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Aim: To study if functional electrical stimulation (FES) of the peroneal nerve, which activates dorsiflexion, can improve body functions, activities, and participation and could be an effective alternative treatment in individuals with unilateral spastic cerebral palsy (CP). Method: A randomized cross‐over trial was performed in 25 children with unilateral spastic CP (classified in Gross Motor Function Classification System levels I and II) aged 4 to 18 years (median age at inclusion 9 years 8 months, interquartile range = 7 years–13 years 8 months), 15 patients were male. The study consisted of two 12‐week blocks of treatment, that is, conventional treatment (ankle foot orthosis [AFO] or adapted shoes) and FES, separated by a 6‐week washout period. Outcome measures included the Goal Attainment Scale (GAS), the Cerebral Palsy Quality of Life questionnaire, and a three‐dimensional gait analysis. Results: Eighteen patients completed the trial. The proportion of GAS goals achieved was not significantly higher in the FES versus the conventional treatment phase (goal 1 p = 0.065; goal 2 p = 1.00). When walking while stimulated with FES, ankle dorsiflexion during mid‐swing decreased over time (p = 0.006, average decrease of 4.8° with FES), with a preserved increased ankle range of motion compared to conventional treatment (p < 0.001, mean range of motion with FES +10.1° compared to AFO). No changes were found in the standard physical examination or regarding satisfaction with orthoses and feelings about the ability to dress yourself. In four patients, FES therapy failed; in 12 patients FES therapy continued after the trial. Interpretation: FES is not significantly worse than AFO; however, patient selection is critical, and a testing period and thorough follow‐up are needed. [ABSTRACT FROM AUTHOR]

Background: Prior studies investigated selected discrete sagittal‐plane outcomes (e.g., peak knee flexion) in relation to running economy, hereby discarding the potential relevance of running technique parameters during noninvestigated phases of the gait cycle and in other movement planes. Purpose: Investigate which components of running technique distinguish groups of runners with better and poorer economy and higher and lower weekly running distance using an artificial neural network (ANN) approach with layer‐wise relevance propagation. Methods: Forty‐one participants (22 males and 19 females) ran at 2.78 m∙s−1 while three‐dimensional kinematics and gas exchange data were collected. Two groups were created that differed in running economy or weekly training distance. The three‐dimensional kinematic data were used as input to an ANN to predict group allocations. Layer‐wise relevance propagation was used to determine the relevance of three‐dimensional kinematics for group classification. Results: The ANN classified runners in the correct economy or distance group with accuracies of up to 62% and 71%, respectively. Knee, hip, and ankle flexion were most relevant to both classifications. Runners with poorer running economy showed higher knee flexion during swing, more hip flexion during early stance, and more ankle extension after toe‐off. Runners with higher running distance showed less trunk rotation during swing. Conclusion: The ANN accuracy was moderate when predicting whether runners had better, or poorer running economy, or had a higher or lower weekly training distance based on their running technique. The kinematic components that contributed the most to the classification may nevertheless inform future research and training. [ABSTRACT FROM AUTHOR]

Understanding how loading and damage on common running injury locations changes across speeds, surface gradients, and step frequencies may inform training programs and help guide progression/rehabilitation after injuries. However, research investigating tissue loading and damage in running is limited and fragmented across different studies, thereby impairing comparison between conditions and injury locations. This study examined per‐step peak load and impulse, cumulative impulse, and cumulative weighted impulse (hereafter referred to as cumulative damage) on three common injury locations (patellofemoral joint, tibia, and Achilles tendon) across different speeds, surface gradients, and cadences. We also explored how cumulative damage in the different tissues changed across conditions relative to each other. Nineteen runners ran at five speeds (2.78, 3.0, 3.33, 4.0, 5.0 m s−1), and four gradients (−6, −3, +3, +6°), and three cadences (preferred, ±10 steps min−1) each at one speed. Patellofemoral, tibial, and Achilles tendon loading and damage were estimated from kinematic and kinetic data and compared between conditions using a linear mixed model. Increases in running speed increased patellofemoral cumulative damage, with nonsignificant increases for the tibia and Achilles tendon. Increases in cadence reduced damage to all tissues. Uphill running increased tibial and Achilles tendon, but decreased patellofemoral damage, while downhill running showed the reverse pattern. Per‐step and cumulative loading, and cumulative loading and cumulative damage indices diverged across conditions. Moreover, changes in running speed, surface gradient, and step frequency lead to disproportional changes in relative cumulative damage on different structures. Methodological and practical implications for researchers and practitioners are discussed. [ABSTRACT FROM AUTHOR]

Background: An increasing number of commercially available wearables provide real‐time feedback on running biomechanics with the aim to reduce injury risk or improve performance. Objective: Investigate whether real‐time feedback by wearable insoles (ARION) alters running biomechanics and improves running economy more as compared to unsupervised running training. We also explored the correlation between changes in running biomechanics and running economy. Methods: Forty recreational runners were randomized to an intervention and control group and performed ~6 months of in‐field training with or without wearable‐based real‐time feedback on running technique and speed. Running economy and running biomechanics were measured in lab conditions without feedback pre and post intervention at four speeds. Results: Twenty‐two individuals (13 control, 9 intervention) completed both tests. Both groups significantly reduced their energetic cost by an average of −6.1% and −7.7% for the control and intervention groups, respectively. The reduction in energy cost did not significantly differ between groups overall (−0.07 ± 0.14 J∙kg∙m−1, −1.5%, p = 0.63). There were significant changes in spatiotemporal metrics, but their magnitude was minor and did not differ between the groups. There were no significant changes in running kinematics within or between groups. However, alterations in running biomechanics beyond typical session‐to‐session variation were observed during some in‐field sessions for individuals that received real‐time feedback. Conclusion: Alterations in running biomechanics as observed during some in‐field sessions for individuals receiving wearable‐based real‐time feedback did not result in significant differences in running economy or running biomechanics when measured in controlled lab conditions without feedback. [ABSTRACT FROM AUTHOR]

Spatiotemporal metrics such as step frequency have been associated with running injuries in some studies. Wearables can measure these metrics and provide real‐time feedback in‐field, but are often not validated. This study assessed the validity of commercially available wireless instrumented insoles (ARION) for quantifying spatiotemporal metrics during level running at different speeds (2.78–5.0 m s−1,) and slopes (3° and 6° up/downhill) to an instrumented treadmill. Mean raw, percentage and absolute percentage error, and limits of agreement (LoA) were calculated. Agreement was statistically quantified using four thresholds: excellent, <5%; good, <10%; acceptable, <15%; and poor, >15% error. Excellent agreement (<5% error) was achieved for stride time across all conditions, and for step frequency across all but one condition with good agreement. Contact time and swing time generally showed at least good agreement. The mean difference across all conditions was −0.95% for contact time, 0.11% for stride time, 0.6% for swing time, −0.11% for step frequency, and −0.09% when averaged across all outcomes and conditions. The accuracy at an individual level was generally good to excellent, being <10% for all but two conditions, with these conditions being <15%. Additional experiments among four runners showed that step length could also be measured with an accuracy of 1.76% across different speeds with an updated version of the insoles. These findings suggests that the ARION wearable may not only be useful for large‐scale in‐field studies investigating group differences, but also to quantify spatiotemporal metrics with generally good to excellent accuracy for individual runners. [ABSTRACT FROM AUTHOR]

Background: Markerless motion capture based on low‐cost 2‐D video analysis in combination with computer vision techniques has the potential to provide accurate analysis of running technique in both a research and clinical setting. However, the accuracy of markerless motion capture for assessing running kinematics compared to a gold‐standard approach remains largely unexplored. Objective: Here, we investigate the accuracy of custom‐trained (DeepLabCut) and existing (OpenPose) computer vision techniques for assessing sagittal‐plane hip, knee, and ankle running kinematics at speeds of 2.78 and 3.33 m s−1 as compared to gold‐standard marker‐based motion capture. Methods: Differences between the markerless and marker‐based approaches were assessed using statistical parameter mapping and expressed as root mean squared errors (RMSEs). Results: After temporal alignment and offset removal, both DeepLabCut and OpenPose showed no significant differences with the marker‐based approach at 2.78 m s−1, but some significant differences remained at 3.33 m s−1. At 2.78 m s−1, RMSEs were 5.07, 7.91, and 5.60, and 5.92, 7.81, and 5.66 degrees for the hip, knee, and ankle for DeepLabCut and OpenPose, respectively. At 3.33 m s−1, RMSEs were 7.40, 10.9, 8.01, and 4.95, 7.45, and 5.76 for the hip, knee, and ankle for DeepLabCut and OpenPose, respectively. Conclusion: The differences between OpenPose and the marker‐based method were in line with or smaller than reported between other kinematic analysis methods and marker‐based methods, while these differences were larger for DeepLabCut. Since the accuracy differed between individuals, OpenPose may be most useful to facilitate large‐scale in‐field data collection and investigation of group effects rather than individual‐level analyses. [ABSTRACT FROM AUTHOR]

Knowledge about muscular forces and fascicle behavior during hamstring exercises can optimize exercise prescription, but information on these outcomes across different exercises is lacking. We aimed to characterize and compare lower‐limb muscle forces and biceps femoris long head muscle fascicle behavior between three hamstring exercises: the Nordic hamstring curl (NHC), single‐leg Roman chair (RCH), and single‐leg deadlift (DL). Ten male participants performed the exercises while full‐body kinematics, ground reaction forces, surface muscle activation, and biceps femoris long head fascicle behavior were measured. Mean fascicle length was highest in the DL, followed by the RCH and NHC. Fascicle lengthening was higher in the NHC compared with the RCH and DL, with no difference between the RCH and DL. Biceps femoris short and long head, semitendinosus, and semimembranosus peak forces were generally higher in the NHC compared with the RCH and DL, while mean forces during the eccentric phase were generally not different between the NHC and RCH. Peak forces in the NHC coincided with low biceps femoris long head and semimembranosus muscle activation. The NHC generally has the highest peak hamstring muscle forces and results in more fascicle lengthening when compared to the DL and RCH. The NHC may therefore be most effective to promote increases in fascicle length. While the NHC may be effective to promote biceps femoris short head and semitendinosus strength adaptations, the RCH and DL may be more effective to promote strength increases in the biceps femoris long head and semimembranosus. [ABSTRACT FROM AUTHOR]

Ankle fractures are among the most common lower limb fractures. Associations between postoperative radiographic results and clinical outcome have been found, but less is known about the relevant ankle biomechanics. This study analyzed ankle kinematics, radiographic findings, and patient‐reported outcome measures (PROM) in patients treated for ankle fractures. The hypothesis was that patients after ankle fracture surgery had less flexion/extension in the ankle compared to healthy subjects and that fracture severity had significant influence on kinematics and patient satisfaction. Thirty‐three patients (n = 33 feet) operated for ankle fractures were recruited. Ankle kinematics were analyzed using the Oxford Foot model, and results were compared with an age‐matched healthy control group (11 patients, 20 feet). In addition, patients were divided by fracture (severity) classification and kinematic results were correlated with PROM and radiographic findings. Patients treated for ankle fracture showed lower walking speed (p < 0.001) when asked to walk in preferred normal speed. When compared at equal speed, significantly less range of motion (ROM) between the hindfoot and tibia in the sagittal plane (flexion/extension) during loading and push‐off phases (p = 0.003 and p < 0.001) was found in patients after ankle fractures compared to healthy subjects. Lowest ROM and poorest PROM results were found for patients with trimalleolar ankle fractures. There was a significant correlation between ROM (flexion/extension) during the push‐off phase and SF‐36 physical functioning (r2 = 0.403, p = 0.027) and SF‐36 general health (r2 = 0.473, p = 0.008). Fracture severity was significantly correlated with flexion/extension ROM in the ankle during both loading and push‐off phases (r2 = −0.382, p = 0.005, and r2 = −0.568, p < 0.001) and was also significantly correlated with PROM. This study found that patients with ankle fractures had significantly altered ankle kinematics compared to healthy subjects. The poorest results were found among patients with trimalleolar fractures. Weak to strong significant correlations were found between fracture severity, ankle kinematics, and PROM. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:1658–1666, 2019. [ABSTRACT FROM AUTHOR]

Osteoarthritis is one of the major causes of immobility and its current prevalence in elderly (>60 years) is 18% in women and 9.6% in men. Patients with osteoarthritis display altered movement patterns to avoid pain and overcome movement limitations in activities of daily life, such as sit-to-stand transfers. Currently, there is a lack of evidence that distinguishes effects of knee osteoarthritis on sit-to-stand performance in patients with and without obesity. The purpose of this study was therefore to investigate differences in knee and hip kinetics during sit-to-stand movement between healthy controls and lean and obese knee osteoarthritis patients. Fifty-five subjects were included in this study, distributed over three groups: healthy controls (n=22), lean knee osteoarthritis (n=14), and obese knee OA patients (n=19). All subjects were instructed to perform sit-to-stand transfers at self-selected, comfortable speed. A three-dimensional movement analysis was performed to investigate compensatory mechanisms and knee and hip kinetics during sit-to-stand movement. No difference in sit-to-stand speed was found between lean knee OA patients and healthy controls. Obese knee osteoarthritis patients, however, have reduced hip and knee range of motion, which is associated with reduced peak hip and knee moments. Reduced vertical ground reaction force in terms of body weight and increased medial ground reaction forces indicates use of compensatory mechanisms to unload the affected knee in the obese knee osteoarthritis patients. We believe that an interplay between obesity and knee osteoarthritis leads to altered biomechanics during sit-to-stand movement, rather than knee osteoarthritis alone. From this perspective, obesity might be an important target to restore healthy sit-to-stand biomechanics in obese knee OA patients. [ABSTRACT FROM AUTHOR]

Background: Accurately measuring of intrinsic foot kinematics using skin mounted markers is difficult, limited in part by the physical dimensions of the foot. Existing kinematic foot models solve this problem by combining multiple bones into idealized rigid segments. This study presents a novel foot model that allows the motion of the 26 bones to be individually estimated via a combination of partial joint constraints and coupling the motion of separate joints using kinematic rhythms. Methods: Segmented CT data from one healthy subject was used to create a template Glasgow-Maastricht foot model (GM-model). Following this, the template was scaled to produce subject-specific models for five additional healthy participants using a surface scan of the foot and ankle. Forty-three skin mounted markers, mainly positioned around the foot and ankle, were used to capture the stance phase of the right foot of the six healthy participants during walking. The GM-model was then applied to calculate the intrinsic foot kinematics. Results: Distinct motion patterns where found for all joints. The variability in outcome depended on the location of the joint, with reasonable results for sagittal plane motions and poor results for transverse plane motions. Conclusions: The results of the GM-model were comparable with existing literature, including bone pin studies, with respect to the range of motion, motion pattern and timing of the motion in the studied joints. This novel model is the most complete kinematic model to date. Further evaluation of the model is warranted. [ABSTRACT FROM AUTHOR]

Background and objective Walking aids, such as rollator or draisine, improve mobility and functional exercise performance in individuals with chronic obstructive pulmonary disease ( COPD) during an indoor 6-min walk test. However, this test does not reflect everyday walking, which is the most frequently reported problematic activity of daily life in individuals with COPD. To date, efficacy of walking aids during self-paced outdoor walking remains unknown. Therefore, we aimed to determine the efficacy of a rollator and draisine on self-paced outdoor walking in individuals with COPD. Methods Fifteen individuals with COPD (68% men; age: 63 ± 8 years; forced expiratory volume in 1 s: 40 ± 14% predicted) performed three self-paced outdoor walking tests on two consecutive days: test 1 unaided, and tests 2 and 3 with rollator or draisine in random order. Participants had to walk as long as possible at their own pace. The test ended when participants needed to stop, with a maximum duration of 30 min. Results The use of rollator resulted in the highest walk distance and time ( P < 0.05 vs unaided and draisine). Furthermore, individuals with COPD walked significantly further and longer during an unaided test compared with a draisine aided test ( P < 0.05). Moreover, use of draisine resulted in a significantly higher walking speed, fewer strides, greater stride length, and higher step and stride variability ( P < 0.05 vs unaided and rollator). Conclusion To conclude, a rollator improves the self-paced outdoor walk distance and time in individuals with moderate and advanced COPD and a poor functional exercise capacity, whereas the use of a draisine had a detrimental effect compared with unaided walking. [ABSTRACT FROM AUTHOR]

Unilateral peripheral vestibular disorder ( UPVD) causes deficient locomotor responses to novel environments due to a lack of accurate vestibular sensory information, increasing fall risk. This study aimed to examine recovery response (stability recovery actions) and adaptive feedback potential in dynamic stability of UPVD-patients and healthy control subjects during perturbed walking. 17 UPVD-patients (>6 months since onset) and 17 matched healthy control participants walked on a treadmill and were subjected to eight unexpected perturbations during the swing phase of the right leg. For each perturbation, the margin of stability ( MS; state of body's centre of mass in relation to the base of support), was determined at touchdown of the perturbed leg and during the following six recovery steps. The first perturbation caused a reduced MS at touchdown for the perturbed leg compared to baseline, indicating an unstable position, with controls requiring five recovery steps to return to MS baseline and UPVD-patients not returning to baseline level within the analyzed six recovery steps. By the eighth perturbation, control subjects needed two steps, and UPVD-patients required three recovery steps, both thereby improving their recovery response with practice. However, MS at touchdown of the perturbed leg increased only for the controls after repeated perturbations, indicating adaptive feedback-driven locomotor improvements for the controls, but not for the UPVD-patients. We concluded that UPVD-patients have a diminished ability to control dynamic gait stability during unexpected perturbations, increasing their fall risk, and that vestibular dysfunction may inhibit the neuromotor system adapting the reactive motor response to perturbations. [ABSTRACT FROM AUTHOR]

Background Higher plantar pressures play an important role in the development of plantar foot ulceration in diabetic polyneuropathy and earlier studies suggest that higher pressures under the forefoot may be related to a decrease in lower leg muscle strength. Therefore, in this randomised controlled trial we evaluated whether lower-extremity strength training can reduce plantar pressures in diabetic polyneuropathy. Methods This study was embedded in an unblinded randomised controlled trial. Participants had diabetes and polyneuropathy and were randomly assigned to the intervention group (n = 48) receiving strength training during 24 weeks, or the control group (n = 46) receiving no intervention. Plantar pressures were measured in both groups at 0, 12, 24 and 52 weeks. A random intercept model was applied to evaluate the effects of the intervention on peak pressures and pressure-time-integrals, displacement of center-of-pressure and the forefoot to rearfoot pressure-time-integral-ratio. Results Plantar pressure patterns were not affected by the strength training. In both the intervention and control groups the peak pressure and the pressure-time-integral under the forefoot increased by 55.7 kPa (95% CI: 14.7, 96.8) and 2.0 kPa.s (95% CI: 0.9, 3.2) over 52 weeks, respectively. Both groups experienced a high number of drop-outs, mainly due to deterioration of health status and lower-extremity disabilities. Conclusions Plantar pressures under the forefoot increase progressively over time in people with diabetic polyneuropathy, but in this study were not affected by strength training. Future intervention studies should take this increase of plantar pressure into account and alternative interventions should be developed to reduce the progressive lower extremity problems in these patients. Trial registration This study was embedded in a clinical trial with trial number NCT00759265. [ABSTRACT FROM AUTHOR]

To investigate the relationship between skeletal muscle fiber type-specific characteristics, circulating hormone concentrations, and skeletal muscle mass and strength in older men. Cross-sectional analyses. University research center. Forty-one community dwelling elderly men (≥65). Leg strength (1-repetition maximum, 1RM) and whole-body and limb muscle mass were determined, and muscle fiber type composition, cross-sectional area (CSA), myonuclear content, and satellite cell (SC) content were assessed in skeletal muscle biopsy samples. In addition, blood samples were collected to determine serum testosterone, sex hormone-binding globulin, insulinlike growth factor (IGF)-1, and IGF binding protein-3 concentrations. Muscle mass correlated with muscle strength (0.41 ≤ correlation coefficient ( r)≤0.72; P<.01). Muscle fiber CSA, myonuclear content, and SC content were significantly lower in type II than in type I muscle fibers. Myonuclear and SC content were positively correlated with muscle fiber CSA. Furthermore, greater muscle fiber CSA (type I and II) was associated with greater thigh muscle area and muscle strength (0.30 ≤ r ≤ 0.45; P<.05). Testosterone concentration was positively correlated with muscle mass and muscle fiber CSA. Regression analysis showed that SC content, myonuclear content, and testosterone concentration are predictive of muscle fiber CSA. Furthermore, muscle mass and type II muscle fiber CSA are predictive of muscle strength. Skeletal muscle mass and strength in elderly men are positively correlated with muscle fiber type-specific CSA, myonuclear content, and SC content. These findings support the assumption that a decline in SC content plays an important role in age-related decline in muscle mass and strength. [ABSTRACT FROM AUTHOR]

Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation-based balance training (PBT) is an emerging task-specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill-based systems and therapist-applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long-term follow-up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; 17: 2294-2303.. [ABSTRACT FROM AUTHOR]