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Background: An important goal in the treatment of osteoporotic vertebral compression fractures (OVCFs) is the prevention of new vertebral fractures and the subsequent progression to global sagittal malalignment. Current conservative treatment is multimodal and comprises analgesics, medication for osteoporosis, and physical therapy. However, little is known about the value of orthoses in the treatment of OVCFs.Aims: The primary purpose of this study was to examine the direct effect of a semirigid thoracolumbar orthosis on gait in patients suffering from an OVCF. The secondary purpose was to evaluate changes in gait, radiographic sagittal alignment, pain, and quality of life over time.Methods: Fifteen postmenopausal patients with an OVCF were treated with a semirigid thoracolumbar orthosis. At baseline, after 6 weeks, and after 6 months, gait analysis was performed with a dual belt instrumented treadmill with a 180 degrees projection screen providing a virtual environment (computer-assisted rehabilitation environment) combined with clinical and radiographic assessments.Results: At baseline, bracing caused a significantly more upright posture during walking and patients walked faster, with larger strides, longer stride times, and lower cadence compared to walking without orthosis. After 6 weeks, radiographic and dynamic sagittal alignment had improved compared to baseline. The observed effect was gone after 6 months, when the orthosis was not worn anymore.Conclusion: A semirigid thoracolumbar orthosis seems to have a positive effect on gait and stability in patients suffering from an OVCF, as was shown by a more upright posture, which may result in decreased compressive loading of the vertebrae. For studying the true effectiveness of dynamic bracing in the treatment of OVCFs, a prospective, randomized controlled trial will be needed.

Objectives: To investigate immediate changes in walking performance associated with three implicit motor learning strategies and to explore patient experiences of each strategy. Design: Participants were randomly allocated to one of three implicit motor learning strategies. Within-group comparisons of spatiotemporal parameters at baseline and post strategy were performed. Setting: Laboratory setting. Subjects: A total of 56 community-dwelling post-stroke individuals. Interventions: Implicit learning strategies were analogy instructions, environmental constraints and action observation. Different analogy instructions and environmental constraints were used to facilitate specific gait parameters. Within action observation, only videotaped gait was shown. Main measures: Spatiotemporal measures (speed, step length, step width, step height) were recorded using Vicon 3D motion analysis. Patient experiences were assessed by questionnaire. Results: At a group level, three of the four analogy instructions (n = 19) led to small but significant changes in speed (d = 0.088 m/s), step height (affected side d = 0.006 m) and step width (d = -0.019 m), and one environmental constraint (n = 17) led to significant changes in step width (d = -0.040 m). At an individual level, results showed wide variation in the magnitude of changes. Within action observation (n = 20), no significant changes were found. Overall, participants found it easy to use the different strategies and experienced some changes in their walking performance. Conclusion: Analogy instructions and environmental constraints can lead to specific, immediate changes in the walking performance and were in general experienced as feasible by the participants. However, the response of an individual patient may vary quite considerably.

Facioscapulohumeral dystrophy (FSHD) is a progressive muscle-wasting disease which leads to a decline in upper extremity functionality. Although the scapulohumeral joint's stability and functionality are affected, evidence on the synergetic control of the shoulder muscles in FSHD individuals is still lacking. The aim of this paper is to understand the neuromuscular changes in shoulder muscle control in people with FSHD. Upper arm kinematics and electromyograms (EMG) of eight upper extremity muscles were recorded during shoulder abduction-adduction and flexion-extension tasks in eleven participants with FSHD and 11 healthy participants. Normalized muscle activities were extracted from EMG signals. Non-negative matrix factorization was used to compute muscle synergies. Maximum muscle activities were compared using non-parametric analysis of variance. Similarities between synergies were also calculated using correlation. The Biceps Brachii was significantly more active in the FSHD group (25 +/- 2%) while Trapezius Ascendens and Serratus Anterior were less active (32 +/- 7% and 39 +/- 4%, respectively). Muscle synergy weights were altered in FSHD individuals and showed greater diversity while controls mostly used one synergy for both tasks. The decreased activity by selected scapula rotator muscles and muscle synergy weight alterations show that neuromuscular control of the scapulohumeral joint is less consistent in people with FSHD compared to healthy participants. Assessments of muscle coordination strategies can be used to evaluate motor output variability and assist in management of the disease.

Eva Jacobs,1 Rachel Senden,2 Christopher McCrum,2,3 Lodewijk W van Rhijn,1 Kenneth Meijer,2 Paul C Willems1 1Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center+, Maastricht 6229 HX, the Netherlands; 2Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands; 3Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany Background: An important goal in the treatment of osteoporotic vertebral compression fractures (OVCFs) is the prevention of new vertebral fractures and the subsequent progression to global sagittal malalignment. Current conservative treatment is multimodal and comprises analgesics, medication for osteoporosis, and physical therapy. However, little is known about the value of orthoses in the treatment of OVCFs.Aims: The primary purpose of this study was to examine the direct effect of a semirigid thoracolumbar orthosis on gait in patients suffering from an OVCF. The secondary purpose was to evaluate changes in gait, radiographic sagittal alignment, pain, and quality of life over time.Methods: Fifteen postmenopausal patients with an OVCF were treated with a semirigid thoracolumbar orthosis. At baseline, after 6 weeks, and after 6 months, gait analysis was performed with a dual belt–instrumented treadmill with a 180° projection screen providing a virtual environment (computer-assisted rehabilitation environment) combined with clinical and radiographic assessments.Results: At baseline, bracing caused a significantly more upright posture during walking and patients walked faster, with larger strides, longer stride times, and lower cadence compared to walking without orthosis. After 6 weeks, radiographic and dynamic sagittal alignment had improved compared to baseline. The observed effect was gone after 6 months, when the orthosis was not

Tendons transfer forces produced by muscle to the skeletal system and can therefore have a large influence on movement effectiveness and safety. Tendons are mechanosensitive, meaning that they adapt their material, morphological and hence their mechanical properties in response to mechanical loading. Therefore, unloading due to immobilization or inactivity could lead to changes in tendon mechanical properties. Additionally, ageing may influence tendon biomechanical properties directly, as a result of biological changes in the tendon, and indirectly, due to reduced muscle strength and physical activity. This review aimed to examine age-related differences in human leg extensor (triceps surae and quadriceps femoris) muscle-tendon unit biomechanical properties. Additionally, this review aimed to assess if, and to what extent mechanical loading interventions could counteract these changes in older adults. There appear to be consistent reductions in human triceps surae and quadriceps femoris muscle strength, accompanied by similar reductions in tendon stiffness and elastic modulus with ageing, whereas the effect on tendon cross sectional area is unclear. Therefore, the observed age-related changes in tendon stiffness are predominantly due to changes in tendon material rather than size with age. However, human tendons appear to retain their mechanosensitivity with age, as intervention studies report alterations in tendon biomechanical properties in older adults of similar magnitudes to younger adults over 12-14 weeks of training. Interventions should implement tendon strains corresponding to high mechanical loads (i.e., 80-90% MVC) with repetitive loading for up to 3-4 months to successfully counteract age-related changes in leg extensor muscle-tendon unit biomechanical properties.

BACKGROUND: Resident loved ones of patients with COPD can play an important role in helping these patients engage in physical activity. We aimed to compare activity levels and exercise motivation between patients with COPD and their resident loved ones; to compare the same outcome measures in patients after stratification for the physical activity level of the loved ones; and to predict the likelihood of being physically active in patients with a physically active resident loved one.METHODS: One hundred twenty-five patient/loved one dyads were cross-sectionally and simultaneously assessed. Sedentary behavior, light activities, and moderate to vigorous physical activity (MVPA) were measured with a triaxial accelerometer during free-living conditions for at least 5 days. Five exercise-motivation constructs were investigated: amotivation, external regulation, introjected regulation, identified regulation, and intrinsic regulation.RESULTS: Patients spent more time in sedentary behavior and less time in physical activity than their loved ones (P <.0001). More intrinsic regulation was observed in loved ones compared with patients (P = .003), with no differences in other constructs. Despite similar exercise motivation, patients with an active loved one spent more time in MVPA (mean 31 min/d; 95% CI, 24-38 min/d vs mean, 18 min/d; 95% CI, 14-22 min/d; P = .002) and had a higher likelihood of being active (OR, 4.36; 95% CI, 1.41-13.30; P = .01) than did patients with an inactive loved one after controlling for age, BMI, and degree of airflow limitation.CONCLUSIONS: Patients with COPD are more physically inactive and sedentary than their loved ones, despite relatively similar exercise motivation. Nevertheless, patients with an active loved one are more active themselves and have a higher likelihood of being active.

Background: Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults.Methods: A systematic search was conducted in PubMed, Web of Science, MEDLINE and CINAHL databases in December 2015, repeated in May 2016, using sets of terms relating to gait, perturbations, adaptation and training, and ageing. Inclusion criteria: studies were conducted with healthy participants of 60 years or older; repeated, unpredictable, mechanical perturbations were applied during walking; and reactive recovery responses to gait perturbations or the incidence of laboratory or daily life falls were recorded. Results were narratively synthesised. The risk of bias for each study (PEDro Scale) and the levels of evidence for each perturbation type were determined.Results: In the nine studies that met the inclusion criteria, moveable floor platforms, ground surface compliance changes, or treadmill belt accelerations or decelerations were used to perturb the gait of older adults. Eight studies used a single session of perturbations, with two studies using multiple sessions. Eight of the studies reported improvement in the reactive recovery response to the perturbations. Four studies reported a reduction in the percentage of laboratory falls from the pre-to post-perturbation experience measurement and two studies reported a reduction in daily life falls. As well as the range of perturbation types, the magnitude and frequency of the perturbations varied between the studies.Conclusions: To date, a range of perturb

Background: Patients with intermittent claudication (IC) tend to walk slower and consume approximately 40% more oxygen during walking compared with healthy individuals. An unfavorable locomotion pattern has been suggested to explain this metabolic inefficiency. However, detailed knowledge of gait parameters in IC is lacking.Methods: In a cross-sectional study, the gait pattern of newly diagnosed IC patients was compared with that of healthy controls. Spatiotemporal gait parameters such as step length and duration of stance phase were obtained by a photoelectric technique (OptoGait; Microgate, Bolzano, Italy). This system was previously found to have favorable concurrent validity and test-retest reliability characteristics. Parameters were determined during pain-free and painful treadmill walking at a comfortable self-determined walking pace. Each parameter was averaged on the basis of 80 steps.Results: A total of 28 patients and 28 controls were examined. IC patients walked 1.2 km/h (-27%) slower than controls (P <.001), coinciding with a significantly shorter step length (-20%) and lower cadence (-11%). IC patients demonstrated a longer stance and double support phase, even before the onset of ischemic pain. Differences were also observed in segments of the stance phase, as a 14% shorter propulsion (P <.001) and 17% longer flat foot phase (P <.001) during painful walking were found. In considering the absolute duration of these stance phase segments, differences were found only for the flat foot time (Delta 0.10 second; P <.001).Conclusions: Patients with IC demonstrate an altered gait pattern compared with healthy controls. The most prominent differences were a prolonged relative and absolute duration of the flat foot position during the stance phase. This adaptation may be intuitive as an augmented arterial blood flow into skeletal muscles is allowed during a prolonged relaxation phase. Therefore, not only the lack of propulsio

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..

Background: Arthrodesis of the first metatarsophalangeal (MTP1) joint is an intervention often used in patients with severe MTP1 joint osteoarthritis and relieves pain in approximately 80% of these patients. The kinematic effects and compensatory mechanism of the foot for restoring a more normal gait pattern after this intervention are unknown. The aim of this study was to clarify this compensatory mechanism, in which it was hypothesized that the hindfoot and forefoot would be responsible for compensation after an arthrodesis of the MTP1 joint.Methods: Gait properties were evaluated in 10 feet of 8 patients with MTP1 arthrodesis and were compared with 21 feet of 12 healthy subjects. Plantar pressures and intersegmental range of motion were measured during gait by using the multisegment Oxford Foot Model. Pre- and postoperative X-rays of the foot and ankle were also evaluated.Results: The MTP1 arthrodesis caused decreased eversion of the hindfoot during midstance, followed by an increased internal rotation of the hindfoot during terminal stance, and ultimately more supination and less adduction of the forefoot during preswing. In addition, MTP1 arthrodesis resulted in a lower pressure time integral beneath the hallux and higher peak pressures beneath the lesser metatarsals. A mean dorsiflexion fusion angle of 30 5.4 degrees was observed in postoperative radiographs.Conclusion: This study demonstrated that the hindfoot and forefoot compensated for the loss of motion of the MTP1 joint after arthrodesis in order to restore a more normal gait pattern. This resulted in a gait in which the rigid hallux was less loaded while the lesser metatarsals endured higher peak pressures. Further studies are needed to investigate whether this observed transfer of load or a preexistent decreased compensatory mechanism of the foot can possibly explain the disappointing results in the minority of the patients who experience persistent complaints after a MTP1 arthr

Van Hooren, B, Bosch, F, and Meijer, K. Can resistance training enhance the rapid force development in unloaded dynamic isoinertial multi-joint movements? A systematic review. J Strength Cond Res 31(8): 2324-2337, 2017-The objectives of this systematic review were to (a) evaluate whether resistance training can improve the rapid force development in unloaded dynamic isoinertial multi-joint movements and (b) investigate whether these effects differ between untrained/ recreationally trained and well-trained individuals. Four electronic databases were screened for studies that measured the effects of resistance training on rapid force development in unloaded dynamic isoinertial multi-joint movements. Twelve studies with a total of 271 participants were included. 10/26 (38%) and 6/14 (43%) of the measures of rapid force development in unloaded dynamic isoinertial multi-joint movements significantly improved following training in the untrained/recreationally trained and well-trained individuals, respectively. Additionally, 7/14 (50%) and 3/12 (25%) of the measures significantly improved during a countermovement and squat jump in the untrained/recreationally trained individuals and 4/6 (67%) and 2/8 (25%) significantly improved during a countermovement and squat jump in the well-trained individuals, respectively. These findings indicate that resistance training has a limited transfer to rapid force development in unloaded dynamic isoinertial multi-joint movements, especially for well-trained individuals and in movements without a countermovement. Furthermore, rapid force development has likely a limited transfer from movements with countermovement to movements without a countermovement and from bilateral movements to unilateral movements. Therefore, it is important to specifically mimic the actual sport movement in order to maximize the transfer of training and testing.

We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV1], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV1, worse dyspnoea and higher ADO index compared to other clusters (p < 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.