiredness at the end of the workday (OR = 2.05, 95% CI 1.29–3.26) and shortage of personnel (OR = 1.71, 95% CI 1.06–2.76) are significantly associated with neck pain. The results of this study indicate that physical and psychosocial work factors, as well as individual variables, are associated with the frequency of neck pain. These association patterns suggest also opportunities for intervention strategies in order to stimulate an ergonomic work place setting and increase a positive psychosocial work environment.

The purpose of this study was to examine the repeatability and reproducibility of the different tests of a clinical test battery evaluating the components of functional spinal stability: postural control (sway velocity data), proprioception (repositioning error), and muscle activation (electromyographic data).A total of 28 healthy volunteers participated in this study: 14 in the repeatability study and 14 in the reproducibility study. Each subject was tested three times, with an interval of 1 wk between the test sessions. The intraclass correlation coefficients and the standard error of the measurements as a percentage of the grand mean were calculated.The intraclass correlation coefficients for both the repeatability and the reproducibility evaluation showed good to excellent reliability for all variables (intraclass correlation coefficient, 0.60-0.98). The standard error of the measurements as a percentage of the grand mean ranged from 0.004 to 19.94.The functional clinical test battery investigated in this study proved to be a reliable tool in the assessment of healthy subjects. The evaluation of postural control, proprioception, and muscle activity (coordination, stabilization, maximal voluntary isometric contraction, endurance, and flexion-relaxation) showed good to excellent repeatability and reproducibility. Further analysis of the reliability of these variables in a clinical setting, particularly in patients with low back pain, seems appropriate.

The present pilot study investigated the analgesic efficacy of light-emitting diode (LED). In view of a standardised and controlled pain reduction study design, this in vivo trial was conducted on experimentally induced delayed-onset muscle soreness (DOMS). Thirty-two eligible human volunteers were randomly assigned to either an experimental (n=16) or placebo group (n=16). Immediately following the induction of muscle soreness, perceived pain was measured by means of a visual analog scale (VAS), followed by a more objective mechanical pain threshold (MPT) measurement and finally an eccentric/concentric isokinetic peak torque (IPT) assessment. The experimental group was treated with infrared LED at one of both arms, the other arm served as control. Irradiation lasted 6 min at a continuous power output of 160 mW, resulting in an energy density of 3.2 J/cm(2). The subjects of the placebo group received sham irradiation at both sides. In post-treatment, a second daily assessment of MPT and VAS took place. The treatment and assessment procedure (MPT, VAS and IPT) was performed during 4 consecutive days. Statistical analysis (a general linear model followed by post hoc least significant difference) revealed no apparent significant analgesic effects of LED at the above-described light parameters and treatment procedure for none of the three outcome measures. However, as the means of all VAS and MPT variables disclose a general analgesic effect of LED irradiation in favour of the experimental group, precaution should be taken in view of any clinical decision on LED. Future research should therefore focus on the investigation of the mechanisms of LED action and on the exploration of the analgesic effects of LED in a larger randomised clinical trial and eventually in more clinical settings.

Keywords: Spinal manipulation; cervical spine; safety; side-effects; adverse effects; clinical decision algorithm

Objective To describe a case of a simultaneous occurrence of an ossified stylohyoid ligament in a 56-year-old male cadaver and anomalies of the vertebral artery, and to consider the clinical implications for manipulative therapists. Intervention and Outcome Dissection showed a simultaneous occurrence of complete developmental ossification of the left hyoid apparatus, variants of the vertebral artery, and a left superior vena cava in a 56-year-old male cadaver. Discussion Developmental variants, posttraumatic and degenerative changes of the hyoid apparatus may result in variable degrees of ossification or calcification. Conclusion This unusual disorder should be considered in the differential diagnosis of facial and neck pain especially within the scope of manipulation of the upper cervical spine. Cervical spine manipulation may exacerbate existing pathological conditions of the stylohyoid apparatus, thereby irritating neurovascular structures, and induce a fracture. Developmental ossification of this apparatus might be associated with anomalies in the atlantic section of the vertebral artery which make the patient more susceptible to vertebrobasilar insufficiency. We conclude that extreme care should be taken in the presence of such an ossification to avoid trauma to the stylohyoid apparatus and maybe even because of increased vertebrobasilar risk ( J Manipulative Physiol Ther . 2005;28:346-351).

The introduction of light emitting diode (LED) devices as a novel treatment for pain relief in place of low-level laser warrants fundamental research on the effect of LED devices on one of the potential explanatory mechanisms: peripheral neurophysiology in vivo. A randomised controlled study was conducted by measuring antidromic nerve conduction on the peripheral sural nerve of healthy subjects (n=64). One baseline measurement and five post-irradiation recordings (2-min interval each) were performed of the nerve conduction velocity (NCV) and negative peak latency (NPL). Interventional set-up was identical for all subjects, but the experimental group (=32) received an irradiation (2 min at a continuous power output of 160 mW, resulting in a radiant exposure of 1.07 J/cm(2)) with an infrared LED device (BIO-DIO preprototype; MDB-Laser, Belgium), while the placebo group was treated by sham irradiation. Statistical analysis (general regression nodel for repeated measures) of NCV and NPL difference scores, revealed a significant interactive effect for both NCV (P=0.003) and NPL (P=0.006). Further post hoc LSD analysis showed a time-related statistical significant decreased NCV and an increased NPL in the experimental group and a statistical significant difference between placebo and experimental group at various points of time. Based on these results, it can be concluded that LED irradiation, applied to intact skin at the described irradiation parameters, produces an immediate and localized effect upon conduction characteristics in underlying nerves. Therefore, the outcome of this in vivo experiment yields a potential explanation for pain relief induced by LED.

The chronic metabolic disorder diabetes mellitus is an important cause of morbidity and mortality due to a series of common secondary metabolic complications, such as the development of severe, often slow healing skin lesions. In view of promoting the wound-healing process in diabetic patients, this preliminary in vitro study investigated the efficacy of green light emitting diode (LED) irradiation on fibroblast proliferation and viability under hyperglycemic circumstances.To achieve hyperglycemic circumstances, embryonic chicken fibroblasts were cultured in Hanks' culture medium supplemented with 30 g/L glucose. LED irradiation was performed on 3 consecutive days with a probe emitting green light (570 nm) and a power output of 10 mW. Each treatment lasted 3 min, resulting in a radiation exposure of 0.1 J/cm2.A Mann-Whitney U test revealed a higher proliferation rate (p = 0.001) in all irradiated cultures in comparison with the controls.According to these results, the effectiveness of green LED irradiation on fibroblasts in hyperglycemic circumstances is established. Future in vivo investigation would be worthwhile to investigate whether there are equivalent positive results in diabetic patients.

The purpose of this study was to examine the test-retest reliability for the real time ultrasonic measurement method that is used to determine the stiffness of the Achilles tendon. Twenty-one healthy men and women aged 20-50 years took part in the study. The subjects underwent three identical test sessions held seven days apart. The lengthening of the tendon during maximal isometric plantar flexion was determined using ultrasonography. A dynamometer was used to measure torque output during isometric plantar flexion. The relationship between the muscle force and the elongation of the tendon was calculated to become a measure of the stiffness of the Achilles tendon. The ICC for the stiffness of the right and the left Achilles tendon was 0.80 and 0.82 respectively, indicating a good reliability. The results demonstrate that this technique is reliable for the evaluation of the elastic properties of the Achilles tendon. This may be clinically important in the assessment of tendon properties.

Background Today, no clinical studies have been undertaken to examine the long-term effects of an open kinetic chain or closed kinetic chain program. Hypothesis The long-term follow-up results after a conservative exercise protocol are significantly worse than the short-term results. The long-term effect of closed kinetic chain training is significantly better compared to the effect of open kinetic chain training. Study Design Prospective randomized clinical trial. Methods Sixty patients were randomized into a 5-week conservative program, consisting of only closed kinetic chain exercises or only open kinetic chain exercises. Assessment of muscular characteristics, subjective symptoms, and functional performance was evaluated in this study at the time of initial physical examination, at the end of the treatment period, and 5 years later. Results At the 5-year follow-up, both groups demonstrated maintenance of good subjective and functional outcomes achieved immediately after the conservative treatment. No significant difference between both groups was observed at the 5-year follow-up for the majority of the examined parameters. However, on 3 of the 18 visual analog scales, the open kinetic chain group showed significantly less complaints compared to the closed kinetic chain group. Conclusions On the basis of these results, the authors conclude that both open kinetic chain and closed kinetic chain programs lead to an equal long-term good functional outcome.

There have been numerous reports about the use of knee braces to prevent traumatic knee injuries. Despite the frequent use of braces, very few prospective studies have been performed to study the effect of knee braces for preventing anterior knee pain syndrome (AKPS). The purpose of this study was to assess the effectiveness of a dynamic patellofemoral brace (On-Track System, dj Orthopedics) in the prevention of AKPS. 167 military recruits without history of knee pain were randomized into two groups prior to the start of their 6-week basic military training (BMT) program. The first group (brace group) consisted of 54 recruits who wore the braces for all physical activities during these 6 weeks. 113 recruits served as a control group, and followed the same 6-week strenuous training program. Chi square statistics (Fisher exact test) were used to compare the number of AKPS patients in the brace group and in the non-brace group. Our results indicated that recruits in the brace group appeared to develop significantly less anterior knee pain compared to the recruits in the control group (p =0.020). Out of the 54 recruits in the brace group, ten (18.5%) developed anterior knee pain during this study. In the control group (n =113), 42 recruits (37%) developed anterior knee pain. We conclude that the result of the present study suggests that the use of a dynamic patellofemoral brace is an effective way to prevent the development of anterior knee pain in persons undergoing a strenuous training program.

Objective: To determine the influence of ageing on lean muscle area and isometric and concentric and eccentric muscle strength in the upper and lower extremity in a cross-sectional study design. Subjects and methods: Lean muscle area and maximal muscle strength (isometric and isokinetic, 60degrees and 120degrees/s) of both upper and lower extremity were assessed of 45 men and 56 women (20 to 89 years). Results: One-way variance analysis and regression analyses revealed a parallel decline with age in both sexes for maximal muscle strength. The decline in maximal muscle strength from age 60 was 34 to 45% in men and 11 to 32% in women in the arms and 40 to 47% in men and 37 to 45% in women in the legs. Isometric, concentric and eccentric contractions showed a similar decline in ageing in both sexes. There was a better maintenance with age of the strength in the arms than in the legs (p < 0.01) and at 120degrees/s than at 60degrees/s (p < 0.05). Conclusions: The present findings suggest a parallel decline in lean muscle area and strength and similar losses in isometric, concentric and eccentric strength with increasing age.

The purpose of this prospective randomized intervention study was to evaluate the effect of two exercise protocols on reflex response time of vastus medialis obliquus (VMO), vastus lateralis (VL), in patients with anterior knee pain. Sixty patients were randomized into a 5-week treatment program, which consisted of only open kinetic chain tonification exercises (group I) (n = 30), or only closed kinetic chain tonification exercises (group II) (n = 30). Assessment of an aspect of neuromotor control was obtained by measuring the reflex response times of VMO and VL at the time of initial clinical examination, at the end of the exercise period (five weeks), and three months after the completion of the exercise period. At these evaluation occasions, the intensity and the number of times that the patients experienced anterior knee pain during daily life was recorded on a Visual Analog Scale (VAS). No alterations in reflex response times of VMO and VL were observed in either group. Changes of anterior knee pain over time were statistically significant in both groups. Only small and not statistically supported differences in anterior knee pain were found between the two groups. These results suggest that the reflex response times of the two vasti muscles can not be altered after a five week open or closed kinetic chain exercise program. In contrast, knee pain decreased significantly in both groups.

Background and Objective: As Light Emitting Diode (LED) devices are commercially introduced as an alternative for Low Level Laser (LLL) Therapy, the ability of LED in influencing wound healing processes at cellular level was examined. Study Design/Materials and Methods: Cultured fibroblasts were treated in a controlled, randomized manner, during three consecutive days, either with an infrared LLL or with a LED light source emitting several wavelengths (950 nm, 660 nm and 570 nm) and respective power outputs. Treatment duration varied in relation to varying surface energy densities (radiant exposures). Results: Statistical analysis revealed a higher rate of proliferation (p ≤ 0.001) in all irradiated cultures in comparison with the controls. Green light yielded a significantly higher number of cells, than red (p ≤ 0.001) and infrared LED light (p ≤ 0.001) and than the cultures irradiated with the LLL (p ≤ 0.001); the red probe provided a higher increase (p ≤ 0.001) than the infrared LED probe and than the LLL source. Conclusion: LED and LLL irradiation resulted in an increased fibroblast proliferation in vitro. This study therefore postulates possible stimulatory effects on wound healing in vivo at the applied dosimetric parameters.

Objective: To evaluate the efficacy of intermittent pneumatic compression (IPC) in treating sensory impairments in the hemiplegic upper limb in stroke patients. Design: Twenty-three stroke patients were enrolled in a randomized, controlled preliminary trial that compared the application of intermittent pneumatic compression with a passive treatment strategy. Setting: Four Belgian day centers for treatment of neurological disabilities. Four acute and rehabilitation care wards specialized in neurological treatment. Subjects: Twenty-three stroke patients. Interventions: The experimental group ( n = 11) received standard physiotherapy combined with intermittent pneumatic compression treatment (10 cycles of 3 minutes with a peak of 40 mmHg) for their hemiplegic upper limb. The control group ( n = 12) received supplementary to their conventional physiotherapy a placebo treatment, namely sham short-wave therapy on the hemiplegic shoulder for 30 minutes. Main outcome measures: Sensory impairments were clinically assessed at three occasions over a period of four weeks using the Nottingham Sensory Assessment scale. Results: Both groups improved in somatosensation over time, but the experimental group improved more than the control group ( p = 0.036) or 81.1% improvement versus 30.9%. Conclusions: The use of intermittent pneumatic compression in the rehabilitation of stroke patients may be of clinical importance for the restoration of sensory function.

Background Muscular tightness is frequently postulated as an intrinsic risk factor for the development of a muscle injury. However, very little prospective data exist to prove this. Hypothesis Increased muscle tightness identifies a soccer player at risk for a subsequent musculoskeletal lesion. Study Design Prospective cohort study. Methods We examined 146 male professional soccer players before the 1999–2000 Belgian soccer competition. None of the players had a history of muscle injury in the lower extremities in the previous 2 years. The flexibility of the hamstring, quadriceps, adductor, and calf muscles of these players was measured goniometrically before the start of the season. All of the examined players were monitored throughout the season to register subsequent injuries. Results Players with a hamstring (N = 31) or quadriceps (N = 13) muscle injury were found to have significantly lower flexibility in these muscles before their injury compared with the uninjured group. No significant differences in muscle flexibility were found between players who sustained an adductor muscle injury (N = 13) or a calf muscle injury (N = 10) and the uninjured group. Conclusions These results indicate that soccer players with an increased tightness of the hamstring or quadriceps muscles have a statistically higher risk for a subsequent musculoskeletal lesion. Clinical Significance Preseason hamstring and quadriceps muscle flexibility testing can identify male soccer players at risk of developing hamstring and quadriceps muscle injuries.

A substantial proportion of older adults living in residential aged care facilities are use wheelchairs or walk with aids. The relationship between using walking aids and falling is somewhat inconsistent and poorly understood.To investigate the use of walking aids as a risk factor for future falls among older adults living in residential aged care facilities and to identify spatiotemporal gait parameters that mediate the potential relationship between walking aids and falling.Forty-three older adults (22 using walking aids and 21 not using walking aids) living in residential aged care facilities were enrolled in this study. Fall history, fear of falling, and the use of psychotropic agents were registered. Spatiotemporal gait (GAITRite®), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars.Individuals using walking aids were older (P = .012), had a greater fear of falling (P = .017), and demonstrated a more conservative gait pattern compared with those not using walking aids. They walked slower (P.001) and had a lower cadence (P.001) and shorter step length (P = .018) and step time (P = .003). Twenty-two participants (15 using walking aids vs 7 not using walking aids) reported at least one fall ("fallers"). Univariate logistic regression identified using walking aids as a risk factor for future falls (odds ratio, 3.98; 95% confidence interval, 1.10-14.37; P = .035). A lower cadence, increased stance percentage, decreased swing percentage, increased age, and greater psychotropic drug intake were mediators that reduced the odds ratio of the relationship between using walking aids and faller status the most.Using walking aids is a risk factor for future falls among the older population living in residential settings. A substantial proportion of the relationship between walking aids and future falls could be explained by an altered spatiotemporal gait pattern, increased age, and psychotropic drug intake. This finding supports the aim of extensive training periods and appropriate instructions on the proper use of walking aids in terms of adequate and safe gait patterns.

The aim of this study is to determine the rest-retest reproducibility for measuring the peak torque and the total work of the protractors and retractors of the shoulder girdle according to the isokinetic concentric muscle action. The tests were performed in two sessions at a 7 day interval. Nineteen healthy volunteers were included. Evaluation was carried out with a Biodex System 3 isokinetic dynamometer using the closed chain attachment. The protocol consisted of 5 isokinetic concentric contractions at a linear velocity of 12.2 cm/sec and 10 repetitions at a velocity of 36.6 cm/sec. The shoulder girdle protraction and retraction movements were performed with the arm horizontal in the scapular plane, which is 30 ◦ anterior of the frontal plane. Intraclass-Correlation-Coefficients were calculated to establish day-to-day repeatability. Results show an excellent reproducibility for isokinetic peak torque at both velocities on the non dominant side (ICC 0.94-0.96) and very good to excel lent reproducibility on the dominant side (ICC 0.88-0.92). Reproducibility was also very good for total work values in both movement directions at both velocities (ICC 0.82-0.89). The results indicate that isokinetic protraction and retraction strength evaluation is a reliable tool in the evaluation of shoulder girdle muscular performance. This may be clinically important in the assessment of shoulder dysfunction.

The goal of this prospective study was to determine the outcome-predictive role of various parameters in the nonoperative treatment of chronic anterior knee pain patients. Thirty patients followed a five-week treatment program, which consisted out of only closed kinetic chain exercises. Prior to this treatment all subjects were evaluated on muscular characteristics, subjective symptoms, weight, sex, duration of symptoms and functional performance. A multiple stepwise regression analysis revealed that the reflex response time of m. vastus medialis obliquus (VMO) (P=0.041; 0.026), and the duration of symptoms (P=0.019; 0.045) were the only two parameters which were significantly associated with the outcome (evaluated by the Kujala score) at five weeks, and at three months. The shorter the duration of symptoms, or the faster the reflex response time of VMO prior to the treatment, the better the outcome after a closed kinetic chain exercise program. The statistical significance of these parameters in this study may be seen as an indication of the importance of these variables as predictors of the outcome of a closed kinetic chain strengthening program. Using this information, it seems clinically important to begin the treatment program before the anterior knee pain becomes more chronic and treatment results become less good.

The purpose of this study was to determine the effect of different training schedules on the cross-sectional area (CSA) of the paravertebral muscles (PA) in chronic low back pain (CLBP) patients. To achieve this goal 59 patients were randomly assigned to three different 10-week rehabilitation programs: stabilization training (group 1, n=19), stabilization training combined with dynamic resistance training (group 2, n=20) and stabilization training combined with dynamic-static resistance training (group 3, n=20). The CSA of the PA was derived from standard computerized tomography (CT) images at three different levels. The CSA of the PA was found to increase statistically in group 2 (upper end-plate of L4) and group 3 (upper end-plate of L3 and lower end-plate of L4). In contrast, no statistical differences over time were found in group 1. Since stabilization exercises have no effect on the CSA of the PA, intensive lumbar resistance training seems to be necessary to restore the size of the PA in CLBP patients with atrophied back muscles. No systematic difference in hypertrophy between dynamic and dynamic-static strengthening training modes was found.