External to internal glenohumeral strength ratio in non-traumatic rotator cuff pathologies.

Background and study aims: A correct agonist -antagonist strength relationship for shoulder external and internal rotation is necessary for functional stability of the shoulder. This strength relationship is described by the ratio of external to internal strength (ER/IR).The aim of this stydy is to produce comparative data as regards the ER/IR ratio in subjects with different non-traumatic rotator cuff diseases. Design and setting: A cross-sectional study in an outpatient clinic in a tertiary care university hospital. Methods: In 55 subjects with rotator cuff disease (confirmed by physical examination and assessed by ultrasound and magnetic resonance arthrography), the ER/IR ratio of the shoulder was isometrically measured with a hand-held dynamometer and compared with values pertaining to the unaffected shoulder of the same individuals. Results: The mean ER/IR values in the overall group were 0.89 (SD 0.18) and 0.94 (SD 0.22) for the affected and unaffected shoulders, respectively. The ratio was 0.87 (SD 0.23) in patients with subdeltoid bursitis, 0.88 (SD 0.16) in rotator cuff tendinopathy and 0.87 (SD 0.22) in patients with rotator cuff tears. Conclusions: The ER/IR ratio appears to be similar between the affected and unaffected shoulders of subjects with nontraumatic cuff pathologies.

Early electrodiagnosis in the management of neonatal brachial plexus palsy: A systematic review.

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.

Parents' perspectives on participation of young children with attention deficit hyperactivity disorder, developmental coordination disorder, and/ or autism spectrum disorder: A systematic scoping review.

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).

Coronal plane trunk asymmetry is associated with whole-body sagittal alignment in healthy young adolescents before pubertal peak growth.

PURPOSE: To investigate coronal plane trunk asymmetry (TA) and its association with sagittal postural alignment in healthy subjects before pubertal peak growth. METHODS: 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. RESULTS: 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 < 0.001) compared to neutrals. A sway-back was 2.2 times more likely to show TA (p = 0.016) than a neutral, yet only in boys. Significant associations with coronal TA were also found for trunk lean, thoracic kyphosis and body mass index. These correlations, however, were gender and posture class specific. The spinal region where asymmetry is seen, varies according to the whole-body sagittal alignment type: primary thoracic curves were the most frequent in leaning-forwards, whereas primary curves in the lumbar or declive thoracolumbar segment were the most common in sway-backs. CONCLUSIONS: In immature spines without known scoliosis, coronal plane TA is associated with whole-body sagittal alignment. It is more often seen in non-neutral than neutral sagittal posture types. Whether adolescent idiopathic scoliosis is related with postural characteristics before pubertal growth peak, should be addressed in future prospective studies.

Updating the Evidence on Functional Capacity Evaluation Methods: A Systematic Review.

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.

Measuring participation as defined by the World Health Organization in the International Classification of Functioning, Disability and Health. Psychometric properties of the Ghent Participation Scale.

OBJECTIVE: To examine the internal consistency, test-retest reliability, construct validity, discriminant validity and responsiveness of the Ghent Participation Scale. DESIGN: Cross-sectional study with a test-retest sample. SETTING: Six outpatient rehabilitation centres in Belgium. SUBJECTS: A total of 365 outpatients from eight diagnostic groups. MEASURES: The Ghent Participation Scale, the Impact on Participation and Autonomy, the Utrecht Scale for Evaluation of Rehabilitation-Participation and the Medical outcome study Short Form SF-36. RESULTS: The Ghent Participation Scale was found to have good internal consistency (Cronbach's α between 0.75 and 0.83). At item level, the test-retest reliability was good; weighted kappas ranged between 0.57 and 0.88. On the dimension level intraclass correlation coefficients ranged between 0.80 and 0.90. Evidence for construct validity came from high correlations between the subscales of the Ghent Participation Scale and four subscales of the Impact on Participation and Autonomy (range, r = -0.71 to -0.87) and two subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (range, r = 0.54 to 0.72). Standardized response mean ranged between 0.23 and 0.68 and the area under the curve ranged between 68% and 88%. CONCLUSION: The Ghent Participation Scale appears to be a valid and reliable method of assessing participation irrespective of the respondent's health condition. The Ghent Participation Scale is responsive and is able to detect changes over time.

The effect of experimental low back pain on lumbar muscle activity in people with a history of clinical low back pain: a muscle functional MRI study.

In people with a history of low back pain (LBP), structural and functional alterations have been observed at several peripheral and central levels of the sensorimotor pathway. These existing alterations might interact with the way the sensorimotor system responds to pain. We examined this assumption by evaluating the lumbar motor responses to experimental nociceptive input of 15 participants during remission of unilateral recurrent LBP. Quantitative T2 images (muscle functional MRI) were taken bilaterally of multifidus, erector spinae, and psoas at several segmental levels (L3 upper and L4 upper and lower endplate) and during several conditions: 1) at rest, 2) upon trunk-extension exercise without pain, and 3) upon trunk-extension exercise with experimental induced pain at the clinical pain-side (1.5-ml intramuscular hypertonic saline injections in erector spinae). Following experimental pain induction, muscle activity levels similarly reduced for all three muscles, on both painful and nonpainful sides, and at multiple segmental levels (P = 0.038). Pain intensity and localization from experimental LBP were similar as during recalled clinical LBP episodes. In conclusion, unilateral and unisegmental experimental LBP exerts a generalized and widespread decrease in lumbar muscle activity during remission of recurrent LBP. This muscle response is consistent with previous observed patterns in healthy people subjected to the same experimental pain paradigm. It is striking that similar inhibitory patterns in response to pain could be observed, despite the presence of preexisting alterations in the lumbar musculature during remission of recurrent LBP. These results suggest that motor output can modify along the course of recurrent LBP.

Neural signature of developmental coordination disorder in the structural connectome independent of comorbid autism.

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.

Multivariable modeling of factors associated with spinal pain in young adolescence.

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.

A study of whether video scoring is a reliable option for blinded scoring of the Gross Motor Function Measure-88.

OBJECTIVE: To investigate the agreement between live and video scores of the Gross Motor Function Measure-88. DESIGN: Reliability study. SUBJECTS: Forty children with bilateral spastic cerebral palsy. INTERVENTIONS: Fifty evaluations were administered according to the test guidelines, and were videotaped. After a minimum interval of one month, the video recordings were again rated by the same assessor. Two physical therapy students also each scored the recordings twice, with a minimal interval of one month. MAIN MEASURES: Agreement between live and video scores as well as inter-rater and intra-rater agreement of the video scores were assessed using intra-class correlation coefficients (ICC), standard error of measurements (SEM), and smallest detectable changes (SDC). Weighted kappa coefficients were used to analyse individual items. RESULTS: The live and video scores from the same assessor showed good to very good agreement for the total score (ICC, 0.973; SEM, 2.28; SDC, 6.32) and dimensions B (ICC, 0.938), D (ICC, 0.965), and E (ICC, 0.992) but lower agreement for A (ICC, 0.720) and C (ICC, 0.667). Live-versus-video agreement for the total score was higher than inter-rater agreement by video (ICC, 0.949; SEM, 3.15; SDC, 8.73) but lower than intra-rater agreement by video (ICC, 0.989; SEM, 1.42; SDC, 3.96). CONCLUSION: The Gross Motor Function Measure-88 can be reliably scored using video recordings. The agreement between live and video scores is lower than the intra-rater reliability using video recordings only. Future clinical trial results should be interpreted using the appropriate SEM and SDC values.

A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome: the TRAumeel in ROtator cuff syndrome (TRARO) study protocol.

BACKGROUND: Shoulder pain is a common musculoskeletal symptom with a wide range of potential causes; however, the majority of conditions can be managed with conservative treatment. The aim of this study is to assess the efficacy and safety of Traumeel injections versus corticosteroid injections and placebo in the treatment of rotator cuff syndrome and bursitis and expand the current evidence base for the conservative treatment of rotator cuff syndrome. METHODS/DESIGN: This is a multi-center, randomized, double-blind, 16-week, three-arm, parallel-group, active- and placebo-controlled trial to assess the efficacy and safety of Traumeel 2 ml injection versus dexamethasone 8 mg injection versus placebo (saline solution). Patients will be randomly allocated to Traumeel, dexamethasone or placebo in a 2:2:1 randomization. After 1 week screening, patients will receive 3 injections at weekly intervals (days 1, 8 and 15) with additional follow-up assessments on day 22, a telephone consultation in week 9 and a final visit at week 15. Male and female patients aged 40 to 65 years, inclusive, will be recruited if they have acute episodes of chronic rotator cuff syndrome and/or bursitis. Patients with calcifications in the shoulder joint or a complete rotator cuff tear will be excluded. At least 160 patients will be recruited. All subacromial injections will be performed under ultrasound guidance utilizing a common technique. The only rescue medication permitted will be paracetamol (acetaminophen), with usage recorded. The primary endpoint is change from baseline in abduction-rotation pain visual analog scale (0-100 mm scale, 0 corresponds to no pain and 100 to extreme pain) at day 22 (Traumeel injections versus dexamethasone injections) for active external rotation. Secondary efficacy parameters include range of motion, disability of arm, shoulder, hand score and patient's/investigator's global assessment. Clinical efficacy will be assessed as non-inferiority of Traumeel with respect to dexamethasone regarding the primary efficacy parameter. DISCUSSION: It is hoped that the results of this trial will expand the treatment options and evidence base available for the management of rotator cuff disease. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01702233 . EudraCT number: 2012-003393-12.

A randomized, single-blind cross-over design evaluating the effectiveness of an individually defined, targeted physical therapy approach in treatment of children with cerebral palsy.

OBJECTIVE: A pilot study to compare the effectiveness of an individual therapy program with the effects of a general physical therapy program. DESIGN: A randomized, single-blind cross-over design. PARTICIPANTS: Ten ambulant children with bilateral spastic cerebral palsy, age four to nine years. INTERVENTION: Participants were randomly assigned into a ten-week individually defined, targeted or a general program, followed by a cross-over. MAIN OUTCOME MEASURES: Evaluation was performed using the Gross Motor Function Measure-88 and three-dimensional gait analysis. General outcome parameters were Gross Motor Function Measure-88 scores, time and distance parameters, gait profile score and movement analysis profiles. Individual goal achievement was evaluated using z-scores for gait parameters and Goal Attainment Scale for gross motor function. RESULTS: No significant changes were observed regarding gross motor function. Only after individualized therapy, step- and stride-length increased significantly (p = 0.022; p = 0.017). Change in step-length was higher after the individualized program (p = 0.045). Within-group effects were found for the pelvis in transversal plane after the individualized program (p = 0.047) and in coronal plane after the general program (p = 0.047). Between-program differences were found for changes in the knee in sagittal plane, in the advantage of the individual program (p = 0.047). A median difference in z-score of 0.279 and 0.419 was measured after the general and individualized program, respectively. Functional goal attainment was higher after the individual therapy program compared with the general program (48 to 43.5). CONCLUSION: The results indicate slightly favorable effects towards the individualized program. To detect clinically significant changes, future studies require a minimal sample size of 72 to 90 participants.

Classification system of the sagittal standing alignment in young adolescent girls.

PURPOSE: 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. METHODS: 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. RESULTS AND CONCLUSION: 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.

Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial.

BACKGROUND: Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at 'training the brain' is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up.The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. METHODS/DESIGN: The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web-based questionnaires will be completed at baseline, after the first 3 treatment sessions, post-treatment, and at 6 and 12-months follow-up. DISCUSSION: Findings may provide empirical evidence on: (1) the effectiveness of a modern neuroscience approach to CSP for reducing pain and improving functioning, (2) the effectiveness of a modern neuroscience approach for normalizing brain gray matter in CSP patients, and (3) factors associated with therapy success. Hence, this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities' recommendations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02098005.

Gender differences in sagittal standing alignment before pubertal peak growth: the importance of subclassification and implications for spinopelvic loading.

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.

Gait analysis with cognitive-motor dual tasks to distinguish fallers from nonfallers among rehabilitating stroke patients.

OBJECTIVES: To evaluate fall risk in stroke patients based on single- and dual-task gait analyses, and to investigate the difference between 2 cognitive tasks in the dual-task paradigm. DESIGN: Prospective cohort study. SETTING: Rehabilitation hospitals. PARTICIPANTS: Subacute stroke patients (N=32), able to walk without physical/manual help with or without walking aids, while performing a verbal task. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional gait measures were Functional Ambulation Categories (FAC) and use of a walking aid. Gait measures were evaluated by an electronic walkway system under single- and dual-task (DT) conditions. For the single-task, subjects were instructed to walk at their usual speed. One of the DTs was a verbal fluency dual task, whereby subjects had to walk while simultaneously enumerating as many different animals as possible. For the other DT (counting dual task), participants had to walk while performing serial subtractions. After inclusion, participants kept a 6-month falls diary. RESULTS: Eighteen (56.3%) of the 32 included patients fell. Ten (31.3%) were single fallers (SFs), and 8 (25%) were multiple fallers (MFs). Fallers (Fs) more frequently used a walking aid and more frequently needed an observatory person for walking safely (FAC score of 3) than nonfallers (NFs). Two gait decrement parameters in counting dual task could distinguish potential Fs from NFs: decrement in stride length percentage (P=.043) and nonparetic step length percentage (P=.047). Regarding the division in 3 groups (NFs, SFs, and MFs), only MFs had a significantly higher percentage of decrement for paretic step length (P=.023) than SFs. CONCLUSIONS: Examining the decrement of spatial gait characteristics (stride length and paretic and nonparetic step length) during a DT addressing working memory can identify fall-prone subacute stroke patients.

Posterior muscle chain activity during various extension exercises: an observational study.

BACKGROUND: Back extension exercises are often used in the rehabilitation of low back pain. However, at present it is not clear how the posterior muscles are recruited during different types of extension exercises. Therefore, the present study will evaluate the myoelectric activity of thoracic, lumbar and hip extensor muscles during different extension exercises in healthy persons. Based on these physiological observations we will make recommendations regarding the use of extensions exercises in clinical practice. METHODS: Fourteen healthy subjects performed four standardized extension exercises (dynamic trunk extension, dynamic-static trunk extension, dynamic leg extension, dynamic-static leg extension) in randomized order at an intensity of 60% of 1-RM (one repetition maximum). Surface EMG signals of Latissimus dorsi (LD), Longissimus thoracis pars thoracic (LTT) and lumborum (LTL), Iliocostalis lumborum pars thoracic (ILT) and lumborum (ILL), lumbar Multifidus (LM) and Gluteus Maximus (GM) were measured during the various exercises. Subsequently, EMG root mean square values were calculated and compared between trunk and leg extension exercises, as well as between a dynamic and dynamic-static performance using mixed model analysis. During the dynamic exercises a 2 second concentric contraction was followed by a 2 second eccentric contraction, whereas in the dynamic-static performance, a 5 second isometric interval was added in between the concentric and eccentric contraction phase. RESULTS: In general, the muscles of the posterior chain were recruited on a higher level during trunk extension (mean ± SD, 56.6 ± 30.8%MVC) compared to leg extension (47.4 ± 30.3%MVC) (p ≤ 0.001). No significant differences were found in mean muscle activity between dynamic and dynamic-static performances (p = 0.053). The thoracic muscles (LTT and ILT) were recruited more during trunk extension (64.9 ± 27.1%MVC) than during leg extension (54.2 ± 22.1%MVC) (p = 0.045) without significant differences in activity between both muscles (p = 0.138). There was no significant differences in thoracic muscle usage between the dynamic or dynamic-static performance of the extension exercises (p = 0.574). CONCLUSION: The recruitment of the posterior muscle chain during different types of extension exercises was influenced by the moving body part, but not by the type of contraction. All muscle groups were activated at a higher degree during trunk extension compared to leg extension. Based on the recruitment level of the different muscles, all exercises can be used to improve the endurance capacity of thoracic muscles, however for improvement of lumbar muscle endurance leg extension exercises seem to be more appropriate. To train the endurance capacity of the LD and GM extension exercises are not appropriate.

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.

Motor imagery ability in patients with traumatic brain injury.

OBJECTIVE: To assess motor imagery (MI) ability in patients with moderate to severe traumatic brain injury (TBI). DESIGN: Prospective, cohort study. SETTING: University hospital rehabilitation unit. PARTICIPANTS: Patients with traumatic brain injury (mean coma duration, 18d) undergoing rehabilitation (n=20) and healthy controls (n=17) matched for age and education level. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The vividness of MI was assessed using a revised version of the Movement Imagery Questionnaire-Revised second version (MIQ-RS); the temporal features were assessed using the time-dependent motor imagery (TDMI) screening test, the temporal congruence test, and a walking trajectory imagery test; and the accuracy of MI was assessed using a mental rotation test. RESULTS: The MIQ-RS revealed a decrease of MI vividness in the TBI group. An increasing number of stepping movements was observed with increasing time periods in both groups during the TDMI screening test. The TBI group performed a significantly smaller number of imagery movements in the same movement time. The temporal congruence test revealed a significant correlation between imagery and actual stepping time in both groups. The walking trajectory test revealed an increase of the imagery and actual walking time with increasing path length in both groups, but the ratio of imaginary walking over actual walking time was significantly greater than 1 in the TBI group. Results of the hand mental rotation test indicated significant effects of rotation angles on imagery movement times in both groups, but rotation time was significantly slower in the TBI group. CONCLUSIONS: Our patients with TBI demonstrated a relatively preserved MI ability indicating that MI could be used to aid rehabilitation and subsequent functional recovery.

A clinical postural model of sagittal alignment in young adolescents before age at peak height velocity.

INTRODUCTION: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.