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Participation has become an important measure of outcome in child rehabilitation as young children with developmental disabilities are increasingly at risk of decreased participation. Therefore, this study garnered information on clinicians’ perspectives regarding perceived facilitators and barriers when rendering participation-based interventions using a qualitative research design. Semi-structured interviews of clinicians (Ns = 12, 25–57 years) were conducted and evaluated via an inductive thematic analysis. Results denote that current mechanisms of providing participation-based interventions resembled traditionally focused interventions; thus, resulting in a knowledge-to-practice gap. Clinicians desired more opportunities to communicate with caregivers and to be able to influence the children’ s natural environments. They also identified shortness of time, resources, and rigid health care regulations as barriers hampering the efficacy of participation-based services.

Neonatal brachial plexus palsy (NBPP) is a prominent form of newborn morbidity with a potentially disabling persistence. Neurosurgical intervention is indicated in select NBPP patients. Early prognostic assessment would facilitate rational selection of those infants for surgery. We conducted a systematic literature review to determine the prognostic value of early electrodiagnosis (EDx) in NBPP. We included 16 observational studies with a total sample size of 747 children. Risk of bias and quality of evidence were rated. Wide variation was found in EDx techniques, outcome algorithms, and decisionmaking. Nevertheless, the most methodologically sound studies support the use of EDx, at standardized time-frames, as a key prognostic modality for complementing clinical judgment and neuroimaging. An accurate knowledge of the underlying anatomy of the nerve injury helps to counsel families and to guide reconstructive strategy.

ObjectivesParticipation refers to a person’s involvement in activities and roles that provide interaction with others as well as engagement in family and community activities. Young children with developmental disabilities (DD) such as attention deficit hyperactive disorder, autism spectrum disorder and developmental coordination disorder are limited in their participation compared with their typically developing peers. This study aimed to obtain information regarding parental needs and strategies used to enable their child’s participation.DesignA thematic inductive approach with in-depth interviews was used to explore parental experiences. Eleven women and two men, between 30 and 40 years of age, who had a child (4–9 years old) with a DD diagnosis based on Diagnostic and Statistical Manual of Mental Disorders criteria, participated in semistructured interviews.ResultsTwo central themes emerged: parental needs and parental strategies used to enable their child’s participation. Parental needs were the following: increasing awareness, ameliorating parental burden, providing tailored interventions and supporting parents in finding suitable leisure activities. Parental strategies aimed at increasing their child’s resiliency, attaining maximal fit between activity requirements and child capacity, and creating inclusive opportunities and awareness.ConclusionsUnderstanding what families’ needs are and how families use and integrate strategies within the context of their daily lives provides practitioners with insights needed to support families’ resiliency in promoting their children’s participation. The results have implications for professionals as this information can be used to inform, refine, or tailor participation-based and family-centred services.

Objectives To synthesize the evidence on the psychometrics functional capacity evaluation (FCE) methods. Methods A systematic literature search in nine databases. The resulting articles were screened based on predefined in- and exclusion criteria. Two reviewers independently performed this screening. Included studies were appraised based on their methodological quality. Results The search resulted in 20 eligible studies about nine different FCE methods. The Baltimore Therapeutic Equipment work simulator showed a moderate predictive validity. The Ergo-Kit (EK) showed moderate variability and high inter- and intra-rater reliability. Low discriminative abilities and high convergent validity were found for the EK. Concurrent validity of the EK and the ERGOS Work Simulator was low to moderate. Moderate to high test–retest, inter- and intra-reliability was found in the Isernhagen Work-Systems (IWS) FCE. The predictive validity of the IWS was low. The physical work performance evaluation (PWPE) showed moderate test–retest reliability and moderate to high inter-rater reliability. Low internal and external responsiveness were found for the PWPE, predictive validity was high. The predictive validity of the short-form FCE was also high but need to be further examined on several psychometric properties. Low discriminative and convergent validity were found for the work disability functional assessment battery. The WorkHab showed moderate to high test–retest, inter- and intra-rater reliability. Conclusion Well-known FCE methods have been rigorously studied, but some of the research indicates weaknesses in their reliability and validity. Future research should address how these weaknesses can be overcome.

Participation, defined as 'involvement in life situations' according to the World Health Organisation, is a well-recognized concept and critical indicator of quality of life. In addition it has become an important outcome measure in child rehabilitation. However, little is known about the level of participation of young children with Developmental Disabilities. The aim of this study was to capture their subjective experiences of participation. An adapted informed consent based on a comic strip was used to get the children's assent. A Photo Elicitation study was used, in which photographs were taken by the children when they were involved in meaningful activities. The photographs were then used to facilitate communication with the children and to initiate in depth-interviews. Forty-seven interviews with 16 children between five and nine years were conducted based on their photographs. This method generated rich data, confirming that young children with Developmental Disabilities were able to inform us accurately on their experiences of participation. Data was analysed by means of an inductive thematic analysis. Results showed that children perceived their participation as satisfying when they can play, learn and join in family gatherings resulting in feelings of inclusion, recognition and belonging. When there are-on occasions-moments that their participation was obstructed, the children used two strategies to resolve it. Or they walked away from it and choose not to participate, or when autonomously motivated for the activity, they relied primarily on their context (i.e. mothers) as enabling their participation. Related to the data, children discussed themes related to their person, activities, connections and mediators between those themes. These themes fit well within earlier and current research on the subject of participation.

Background: “Ehlers–Danlos syndrome” (EDS) is a heritable connective disorder influencing multiple aspects of daily life. Most studies have focused on describing the physical symptoms and level of disability, but little knowledge exists about the psychosocial effects of the pathology. Participation in employment is an aspect that strongly influences quality of life of patients with chronic pathologies. This study, therefore, aimed to explore the lived experiences in employment participation of patients diagnosed with “hypermobile EDS”. Methods: An inductive thematic analysis, using semi-structured interviews was used. Nine patients, purposively selected by a continuum sampling strategy, were included. Interviews were audio-recorded and transcribed verbatim. Results: Data analysis resulted in three main themes: (1) elements assisting participation in employment, (2) limitations in employment participation, and (3) unemployment due to the “hypermobile EDS”. On the one hand, the results show that related health complaints can impede employment participation to an important extent. On the other hand, patients also report several aspects of work that can affect their well-being in a positive way. Conclusion: There are specific reasons for a person with “hypermobile EDS” to participate in employment. These reasons are different for each person and may even vary in time.Implications for rehabilitation “Hypermobile EDS” greatly impacts activities and participation in daily life. “Living with limitations” is the central theme in the lives of “Hypermobile EDS” patients. Various aspects influence work participation in people with “Hypermobile EDS”, such as work pressure, tasks, and transport to work. Work has positive effects in the lives of people with “Hypermobile EDS.” Work can create difficulties when the job requirements and tasks do not match the functional abilities of a person with “Hypermobile EDS.”.

Background The consequences of the Ehlers-Danlos Syndrome hypermobility type (EDS-HT) affect many aspects of daily life. “Living with limitations” is a central theme in the life of patients affected by this heritable disorder of connective tissue. The aim of the present study was to explore the lived experiences of women with EDS-HT concerning diagnosis, influence on daily life and becoming and being a mother. Method A phenomenological-hermeneutical study, using in-depth interviews. Patients were selected by a purposive sampling strategy. Results This study shows that the EDS-HT syndrome affects daily life. Ten woman between 31 and 65 years were interviewed. They have between 2 and 5 children. The data analysis results in six themes. (1) Getting a diagnosis is a relief and supports the choice to become a mother; (2) EDS-HT causes emotional distress, imposes a physical burden and has a major impact on social behavior; (3) EDS-HT demands a restructuring of everyday activities; (4) Children’s and mothers’ expectations do not correspond; (5) Having a supportive social and physical environment is of major importance; (6) The presence of the child reduces the feeling of illness of the mother. Conclusion The diagnosis of EDS-HT is a catalysing factor in the choice of whether or not to become a mother. EDS-HT has a huge impact on bodily functions, which in turn influences activities and participation. Implications This study gives insight in the activities of daily life of persons with EDS-HT. Health care professionals can be of great importance to help patients in (re)organizing their lives according to the available energy and in supporting their choices. They can help defining goals and setting priorities in daily life.

The harmonization of staff education is a key element for ensuring the highest standard of rehabilitation care across Europe. With this aim, the European Union of Medical Specialists (UEMS) has created a Common Training Framework, which consists of a common set of knowledge, skills and competencies for postgraduate medical training. As a body linked to the Physical and Rehabilitation (PRM) Section of the UEMS, the European PRM Board is committed to promoting the harmonization of PRM physicians qualifications. The European PRM Board accomplishes this mission, not only by determining the theoretical knowledge necessary for the practice of the PRM specialty, and the core competencies (training outcomes) to be achieved at the end of training, but also by ascertaining that a standard level of education is achieved and maintained by PRM physicians, through a medically driven system of certification. This paper provides an overview of the methodology and outcomes of the European PRM Board examination, while showing how the approach to PRM education should be considered as a reference point by scientific societies, higher education institutions, health policymakers, patients associations, and all the other bodies caring for high-quality rehabilitation provision to disabled people, at the national and European level.

Background During the early years of a child's life, participation is essential for learning and development. Children with disabilities are at risk for decreased participation. The interplay between environment and participation is identified as one of the most important factors influencing successful participation. The objective of this scoping review was to synthesize peer-reviewed literature about barriers and facilitators of participation according to the perspective of parents of children younger than 6 years with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/ or Developmental Coordination Disorder (DCD). Methods The scoping review followed Arksey and O'Malley's framework. Relevant studies were identified by a comprehensive search of scientific databases (PubMed and Web of Science). Studies describing perspectives of parents regarding their child's participation, written in English, and published between 2001 and September 2017 were included. Results A total of 854 articles were retrieved, with 13 meeting the criteria. Elements contributing to perceived barriers and facilitators were identified and organized according to the International Classification of Functioning, Child-Youth framework. Concepts contained in these studies were linked to "activities and participation" (general tasks and demands, such as bedtime and dinner routines, and social, civic life, such as play and leisure). Environment-focused factors identified were situated on "support and relationships, " "attitudes, " and "services, systems, and policies." Conclusion The review revealed guidelines focusing on family-centred care, communication with, and providing information to parents with young children with developmental disabilities (ADHD, DCD, and/ or ASD).

Background: Rehabilitation services are increasingly targeting involvement in daily life. In the International Classification of Functioning, Disability and Health this is referred to as “participation”. How-ever, questions have arisen regarding the conceptualization of participation, and consensus is lacking. Methods: The first phase of this study is a critical review of the literature to detect recurring conceptual problems in the application of participation and how researchers deal with these. The second phase is a systematic review to identify how participation measures are operationalized. Results: The critical review found possible solutions to 4 recurring key limitations: (i) how to deal with ambiguity and vagueness regarding the term “participation”; (ii) how to differentiate between activity and participation; (iii) what is the current empirical knowledge about the subjective aspects of participation; (iv) what are the different ways to measure participation. The systematic review found 18 instruments operationalizing participation in different ways: (i) unidimensional: frequency of performing activities; (ii) unidimensional: limitations in experiencing participation when performing activities; (iii) multidimensional: multiple subjective dimensions when performing activities; and (iv) multidimensional: objective and subjective dimensions. Discussion and conclusion: Notwithstanding an increasing body of knowledge, some issues remain unclear and how participation is measured is subject to debate. This results in difficulties in the use of participation in clinical practice. However, insight into the current body of knowledge and awareness of shortcomings might help clinicians who aim to apply participation in practice.

Trunk extension exercises are used to train endurance and strength of the trunk extensor muscles. Appropriate exercise dosage is crucial to achieve specific training effects, however literature describing the relation between the predetermined exercise intensity and the actual trunk extensors activity is scarce and inconclusive. To examine whether the actual activity of the thoracic and lumbar extensors during extensions exercises correspond with the predetermined intensity, electromyographic evaluation of the trunk extensors was performed during trunk extension exercises at various intensities expressed as percentages of 1-RM. The 1-RM was predetermined using 2 different methods: (1) through direct estimation by determining the maximum isometric force produced during semi-seated trunk extension on a Tergumed rehabilitation device, (2) through indirect estimation calculated based on the relation between the maximum number of repetitions of trunk extension from prone lying on a variable angle chair and the submaximal resistance at which the repetitions were performed as presented on the Holten-diagram. The total trunk muscle activity during extension exercises performed semi-seated on a rehabilitation device or from prone lying corresponds with the predetermined dosage using both estimation methods. The indirect estimation method more accurately predicts the actual trunk extensor activity for low load training than for high load training. However, the direct estimation method is suitable to closely predetermine the load and actual trunk extensors activity during high load exercises. A shift from a differential recruitment between the thoracic and lumbar extensors at low intensities to a more homogenous recruitment at high intensities is observed during semi-seated trunk extension exercises. During prone extension exercises both muscle groups equally contribute to the total muscle work regardless of the exercise intensity. Based on these findings suggestions regarding the appropriate choice of estimation and performance method are made.

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

The aim of this study was to analyse muscle activity and subjectively perceived exertion [rating of perceived exertion (RPE)] during whole-body vibration (WBV) in breast cancer survivors. Twenty breast cancer survivors and 20 healthy controls performed isometric squats on a vibration platform. RPE and muscle activity (surface electromyography) of the rectus femoris, vastus medialis, biceps femoris, tibialis anterior and gastrocnemius were recorded under the following conditions: nonvibration (0 Hz) and vibration (20-30-40-50 Hz) conditions. No significant differences were found between groups with regard to muscle activity (P=0.471) and RPE (P=0.629). Only for vastus medialis was muscle activity higher at 20 and 30 Hz compared with 40 and 50 Hz (P

The present study examined the activity levels of the thoracic and lumbar extensor muscles during different extension exercise modalities in healthy individuals. Therefore, 14 subjects performed four different types of extension exercises in prone position: dynamic trunk extension, dynamic-static trunk extension, dynamic leg extension, and dynamic-static leg extension. Pre- and post-exercise muscle functional magnetic resonance imaging scans from the latissimus dorsi, the thoracic and lumbar parts of the longissimus, iliocostalis, and multifidus were performed. Differences in water relaxation values (T2-relaxation) before and after exercise were calculated (T2-shift) as a measure of muscle activity and compared between extension modalities. Linear mixed-model analysis revealed higher lumbar extensor activity during trunk extension compared with leg extension (T2-shift of 5.01 ms and 3.55 ms, respectively) and during the dynamic-static exercise performance compared with the dynamic exercise performance (T2-shift of 4.77 ms and 3.55 ms, respectively). No significant differences in the thoracic extensor activity between the exercises could be demonstrated. During all extension exercises, the latissimus dorsi was the least activated compared with the paraspinal muscles. While all extension exercises are equivalent effective to train the thoracic muscles, trunk extension exercises performed in a dynamic-static way are the most appropriate to enhance lumbar muscle strength.

Introduction/Background Rehabilitation services are increasingly targeting involvement in daily life. Within the ICF this is referred to as participation. Questions regarding its conceptualization have been raised and a consensus is lacking. Material and method In a first phase a critical review of the literature was performed to detect recurring conceptual problems in applying participation and to detect how researchers deal with these. This leaded in the second phase to a systematic review to identify how participation measures are operationalized. Results Phase 1 resulted in possible solutions to overcome 4 recurring key-limitations: (1) how to deal with ambiguity and vagueness about the term itself, (2) how to differentiate between activity and participation (3) what is the current empirical knowledge about the subjective aspects of participation (4) what are the different ways to measure participation. Phase 2 resulted in 18 instruments operationalising participation in different ways: (a) unidimensional; the frequency of performing activities (b) unidimensional; the limitations in experiencing participation when performing activities (c) multidimensional; multiple subjective dimensions when performing activities and (d) multidimensional: objective and subjective dimensions. Conclusion Notwithstanding an increasing body-of-knowledge some issues still remain blurred and specifically how participation is measured is subject to debate. This leads to difficulties to use participation in clinical practice. However: insight in current body-of-knowledge and awareness of shortcomings might inspire professionals aiming it's application.

The aim of this study was to analyze gender differences in sagittal standing alignment at pre-peak height velocity age thereby applying a scientifically sound and practically oriented classification scheme for overall standing balance. The study population consisted of healthy boys (n = 639) and girls (n = 557) before pubertal peak growth. During subjects' habitual standing, sagittal plane measures of the spine, pelvis and lower limbs were collected using a clinical screening protocol. With each subject classified as one of three postural types (neutral, sway-back, or leaning-forward), differences in sagittal plane alignment were analyzed between sexes. The results revealed clear differences between genders in each of the postural types. Within the neutral and sway-back postural subgroups, boys presented more forward inclination of the trunk, more thoracic kyphosis and more pelvis backtilt compared with girls. Within the leaning-forward category, girls displayed more forward trunk lean, less thoracic kyphosis and more pelvic anteversion. A state of lumbar segmental hyperextension appeared to exist in female leaning-forward subjects. Our results reveal for the first time that sagittal standing alignment is different between prepubescent boys and girls when subjects are appropriately subclassified, and conversely represent a ‘wash-out effect’ when pooled. When the classification system is applied, gender-specificity in gravity line position is suggested, implying gender-related differences in lever arms and thus load. Present findings may add to our understanding of gender-specific biomechanical challenges posed by habitual posture, and may shed new light on sagittal standing alignment as a possible contributory factor in developmental spinal-pelvic disorders.

The purpose of this cohort study was to classify sagittal standing alignment of pre-peak height velocity (pre-PHV) girls, and to evaluate whether identified subgroups were associated with measures of spinal pain. This study further aimed at drawing attention to similarities and differences between the current postural classification and a previous system determined among pre-PHV boys. 557 pre-PHV girls [mean age, 10.6 years (SD, 0.47 years)] participated in the study. Three gross body segment orientation parameters and five specific lumbopelvic characteristics were quantified during habitual standing. Postural subgroups were determined by cluster analysis. Logistic regression was applied to assess the relationship between postural subgroups and spinal pain measures (pain and seeking care, assessed by self-administered questionnaire). Chi-square statistics, independent samples T test, and distribution-based methods were used for comparison with postural categorization in pre-PHV boys. Among pre-PHV girls, clinically meaningful posture clusters emerged both on the gross body segment and specific lumbopelvic level. The postural subtypes identified among pre-PHV girls closely corresponded to those previously described in pre-PHV boys, thereby allowing the use of the same, working nomenclature. In contrast to previous findings among pre-PHV boys, no associations between posture clusters and spinal pain measures were significant in girls at pre-PHV age. When comparing discrete ‘global’ alignment scores across corresponding posture types, some intriguing differences were found between genders which might involve different biomechanical loading patterns. Whether habitual posture forms a risk factor for developing spinal pain up to adulthood needs evaluation in prospective multifactorial follow-up research.

The objective of this study was to explore the experiences of men with paraplegia with regard to how they choose activities. The study involved a qualitative research design, based on a phenomenological–hermeneutical method. The findings revealed that the activities participants were choosing could be on a continuum between the individual’s self and the influence from their environment. On this continuum, the choice to perform activities was influenced by two mediating factors: the individual’s activities performed during their life-history, and their activity challenges for the future. We conclude that choosing activities is an individually constructed internal process of negotiation. Feelings of resignation and revolt appear in combination with feelings of justice and injustice when balance is not found. This knowledge provides a better understanding of the impact of spinal cord injury, sheds light on the development of distress after spinal cord injury and sheds new light on individuals’ feelings of pa...

Load-bearing exercises are performed by transfemoral amputees fitted with an osseointegrated implant to facilitate bone remodelling.This study presents the loading compliance comparing loads prescribed and applied on the three axes of the implant during static load-bearing exercises with a specific emphasis on axial and vectorial comparisons.Cohort study.A total of 11 fully rehabilitated unilateral transfemoral amputees fitted with an osseointegrated implant performed five trials in four loading conditions using a static standing frame. The load prescribed was monitored using a vertical single-axis strain gauge connected to an electronic display. The tri-axial forces applied on the implant were measured directly with an instrumented pylon including a six-channel transducer. The analysis included 'axial' and 'vectorial' comparisons corresponding to the difference between the force applied on the long axis of the implant and the load prescribed as well as the resultant of the three components of the load applied and the load prescribed, respectively.The results demonstrated that axial and vectorial differences were significant in all conditions ( p 0.05), except for the vectorial difference for the 40 kg condition ( p = 0.182).The significant lack of axial compliance led to systematic underloading of the long axis of the implant. Clinical relevance This study contributes to a better understanding of the load applied on an osseointegrated implant during the static load-bearing exercises that could contribute to improve the design of apparatus to monitor loading exercises as well as clinical guidelines for the loading progression during rehabilitation.

To investigate coronal plane trunk asymmetry (TA) and its association with sagittal postural alignment in healthy subjects before pubertal peak growth. In this cross-sectional baseline study, 1190 healthy pre-peak growth velocity subjects were included. Coronal plane TA was evaluated using back surface topography. Whole-body sagittal alignment (previously validated and objectively classified as neutral, sway-back or leaning-forward) and sagittal spinopelvic profile (trunk lean, lumbar lordosis, thoracic kyphosis, sacral inclination and length of the posteriorly inclined thoracolumbar segment) were determined, as were height, proportion of trunk to body length, body mass index, generalized joint laxity, and handedness. Logistic regression analysis yielded overall sagittal posture class to be independently associated with coronal plane TA: having a leaning-forward posture associated with a nearly three times higher odds of coronal TA (p

Examine whether implementing an active lumbopelvic control strategy during high load prone lumbar extension exercises affects posterior extensor chain recruitment and lumbopelvic kinematics.Thirteen healthy adults acquired an optimal active lumbopelvic control strategy during guided/home-based training sessions. During the experimental session electromyography was used to evaluate the activity of the posterior extensor chain muscles during high load trunk/bilateral leg extension exercises with/without application of the strategy. Video-analysis was used to evaluate thoracic/lumbar/hip angles.Implementing the active lumbopelvic control strategy decreased the lordotic angle during trunk (p=0.045; -3.2°) and leg extension exercises (p=0.019; -10°). The hip angle was solely affected during trunk extension (p0.001;+9.2°). The posterior extensor chain (i.e. mean of the relative activity of all muscles (%MVIC) was recruited to a higher extent (p=0.026;+9%) during trunk extension exercises performed with active lumbopelvic control. Applying the strategy during leg extension exercises lead to less activity of longissimus thoracic (p=0.015; -10.2%) and latissimus dorsi (p=0.010; -4.4%), and increased gluteus maximus activity (p≤0.001;+16.8%).When healthy people are taught/instructed to apply an active lumbopelvic control strategy, this will decrease the degree of lumbar (hyper)lordosis and this influences the recruitment patterns of trunk and hip extensors. Hence, the possible impact on predetermined training goals should be taken into account by trainers.

Lumbar muscle degeneration is a common feature in non-specific low back pain (LBP). It is hypothesized that degenerated muscles might compromise spinal stability and lead to further injury/pain. However, little is known about lumbar muscle morphometry after resolution of LBP. Therefore, this study investigated the extent of lumbar muscle atrophy and fatty infiltration in individuals who are at risk for a recurrence of LBP. Thirteen participants in remission of unilateral recurrent LBP were compared to 13 healthy controls, comparable for age, weight, length and level of physical activity. Total, lean muscle and fat cross-sectional area (CSA) of lumbar multifidus (MF), erector spinae (ES) and psoas (PS) were investigated on T1-weighted Magnetic Resonance Imaging (MRI), bilaterally and at 3 lumbar levels (L3 upper, L4 upper and L4 lower endplate). In addition, a muscle-fat-index (MFI) was calculated reflecting the amount of fatty infiltration in lean muscle tissue. No significant differences for total, lean muscle and fat CSA were found between people in remission of recurrent LBP and the control group. Conversely, MFI was increased bilaterally at the 2 lowest lumbar levels. There were no differences between the previously painful and non-painful side of the LBP group for any of the parameters. These results show a generalized increase in intramuscular fatty infiltration in lean muscle tissue in the absence of macroscopical signs of muscle degeneration after resolution of LBP. These findings reflect a decreased muscle quality, but not quantity, and might indicate a pathophysiological mechanism contributing to recurrence of LBP.

Study design. Cross-sectional baseline dataset on the sagittal standing posture of 1196 adolescents. Objective. To describe and quantify common variations in the sagittal standing alignment in boys and girls who are in the same phase of growth, and to explore the association between habitual standing posture and measures for spinal pain. Summary of Background Data. Data on postural characteristics and spinal pain measures in adolescence is sparse, especially when somatic and biological maturity status is to be considered. Furthermore, our understanding of the relation between standing posture in the sagittal plane and spinal pain is deficient. Methods. Six hundred thirty-nine boys (mean ± SD age, 12.6±0.54 years) and 557 girls (10.6±0.47 years) with predicted years from peak height velocity (PHV) being 1.2±0.71 years and 1.2±0.59 years pre-PHV, respectively, were studied. Postural examination included the assessment of global alignment and local spinopelvic characteristics, using post-hoc analyses of digital images and direct body measurements (palpation, digital inclinometry, and wheeled accelerometry). Spinal pain experience was assessed by questionnaire. Results. A wide interindividual variation in sagittal posture characteristics was observed. Logistic regression analyses yielded global alignment parameters to be associated with low back pain (lifetime prevalence), neck pain (lifetime prevalence, 1-month prevalence, and doctor visit), and thoracic spine pain (doctor visit) outcome measures. None of the included local spinopelvic parameters could be identified as an associated factor with measures of spinal pain. Conclusions. The orientation of gross body segments with respect to the gravity line appear superior to local spinopelvic features in terms of clinical importance, at least in the current pre-PHV cohort. Opportunities may exist for postural subgrouping strategies to begin with global alignment parameters in order to gain further insight in the relationship between sagittal alignment and the relative risk of developing spinal pain/seeking medical consultation for this pain.

From a clinical point of view, knowledge of customary standing positions among healthy young adolescents is of primary importance. The purpose of this study was to document the correlations between sagittal standing posture parameters in a pre-peak height velocity (pre-PHV) cohort.This cohort study included 639 pre-PHV boys (age 12.6 [SD, 0.54] years) and 557 pre-PHV girls (age 10.6 [SD, 0.47] years). Gross body segment orientations and spinopelvic orientation/shape indexes were quantified using a clinical screening protocol. Pearson's correlation coefficients were determined for all sagittal standing plane alignment parameters, and a postural model was used to analyze the correlations between parameters.Both at the gross body segment and spinopelvic level, an interdependence was found between postural parameters. No correlations were observed between 'global' parameters related to the pelvis, trunk or body anteroposterior translation postures and 'local' spinopelvic geometries. A similar pattern and strength of correlations was obtained in pre-PHV boys and girls, except for the reciprocal relationships between the craniovertebral angle and adjacent anatomic segment characteristics and between thoraco-lumbar geometries.Although the correlation schemes do not imply a causal relationship, the proposed postural model allows conjecture about standing posture to be organized slightly differently in pre-PHV boys and girls. Whereas the standing posture in pre-PHV boys might be organized predominantly according to an ascending mode, bottom-up and top-down organizations appear to coexist in pre-PHV girls.

Vereecken M, Vanderstraeten G, Ilsbroukx S. From "Wheelchair Circuit" to "Wheelchair Assessment Instrument for people with Multiple Sclerosis": reliability and validity analysis of a test to assess driving skills in manual wheelchair users with multiple sclerosis. Objectives To assess the reliability and validity of the Wheelchair Assessment Instrument for people with Multiple Sclerosis (WAIMS), a test to measure driving skills in manual wheelchair users with multiple sclerosis (MS). Design Three test trials per subject were conducted by 2 raters to examine reliability (inter- and intrarater) and validity (concurrent and construct). Setting A national multiple sclerosis rehabilitation center. Participants Convenience sample of manual wheelchair users with MS (n=50), participating in an inpatient or outpatient rehabilitation program in a national multiple sclerosis center. Interventions Not applicable. Main Outcome Measures The WAIMS consists of 8 items and results in 3 final test scores: ability sum score, performance time sum score, and covered distance. These 3 scores are used to calculate inter- and intrarater reliability, concurrent validity, and construct validity. Concerning validity, the test scores on the WAIMS are compared with (1) the Belgian medical prescription of a wheelchair on the item d445 (hand and arm use), based on the International Classification of Functioning, Disability and Health, (2) the Expanded Disability Status Scale, and (3) the mobility (wheelchair) item of the FIM. Results Intrarater reliability was found to be higher than interrater reliability. Except for the interrater reliability of the ability sum score, all intraclass correlation coefficients met our standard of 0.80. Concurrent validity was rather low, but construct validity showed that the WAIMS is a valid instrument to assess driving skills in manual wheelchair users with MS. Conclusions The WAIMS is a promising tool to assess driving skills in manual wheelchair users with MS, but it needs some refinements and future studies to confirm this statement.

Skeletal muscle injuries are the most common sports-related injuries and present a challenge in primary care and sports medicine. Most types of muscle injuries would follow three stages: the acute inflammatory and degenerative phase, the repair phase and the remodeling phase. Present conservative treatment includes RICE (rest, ice, compression, elevation), nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. However, if use improper, NSAIDs may suppress an essential inflammatory phase in the healing of injured skeletal muscle. Furthermore, it remains controversial whether or not they have adverse effects on the healing process or on the tensile strength. However, several growth factors might promote the regeneration of injured skeletal muscle, many novel treatments have involved on enhancing complete functional recovery. Exogenous growth factors have been shown to regulate satellite cell proliferation, differentiation and fusion in myotubes in vivo and in vitro, TGF-β1 antagonists behave as inhibitors of TGF-β1. They prevent collagen deposition and block formation of muscle fibrosis, so that a complete functional recovery can be achieved.

To open a discourse on the concept of autonomy as a precursor for participation in individuals with Spinal Cord Injury (SCI) by exploring the experiences about their perceived autonomy in their transition period from hospital to home.Based on the 'grounded theory' approach; in-depth, semi structured interviews were conducted with 11 SCI-patients. A theoretical sampling strategy was used and the data was analysed according to the constant comparative method.To capture this complexity of autonomy, the results have been structured in themes with regard to the self of the patient and his independency. The analysis showed four different typologies of how autonomy is perceived; (1) the active agent, (2) the active follower, (3) the passive follower and (4) the passive victim.Rehabilitation professionals can help individuals in disconnecting their internalised ideal of independency to avoid the illusion of being autonomous and can gain insight in the patients' typology and empower patients to avoid the paradox of being autonomous. If the ultimate goal of rehabilitation is participation; empowering the patient to achieve a 'sense of agency' instead of autonomy is the central goal for rehabilitation professionals. Empowerment and agency are key topics for the patient to gain mastery over his own life.

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

Objetivo La prueba neurodinamica del nervio mediano (PNES1, prueba neurodinamica 1 de la extremidad superior, o ULNT1 en ingles) se utiliza con frecuencia para evaluar la mecanica y la fisiologia del plexo braquial y del nervio mediano. El presente estudio investiga las PNES1 positivas en una poblacion sana con arco axilar de Langer (AAL) y analiza si el AAL afecta al arco de movimiento durante la extension de codo (AM-EC) durante la PNES1. Material y metodos De los 640 voluntarios examinados, finalmente se incluyeron 26 lados con AAL. La realizacion de un cuestionario clinico adicional revelo “sintomas menores” en algunos sujetos. Estos sintomas menores no se consideraron un trastorno porque no suponian un obstaculo para la realizacion de las actividades diarias y los sujetos no solicitaron atencion medica. Este estudio investiga si la PNES1 puede producir o reproducir sintomas menores o respuestas anormales en sujetos con AAL. Se comparo el AM-EC del lado izquierdo y derecho de los sujetos. Por otra parte, se comparo el angulo de sustraccion, que es el efecto de colocar la columna cervical en flexion lateral contralateral, entre los lados con AAL y los controles. Resultados Los lados con arco axilar de Langer mostraron un aumento significativo en la aparicion de sintomas menores y PNES1 positivas, pero no se observo efecto alguno en el AM-EC. Conclusiones Estos hallazgos indican que el AAL puede afectar de forma transitoria al haz neurovascular axilar. La falta de efectos sobre los AM-EC puede ser consecuencia del origen vascular de los sintomas menores o de una respuesta del nervio cubital/cordon medial a la PNES1.

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

The etiology of heterotopic ossification (HO) is still obscure, it is difficult to devise an effective preventive or therapeutic approach. The options for the prevention of HO are still limited. The prophylactic effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is insufficient. Moreover, NSAIDs increase the risk of nonunion and loosening in patients with multiple joint injuries. The present experimental study was designed to compare methylprednisolone with free radical scavengers for the prevention of HO. The model of Michelsson et al. was used to induce HO in the hind legs of 30 female New Zealand albino rabbits, weighing approx. 4 kg. The animals were randomized into three groups of 10 animals each, and received daily either placebo, a free radical scavenger cocktail [allopurinol and N-acetylcysteine (A/A)], or methylprednisolone in a randomized, double-blind fashion. Every four days, X-rays were obtained to measure the thickness and the length of new bone formation at the thigh. A statistically significant difference in thickness and length of newly formed bone was found between the three groups. In the placebo group HO increased from day 16 toward a medium length of 6 mm and a median thickness of 1.5 mm. In the A/A group, no signs of HO were found. In the methylprednisolone group, only one animal presented minor HO from day 32. Both free radical scavengers and methylprednisolone were found to inhibit HO, and may be considered effective measures for the prevention of heterotopic bone formation. However, it could not be demonstrated which of the two had the strongest inhibitory effect.

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

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

Objective The neurodynamic test of the median nerve (ULNT1) is frequently used to assess the mechanics and physiology of the brachial plexus and median nerve. The present study looks for a positive ULNT1 in a healthy population with Langer's axillary arch (LAA) and analyzes whether LAA affects the elbow extension range of motion (EE-ROM) of the ULNT1. Method Of 640 volunteers screened, 26 LAA sides were finally included. Additional history taking revealed “minor symptoms” in some subjects. Minor symptoms do not qualify as a disorder because there is no interference with daily activities and no medical advice is sought. This study investigates whether the ULNT1 can (re)produce minor symptoms or abnormal responses in subjects with LAA. The EE-ROM was compared between the subjects' left and right side, and the subtraction angle—which is the effect of placing the cervical spine in contralateral lateral flexion—was compared between LAA sides and controls. Results Langer's axillary arch sides showed a significant increase in the occurrence of minor symptoms and positive ULNT1, but no influence was observed on the EE-ROM. Conclusions These findings suggest that LAA may be capable of transiently provoking the axillary neurovascular bundle. The unaffected EE-ROM may be the consequence of a vascular origin of the minor symptoms or the consequence of an ulnar nerve/medial cord response to the ULNT1.

Objective: To evaluate gastrointestinal risk profiles in patients with osteoarthritis who are currently being treated, or who are candidates for treatment, with a non-steroidal anti-inflammatory drug. Methods: Patients with osteoarthritis treated by primary care physicians or physical and rehabilitation medicine (PRM) specialists in Belgium and Luxembourg were scored for gastrointestinal risk profile, low, moderate or high, based on the presence of gastrointestinal risk factors. These included advanced age, gastrointestinal history, comorbidities, medication use, smoking, and alcohol consumption. Use of gastro-protective agents (proton pump inhibitors) was also assessed. Results: A total of 190 primary care physicians and PRM specialists provided data on 885 patients. A large majority of patients were rated high-risk gastrointestinal (77.8%), with fewer moderate (19.4%) or low (2.8%) risk. The proportion of high-risk patients treated by PRM specialists was significantly lower than that treated by primary care physicians (64.7% vs 79.9%; p

Lipoma arborescens is a rare cause of chronic monoarticular arthritis, with only a few cases reported in the literature. It is most commonly seen in the knee, but cases in other joints such as the wrist, shoulder, and elbow have also been described. It is a benign condition, in which the subsynovial tissue is replaced diffusely by mature fat cells. We describe a case involving the knee and discuss the symptoms, diagnosis, and treatment.

Low back pain is a major problem involving high medical costs, therefore effective prevention strategies are essential. Stabilization exercises seem to facilitate the neuromuscular control of the lumbar spine and may be useful in prevention programs. To investigate whether specific lumbar stabilization training has an effect on muscle recruitment patterns in a healthy population, in the present study 30 subjects were recruited to perform two types of testing exercises, i.e. bridging exercises and exercises in four-point kneeling, both before and after training. Surface electromyographic data of different abdominal and back muscles were obtained. After training, analysis of the relative muscle activity levels (percentage of maximal voluntary isometric contraction) showed a higher activity of the local (segmental-stabilizing) abdominal muscles, but not of the local back muscles; minimal changes in global (torque-producing) muscle activity also occurred. Analysis of the local/global relative muscle activity ratios revealed higher ratios during all exercises after training, although not all differences were significant. These results indicate that muscle recruitment patterns can be changed in healthy subjects by means of a training program that focuses on neuromuscular control. Additional studies are needed to evaluate this type of training as a prevention strategy.

The pathogenesis of heterotopic ossification is still unclear and the preventive therapies are usually insufficient. The present study was designed to investigate the possible preventive effect of free radical scavengers on the development of experimentally induced heterotopic ossification in a rabbit model and to compare free radical scavengers with indomethacin to determine whether they act synergistically. A standard immobilization-manipulation model was used to induce heterotopic ossification in the hind legs of 40 1-year-old female New Zealand albino rabbits. The animals were divided into four groups and received daily either placebo, a free radical scavenger cocktail [allopurinol and N-acetylcysteine (A/A)], indomethacin or the combination of A/A and indomethacin in a randomized double-blind fashion. Every 4 days an X-ray was taken and the thickness and length of new bone formation was measured at the thigh. A marked statistically significant difference was found between the four groups. In the groups that received A/A, either alone or combined with indomethacin, an inhibition of bone growth, both in thickness and in length was demonstrated. In this experimental model free radical scavengers had a superior inhibitory effect on heterotopic ossification than indomethacin. Free radicals could play an important role in the pathogenesis of heterotopic ossification.

Objectives To investigate the electromyographic (EMG) trunk muscle activity during a low-load instrumented axial rotation exercise (Tergumed) and the relevance of increasing resistance. Setting Evaluation was done in a training centre in a university hospital. Participants Thirty healthy subjects without musculoskeletal or neuromuscular complaints. Main outcome measures The normalized (as a percentage of maximal voluntary isometric contractions (MVIC)) EMG activity of 14 abdominal and back muscles were investigated during dynamic trunk rotation exertions at 30%, 50% and 70% of maximum mean force (MMF). Results During the low-load (30% MMF) rotation exercise, the internal abdominal oblique muscle reached activity levels of 30% of MVIC. All the examined back muscles and the external abdominal obliques reached activity levels of 60% of MVIC. Increasing the resistance during seated axial rotation, created significantly higher relative muscle activity levels for all trunk muscles. Conclusions The results of the present study indicate that increasing resistance to 50% and 70% MMF during seated axial rotation in a Tergumed training device consistently created higher relative activity levels in all trunk muscles. In the vulnerable spine undergoing rehabilitation the results suggest that training at 30% MMF may be sufficient.

The ICF reflects a bio-psycho-social paradigm and is increasingly used in outpatients rehabilitation settings. The component of participation is in the ICF the manifestation of a bio-psycho-social reasoning. Different participation measures have already been developed and were operationalized through objective and/or a limited set of subjective variables, but keeping them as separate concepts. There is still need for a generic participation instrument including both objective and all relevant subjective variables resulting in one participation score.To develop a generic participation measure based on objective and subjective aspects and leading to one final score; the Ghent Participation Scale (GPS). Additionally it was the aim to explore whether the GPS has a good internal validity by means of factorial validity and homogeneity and whether the GPS is feasible and interpretable.Cross-sectional study.Outpatient rehabilitation centre.One hundred thirty former rehabilitation outpatients with various conditions.Item derivation for the GPS was based on qualitative research. The participants administered the GPS in the third week after discharge from the Ghent University Hospital. An exploratory factor analysis was performed to determine underlying dimensions. Statistical coherence was expressed in both item-total correlations and in Cronbach's α coefficient.An exploratory factor analysis showed 3 underlying dimensions within the GPS: 1) performing activities according to preferred choices and wishes; 2) social appreciation and acceptance by performing activities; and 3) the need to delegate activities explaining 55.8% of the total variance. The results show a good to strong homogeneity (item-total ranged from 0.58 to 0.80) and a strong internal consistency (Cronbach's α ranged from 0.76-0.92).The results of this preliminary validation study suggest that the GPS appears to be a valid measure to rate participation.Further research and more and more powerful psychometric models such as Rash Analysis or Item Response models are needed to establish a psychometrically sound instrument.

PURPOSE: To investigate the factors related to the 1-month period prevalence of low back pain (LBP), neck pain (NP) and thoracic spine pain (TSP) in young adolescents, thereby considering potential correlates from the physical, sociodemographic, lifestyle, psychosocial and comorbid pain domains. METHODS: In this cross-sectional baseline study, 69 factors potentially associated with spinal pain were assessed among 842 healthy adolescents before pubertal peak growth. With consideration for possible sex differences in associations, multivariable analysis was used to simultaneously evaluate contributions of all variables collected in the five domains. RESULTS: A significantly higher odds of LBP was shown for having high levels of psychosomatic complaints (odds ratio: 4.4; 95 % confidence interval: 1.6-11.9), a high lumbar lordotic apex, retroversed pelvis, introverted personality, and high levels of negative over positive affect. Associations with a higher prevalence and odds of NP were found for psychosomatic complaints (7.8; 2.5-23.9), TSP in the last month (4.9; 2.2-10.8), backward trunk lean, high levels of negative over positive affect and depressed mood. Having experienced LBP (2.7; 1.3-5.7) or NP (5.5; 2.6-11.8) in the preceding month was associated with a higher odds of TSP, as were low self-esteem, excessive physical activity, sedentarism and not achieving the Fit-norm. CONCLUSIONS: Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that "physical factors" play in non-adult spinal pain may have been underestimated by previous studies.

Children with autism spectrum disorders (ASD) often exhibit motor clumsiness (Developmental Coordination Disorder, DCD), i.e. they struggle with everyday tasks that require motor coordination like dressing, self-care, and participating in sport and leisure activities. Previous studies in these neurodevelopmental disorders have demonstrated functional abnormalities and alterations of white matter microstructural integrity in specific brain regions. These findings suggest that the global organization of brain networks is affected in DCD and ASD and support the hypothesis of a ‘dys-connectivity syndrome’ from a network perspective. No studies have compared the structural covariance networks between ASD and DCD in order to look for the signature of DCD independent of comorbid autism. Here, we aimed to address the question of whether abnormal connectivity in DCD overlaps that seen in autism or comorbid DCD-autism. Using graph theoretical analysis, we investigated differences in global and regional topological properties of structural brain networks in 53 children: 8 ASD children with DCD (DCD+ASD), 15 ASD children without DCD (ASD), 11 with DCD only, and 19 typically developing (TD) children. We constructed separate structural correlation networks based on cortical thickness derived from Freesurfer. The children were assessed on the Movement-ABC and the Beery Test of Visual Motor Integration. Behavioral results demonstrated that the DCD group and DCD+ASD group scored on average poorer than the TD and ASD groups on various motor measures. Furthermore, although the brain networks of all groups exhibited small-world properties, the topological architecture of the networks was significantly altered in children with ASD compared with DCD and TD. ASD children showed increased normalized path length and higher values of clustering coefficient. Also, paralimbic regions exhibited nodal clustering coefficient alterations in singular disorders. These changes were disorder-specific, and included alterations in clustering coefficient in the isthmus of the right cingulate gyrus and the pars orbitalis of the right inferior frontal gyrus in ASD children, and DCD-related increases in the lateral orbitofrontal cortex. Children meeting criteria for both DCD and ASD exhibited topological changes that were more widespread from those seen in children with only DCD, i.e. children with DCD+ASD showed alterations of clustering coefficient in (para)limbic regions, primary areas, and association areas. The DCD+ASD group showed changes in clustering coefficient in the left association cortex relative to the ASD group. Finally, the DCD+ASD group shared ASD-specific abnormalities in the pars orbitalis of right inferior frontal gyrus, which was hypothesized to reflect atypical emotional-cognitive processing. Our results provide evidence that DCD and ASD are neurodevelopmental disorders with a low degree of overlap in abnormalities in connectivity. The co-occurrence of DCD+ASD was also associated with a distinct topological pattern, highlighting the unique neural signature of comorbid neurodevelopmental disorders.