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There is a call to action for physiotherapists worldwide to contribute to the transition towards 'sustainable health'. In this paper, we build upon the current definition of 'sustainable health' and also on 'sustainable physical activity' to introduce and theoretically substantiate the concept of sustainable human movements, and suggest a definition thereof. Sustainable human movements will be described as a threshold concept with three aligned critical concepts; (i) movement control, including forces as causes of emerging movements, (ii) movement quality, referring to how movements are performed in terms of optimisation, and (iii) physical literacy, including motivation, confidence and physical competence. A deep understanding of these concepts, combined with a collaboration and learning approach applied together with the patient, is proposed to enable a sustainable human movement approach to permeate physiotherapy theory and practice. To facilitate this, a generic and easily accessible tool has recently been developed. It combines support for structured observational movement analysis and pedagogical support for creating a mutual and extended understanding of a patient's lived experience. This encourages the patient to become actively involved and take responsibility for promoting his/her 'sustainable health'. The aims of this paper are to a) suggest a theoretical framework for and definition of the concept sustainable human movements, and b) introduce a clinical tool that ultimately aims at promoting sustainable movements and health., Säker i varje steg 2.0

Background: Whole-body movement adjustments during gait are common post-stroke, but comprehensive ways of quantifying and evaluating gait from a whole-body perspective are lacking. Research question: Can novel kinematic variables related to Center of Mass (CoM) position discriminate side asymmetries as well as coordination between the upper and lower body during gait within persons post-stroke and compared to non-disabled controls? Methods: Thirty-one persons post-stroke and 41 age-matched non-disabled controls walking at their self-selected speed were recorded by 3D motion capture. The Ankle-CoM Inclination Angle (A-CoMIA) and the Head-CoM Inclination Angle (H-CoMIA) defined the angle between the CoM and the ankle and the head, respectively, in the frontal plane. These angles and their angular velocities were compared between groups, and with regard to motor impairment severity during all phases of the gait cycle (GC) using a functional interval-wise testing analysis suitable for curve data. Upper and lower body coordination was assessed using cross- correlation. Results: The A-CoMIA was symmetrical between body sides in persons post-stroke but larger compared to controls. The angular velocity of A-CoMIA also differed when compared to controls. The H-CoMIA was consistently asymmetrical in persons post-stroke and larger than in controls throughout the stance phase. There were only minor group differences in the angular velocity of H-CoMIA, with some side asymmetry in persons post-stroke. The A-CoMIA of the non-affected side, and the H- CoMIA, discriminated between persons with more severe impairments compared to those with milder impairments post-stroke. The variables showed strong cross- correlations in both groups. Significance: The A-CoMIA and Head-CoMIA discriminated post-stroke gait from non-disabled, as well as motor impairment severity. These variables with the advantageous curve analysis during the entire GC add valuable whole-body information to existing pa, Rörelsekontroll efter stroke - kliniska och laboratoriebaserade utfallsmått och i relation till funktionell hjärnavbildning, Förbättrad analys och tolkning av rörelsedata från personer med funktionshinder - innovativa statistiska metoder

Objective. The NeuroFlexor is a novel method incorporating a biomechanical model for the measurement of neural and nonneural contributions to resistance induced by passive stretch. In this study, we used the NeuroFlexor method to explore components of passive movement resistance in the wrist and finger muscles in subjects with Parkinson's disease (PD). Methods. A cross-sectional comparison was performed in twenty-five subjects with PD with clinically identified rigidity and 14 controls. Neural (NC), elastic (EC), and viscous (VC) components of the resistance to passive extension of the wrist were calculated using the NeuroFlexor. Measurements were repeated during a contralateral activation maneuver. Results. PD subjects showed greater total resistance (P < 0.001) and NC (P = 0.002) compared to controls. EC and VC did not differ significantly between groups. Contralateral activation maneuver resulted in increased NC in the PD group but this increase was due to increased resting tension. Total resistance and NC correlated with clinical ratings of rigidity and with bradykinesia. Conclusions. The findings suggest that stretch induced reflex activity, but not nonneural resistance, is the major contributor to rigidity in wrist muscles in PD. The NeuroFlexor is a potentially valuable clinical and research tool for quantification of rigidity.

We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait., Le contrôle nerveux et la biomécanique de la marche chez le sujet sain et le sujet hémiplégique ainsi que les stratégies de rééducation au regard de la physiopathologie de la marche après accident vasculaire cérébral (AVC) ont été passés en revue. Chez le sujet sain ou hémiplégique, un contrôle moteur de type modulaire tâche-dépendant assure simultanément le support antigravitaire, le contrôle de l’équilibre et la déambulation au cours de la marche. L’hémiparésie après AVC est due à une interruption de voies nerveuses descendantes habituellement sans lésion directe des structures du tronc cérébral et du cervelet impliqués dans le contrôle moteur automatique. Après AVC, la récupération d’une station debout et de la marche se fait habituellement avec un comportement postural impliquant davantage le côté non atteint dans le contrôle du support et de l’équilibre, probablement suite à la faiblesse musculaire initiale du côté atteint. Divers types de rééducation sont pratiqués, visant directement le comportement musculaire ou des tâches posturales ou de locomotion en utilisant un équipement plus ou moins sophistiqué. Bien que la faible vitesse de marche s’améliore souvent avec le temps ou après diverses rééducations, le comportement postural asymétrique est souvent renforcé, maintenu ou seulement réduit transitoirement. Ce comportement postural asymétrique apparaît robuste, avec utilisation prédominante du côté non atteint pour assurer les tâches posturales antigravitaires. Ainsi chez les patients post-AVC, il est suggéré que la rééducation, incluant des renforcements et étirements des muscles parétiques, associe aussi divers exercices impliquant une utilisation posturale automatique des muscles parétiques pour corriger le comportement postural asymétrique et en tirer un bénéfice secondaire sur la marche.

Knowledge regarding neuroplasticity post-stroke is increasingly expanding. In spite of this, only a few physiotherapy interventions have been able to demonstrate effectiveness in achieving recovery of lost sensorimotor control. The aims of this review article are to highlight and discuss challenges for physiotherapists working with patients post-stroke, to question some current assessment methods and treatment approaches, and to pose critical questions indicating a possible new direction for physiotherapists in stroke rehabilitation. Differentiation between recovery and compensation post-stroke is increasingly being emphasized. Implementation of this goal in the clinic is insufficient, with a lack of assessment tools with potential to discriminate between the concepts. Large-scale reviews are performed without considering whether functional gains are achieved through “more effective” compensatory strategies or through recovery. Cortical plasticity in neurorehabilitation research and voluntary control in contemporary treatment methods are in focus. Challenges for physiotherapists in stroke rehabilitation consist of rethinking, including looking upon the body under the influence of gravity, focusing on implicit factors that impact movement control and developing new assessment tools. The introduction of a new assessment and treatment concept aiming at expanding the boundaries of center of mass movements towards the paretic side is proposed. In conclusion, we need to assume our responsibilities and step forward as the experts in movement science that we have the potential to be.

Background: Sit-to-stand (STS) is a crucial transfer influencing a person's independence in daily activities, as well as safety and quality of life, and is thus vital to evaluate in research and in practice. Clinical STS tests provide single values in seconds or numbers of STS. There is, however, increasing numbers of research papers reporting spatial and temporal kinematic and kinetic process STS data. Objectives: To provide an overview of research findings from laboratory-based movement analyses regarding phases and determinants of typical STS, characteristics of successful versus failed STS transfers, and finally STS performance in some neurological conditions. Major Findings: The STS transfer, previously regarded as mainly requiring lower limb muscle strength, is increasingly recognized as a complex transfer skill. Muscle strength, balance, foot position, chair height and the movement strategy are major determinants influencing STS performance. Scaling and timing of momentum generation throughout STS seems critical for success or failure. Sit-to-stand in stroke and Parkinson's disease (PD) is characterized by asymmetry in force generation and difficulties in switching movement direction, respectively. In-depth, knowledge regarding mechanisms of momentum control during STS sub-phases, STS failures, as well as exploration of variability in normal and atypical STS is still lacking. Conclusions: Recent research based on instrumented movement analyses has generated better understanding of movement control during STS, but the specifics are not yet reflected in clinical assessments. There seems to be a call for clinical tools capturing determinants and process characteristics of the STS transfer for a more comprehensive evaluation in rehabilitation.

The purpose of the study was to apply the Arm Posture Score (APS) to a stroke population, since comprehensive measures to quantify arm swing in the affected and non-affected arms during gait are lacking. A further aim was to investigate how gait speed and upper limb function estimated by clinical measures are related to the APS in the stroke group. The APS is the summarized root mean square deviation (RMSD) from normal, based on kinematics. Four arm movements (sagittal and frontal planes) as well as six arm movements (incorporating transversal plane) were included in the calculation of APS, referred to as APS4 and APS6, respectively. The study population consisted of 25 persons with stroke and 25 age- and gender-matched controls. The APS measures were significantly different between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls (p≤0.001). Spasticity significantly influenced both APS measures, while speed only had a significant effect on the APS4. The APS measures correlated significantly to clinical measures of upper limb function. Both APS measures seem to be useful indices to quantify and discriminate between impaired and normal arm swing during gait after stroke. The variability of rotational arm movements needs to be studied further before considering the additional value of the APS6 over the APS4. When interpreting the APS, complementary kinematics should be taken into account, as the single value of the APS gives no information about the direction of the deviation.

In 3D gait analysis, quantification of leg movements is well established, whereas ameasure of armswing has been lacking. Recently, the Arm Posture Score (APS) was introduced to characterize arm movements in children with cerebral palsy, including information from four variables (APS(4)) in the sagittal and frontal planes. A potential limitation of the APS is that it does not include rotational movements and has not yet been evaluated with regard to gait speed. The aims of this study were (i) to investigate the effect on APS of adding two components of arm rotation (APS(6)) and (ii) to determine the influence of gait speed on the APS measures, when applied to non-disabled adults. Forty-two subjects walked 10 m at a selfselected speed (1.34 m/s), and in addition a subgroup of 28 subjects walked at a slowspeed (0.66 m/s) set by a metronome. Data were collected from markers in a whole-body set up and by eight optoelectronic cameras. The results demonstrated significantly higher APS(6) than APS(4) values for both arms, irrespective of gait speed. Speed condition, whether self-selected or slow, had a significant effect on both APS measures. The two additional arm components are suggested to provide relevant information about arm swing during walking. However, APS(6) needs to be implemented in gait analysis of individuals with gait arm pathologies in order to further examine its utility. Werecommend that gait speed should to be taken into account when using APS measures to quantify arm swing during gait. (C) 2014 Elsevier B. V. All rights reserved.

OBJECTIVES: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups. DESIGN: Cross-sectional. SETTING: Research laboratory. PARTICIPANTS: A convenience sample of persons with hemiparesis (n=10; age 50-67y) more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs). RESULTS: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group. CONCLUSIONS: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.