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Background: Soccer assessments often lack specificity and complexity. Examinations of validity for soccer assessments, based on the relation between test and match performance, are available although they are scarce. A complex soccer-specific field test which is validated cannot be found in the literature at all., Objective: The aim of this follow-up study was to assess the validity of a soccer-specific complexity test (FBKT) and a repeated non-specific sprint test (ST) based on three gold standards: match performance, coach ranking, and league affiliation., Materials and Methods: A German fourth league soccer team (n = 14) was assessed using FBKT and ST in the pre-season for the second half of the 2010/2011 season. Afterwards, their performance in 17 matches was evaluated using video analysis in order to compare them with the test parameters (e. g., pass/assist ratio, goals, duelling behaviour). Eighteen months later, the league affiliation of all players was identified and the coach evaluated the tested players., Results: With regard to match performance, playing time was proved to be the most suitable parameter for validating the test performance (FBKT, ST). The total and minimum times of ST were the most powerful parameters in relation to playing time and explained 50 % and 46 % of the variance, respectively. Concerning the FBKT, the parameters "sum of all linear sprints" (24 %) and "total time of all activity series with penalty time in round two" (22 %) explained the highest amount of variance. Coach ranking generated significant odds ratios for the minimum time of ST (OR = 6.5; CI: 3.2 - 5.2 × 1015; p = 0.037), and total time of speed dribbling of the FBKT (OR = 1.3; CI: 1.2 - 199.5; p = 0.036) based on a proportional-odds model. With regard to league affiliation, significant odds ratios occurred with the following parameters: minimum time of ST (OR = 15.8; CI: 2.16 - 115.4; p = 0.007); total time of ST (OR = 3.28; CI: 1.31 - 8.21; p = 0.011); and, total time of speed dribbling for the FBKT (OR = 1.3; CI: 1.01 - 1.61; p = 0.044)., Conclusions: This study showed that the larger logical validity of soccer-specific complex tests does not necessarily translate to a larger construct validity, as compared to non-specific tests. However, their value is not limited to performance evaluation. The FBKT provides valuable information concerning training process control. It is possible that its low validity is caused by the poor performance of the players in soccer-specific consequences of actions (centres, goals) due to the restricted differentiation of players., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: To validate previously proposed findings and to develop an objective, feasible and efficient bifactorial (risk factors: gait impairment and balance disorders) fall risk assessment., Design: Prospective follow-up study Setting: Nursing homes (Halle/Saale, Germany)., Subjects: One hundred and forty-six nursing home residents (aged 62-101 years) were recruited., Methods: Gait data were collected using a mobile inertial sensor-based system (RehaWatch). Postural regulation data were measured with the Interactive Balance System. Falls were recorded in standardized protocols over a follow-up period of 12 months., Main Measures: Gait parameters (e.g. spatial-temporal parameters), posturographic parameters (e.g. postural subsystems), number of falls., Results: Seventeen (12%) of the participants had more than two falls per year. The predictive validity of the previously selected posturographic parameters was inadequate (sensitivity: 47%). The new measurement tool defined 67 participants showing an increased risk of falls. In reality, only 8 participants actually fell more than twice during the follow-up period (positive predictive value (PPV): 12%). The negative predictive value (NPV) was 88%. The posturographic frequency range F2-4 (peripheral-vestibular system), stride time and standard deviation of landing phase were the most powerful parameters for fall prediction. Gait and postural variability were larger in the high-risk group (e.g. gait speed; confidence interval (CI)(high): 0.57-0.79 vs. CI(low): 0.72-0.81 m/s)., Conclusion: RehaWatch and the Interactive Balance System are able to measure two of the most important fall risk factors, but their current predictive ability is not satisfactory yet. The correlation with physiological mechanisms is only shown by the Interactive Balance System.

Background: Sports-specific, biomechanical measuring stations and measuring-station trainings have become common practice in many forms of sports and are an essential element of the complex assessment of physical performance. In handball, however, there is still considerable research potential in this respect as well as in the systematic generation and acquisition of the requirements profile and progress of strain., Objective: The prime objective of the longitudinal study was to determine the potential performance and development of handball players (3 rd league) in general and in terms of handball sport in particular. Another objective was to establish correlations between tests and indicators of performance in competitions., Materials and Methods: 13 handball players (age: 26.5 ± 3.6 years) were tested three times (before and after the pre-season preparation phase and at the end of the first half of the season) on two test days each. The examination was composed of sprint test (ST, day 1), handball-specific complex test (HBKT, day 1) and assessment of treadmill diagnostics (LD, day 2). The surveyed parameters were lactate and heart rate (LD/HBKT) as well as time (ST, HBKT) and the number of errors (HBKT)., Results: The cardiac (Hfmax = 201 min-1) and metabolic strain (lactate = 17.8 mmol/L) in the HBKT were very high. In the preparatory phase, the average magnitudes of effect registered were at d = 0.31 (ST parameter), d = 0.68 (HBKT parameter) and d = 0.98 (LD parameter). The most significant improvements throughout the entire period of time were registered in the parameters v2 (LD; η2 = 0.371), total goal-throwing time (HBKT; η2 = 0.250), total penalty time (HBKT; η2 = 0.236) and total round 2 (HBKT; η2 = 0.227). In HBKT and LD, the performance level was stabilised by the end of the first half of the season. In terms of speed, however, there was a decline in performance abilities. The competition performance has its highest degree of correlation with cardial (defense: r = -0.656) and metabolic (offensive: r = -0.655) recuperativeness in HBKT., Conclusions: The findings of this longitudinal survey are on the one hand intended to make assessments of physical performance more efficient (isolated sprint test no longer required) and to improve data output (HBKT: throwing velocity; reference database). In this context, a more extensive consideration of indicators for competition performance and their correlation to specific parameters is recommendable. On the other hand, the applied training contents must be further optimised in terms of their severity and chronology., (© Georg Thieme Verlag KG Stuttgart · New York.)

Inertial sensor gait analysis systems (ISGAS) facilitate gait analysis in an unobstructed environment outdoors or outside of a conventional gait laboratory. However, their use in clinical settings and in large scale studies necessitates thorough evaluation of their performance in different settings and populations and reference data on healthy subjects. The purposes of this study were to obtain spatio-temporal gait parameters using a large cohort of subjects of all ages and to identify relationships between gait parameters and subject characteristics. An inertial sensor based system (RehaWatch(®), HASOMED(®)) was used to collect gait data for 1860 healthy subjects (919 men; aged 5-100 years). Following two practice trials, data of one trial were collected for each subject while walking on a 20m walkway. Spatio-temporal gait parameters were calculated and normalized to body height. Demographic and morphological data including age, gender, body height and body mass were recorded. Multifactorial regression models were used to evaluate determinants of different gait parameters. Strong non-linear relationships between predictors (age) and gait parameters were identified. Overall, the predictors explained the largest portion of variance for stride length (R(2)=0.46). Normalized cadence showed one peak across all ages. Normalized walking speed and normalized stride length showed two peaks across all ages. The largest and smallest variations across the ages were observed for normalized walking speed (98%) and for normalized stride length (89%), respectively. This reference database is the foundation for future evaluations of gait disorders in patients of all ages and has been integrated in the RehaWatch(®) system., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: Soccer has increasingly become a technical - tactical (speed of activity!) and athletic sport over the last years. Simultaneously the new training and contest conditions result in new challenges to sports science and sports medicine evaluation. Complex, sports specific field tests for soccer exist rarely and only in low quality., Objective: Development and evaluation of a standardised complexity test in soccer (FBKT) for assessment of the complex sports specific and league specific physical performance., Materials and Methods: Two regional German soccer teams (Verbandsliga [VL], Oberliga [OL]) (n = 27) were assessed with FBKT. The assessment included lactate levels, heart rate as well as time and error frequency (penalty time per error: 5 s) for defined activity series at defined time points (heart rate: rest, after round 1, prior to round 2, E 0, E 2, E 6, E 10, E 14; lactate: rest, E 2, E 6, E 10, E 14)., Results: The heart rate (hr (max) = 200 min (-1)) and metabolic rate (lactate (max) = 17.1 mmol/l) were very excessively high and did only partially differ between the groups (heart rate difference at rest p = 0.005, prior to round 2: p = 0.014, E 6: p = 0.042). Furthermore no significant differences occurred in the following parameters: recovery potential (hr (E0 - E14): p = 0.560; lactate (Max-Min): p = 0.448), technical error (p = 0.384), sprint (p = 0.499), slalom dribbling (p = 0.310), time round 1 (p = 0.119), shots on goal (p = 0.585) and crosses (p = 0.676). Significant difference were only found in the parameters time round 2 (p = 0.004), time round 1 and round 2 (p = 0.013), overall time (running)(time + penalty)(time) (p = 0.022) and speed dribbling (p = 0.005)., Conclusions: Soccer specific complex loads generate very high physical demamds. Although complex, the FBKT proved to be a practical assessment tool with high standardising potential. The FBKT gives plentiful information under competition - like conditions such as technical skills, speed, speed endurance or anaerobe capacity., (© Georg Thieme Verlag KG Stuttgart · New York.)

Quantitative gait analysis plays an important role in neurological and orthopedic rehabilitation regarding the evaluation of rehabilitation progress. However, most of the currently available gait analysis systems share the disadvantage of being expensive, time-consuming, and complex. A promising alternative is the portable gait analysis system RehaWatch. It is based on inertial sensors that allow the quantitative measurement of the important kinemetric variables acceleration and angular velocity. The associated software analyzes the sensor signals and calculates temporal (e.g., stride duration, gait phases) and spatial (e.g., stride length, foot angle) parameters on this basis. The aim of this study was to investigate the intraobserver reliability of RehaWatch. A total of 44 healthy subjects (age: 27.7±4.2 years) were included in the study. Each participant underwent three measurements (walking distance: 20 m) for each of the three sessions with a time interval of 48 h in-between. Variance analysis (General Linear Model) revealed no significant differences between gait parameters at different measuring points. ICCs (Average Measure Intraclass Correlations) were between 0.691 and 0.959. In addition to the results of the variance and correlation analysis the Bland-Altman plots suggest high reliability.

Background: The physiological demands of handball players on international level has increased during the last years mainly due to rule changes. Therefore a scientific funded training method under sports medical supervision gets more and more important. Nevertheless any only limited data are available concerning adequate tests and methods on endurance and sports related assessment of physical performance in handball., Objective: Goal of this experimental cross sectional study was to record the endurance of handball players (regional league) in general and related to their sport. This study was performed in conjunction with the development and testing of a new handball specific complexity test (HBKT) and the use of a new lactate analysis software wesp-analysis during a treadmill test (TT)., Methods: 16 semi-professional handball players (mean age: 27.5 +/- 6.78 years) of a regional team were investigated with TT and HBKT on two different days (time delay 72 h). The parameters lactate, heart rate (TT/HBKT) and the time and rate of faults in the HBKT were recorded., Results: The players showed large deficits in basic endurance capacity. There was a great performance difference within the team, especially in the lower intensity regions (< or = 3 mmol/l). Whereas the maximal heart rate was significantly higher in the TT versus the HBKT (TT: 192 +/- 8.67 min (-1) versus HBKT: 180 +/- 9.23 min (-1); p < 0.001; eta(2) = 0.794). The maximum lactate levels showed directly the opposite (10.1 +/- 2.91 mmol/l for TT versus 12.8 +/- 1.99 mmol/l for HBKT; p < 0.001, eta(2) = 0.644). Maximal run velocity (TT) and general performance (HBKT) was related on a mean level (r = -0.566)., Conclusions: The results show the necessity of individual heart rate dependant basic endurance training. The correlation between the tests is a further sign for the significant importance of endurance capacity for sports performance. A comparison of these results to a higher level handball team would yield further information regarding interpretation and grading of the data. HBKT und lactate analysis software wesp-analysis showed to be practical assessment tools., (Georg Thieme Verlag KG Stuttgart, New York.)

Objective: The contribution of the human anterior intraparietal area and the dorsal premotor cortex to arbitrary visuo-motor mapping during grasping were tested., Methods: Trained right-handed subjects reached for and pincer-grasped a cube with the right hand in the absence of visual feedback after the cube location had been displayed for 200ms. During the reaching movements, the colour of the cube changed and visual feedback about the change of colour was provided for 100ms at 500ms after movement onset (at the time of peak grasp aperture). Depending on colour, subjects were instructed to either pincer-grasp the cube in a horizontal or vertical grasp position with the latter necessitating wrist rotation (experiment 1) or to pincer-grasp and transport the cube to either a left or right target position (experiment 2). Within two consecutive 200ms time windows (TMS 1 and 2) starting 500ms and 700ms after movement onset, respectively, double pulses of supra-threshold transcranial magnetic stimulation (inter-stimulus interval: 100ms) were delivered over (i) the left primary motor cortex (90 degrees vertically angulated coil position, control stimulation), (ii) the left dorsal premotor cortex or (ii) the left anterior intraparietal area., Results: Compared to control stimulation, stimulation of the anterior intraparietal area, but not of the dorsal premotor cortex, at TMS 1 delayed the times to wrist rotation (experiment 1) and hand transport (experiment 2). Compared to control stimulation, stimulation of the dorsal premotor cortex, but not of the anterior intraparietal area, at TMS 2 delayed both wrist rotation (experiment 1) and hand transport (experiment 2)., Conclusions: We contend that the anterior intraparietal area and the dorsal premotor cortex are both involved albeit at different phases during the mapping of arbitrary visual cues with goal directed grasp and transport movements., Significance: These data add to the current understanding of how human cortical areas work in concert during manual activities.

Nigrostriatal and cerebellar systems are important postural subsystems in neurologic rehabilitation. In this study, we investigated the ability to differentiate both systems via posturography and spectral analysis. This cross-sectional study included 156 study subjects with 52 individuals in each group (healthy controls, Parkinson's disease and cerebellar disease patients). The mean age of all groups was 61.3+/-13.4 years. We used the interactive balance system (IBS) to differentiate vertical pressure fluctuations on four independent force plates, each supporting one heel or the toes of each leg in eight test positions. We also performed a frequency analysis of the force/time signal. The univariate, multifactor covariance analysis was used for statistical evaluation. Variance analysis of the Parkinson's group (mean/95% CI: 23.0/20.5-25.5) and control group (mean/95% CI: 16.7/14.2-19.2) revealed the greatest differences in frequency range F1. Subjects with cerebellar disease showed significant differences compared with controls in all frequency ranges. Furthermore, cerebellar disease subjects showed a consistently lower postural stability compared with the Parkinson's (p<0.001) and control groups (p<0.001). Results from the present study suggest that the cerebellar and nigrostriatal system can be effectively differentiated and assessed with frequency-analyzed posturographic parameters. Furthermore, the IBS allows a highly practical differential assessment in neurologic rehabilitation.

Background: Previous work has suggested that both the level of activity and the type of sport may have a major impact on postural control. However, no systematic investigation has been performed regarding the various types of professional sports. Particularly, the impact of competitional sports on the postural subsystems has not been elucidated so far., Objective: The aim of this study was to investigate the influence of the major professional sport types, such as handball, gymnastics, swimming, and shooting, on the subsystems of postural control. We also tested the hypothesis that specific types of sport have specific effects on postural regulation., Methods: 155 competitive male and female athletes (handball: n = 30; gymnastics: n = 44; swimming: n = 50; shooting: n = 31), and 34 age- and gender-matched controls were investigated using the Interactive Balance System (IBS; Tetrax Inc., Ramat Gan, Israel). The following spectral and time-domain indices were determined: power in the following frequency bands: P(F1) (0.03 - 0.1 Hz), P(F)(2 - 4) (0.1 - 0.5 Hz), P(F)(5 - 6) (0.5 - 1.0 Hz), P(F)(7 - 8) (> 1.0 Hz), stability index (STABI), and synchronisation index (SYN)., Results: Shooting athletes exhibited significantly smaller values of P(F1) (p = 0.003), P(F)(2 - 4) (p < 0.001), and P(F)(7 - 8) (p = 0.002), respectively, than the other athletes investigated. Also, the shooting athletes exhibited the smallest STABI values (p = 0.002). In contrast, the gymnasts showed the largest SYN values (p = 0.002)., Conclusions: Different types of competitive sports exert different effects on the various subsystems of posture control, where especially shooting competitors demonstrate a significantly better posture regulation. Those effects can be parameterised and quantified with the IBS which thus enables an efficient and purposeful training. Furthermore, the IBS is highly suitable for aptitude screening in sports with high posture regulatory demands (shooting competitions, gymnastics, diving etc.)., (Copyright Georg Thieme Verlag KG Stuttgart . New York .)

Background: Hippotherapy has become an important therapeutic option in patients suffering from motoric dysfunction. The physiologic basis of this approach is the three-dimensional transmission of the horse's motion onto the patients body. These motion stimuli are believed to exert possitve effects on the patients's postural control systems., Aim: To test the hypothesis that hippotherapy has both positive short- and lang-term effects on gait and posture control of persons suffering from motoric disabilities., Methods: Twenty-two children and adolescents aged 9.69 +/- 4.01 years (range: 9.69 +/- 4.01 years) with motoric dysfunctions were included in a prospective matched control study. In each participant, gait and posture control were investigated on four different occasions (O1 - O4) using the Interactive balance system (IBS; Tetrax Inc., Ramat Gan, Israel) and the portable gait analysis sytem RehaWatch (Hasomed, Magdeburg, Germany). The dates of gait and posture analysis were defined as follows: O 1: immediately prior to first therapeutic riding session (TRS); O 2: immediately after first TRS; O 3: after the last day of an eight weeks period of daily TRS; O 4: seven weeks later after a TRS free interval., Results: The following parameters were slightly improved (adjusted significance level of p < 0.003) after eight weeks of therapeutic riding: (O1 vs. O 3): (1) walking distance (p = 0.009, eta(2) = 0.339); (2) pace frequency (p = 0.007, eta(2) = 0.358); (3) walking speed (p = 0.006, eta(2) = 0.367), and (4) time of attachment (p = 0.007, eta(2) = 0.360). The only short-term effect observed was a significant decrease of the attachment phase (p = 0.002, eta(2) = 0.387). Interestingly, gait symmetry remained unaffected. Posturography (adjusted significance level of p < 0.01) at O 1 versus O 2 (short-term) showed a significant decrease of the performance of both the visual-nigrostriatal subsystem (p < 0.001) and the somato-sensory subsystem (p = 0.001). At O 1 versus O 3 (long-term), the following parameters were sharply decreased: (1) postural stability (p = 0.011), and (2) somatosensory performance (p = 0.011)., Conclusions: In the individuals investigated, an eight weeks series of therapeutic riding did not improve posture control and had only a small positive effect on gait performance. The reasons for these rather disappointing results could have been the low number of therapeutic riding sessions (0.5 sessions per week), and the relatively short duration (30 min) of each session. It remains to be seen, whether a higher density and longer duration of therapeutic riding sessions yields better results.

Aim: The purpose of this clinical study is to evaluate the postoperative walking ability after total hip replacement (THR) in terms of different surgical approaches by means of an evaluation of gait velocity., Methods: 21 patients underwent a total hip replacement using an anterolateral minimally invasive modified Watson-Jones approach (MIS group). 20 other patients received a THR using a transgluteal approach (standard group). Differences in functional indices of ground reaction forces and symmetry indices were measured one day pre-operatively, and at 6 and 13 weeks postoperatively on the walkway. The intervention of gait velocity was done by means of a digital metronome. The given step frequences were 70, 90 and 110 steps/minute. The results were compared to an age-matched control group (n = 20)., Results: There are significantly reduced pain symptoms in both surgical groups at 6 weeks post-operatively. The MIS group has a higher functional ability, improved symmetry indices of stance time, loading rate and single limb stance compared to the control group at 6 weeks postoperatively. At 13 weeks postoperatively there are no differences between the two surgical groups, except for the parameter "loading rate". The patients in the MIS group had an increasing improvement already at 6 weeks after THR. From 6 to 13 weeks after surgery there were important changes in the control group., Conclusion: Obviously, the early postoperative advantages of the minimal invasive approach provide for an improved re-establishment of symmetry and load. In this clinical course study, the proof is validated because the trends in the biomechanical gait parameters are comparable by means of gait velocity standardisation.

Aim: Benefits of less damage of soft tissues and muscles in minimally invasive hip replacement lead to expectations of better results in gait rehabilitation. The aim of the study is to evaluate post-operative walking ability in terms of different surgical approaches., Method: 16 patients underwent a minimally invasive total hip replacement (MIS group) and 16 other patients got a THA using a transgluteal approach (standard group). Differences in functional indices of ground reaction forces and symmetry indices were measured one day pre-operatively as well as 8, 14 and 28 weeks post-operatively. The results were compared between the surgical approaches and to an age-matched healthy control group., Results: There are significantly reduced pain symptoms and a higher functional ability in both surgical groups 8 weeks post-operatively. There are no differences in gait parameters between the surgical groups after 28 weeks. Trends in gait velocity, temporal parameters and in functional indices of ground reaction forces show advantages for the minimally invasive group 8 and 14 weeks post-operatively. Patients do not reach the age-matched control group., Conclusion: Obviously the immediate post-operative advantages of minimally invasive hip replacement provide better chances for gait rehabilitation compared to the transgluteal approach. Due to the complexity of the problem clinical and gait analysis studies should be linked more closely.

Background Data: The influence of strength training on back conditions has been demonstrated quite well, whereas coordinative training being a major component of physical therapy regarding preventive and rehabilitative treatment of back pain is used only occasionally and has been evaluated even more rarely. One has to consider this fact regarding the still growing number of musculo-skeletal diseases., Aim of Study: The influence of several preventive therapies (coordination training in spacecurl, kinaesthetics/back protective patient transfer) has been investigated with regard to coordination, back pain and quality of life in a randomised controlled study., Methods: We used an assessment-set consisting of a specially devised questionnaire regarding job demands, sports activity and back pain and the WHOQOL-BREF for control of quality of life. These methods were combined with body surface electromyography and posturography. Those methods enabled us to determine parameters such as coordination, back pain and quality of life at 3 different stages (untrained individuals) and 4 points (trained individuals) respectively., Results: Trained individuals showed a significant reduction of back pain frequency (p = 0.016) before and after training. In comparison there was no difference in untrained individuals. Furthermore trained individuals showed an increase in quality of life of 5.4 % (p = 0.028), whereas again there was no difference in untrained individuals. Somatic diagnostics (body surface electromyography, posturography) showed significant changes only in the trained group., Conclusion: The used coordination training program is enhancing coordination and reducing back pain whilst having a positive effect upon the quality of life of an individual.