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Contains fulltext : 305556.pdf (Publisher’s version ) (Closed access), Radboud University, 29 mei 2024, Promotores : Geurts, A.C.H., Keijsers, N.L.W. Co-promotor : Smulders, K., 186 p.

Contains fulltext : 307159.pdf (Publisher’s version ) (Closed access), Visual information is essential to navigate the environment and maintain postural stability during gait. Visual field rotations alter the perceived heading direction, resulting in gait trajectory deviations, known as visual coupling. It is unclear how center of mass (CoM) control relative to a continuously changing base of support (BoS) is adapted to facilitate visual coupling. This study aimed to characterize mediolateral (ML) balance control during visual coupling in steady-state gait. Sixteen healthy participants walked on an instrumented treadmill, naive to sinusoidal low-frequency (0.1 Hz) rotations of the virtual environment around the vertical axis. Rotations were continuous with 1) high or 2) low amplitude or were 3) periodic with 10-s intervals. Visual coupling was characterized with cross-correlations between CoM trajectory and visual rotations. Balance control was characterized with the ML margin of stability (MoSML) and by quantifying foot placement control as the relation between CoM dynamics and lateral foot placement. Visual coupling was strong on a group level (continuous low: 0.88, continuous high: 0.91, periodic: 0.95) and moderate to strong on an individual level. Higher rotation amplitudes induced stronger gait trajectory deviations. The MoSML decreased toward the deviation direction and increased at the opposite side. Foot placement control was similar compared with regular gait. Furthermore, pelvis and foot reorientation toward the rotation direction was observed. We concluded that visual coupling was facilitated by reorientating the body and shifting the extrapolated CoMML closer to the lateral BoS boundary toward the adjusted heading direction while preserving CoM excursion and foot placement control. NEW & NOTEWORTHY Healthy, naive participants were unaware of subtle, low-frequency rotations of the visual field but still coupled their gait trajectory to a rotating virtual environment. In response, participants decreased their margin of stabi, 11 p.

01 april 2023, Item does not contain fulltext, PURPOSE: Exoskeleton use by people with complete spinal cord injury (SCI) in daily life is challenging. To optimize daily exoskeleton use, a better understanding of the purpose of use and the accompanying improvements are needed. The perspective of experienced exoskeleton users could guide design improvements. METHODS: Face-to-face semi-structured interviews were held with 13 people with SCI with exoskeleton experience. Interviews were audio-taped, transcribed, and analysed thematically. RESULTS: Participants expressed three future purposes of exoskeleton use: for daily activities (e.g., stair climbing), exercise (e.g., staying healthy), and social interaction (e.g., standing at parties). Exoskeleton use during daily activities was the ultimate goal. Therefore, the future exoskeleton should be: easy to use, small and lightweight, tailor made, safe, comfortable, less distinctive, durable, and affordable. Improving the ease of use was relevant for all purposes, for all participants. The other suggestions for improvement varied depending on the purpose of use and the participant. CONCLUSION: Increasingly more advanced improvements are needed to transition from an exercise purpose to social interaction, and ultimately use during daily activities. In the current study, detailed suggestions for improvements have been made. Only when multiple of these suggestions are adjusted, can the exoskeleton be used to its full potential.IMPLICATIONS FOR REHABILITATIONThe use of an exoskeleton by people with a complete spinal cord injury in daily life is still in its infancy.To optimize daily exoskeleton use, a better understanding of the purpose of use and exoskeleton improvements is needed.More advanced improvements to future exoskeletons are needed to make a transition from use as an exercise device to use during social interaction and daily activities.Improving the ease of use of future exoskeletons is considered a priority by experienced users, followed by making the exoskeleton

Item does not contain fulltext, Different methods exist to select strides that represent preferred, steady-state gait. The aim of this study was to identify the effect of different stride-selection methods on spatiotemporal gait parameters to analyze steady-state gait. A total of 191 patients with hip or knee osteoarthritis (aged 38-85) wearing inertial sensors walked back and forth over 10 m for two minutes. After the removal of strides in turns, five stride-selection methods were compared: (ALL) include all strides, others removed (REFERENCE) two strides around turns, (ONE) one stride around turns, (LENGTH) strides <63% of median stride length, and (SPEED) strides that fall outside the 95% confidence interval of gait speed over the strides included in REFERENCE. Means and SDs of gait parameters were compared for each trial against the most conservative definition (REFERENCE). ONE and SPEED definitions resulted in similar means and SDs compared to REFERENCE, while ALL and LENGTH definitions resulted in substantially higher SDs of all gait parameters. An in-depth analysis of individual strides showed that the first two strides after and last two strides before a turn were significantly different from steady-state walking. Therefore, it is suggested to exclude the first two strides around turns to assess steady-state gait.

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Radboud University, 09 februari 2023, Promotores : Geurts, A.C.H., Keijsers, N.L.W. Co-promotor : Kerkum, Y.L., Contains fulltext : 288657.pdf (Publisher’s version ) (Closed access)

Item does not contain fulltext, BACKGROUND: Hereditary motor and sensory neuropathies (HMSN), also known as Charcot-Marie-Tooth disease, are characterized by affected peripheral nerves. This often results in foot deformities that can be classified into four categories: (1) plantar flexed first metatarsal, neutral hindfoot, (2) plantar flexed first metatarsal, correctable hindfoot varus, (3) plantar flexed first metatarsal, uncorrectable hindfoot varus, and (4) hindfoot valgus. To improve management and for the evaluation of surgical interventions, a quantitative evaluation of foot function is required. The first aim of this study was to provide insight into plantar pressure of people with HMSN in relation to foot deformities. The second aim was to propose a quantitative outcome measure for the evaluation of surgical interventions based on plantar pressure. METHODS: In this historic cohort study, plantar pressure measurements of 52 people with HMSN and 586 healthy controls were evaluated. In addition to the evaluation of complete plantar pressure patterns, root mean square deviations (RMSD) of plantar pressure patterns from the mean plantar pressure pattern of healthy controls were calculated as a measure of abnormality. Furthermore, center of pressure trajectories were calculated to investigate temporal characteristics. Additionally, plantar pressure ratios of the lateral foot, toes, first metatarsal head, second/third metatarsal heads, fifth metatarsal head, and midfoot were calculated to measure overloading of foot areas. RESULTS: Larger RMSD values were found for all foot deformity categories compared to healthy controls (p < 0.001). Evaluation of the complete plantar pressure patterns revealed differences in plantar pressure between people with HMSN and healthy controls underneath the rearfoot, lateral foot, and second/third metatarsal heads. Center of pressure trajectories differed between people with HMSN and healthy controls in the medio-lateral and anterior-posterior direction. The plantar

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Item does not contain fulltext, INTRODUCTION: The population of people with a spinal cord injury (SCI) is changing to a diverse population with an increasing number of incomplete lesions. Often, these individuals have the capacity to walk, but experience disabling gait impairments. CASE PRESENTATION: The course of a 34-year-old male with a chronic incomplete traumatic cervical SCI who initially could walk no more than a few steps with supervision or a wheeled walker is described. He participated in a clinical trial with Targeted Epidural Spinal Stimulation (TESS). After this trial, he was able to walk with a wheeled walker and bilateral orthosis over a distance of 100 meters. Despite these improvements, his main complaints were (1) difficulty to correctly preposition the feet, and (2) pain in his toe and calf muscles. An interdisciplinary approach and the use of structured gait analysis formed the basis for shared decision-making with the team and the patient to perform ankle-foot surgery followed by 2-month gait training with a body weight support system. After this trajectory his walking distance increased to 250 meters, with a wheeled walker; but now without orthosis and with an increased walking speed compared to pre-surgery. Additionally, there was reduction of pain and he experienced no disturbances during sleeping, washing and clothing anymore. DISCUSSION: This case shows that surgical interventions can improve the gait capacity even in case of chronic incomplete SCI. Furthermore, training with a body weight support system after medical-technical interventions is useful to utilize the full potential of these interventions.

Contains fulltext : 296320.pdf (Publisher’s version ) (Open Access), Introduction: Healthcare expenses are reaching unaffordable levels worldwide and reverse innovation could play a role in decreasing these expenses and improving healthcare accessibility. The ReMotion Knee, a prosthetic knee primarily developed for low-income countries, could serve as a reverse innovation for people with a lower limb amputation. This study aimed to evaluate the ReMotion Knee as a potential reverse innovation in high-income countries, specifically in terms of functional mobility. Methods: Nine participants with a transfemoral amputation or knee exarticulation were included in this randomised crossover trial. The ReMotion Knee was compared with the participants’ current prosthetic knee in terms of functional mobility and subjective experiences. The primary outcome in this study was the L test for functional mobility. Secondary outcomes were additional clinical performance tests and subjective experiences (balance confidence, walking comfort, test performance and fatigue). Results: Participants scored significantly better using their current prosthetic knee than using the ReMotion Knee on primary outcome, the L test (p<0.01, median difference 7.5 s, IQR 6.1-10.6) and all secondary outcomes except experienced test performance and fatigue. All participants were able to safely perform all clinical tests with the ReMotion Knee, even after a short familiarisation period. Conclusions: The ReMotion Knee has the potential to become a reverse innovation after modifications improving velocity, walking comfort and weight limit. Collaboration between high-income and low-income countries can facilitate further development of the ReMotion Knee and could result in alternative products and treatments that could reduce healthcare costs while still providing a good quality of care.Trial registration number NCT04700085. Data are available upon reasonable request. The data that support the findings of this study are available on request.

Contains fulltext : 296350.pdf (Publisher’s version ) (Open Access), Assessing a patient's musculoskeletal function during over-ground walking is a primary objective in post-stroke rehabilitation, due to the importance of walking recovery for everyday life. However, the quantitative assessment of musculoskeletal function currently requires lab-constrained equipment, and labor-intensive analyses, which hampers assessment in standard clinical settings. The development of fully wearable systems for the online estimation of muscle-tendon forces and resulting joint torque would aid clinical assessment of motor recovery, it would enhance the detection of neuro-muscular anomalies and it would consequently enable highly personalized treatments. Here, we present a wearable technology that combines (1) a soft garment for the human leg sensorized with 64 flexible and dry electromyography (EMG) electrodes, (2) a generalized and automated algorithm for the localization of leg muscle sites, and (3) an EMG-driven musculoskeletal modeling framework for the estimation of ankle dorsi-plantar flexion torques. Our results showed that the automated clustering algorithm could detect muscle locations in both healthy and post-stroke individuals. The estimated muscle-specific EMG envelopes could be used to drive forward person-specific musculoskeletal models and estimate resulting joint torques accurately across all healthy and post-stroke individuals and across different walking speeds (R2 > 0.82 and RMSD < 0.16). The technology we proposed opens new avenues for automated muscle localization and quantitative musculoskeletal function assessment during gait in both healthy and neurologically impaired individuals.

Contains fulltext : 298945.pdf (Publisher’s version ) (Open Access), OBJECTIVE: People with a lower-limb amputation often have a sedentary lifestyle and increasing physical activity is important to optimize their health and quality of life. To achieve this the Amputee Parateam programme was developed. Amputee Parateam is a sports programme that addresses important physical, environmental, and social barriers for sports participation. This programme was evaluated in terms of various aspects of physical functioning and health. DESIGN: Repeated measures design. PATIENTS: Thirteen participants with a lower-limb amputation, with a median age of 51 (interquartile range (IQR) 40-63). METHODS: Measurements were performed at T0 (baseline), T1 (after 6 weeks) and T2 (follow-up after 12 months). Outcome measures were walking ability, functional mobility, daily activity, health-related quality of life, and adherence to sports at follow-up. RESULTS: Walking ability and functional ability significantly improved between T0 and T1. Adherence to sports at follow-up was high, with 11/13 participants still practicing sports weekly. There were no significant changes in daily activity or health-related quality of life. CONCLUSIONS: The Amputee Parateam programme successfully improved walking ability and functional mobility and resulted in a high adherence to sports among the participants. However, these improvements in physical capacity did not lead to less sedentary behaviour in daily life., 5 p.

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27 december 2022, Item does not contain fulltext, Purpose: The System Usability Scale (SUS) is the most commonly used questionnaire to assess usability of healthcare innovations but is not available in Dutch (D-SUS). This study aims to translate the SUS to Dutch and to determine its internal consistency, test-retest reliability, and construct validity in healthcare innovations focused on rehabilitation technologies. Methods: Translation of the SUS was performed according to the WHO recommendations. Fifty-four participants filled out the D-SUS and Dutch Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) twice. Internal consistency was assessed by Cronbach’s alpha. Test–retest reliability was evaluated by Gwet’s agreement coefficient (Gwet’s AC2) on item scale, and Pearson correlation coefficient (PCC) for the overall D-SUS scores. Construct validity was assessed with the PCC between the D-SUS and D-QUEST overall scores (Netherlands Trial Register, ID: NL9169). Results: After translation, Cronbach's alpha was 0.74. Gwet's AC2 was 0.68 and the PCC between the first and second overall D-SUS scores was 0.75. No significant difference in D-SUS score between the two measurements was found. Repeatability coefficient was 18.4. The PCC between the D-SUS and D-QUEST overall scores was 0.49. Conclusions: The D-SUS is a valid and reliable tool for usability assessment of healthcare innovations, specifically rehabilitation technologies.

Item does not contain fulltext, BACKGROUND: Shoe heel height is considered to influence prosthetic alignment, walking comfort, and gait symmetry in people with a transtibial amputation (TTA). However, research on the effect of heel height is scarce, and no evidence is available on the effects of variations smaller than 20 mm. These small heel height variations between store-bought shoes are often overlooked by people with an amputation and may cause secondary musculoskeletal problems in the long term. OBJECTIVE: To examine the effects of small increases in heel height on gait symmetry in people with a TTA and healthy individuals. STUDY DESIGN: Experimental repeated measures study. METHODS: Fourteen participants with a TTA and 15 healthy controls were included. Pressure data, spatiotemporal data, and experienced walking comfort were measured during walking with four heel height conditions: original height and increased heights of 3, 5, and 8 mm. Symmetry in center of pressure velocity (VCOP), gait parameters, and experienced walking comfort were compared between the heel heights and between healthy controls and prosthetic walkers. RESULTS: Increased heel height resulted in a significant decrease in VCOP symmetry (P = 0.001) and experienced walking comfort (P < 0.001). The VCOP trajectory of the prosthetic leg mainly differed within the first 14.5% of the stance phase. Healthy individuals showed better VCOP symmetry in all conditions (P < 0.001). CONCLUSIONS: Healthcare professionals should advice their clients to be alert of small heel height differences between store-bought shoes, especially those larger than 5 mm. A prosthetic alignment adjustment should be considered when purchasing new shoes.

Contains fulltext : 283876.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext, The aim of this study was to objectively assess and compare gait capacity and gait performance in rehabilitation inpatients with stroke or incomplete spinal cord injury (iSCI) using inertial measurement units (IMUs). We investigated how gait capacity (what someone can do) is related to gait performance (what someone does). Twenty-two inpatients (11 strokes, 11 iSCI) wore ankle positioned IMUs during the daytime to assess gait. Participants completed two circuits to assess gait capacity. These were videotaped to certify the validity of the IMU algorithm. Regression analyses were used to investigate if gait capacity was associated with gait performance (i.e., walking activity and spontaneous gait characteristics beyond therapy time). The ankle positioned IMUs validly assessed the number of steps, walking time, gait speed, and stride length (r >= 0.81). The walking activity was strongly (r >= 0.76) related to capacity-based gait speed. Maximum spontaneous gait speed and stride length were similar to gait capacity. However, the average spontaneous gait speed was half the capacity-based gait speed. Gait capacity can validly be assessed using IMUs and is strongly related to gait performance in rehabilitation inpatients with neurological disorders. Measuring gait performance with IMUs provides valuable additional information about walking activity and spontaneous gait characteristics to inform about functional recovery.

Contains fulltext : 252922.pdf (Publisher’s version ) (Open Access), Background and Objectives: Compensation strategies are essential in Parkinson's disease (PD) gait rehabilitation. However, besides external cueing, these strategies have rarely been investigated systematically. We aimed to: (1) establish the patients' perspective on the efficacy and usability of five different compensation strategies; (2) quantify the efficacy of these strategies on spatiotemporal gait parameters; and (3) explore associations between the effects of specific strategies and patient characteristics. Methods: We recruited persons with PD and self-reported disabling gait impairments for this lab-based, within-subject study. Clinimetrics included: questionnaires (NFOG-Q, VMIQ-2, GMSI), cognitive assessments (ANT, MoCA, Brixton), and physical examinations (MDS-UPDRS III, Mini-BEST, tandem gait, rapid turns test). Gait assessment consisted of six 3-minute trials of continuous walking around a 6-meter walkway. Trials comprised: 1) baseline gait; 2) external cueing; 3) internal cueing; 4) action observation; 5) motor imagery; and 6) adopting a new walking pattern. Spatiotemporal gait parameters were acquired using 3D motion capture analysis. Strategy efficacy was determined by the change in gait variability compared to baseline gait. Associated patient characteristics were explored using regression analyses. Results: 101 participants (50 men; median[range] age: 66[47-91] years) were included. The effects of the different strategies varied greatly among participants. While participants with higher baseline variability showed larger improvements using compensation strategies, participants without freezing of gait, with lower MDS-UPDRS III scores, higher balance capacity and better performance in orienting attention, also showed greater improvements in gait variability. Higher MoCA scores were associated with greater efficacy of external cueing. Discussion: Our findings support the use of compensation strategies in gait rehabilitation for PD, but highlight the i

Item does not contain fulltext, INTRODUCTION: Overuse injuries often start with a musculoskeletal complaint, which can progress over time to an injury. Little or no information is known about the development and severity of overuse injuries in military recruits. This study describes the musculoskeletal complaints in Dutch military recruits during their basic training and examines potential predictive factors for dropout due to injury. METHODS: In this prospective cohort study, Dutch military recruits reported complaints of the lower body weekly using a Numeric Rating Scale (NRS) pain score chart during their basic training. Number, location and severity of complaints during each of the first 12 weeks of basic training were analysed. RESULTS: Of the 930 recruits, 61% reported an NRS pain score of 3 or higher and 34% reported an NRS pain score of 5 or higher at least once. Complaints were mostly reported in the foot and ankle region and least reported in the upper leg region. Injury dropouts (11%) showed significantly higher proportions of complaints and higher maximal pain scores throughout most weeks of basic training. The maximal NRS pain score of the first two weeks was the strongest predictor of dropping out due to injury. CONCLUSIONS: Recruits who drop out due to injury report more severe complaints throughout basic training. Focusing on musculoskeletal complaints in the first phase of training seems helpful to identify recruits who are at risk of developing an injury.

Contains fulltext : 232740.pdf (Publisher’s version ) (Open Access), BACKGROUND: Since adequate sleep is essential for optimal inpatient rehabilitation, there is an increased interest in sleep assessment. Unobtrusive, contactless, portable bed sensors show great potential for objective sleep analysis. OBJECTIVE: The aim of this study was to investigate the feasibility of a bed sensor for continuous sleep monitoring overnight in a clinical rehabilitation center. METHODS: Patients with incomplete spinal cord injury (iSCI) or stroke were monitored overnight for a 1-week period during their in-hospital rehabilitation using the Emfit QS bed sensor. Feasibility was examined based on missing measurement nights, coverage percentages, and missing periods of heart rate (HR) and respiratory rate (RR). Furthermore, descriptive data of sleep-related parameters (nocturnal HR, RR, movement activity, and bed exits) were reported. RESULTS: In total, 24 participants (12 iSCI, 12 stroke) were measured. Of the 132 nights, 5 (3.8%) missed sensor data due to Wi-Fi (2), slipping away (1), or unknown (2) errors. Coverage percentages of HR and RR were 97% and 93% for iSCI and 99% and 97% for stroke participants. Two-thirds of the missing HR and RR periods had a short duration of ≤120 seconds. Patients with an iSCI had an average nocturnal HR of 72 (SD 13) beats per minute (bpm), RR of 16 (SD 3) cycles per minute (cpm), and movement activity of 239 (SD 116) activity points, and had 86 reported and 84 recorded bed exits. Patients with a stroke had an average nocturnal HR of 61 (SD 8) bpm, RR of 15 (SD 1) cpm, and movement activity of 136 (SD 49) activity points, and 42 reported and 57 recorded bed exits. Patients with an iSCI had significantly higher nocturnal HR (t(18)=-2.1, P=.04) and movement activity (t(18)=-1.2, P=.02) compared to stroke patients. Furthermore, there was a difference between self-reported and recorded bed exits per night in 26% and 38% of the nights for iSCI and stroke patients, respectively. CONCLUSIONS: It is feasible to implement the be

Radboud University, 07 mei 2021, Promotor : Geurts, A.C.H. Co-promotores : Keijsers, N.L.W., Nes, I.J.W. van, Contains fulltext : 232866.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 231415.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext, OBJECTIVE: Toe walking due to progressive shortening of the calf muscles is common in people with hereditary spastic paraplegia. Achilles tendon lengthening is a treatment option, but clinicians are often hesitant to use this procedure, as it may result in weakening of the calf muscles and, subsequently, in reduced ankle power and knee instability during the stance phase of gait. We report here a case report supporting that these negative side-effects can be avoided in well-selected people with hereditary spastic paraplegia. METHOD: Bilateral Achilles tendon lengthening, combined with bilateral tenotomy of the tibialis posterior and toe flexors, was performed in a 29-year-old woman with uncomplicated hereditary spastic paraplegia who experienced progressive gait instability due to shortening of the soleus and gastrocnemius muscles (resulting in irreducible pes equinus). RESULTS: Bilateral Achilles tendon lengthening resulted in improvement in both subjective and objective outcomes. Self-selected gait speed improved from 0.75 m/s before surgery to 1.07 m/s after surgery (p < 0.001). Knee instability during the stance phase did not occur post-surgery. The ankle moment trajectories normalized after surgery, while peak ankle powers increased. CONCLUSION: Correction of bilateral irreducible pes equinus by Achilles tendon lengthening may improve gait capacity in well-selected subjects with hereditary spastic paraplegia.

Contains fulltext : 238558.pdf (Publisher’s version ) (Open Access), PURPOSE OF THE ARTICLE: Learning to use an exoskeleton is time consuming and diverse between users. Knowledge about trainability of exoskeleton skills is relevant for planning and expectation management. The objective was to assess predictors of exoskeleton skill performance during and after exoskeleton training. MATERIALS AND METHODS: Twenty-four participants with a motor complete spinal cord injury were given 24 training sessions in 8 weeks. Nine potential predictors were identified: lesion level, age, gender, age at injury, time since injury, BMI, sport, active lifestyle, and anxiety. Univariate and multivariate linear regression analyses were performed to examine predictors of skill performance after 2, 4, 6, and 8 weeks. RESULTS AND CONCLUSIONS: Twenty participants completed the training. Univariate analysis revealed that positive predictors were: low lesion level and more active lifestyle after 2 weeks, whereas low age at injury, low BMI, and more active lifestyle were positive predictors after 6 weeks. Multivariate regression model explained 65% of the performance after 2 weeks (predictors: lesion level, anxiety, active lifestyle) and 66% after 6 weeks (predictors: BMI, active lifestyle, age). Lesion level was a predictor during the first 4 weeks, but did not influence participants' final skill level. BMI, age, and active lifestyle were predictors toward the end of the training period.Implications for rehabilitationWith the help of wearable exoskeletons people with a complete spinal cord injury can regain their standing and walking mobility.Learning to use an exoskeleton is time consuming and the number of training sessions required to walk independently differs greatly between users.This study shows that lesion level was an important predictor of exoskeleton motor learning in the first 4 weeks of training.BMI, age, and active lifestyle were predictors of exoskeleton skill performance toward the end of the 8 week training period.

Item does not contain fulltext, This study aims were twofold: (1) to evaluate the construct validity of the Repetitive Movement Test (RMT) a novel test developed for Wheelchair Rugby classification which evaluates arm coordination impairment at five joints - shoulder, elbow, forearm, wrist and fingers - and (2), pending sufficiently positive results, propose objective minimum impairment criteria (MIC). Forty-two WR athletes with an eligible coordination impairment, and 20 volunteers without impairment completed the RMT and two clinically established coordination tests: the finger-nose test (FNT) and the spiral test (ST). Coordination deduction (CD), an ordinal observational coordination scale, currently used in WR classification, was obtained. Spearman-rank correlation coefficients (SCC) between RMT and ST (0.40 to 0.67) and between RMT and CD (0.31 to 0.53) generally supported RMT construct validity, SCC between RMT and FNT were lower (0.12-0.31). When the scores on ST, FNT and RMT from the sample of WR players were compared with the scores from volunteers without impairment, 93.5% to 100% of WR players had scores > 2SD below the mean of volunteers without impairment on the same test. In conclusion, RMT at the elbow, forearm, wrist and fingers have sufficient construct validity for use in WR. MIC were recommended with ST and RMT.

Item does not contain fulltext, BACKGROUND: The aetiology of chronic therapy resistant plantar fasciitis (CTRPF) is multifactorial with more focus in recent times on the gastroc-soleus complex. This study evaluates the effect of lengthening the gastrocnemius muscle in CTRPF. METHODS: All patients with CRTPF complaints for at least one year underwent the same standard conservative treatment prior to surgery. 32 patients failed this treatment and underwent gastrocnemius recession. Silfverskiöld test, questionnaires and plantar pressure measurements were obtained at 5 visits. RESULTS: One year follow up showed a significantly increase in dorsiflexion of the ankle (16 degrees), a decrease in VAS; 78 (SD: 19) to 20 (SD: 24) and significant improved functional scores. Plantar pressure measurements showed an increase of pressure under the medial proximal part of the midfoot and the 1 st metatarsal and a decrease under the hallux. CONCLUSIONS: A gastrocnemius recession results in a significant gain in dorsiflexion, altered loading of the foot and good clinical outcome in patients with CTRPF. LEVEL OF EVIDENCE: Level 2.

Contains fulltext : 230843.pdf (publisher's version ) (Open Access), Previous research showed that an Inertial Measurement Unit (IMU) on the anterior side of the shank can accurately measure the Shank-to-Vertical Angle (SVA), which is a clinically-used parameter to guide tuning of ankle-foot orthoses (AFOs). However, in this context it is specifically important that differences in the SVA are detected during the tuning process, i.e., when adjusting heel height. This study investigated the validity of the SVA as measured by an IMU and its responsiveness to changes in AFO-footwear combination (AFO-FC) heel height in persons with incomplete spinal cord injury (iSCI). Additionally, the effect of heel height on knee flexion-extension angle and internal moment was evaluated. Twelve persons with an iSCI walked with their own AFO-FC in three different conditions: (1) without a heel wedge (refHH), (2) with 5 mm heel wedge (lowHH) and (3) with 10 mm heel wedge (highHH). Walking was recorded by a single IMU on the anterior side of the shank and a 3D gait analysis (3DGA) simultaneously. To estimate validity, a paired t-test and intraclass correlation coefficient (ICC) between the SVAIMU and SVA3DGA were calculated for the refHH. A repeated measures ANOVA was performed to evaluate the differences between the heel heights. A good validity with a mean difference smaller than 1 and an ICC above 0.9 was found for the SVA during midstance phase and at midstance. Significant differences between the heel heights were found for changes in SVAIMU (p = 0.036) and knee moment (p = 0.020) during the midstance phase and in SVAIMU (p = 0.042) and SVA3DGA (p = 0.006) at midstance. Post-hoc analysis revealed a significant difference between the ref and high heel height condition for the SVAIMU (p = 0.005) and knee moment (p = 0.006) during the midstance phase and for the SVAIMU (p = 0.010) and SVA3DGA (p = 0.006) at the instant of midstance. The SVA measured with an IMU is valid and responsive to changing heel heights and equivalent to the gold standard 3DGA. Th

Contains fulltext : 225521.pdf (publisher's version ) (Open Access), A consequence of a complete spinal cord injury (SCI) is the loss of gait capacity. Wearable exoskeletons for the lower extremity enable household and community ambulation in people with SCI. This study assessed the amount, purpose, and location of exoskeleton use in the home and community environment, without any restrictions. The number of steps taken was read from the exoskeleton software. Participants kept a daily logbook, and completed two user experience questionnaires (Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) and System Usability Scale (SUS)). Fourteen people with a complete SCI used the ReWalk exoskeleton a median of 9 (range [1-15]) out of 16 ([12-21]) days, in which participants took a median of 3,226 ([330-28,882]) steps. The exoskeleton was mostly used for exercise purposes (74%) and social interaction (20%). The main location of use was outdoors (48%). Overall, participants were satisfied with the exoskeleton (D-QUEST 3.7 ± 0.4) and its usability (SUS 72.5 [52.5-95.0]). Participants with complete SCI report satisfaction with the exoskeleton for exercise and social interaction in the home and community, but report limitations as an assistive device during daily life.

Contains fulltext : 220082.pdf (publisher's version ) (Open Access)

Contains fulltext : 228546.pdf (publisher's version ) (Open Access)

Contains fulltext : 218784.pdf (publisher's version ) (Open Access), Quantitative analyses of plantar pressure images typically occur at the group level and under the assumption that individuals within each group display homogeneous pressure patterns. When this assumption does not hold, a personalized analysis technique is required. Yet, existing personalized plantar pressure analysis techniques work at the image level, leading to results that can be unintuitive and difficult to interpret. To address these limitations, we introduce PAPPI: the Personalized Analysis of Plantar Pressure Images. PAPPI is built around the statistical modelling of the relationship between plantar pressures in healthy controls and their demographic characteristics. This statistical model then serves as the healthy baseline to which an individual's real plantar pressures are compared using statistical parametric mapping. As a proof-of-concept, we evaluated PAPPI on a cohort of 50 hallux valgus patients. PAPPI showed that plantar pressures from hallux valgus patients did not have a single, homogeneous pattern, but instead, 5 abnormal pressure patterns were observed in sections of this population. When comparing these patterns to foot pain scores (i.e. Foot Function Index, Manchester-Oxford Foot Questionnaire) and radiographic hallux angle measurements, we observed that patients with increased pressure under metatarsal 1 reported less foot pain than other patients in the cohort, while patients with abnormal pressures in the heel showed more severe hallux valgus angles and more foot pain. Also, incidences of pes planus were higher in our hallux valgus cohort compared to the modelled healthy controls. PAPPI helped to clarify recent discrepancies in group-level plantar pressure studies and showed its unique ability to produce quantitative, interpretable, and personalized analyses for plantar pressure images.

Contains fulltext : 217419.pdf (Publisher’s version ) (Closed access)

Contains fulltext : 221484.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 229815.pdf (Publisher’s version ) (Closed access), INTRODUCTION: This study investigated the effect of operative claw toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). METHODS: Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic claw toes were measured three months before and 12months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N=15). RESULTS: Claw toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. DISCUSSION: These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on claw toe deformity.

Item does not contain fulltext, BACKGROUND: Despite impressive results of the pharmacological management of rheumatoid arthritis, still certain patients suffer from rheumatoid forefoot problems. Surgical treatment of these forefoot deformities can be an option. In literature no high-quality studies on this topic can be found. The goal of present study is to compare the results of a metatarsal head (MTH) resecting technique with a MTH preserving technique in the operative treatment of severe rheumatoid forefoot deformity. METHODS: Patients suffering from well-defined rheumatoid forefoot deformity were prospectively enrolled in three institutions. This non-blinded study had a randomised clinical design and eligible patients were randomly assigned to undergo either resection of preservation of the MTH. The primary outcome measure consisted of the AOFAS score. Secondary outcome measures were: the FFI, the VAS for pain and the SF-36. RESULTS: Twenty-three patients (10 in MTH preservation group) were included and analysed. After one year follow-up no significant differences in AOFAS score and additional outcome factors were found. A total of 10 complications in 23 patients were reported. CONCLUSIONS: This randomised clinical study did not show significant clinical difference between a MTH resecting and a preserving procedure in patients suffering from rheumatoid forefoot deformity. Both procedures resulted in considerable improvement of pain and activity scores.

Item does not contain fulltext, Trunk coordination is essential for many activities of daily living in wheelchair users. This study investigated whether Fitts' law is applicable to trunk movements in a sitting position. Fourteen healthy adults performed two series of 24 tasks of trunk flexion-extension movements in a sitting position. The results showed significant linear relationships between average group movement time (MT) and index of difficulty (ID) over all tasks (r(2) = 0.92) and within target distances (0.94 < r(2) < 1.00). Target distance affected intercept and slope (P < 0.001). Hence, Fitts' law is applicable to the studied trunk movements in a sitting position, indicating these trunk movements tasks could serve as a basis for qualitative trunk coordination tests. Transferability of these conclusions to wheelchair users, and optimal test design should be further investigated.

Contains fulltext : 206267.pdf (publisher's version ) (Open Access)

Contains fulltext : 215583.pdf (publisher's version ) (Closed access), Introduction: Powered robotic exoskeletons are a promising solution to enable standing and walking in patients with spinal cord injury (SCI). Although training and walking with an exoskeleton in motor complete SCI patients is considered safe, the risks of unexpected (technical) adverse events and the risk of fractures are not fully understood. This article reports the occurrence of two different cases of bone fracture during exoskeleton usage. Furthermore, advice is given for extra safety training and instructions. Case presentation: The first case concerns a 47-year-old woman with T12 AIS A SCI. Her exoskeleton shut down unexpectedly probably causing a misalignment of the joints of her lower extremities relative to the joints of the exoskeleton, which resulted in a fracture of her left tibia. The second case involves a 39-year-old man with L1 AIS B SCI. An unexpected fracture of the right distal tibia occurred without a specific prior (traumatic) incident. Discussion: Exoskeleton training instructors, SCI patients and their buddies should be instructed how to handle emergency situations. Furthermore, they should be aware of the risk of stress fractures of the lower extremities. Proper alignment of the exoskeleton relative to the body is of utmost importance to reduce fracture risk. In the case of swelling and discoloring of the skin, radiographic examination should be performed in order to exclude any fracture.

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Contains fulltext : 203261.pdf (publisher's version ) (Open Access), Data reduction techniques are commonly applied to dynamic plantar pressure measurements, often prior to the measurement's analysis. In performing these data reductions, information is discarded from the measurement before it can be evaluated, leading to unkonwn consequences. In this study, we aim to provide the first assessment of what impact data reduction techniques have on plantar pressure measurements. Specifically, we quantify the extent to which information of any kind is discarded when performing common data reductions. Plantar pressure measurements were collected from 33 healthy controls, 8 Hallux Valgus patients, and 10 Metatarsalgia patients. Eleven common data reductions were then applied to the measurements, and the resulting datasets were compared to the original measurement in three ways. First, information theory was used to estimate the information content present in the original and reduced datasets. Second, principal component analysis was used to estimate the number of intrinsic dimensions present. Finally, a permutational multivariate ANOVA was performed to evaluate the significance of group differences between the healthy controls, Hallux Valgus, and Metatarsalgia groups. The evaluated data reductions showed a minimum of 99.1% loss in information content and losses of dimensionality between 20.8% and 83.3%. Significant group differences were also lost after each of the 11 data reductions (alpha=0.05), but these results may differ for other patient groups (especially those with highly-deformed footprints) or other region of interest definitions. Nevertheless, the existence of these results suggest that the diagnostic content of dynamic plantar pressure measurements is yet to be fully exploited.

Contains fulltext : 198297.pdf (publisher's version ) (Open Access)

01 december 2018, Item does not contain fulltext, BACKGROUND CONTEXT: Patients with adolescent idiopathic scoliosis (AIS) perform surprisingly well after spinal correction and fusion. It was previously hypothesized that, during gait, certain mechanisms compensate for the loss in spinal motion. Still, previous studies could not identify such compensatory mechanisms in the lower body. PURPOSE: This study aims to test the hypothesis of a compensatory increased motion of the distal unfused part of the spine during gait after posterior spinal correction and fusion. STUDY: This is a prospective gait study. PATIENTS AND METHODS: Twelve patients with AIS were included. Sets of three VICON skin markers were used to measure the 3D motion of the proximal part of the fusion in relation to the pelvis (PFP) and the distal part of the fusion in relation to the pelvis (DFP). By doing so, PFP represents the motion of the fused and unfused parts of the spine, and DFP represents the motion of the unfused part of the spine. Measurements were performed preoperatively and 3 and 12 months after posterior spinal correction and fusion. RESULTS: Surgery resulted in a decrease in PFP transversal plane range of motion (ROM) (8.3 degrees vs. 5.9 degrees , p=.006). No compensatory increase in the ROM of DFP could be identified. Actually, DFP transversal plane ROM also decreased (8.2 degrees vs. 5.6 degrees , p=.019). No improvement over time was observed when comparing the 3- and 12-month postoperative measurements. CONCLUSIONS: The hypothesis of a compensatory increase in motion of the distal unfused segments after spinal fusion for AIS is a much researched and controversial topic. This study is the first to study this hypothesis in such detail during gait and could not demonstrate such increase.

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Item does not contain fulltext, Previous gait analysis studies of patients with an ankle arthrodesis have reported increased motion in the adjacent joints. However, of similar importance are the forces that act on the ipsi- and contralateral joints and the effect of ankle arthrodesis with regard to balance control. The purpose of the present study was to determine the joint moments and the amount of asymmetrical loading of the ankle and joints adjacent to the ankle in patients after successful ankle arthrodesis. Therefore, 8 patients with a painless ankle fusion were included and assessed using 4 functional tests: preferred and fast speed walking, a sit-to-stand test, and a balance test. The ground reaction force and ankle joint moment were smaller in the fused ankle. During the balance on foam test, the velocity of the center of pressure was significantly larger on the contralateral extremity. In conclusion, ankle arthrodesis leads to small asymmetries in joint moments during gait, indicating greater loading of the contralateral ankle. In addition, the unaffected leg compensates for the operated leg in balance control. Because of the small alterations, overuse of the contralateral ankle is not expected after ankle arthrodesis.