RESUMEN
BACKGROUND: Individuals with Hereditary Motor and Sensory Neuropathy (HMSN) are commonly provided with orthopedic footwear to improve gait. Although orthopedic footwear has shown to improve walking speed and spatiotemporal parameters, its effect on gait adaptability has not been established. RESEARCH QUESTION: What is the effect of orthopedic footwear on gait adaptability in individuals with HMSN? METHODS: Fifteen individuals with HMSN performed a precision stepping task on an instrumented treadmill projecting visual targets, while wearing either custom-made orthopedic or standardized footwear (i.e. minimally supportive, flexible sneakers). Primary measure of gait adaptability was the absolute Euclidean distance [mm] between the target center and the middle of the foot (absolute error). Secondary outcomes included the relative and variable error [mm] in both anterior-posterior (AP) and medial-lateral (ML) directions. Dynamic balance was assessed by the prediction of ML foot placement based on the ML center of mass position and velocity, using linear regression. Dynamic balance was primarily determined by foot placement deviation in terms of root mean square error. Another aspect of dynamic balance was foot placement adherence in terms of the coefficient of determination (R2). Differences between the footwear conditions were analyzed with a paired t-test or Wilcoxon signed-rank test (α = 0.05). RESULTS: The absolute error, relative error (AP) and variable error (AP and ML) decreased with orthopedic footwear, whereas the relative error in ML-direction slightly increased. As for dynamic balance, no effect on foot placement deviation or adherence was found. SIGNIFICANCE: Gait adaptability improved with orthopedic compared to standardized footwear in people with HMSN, as indicated by improved precision stepping. Dynamic balance, as a possible underlying mechanism, was not affected by orthopedic footwear.
RESUMEN
Instrumented gait analysis was developed to assist in clinical decision-making to optimise treatment to improve walking in patients with complex gait problems. In this clinical lesson, two cases are presented in which instrumented gait analysis was used for a different goal. It was used to assist in finding the correct neurological or orthopaedic diagnosis in patients in whom symptoms occurred during walking. In both patients, an accurate diagnosis could not be found based on the symptoms they reported, despite a thorough analysis by the neurologist. Instead, the symptoms were caused by the compensations patients used to optimise walking and not directly by the health condition itself. Through instrumented gait analysis, the direct impact of a health condition on the gait pattern can be distinguished from compensations. It can be an asset in finding the correct diagnosis, especially in patients with complex gait problems or multiple health conditions.
Asunto(s)
Marcha , Multimorbilidad , Humanos , Estudios Transversales , Caminata , Análisis de la Marcha , Fenómenos BiomecánicosRESUMEN
Background: In Paralympic sport, classification of impairment with the ability to detect misrepresentation of abilities is mandatory. In wheelchair rugby, there is currently no objective method to classify arm coordination impairment. In previous research, sufficient correlation between the spiral test (ST) and activity in wheelchair rugby was found in athletes with coordination impairment. However, the ST depends on maximum voluntary effort. Purpose: To assess if the ST is an objective test for arm coordination impairment, in which maximum voluntary effort can be distinguished from intentional misrepresentation. The aims of this study were to (1) assess the test-retest reliability of the ST and (2) assess if Fitts's law is applicable to the ST. Methods: Nineteen volunteers without impairments performed two sessions with three STs per arm. The STs were projected and measured on a tablet and had three different indices of difficulty based on differences in spiral width. The time to complete the spiral was measured and a penalty time was added for each time the borderline of the spiral was touched (3 s) or crossed (5 s). Results: Test-retest reliability was assessed using a Bland-Altman analysis and showed limits of agreement that were wider than the margins of 2SD from the group mean. Repeated measurement correlation coefficients between the index of difficulty according to Fitts's law and the movement time were > 0.95 (p-value < 0.001) for both test and retest. A post-hoc optimisation of penalty times revealed an optimum penalty time of 2.0 s for the dominant arm and 2.5 for the non-dominant arm for any contact with the margins of the spiral. Conclusions: The ST has sufficient test-retest reliability and Fitts's law is applicable. Therefore, it is a promising option for classification of arm coordination impairment with the option to distinguish intentional misrepresentation from maximum voluntary effort.
RESUMEN
BACKGROUND: Orthopedic footwear is often prescribed to improve postural stability during standing and walking in individuals with Hereditary Motor Sensory Neuropathy. However, supporting evidence in literature is scarce. The aim of this study was to investigate the effect of orthopedic footwear on quiet standing balance, gait speed, spatiotemporal parameters, kinematics, kinetics and dynamic balance in individuals with Hereditary Motor Sensory Neuropathy. METHODS: Fifteen individuals with Hereditary Motor Sensory Neuropathy performed a quiet standing task and 2-min walk test on customized orthopedic footwear and standardized footwear. Primary outcome measures were the mean velocity of the center of pressure during quiet standing and gait speed during walking. Secondary outcome measures included center of pressure amplitude and frequency during quiet standing, and spatiotemporal parameters, kinematics, kinetics, and dynamic balance during walking. Two-way repeated measures ANOVA and paired t-tests were performed to identify differences between footwear conditions. FINDINGS: Neither quiet standing balance nor dynamic balance differed between orthopedic and standardized footwear, but orthopedic footwear improved spatiotemporal parameters (higher gait speed, longer step length, shorter step time and smaller step width) during walking. Moreover, less sagittal shank-footwear range of motion, more frontal shank-footwear range of motion, more dorsiflexion of the footwear-to-horizontal angle at initial contact and more hip adduction during the stance phase were found. INTERPRETATION: Orthopedic footwear improved walking in individuals with Hereditary Motor Sensory Neuropathy, whereas it did not affect postural stability during quiet standing or dynamic balance. Especially gait speed and spatiotemporal parameters improved. An improved heel landing at initial contact for all footwear and reduced foot drop during swing for mid and high orthopedic footwear contributed to the gait improvements wearing orthopedic footwear.
Asunto(s)
Zapatos , Caminata , Marcha , Humanos , Aparatos Ortopédicos , Equilibrio PosturalRESUMEN
This study aims were twofold: (1) to evaluate the construct validity of the Repetitive Movement Test (RMT) a novel test developed for Wheelchair Rugby classification which evaluates arm coordination impairment at five joints - shoulder, elbow, forearm, wrist and fingers - and (2), pending sufficiently positive results, propose objective minimum impairment criteria (MIC). Forty-two WR athletes with an eligible coordination impairment, and 20 volunteers without impairment completed the RMT and two clinically established coordination tests: the finger-nose test (FNT) and the spiral test (ST). Coordination deduction (CD), an ordinal observational coordination scale, currently used in WR classification, was obtained. Spearman-rank correlation coefficients (SCC) between RMT and ST (0.40 to 0.67) and between RMT and CD (0.31 to 0.53) generally supported RMT construct validity, SCC between RMT and FNT were lower (0.12-0.31). When the scores on ST, FNT and RMT from the sample of WR players were compared with the scores from volunteers without impairment, 93.5% to 100% of WR players had scores > 2SD below the mean of volunteers without impairment on the same test. In conclusion, RMT at the elbow, forearm, wrist and fingers have sufficient construct validity for use in WR. MIC were recommended with ST and RMT.
Asunto(s)
Brazo/fisiopatología , Ataxia/fisiopatología , Fútbol Americano/fisiología , Articulaciones/fisiopatología , Deportes para Personas con Discapacidad/fisiología , Adolescente , Adulto , Ataxia/clasificación , Rendimiento Atlético , Estudios de Casos y Controles , Estudios Transversales , Articulación del Codo/fisiopatología , Femenino , Articulaciones de los Dedos/fisiopatología , Fútbol Americano/clasificación , Antebrazo , Humanos , Masculino , Persona de Mediana Edad , Paratletas , Desempeño Psicomotor/fisiología , Rango del Movimiento Articular/fisiología , Reproducibilidad de los Resultados , Articulación del Hombro/fisiopatología , Deportes para Personas con Discapacidad/clasificación , Estadísticas no Paramétricas , Articulación de la Muñeca/fisiología , Adulto JovenRESUMEN
This study examined the relationship between proximal arm strength and mobility performance in wheelchair rugby (WR) athletes and examined whether a valid structure for classifying proximal arm strength impairment could be determined. Fifty-seven trained WR athletes with strength impaired arms and no trunk function performed six upper body isometric strength tests and three 10 m sprints in their rugby wheelchair. All strength measures correlated with 2 m and 10 m sprint times (r ≥ -0.43; p ≤ 0.0005) and were entered into k-means cluster analyses with 4-clusters (to mirror the current International Wheelchair Rugby Federation [IWRF] system) and 3-clusters. The 3-cluster structure provided a more valid structure than both the 4-cluster and existing IWRF system, as evidenced by clearer differences in strength (Effect sizes [ES] ≥ 1.0) and performance (ES ≥ 1.1) between adjacent clusters and stronger mean silhouette coefficient (0.64). Subsequently, the 3-cluster structure for classifying proximal arm strength impairment would result in less overlap between athletes from adjacent classes and reduce the likelihood of athletes being disadvantaged due to their impairment. This study demonstrated that the current battery of isometric strength tests and cluster analyses could facilitate the evidence-based development of classifying proximal arm strength impairment in WR.
Asunto(s)
Brazo/fisiología , Fútbol Americano/fisiología , Movimiento/fisiología , Fuerza Muscular/fisiología , Paratletas , Prueba de Estudio Conceptual , Adulto , Ataxia/clasificación , Ataxia/fisiopatología , Rendimiento Atlético/fisiología , Análisis por Conglomerados , Femenino , Fútbol Americano/clasificación , Humanos , Contracción Isométrica/fisiología , Masculino , Paratletas/clasificación , Valores de Referencia , Traumatismos de la Médula Espinal/complicaciones , Deportes para Personas con Discapacidad/fisiología , Silla de RuedasRESUMEN
Background: In Paralympic sports, classification of athletes based on the impact of impairments on the ability to perform is needed, to prevent a one-sided and predictable outcome of the competition in which the least impaired athlete has the best chance to win. Classification is developing from expert opinion based to evidence based. In wheelchair court sports, there is evidence to support the impact of impairment on wheeled mobility, but not on ball handling. To assess the impact of impairment on the ability to perform ball-handling activities, standardised tests for ball handling are needed. Purpose: To assess if reliable and valid standardised tests for the measurement of ball-handling proficiency in a wheelchair or able-bodied court sports exist; to assist in the development of Evidence-Based Classification (EBC) in wheelchair court sports according to the guidelines of the International Paralympic Committee (IPC). Methods: The review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) statement. Search terms used were "wheelchair," "ball," "ball sports," "test," and "performance." Databases searched were Medline, Embase, PubMed, and Sport Discus. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results: Twenty-two articles were included. Foundational Movement Skills in ball-handling proficiency were assessed. Tests for throwing maximal distance showed sufficient reliability and validity. Precision in throwing showed low-to-moderate reliability and conflicting results in validity. Throwing techniques differed between studies. Dribbling the ball showed high reliability, but conflicting results in validity. Conclusions: Tests for throwing maximal distance, throwing precision, and dribbling the ball can be used in standardised tests for activity limitation in wheelchair court sports. However, tests need to be adapted and standardised and then reassessed for reliability and validity in athletes with and without arm impairment.
RESUMEN
In persons with calf muscle weakness, walking energy cost is commonly increased due to persistent knee flexion and a diminished push-off. Provided ankle-foot orthoses (AFOs) usually lower walking energy cost. To maximize the reduction in energy cost, AFO bending stiffness should be individually optimized, but this is not common practice. Therefore, we aimed to evaluate whether individually stiffness-optimized AFOs reduce walking energy cost compared to conventional AFOs in persons with non-spastic calf muscle weakness and, secondarily, whether stiffness-optimized AFOs improve walking speed and gait biomechanics. Thirty-seven persons with non-spastic calf muscle weakness using a conventional AFO were included. Participants were provided a new, individually stiffness-optimized AFO. Walking energy cost, speed and gait biomechanics were assessed, at delivery and 3-months follow-up. Stiffness-optimized AFOs reduced walking energy cost with 9.2% (-0.42J/kg/m, 95%CI: 0.26 to 0.57) compared to the conventional AFOs while walking speed increased with 5.2% (+0.05m/s, 95%CI: 0.03 to 0.08). In bilateral affected persons the effects were larger compared to unilateral affected persons (difference effect energy cost: 0.31J/kg/m, speed: +0.09m/s). Although individually gait biomechanics changed considerably, no significant group differences were found (p > 0.118). We demonstrated that individually stiffness-optimized AFOs considerably and meaningfully reduced walking energy cost compared to conventional AFOs, which was accompanied by an increase in walking speed. Especially in bilateral affected persons large effects of stiffness-optimization were found. The individual differences in gait changes substantiate the recommendation that the AFO bending stiffness should be individually tuned to minimize walking energy cost.
Asunto(s)
Ortesis del Pié , Caminata , Tobillo , Fenómenos Biomecánicos , Marcha , Humanos , Estudios ProspectivosRESUMEN
OBJECTIVES: The purpose of this study was to examine the validity and test-retest reliability of a battery of single-joint isometric strength tests, to establish whether the tests could be used for evidence-based classification in wheelchair rugby (WR). DESIGN: Cross-sectional. METHODS: Twenty male WR athletes with impaired arm strength and thirty able-bodied (AB) participants (15 male, 15 female) performed four isometric strength tests. Each test required three 5-s efforts and examined maximal isometric force for flexion and extension around the shoulder and elbow joint. Test validity was established by comparing differences (Cohen's effect sizes [d]) in strength between WR athletes and AB participants. Differences were also explored between male and female AB participants. Twenty AB participants returned for a second visit to establish the test-retest reliability of the test battery. RESULTS: Significantly lower force values were observed for all isometric strength measures in WR athletes compared to AB participants (p≤0.0005; d≥2.14). Female AB participants also produced significantly less force than male AB participants for all joint actions (p≤0.0005; d≥1.93). No significant differences were identified between trials for any measure of strength, with acceptable levels of test-retest reliability reported (ICCs≥0.97, SEM≤19.3N and CV≤8.4%). CONCLUSIONS: The current results demonstrated the validity of a battery of isometric strength tests, suggesting they can be used to reliably infer strength impairment in WR athletes, which is a pre-requisite when working towards evidence-based classification in Paralympic sport.
Asunto(s)
Brazo/fisiopatología , Fútbol Americano , Contracción Isométrica , Debilidad Muscular/fisiopatología , Paratletas/clasificación , Silla de Ruedas , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Reproducibilidad de los ResultadosRESUMEN
Trunk coordination is essential for many activities of daily living in wheelchair users. This study investigated whether Fitts' law is applicable to trunk movements in a sitting position. Fourteen healthy adults performed two series of 24 tasks of trunk flexion-extension movements in a sitting position. The results showed significant linear relationships between average group movement time (MT) and index of difficulty (ID) over all tasks (r2 = 0.92) and within target distances (0.94 < r2 < 1.00). Target distance affected intercept and slope (P < 0.001). Hence, Fitts' law is applicable to the studied trunk movements in a sitting position, indicating these trunk movements tasks could serve as a basis for qualitative trunk coordination tests. Transferability of these conclusions to wheelchair users, and optimal test design should be further investigated.
Asunto(s)
Fenómenos Biomecánicos/fisiología , Desempeño Psicomotor/fisiología , Sedestación , Torso/fisiología , Adulto , HumanosRESUMEN
Purpose: To determine the effect of trunk and arm impairments on physical and technical performance during wheelchair rugby (WR) competition. Methods: Thirty-one highly trained WR players grouped according to their trunk (no trunk [NT]; some trunk [T] function) and arm impairments (poor, moderate, and good arm function) participated in 5 WR matches. Players' physical (wheelchair mobility) and technical (ball handling) activities were analyzed using an indoor tracking system and video analysis, respectively. Results: Trunk impairment explained some of the variance in physical (10.6-23.5%) and technical (16.2-33.0%) performance. T covered more distance, had more possession, scored more goals, and received and made more passes yet spent less time at low speeds and performed fewer inbounds than NT (≤.05). Arm impairment explained some of the variance in all physical (16.7-47.0%) and the majority of technical (13.1-53.3%) performance measures. Moderate and good arm function covered more distance, reached higher peak speeds, spent more time in higher speed zones, scored more goals, had more possession, and received and made more passes, with a higher percentage of 1-handed and long passes, than poor arm function. Good arm function also received more passes and made a higher percentage of 1-handed passes and defensive blocks than moderate arm function (P ≤ .05). Conclusions: Arm impairment affects a greater number of physical and technical measures of performance specific to WR than trunk impairment during competition. Having active finger function (good arm function) yielded no further improvements in physical performance but positively influenced a small number of technical skills.
Asunto(s)
Brazo/fisiopatología , Rendimiento Atlético , Fútbol Americano , Deportes para Personas con Discapacidad , Torso/fisiopatología , Silla de Ruedas , Adulto , Conducta Competitiva , Humanos , Adulto JovenRESUMEN
OBJECTIVE: To determine the validity of the Trunk Impairment Classification system (TIC) with 4 possible scores (0, most impaired; 0.5; 1.0; 1.5, least impaired) in relation to objective, instrumented measures of impairment. DESIGN: Cross-sectional design. SETTING: National wheelchair rugby and basketball competitions of The Netherlands and Belgium. PARTICIPANTS: Volunteer sample of athletes (N=34) with a minimum of 1-year experience in their sport. INTERVENTIONS: Static sitting balance tasks on a stable and unstable surface; dynamic sitting balance tasks in anterior-posterior, left-right, and oblique directions; and trunk muscle strength tasks in forward, left, right, and backward directions. MAIN OUTCOME MEASURES: Sway area of the center of pressure in static sitting balance, maximum excursion of center of pressure displacement in dynamic sitting balance, and maximum isometric force in trunk muscle strength. RESULTS: Athletes with TIC score 0 were not able to sit unsupported. The Kruskal-Wallis test showed a significant difference in trunk muscle strength (P<.001) and dynamic balance in the oblique direction forward to the left and backward to the right between the TIC scores (P=.012). Post hoc analysis showed a significant difference between TIC score 0 and the other TIC scores for trunk muscle strength in all directions. There was a significant difference between TIC score 1.5 on one hand and TIC scores 0.5 and 1.0 on the other hand for dynamic balance in the right oblique direction. CONCLUSIONS: The TIC is a valid scale for trunk impairment, which measures neuromusculoskeletal trunk impairment, independent of the health condition causing the impairment. Additional research is needed for coordination impairment and to assess whether TIC scores 0.5 and 1.0 should continue as separate scores.
Asunto(s)
Baloncesto/fisiología , Personas con Discapacidad/clasificación , Fútbol Americano/fisiología , Torso/fisiopatología , Adolescente , Adulto , Bélgica , Estudios Transversales , Evaluación de la Discapacidad , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Equilibrio Postural , Silla de RuedasRESUMEN
BACKGROUND: Trunk impairment seems to impact significantly on performance in wheelchair court sports, but evidence to support this impression has never been systematically assessed. The objective of this study is to systematically review, describe and synthesise the literature investigating the impact of trunk impairment on wheelchair activities in court sports. METHODS: This systematic review was performed according to the consensus statement for the meta-analysis of observational studies in epidemiology (MOOSE). The search strategy for original articles comprised Medline (1950- November 2014), Cinahl (1981-November 2014), and Embase (1980- November 2014), using the search terms: trunk, trunk muscles, postural balance, posture and wheelchair. Eligibility criteria for further review were 1) participants included experienced wheelchair users, 2) comparisons were made between a) participants with different levels of trunk impairment or b) between able bodied participants and participants with trunk impairment, or c) between participants with trunk impairment with and without compensatory equipment, and 3) outcome measures were quantitative data on wheelchair activities. For methodological quality assessment, the STROBE (Strengthening the reporting of observational studies in epidemiology) checklist was used. RESULTS: After assessment of 358 potentially relevant studies for the eligibility criteria, 25 studies were appropriate for methodological assessment. Twelve articles fulfilled the predetermined minimum of 15 reported items on the 22-item STROBE checklist. These studies were limited to observational studies with small populations. All but one study were restricted to patients with spinal cord injury (SCI). CONCLUSIONS: Limited evidence was found about the impact of trunk impairment on wheelchair activities. Reach to the front and multidirectional reach was further in able bodied persons than in persons with SCI. In a perturbation that equals deceleration in wheelchair court sports, able bodied persons maintain balance, whereas persons with SCI lose balance. No evidence was found to support a difference in acceleration between persons with partial trunk muscle strength and persons with full trunk muscle strength. For future research, there is a need for a test that includes all types of trunk impairment and identification of activities that determine performance in wheelchair court sports. Furthermore, populations of athletes with all trunk impairment types should be included.
RESUMEN
A representative sample (N=302) of the wheelchair rugby population responded to a survey about the classification system based on prioritized items by International Wheelchair Rugby Federation members. Respondents stated, "The classification system is accurate but needs adjustments" (56%), "Any athlete with tetraequivalent impairment should be allowed to compete" (72%), "Athletes with cerebral palsy and other coordination impairments should be classified with a system different than the current one" (75%), and "The maximal value for trunk should be increased from 1.0 to 1.5" (67%). A minority stated, "Wheelchair rugby should only be open to spinal cord injury and other neurological conditions" (36%) and "There should be a 4.0 class" (33%). Results strongly indicated that athletes and stakeholders want adjustments to the classification system in two areas: a focus on evaluation of athletes with impairments other than loss of muscle power caused by spinal cord injury and changes in classification of trunk impairment.