Visual Biofeedback and Changes in Lower Extremity Kinematics in Individuals With Medial Knee Displacement.

CONTEXT: Increased frontal-plane knee motion during functional tasks, or medial knee displacement, is a predictor of noncontact anterior cruciate ligament injury and patellofemoral pain. Intervention studies that resulted in a reduced risk of knee injury included some form of feedback to address aberrant lower extremity movement patterns. Research on integrating feedback into single-legged tasks and the ability to train 1 task and test another is limited. OBJECTIVE: To determine if adding real-time visual biofeedback to common lower extremity exercises would improve single-legged landing mechanics in females with medial knee displacement. DESIGN: Cohort study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-four recreationally active females with medial knee displacement were randomized to a visual-biofeedback group (n = 12; age = 19.75 ± 0.87 years, height = 165.32 ± 8.69 cm, mass = 62.41 ± 8.91 kg) or a control group (n = 12; age = 19.75 ± 0.97 years, height = 166.98 ± 6.89 cm, mass = 59.98 ± 6.24 kg). INTERVENTION(S): Individuals in the feedback group viewed a real-time digital model of their body segments generated by Microsoft Kinect. The skeletal model changed color according to the knee-abduction angle of the test limb during the exercise tasks. MAIN OUTCOME MEASURE(S): Participants completed 3 trials of the single-legged drop vertical jump (SL-DVJ) while triplanar kinematics at the trunk, hip, knee, and ankle were collected via 3-dimensional motion capture. The feedback and control groups completed lower extremity exercises with or without real-time visual biofeedback, respectively. After the intervention, participants completed 3 additional trials of the SL-DVJ. RESULTS: At baseline, the feedback group had 3.83° more ankle eversion than the control group after initial contact. After the intervention, the feedback group exhibited 13.03° more knee flexion during the flight phase of the SL-DVJ and 6.16° less knee abduction after initial contact than the control group. The feedback group also demonstrated a 3.02° decrease in peak knee-abduction excursion compared with the baseline values (P = .008). CONCLUSIONS: Real-time visual biofeedback immediately improved faulty lower extremity kinematics related to knee-injury risk. Individuals with medial knee displacement adjusted their movement patterns after a single training session and reduced their medial knee motion during a dynamic task.

The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients.

BACKGROUND: Anterior knee pain (AKP) is a widespread problem among young athletes and soldiers. There are many theories on the etiology of AKP but there is little reference to myofascial trigger points (MTrPs) as a possible contributor. AIM: To evaluate the association between AKP and prevalence of active and latent MTrPs in the hip and thigh muscles in soldiers. METHODS: A cross-sectional study was conducted in the Beer-Sheva military outpatient physical therapy clinic. Subjects were 42 men and 23 women referred for physical therapy, 33 with a diagnosis of AKP (cases) and 32 with upper limb complaints (without AKP, controls). All subjects underwent physical evaluation by an examiner blinded to their identity and medical condition. The following muscles were assessed bilaterally for active or latent MTrPs: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal). RESULTS: In six out of eight areas, the cases had a higher prevalence of total active and latent MTrPs than the controls. When summarizing MTrPs by muscle, cases had significantly more MTrPs than controls in each muscle. The largest difference was found in vastus medialis and vastus lateralis; nearly half of the cases had MTrPs in these muscles. CONCLUSIONS: Subjects with AKP have a greater prevalence of MTrPs in their hip and thigh muscles than controls, indicating an association between MTrPs and AKP. Further research is necessary to determine whether MTrPs are the cause or the consequence of AKP.

Abduction in Proximal Hamstring Tendon Avulsion Injury Mechanism: A Report on 3 Athletes.

Proximal hamstring tendon avulsions are typically sustained during forced hip hyperflexion combined with knee extension. We present 3 cases of athletes with a proximal hamstring tendon avulsion caused by an alternative injury mechanism that also involves a considerable hip abduction component (flexion-abduction injury mechanism). All cases had at least one concurrent injury of the medial thigh muscles, either on the ipsilateral or contralateral side. The 2 elite athletes with this injury mechanism returned to sport at preinjury level relatively quickly. A history of the flexion-abduction mechanism should raise suspicion of a hamstring tendon avulsion with concomitant injury of the medial thigh muscles. The magnetic resonance imaging (MRI) protocol should include both legs, and any concurrent injury may need to be addressed as well. In future studies, it would be interesting to investigate whether injury mechanism holds prognostic value in proximal hamstring tendon avulsions.

The validity and usability of an eight marker model for avatar-based biofeedback gait training.

BACKGROUND: Virtual reality presents a platform for therapeutic gaming, and incorporation of immersive biofeedback on gait may enhance outcomes in rehabilitation. Time is limited in therapeutic practice, therefore any potential gait training tool requires a short set up time, while maintaining clinical relevance and accuracy. The aim of this study was to develop, validate, and establish the usability of an avatar-based application for biofeedback-enhanced gait training with minimal set up time. METHODS: A simplified, eight marker model was developed using eight passive markers placed on anatomical landmarks. This allowed for visualisation of avatar-based biofeedback on pelvis kinematics, hip and knee sagittal angles in real-time. Retrospective gait analysis data from typically developing children (n = 41) and children with cerebral palsy (n = 25), were used to validate eight marker model. Gait outcomes were compared to the Human Body Model using statistical parametric mapping. Usability for use in clinical practice was tested in five clinical rehabilitation centers with the system usability score. FINDINGS: Gait outcomes of Human Body Model and eight marker model were comparable, with small differences in gait parameters. The discrepancies between models were <5°, except for knee extension where eight marker model showed significantly less knee extension, especially towards full extension. The application was considered of 'high marginal acceptability' (system usability score, mean 68 (SD 13)). INTERPRETATION: Gait biofeedback can be achieved, to acceptable accuracy for within-session gait training, using an eight marker model. The application may be considered usable and implemented for use in patient populations undergoing gait training.

Eldecalcitol increases bone mineral density in Chinese osteoporotic patients without vitamin D or calcium supplementation.

Eldecalcitol increased bone mineral density (BMD) and prevented vertebral fractures in vitamin D-sufficient osteoporotic subjects. However, the effect of eldecalcitol on BMD under vitamin D insufficiency is unknown. We examined the effect of eldecalcitol on BMD compared with alfacalcidol in osteoporotic patients without vitamin D or calcium supplementation. This is a randomized, double-blind, active comparator trial. 265 Chinese osteoporotic patients were randomly assigned to receive 0.75 µg eldecalcitol or 1.0 µg alfacalcidol for 12 months without vitamin D or calcium supplementation. Baseline calcium intakes were less than 550 mg/day and mean serum 25-hydroxyvitamin D [25(OH)D] was below 43 nmol/L in both groups. Baseline BMD tended to be lower in patients with lower calcium intake and serum 25(OH)D. Lumbar BMD increased by 2.05% higher in eldecalcitol than alfacalcidol group at 12 months. Total hip and femoral neck BMD also increased by 1.33 and 1.78%, respectively, in the eldecalcitol than the alfacalcidol group. The effect of eldecalcitol on BMD was not affected by serum 25(OH)D or calcium intake. The incidence of adverse events was not different between the two groups. Incidence of hypercalcemia in the edecalcitol group was not affected by serum 25(OH)D. In conclusion, baseline BMD tended to be lower in patients with low calcium intake and serum 25(OH)D. Eldecalcitol increased lumbar and hip BMD more than alfacalcidol regardless of serum 25(OH)D or calcium intake without vitamin D or calcium supplementation. These results suggest that eldecalcitol is effective in increasing the BMD of osteoporotic patients regardless of vitamin D status or calcium intake.Clinical Trial Registration number JAPIC CTI 152904.

Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial.

OBJECTIVE: The aim of the present study is to evaluate the effect of a 12 weeks hippotherapy intervention protocol on hip adductors spasticity in children with spastic cerebral palsy. DESIGN: Randomized controlled trial. SETTINGS/LOCATION: The intervention was conducted in an Equestrian and Therapeutic Association. Patients were recruited from a Rehabilitation Unit of Cerebral Palsy. SUBJECTS: A total of 44 children with spastic cerebral palsy (Gross Motor Function Classification System [GMFCS] levels IV-V; 28 boys and 16 girls; aged 8 years 10 months, SD 3 months) were assigned to a treatment (n = 22; mean age 9 years 6 months, SD 3 months) or a control group (n = 22; mean age 8 years 3 months, SD 3 months). INTERVENTIONS: The control group received conventional therapy, and the treatment group received hippotherapy in addition to their conventional treatment. The intervention consisted of a 12-weeks hippotherapy program (1 time/week, 45 min). OUTCOME MEASURES: Both groups were assessed before and after the full program with the Modified Ashworth Scale (MAS). RESULTS: There were significant differences in the MAS scores between the treatment and the control group in both adductors (left adductors: p = 0,040; right adductors: p = 0,047), after a 12-weeks hippotherapy intervention. CONCLUSIONS: A hippotherapy based treatment in addition to conventional therapy, in children with cerebral palsy, produces statistically significant changes in hip adductors spasticity after a 12-weeks intervention. Thus, it seems to produce benefits in the short-term.

Test-retest reliability of myofascial trigger point detection in hip and thigh areas.

BACKGROUND: Myofascial trigger points (MTrP's) are a primary source of pain in patients with musculoskeletal disorders. Nevertheless, they are frequently underdiagnosed. Reliable MTrP palpation is the necessary for their diagnosis and treatment. The few studies that have looked for intra-tester reliability of MTrPs detection in upper body, provide preliminary evidence that MTrP palpation is reliable. Reliability tests for MTrP palpation on the lower limb have not yet been performed. OBJECTIVE: To evaluate inter- and intra-tester reliability of MTrP recognition in hip and thigh muscles. DESIGN: Reliability study. SUBJECTS: 21 patients (15 males and 6 females, mean age 21.1 years) referred to the physical therapy clinic, 10 with knee or hip pain and 11 with pain in an upper limb, low back, shin or ankle. METHODS: Two experienced physical therapists performed the examinations, blinded to the subjects' identity, medical condition and results of the previous MTrP evaluation. Each subject was evaluated four times, twice by each examiner in a random order. Dichotomous findings included a palpable taut band, tenderness, referred pain, and relevance of referred pain to patient's complaint. Based on these, diagnosis of latent MTrP's or active MTrP's was established. The evaluation was performed on both legs and included a total of 16 locations in the following muscles: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal). RESULTS: Inter- and intra-tester reliability (Cohen's kappa (κ)) values for single sites ranged from -0.25 to 0.77. Median intra-tester reliability was 0.45 and 0.46 for latent and active MTrP's, and median inter-tester reliability was 0.51 and 0.64 for latent and active MTrPs, respectively. The examination of the distal vastus medialis was most reliable for latent and active MTrP's (intra-tester k = 0.27-0.77, inter-tester k = 0.77 and intra-tester k = 0.53-0.72, inter-tester k = 0.72, correspondingly). CONCLUSIONS: Inter- and intra-tester reliability of active and latent MTrP evaluation was moderate to substantial. Palpation evaluation can be used for clinical diagnosis of MTrP's in the hip and thigh muscles. SIGNIFICANCE: This study provides evidence that MTrP palpation is a moderately reliable diagnostic tool in the hip and thigh muscles and can be used in clinical practice and research.

Effect of bisphosphonate initiation at week 2 versus week 12 on short-term functional recovery after femoral neck fracture: a randomized controlled trial.

The appropriate time to initiate bisphosphonate treatment after a fragility fracture has not yet been established. In this study, we found no significant differences in short-term functional recovery between femoral neck fracture patients who received bisphosphonate treatment at 2 versus 12 weeks after hemiarthroplasty. INTRODUCTION: Bisphosphonate is the mainstay therapy for prevention and treatment of osteoporosis. The aim of this study was to investigate the effect of bisphosphonate initiation on short-term functional recovery in femoral neck fracture patients at 2 versus 12 weeks after hemiarthroplasty. METHODS: One hundred patients were randomly allocated into two groups in a parallel group designed, randomized, controlled trial. Both groups received risedronate 35 mg/week at either 2 or 12 weeks after hemiarthroplasty. All patients received calcium and vitamin D supplementation. Functional recovery was assessed by de Morton Mobility Index, Barthel Index, EuroQol 5D, visual analog scale, 2-min walk test, and timed get-up-and-go test at 2 weeks, 3 months, and 1 year after surgery. RESULTS: At the 3-month follow-up, all functional outcome measures showed significant improvement in both groups. There were no statistically significant differences in any of the functional outcomes between groups at both the 3-month and 1-year follow-ups. Although patients who received bisphosphonate initiation at week 2 had lower serum calcium level at 3 months and more overall adverse events than patients in the week 12 group, no patients in either group discontinued their prescribed medications. CONCLUSIONS: While underpowered, the findings of this study suggest that there were no significant differences in short-term functional recovery or significant adverse events between the two bisphosphonate groups. Thus, the initiation of bisphosphonate therapy may be considered as early as 2 weeks after femoral neck fracture. It is important that low serum calcium and vitamin D status must be corrected with calcium and vitamin D supplementation prior to or at the time of bisphosphonate initiation. CLINICAL TRIAL REGISTRATION NUMBER: This study was registered in the database via the Protocol Registration and Results System (PRS) (NCT02148848).

Hip and knee effects after implantation of a drop foot stimulator.

BACKGROUND: An active ankle dorsiflexion is essential for a proper gait pattern. If there is a failure of the foot lifting, considerable impairments occur. The therapeutic effect of an implantable peroneus nerve stimulator (iPNS) for the ankle dorsiflexion is already approved by recent studies. However, possible affection for knee and hip motion after implantation of an iPNS is not well described. OBJECTIVE: The objective of this retrospective study was to examine with a patient cohort whether the use of iPNS induces a lower-extremity flexion withdrawal response in the form of an increased knee and hip flexion during swing phase. METHODS: Eighteen subjects (12 m/6 w) treated with an iPNS (ActiGait®, Otto Bock, Duderstadt, Germany) were examined in knee and hip motion by gait analysis with motion capture system (Vicon Motion System Ltd®, Oxford, UK) and Plug-in-Gait model after a mean follow up from 12.5 months. The data were evaluated and compared in activated and deactivated iPNS. RESULTS: Only little changes could be documented, as a slight average improvement in peak knee flexion during stand phase from 1.0° to 2.5° and peak hip flexion in stance from 3.1° to 2.1° In contrast, peak knee flexion during swing appeared similar (25.3° to 25.7°) same as peak hip flexion during swing. In comparison with the healthy extremity, a more symmetric course of the knee flexion during stand phase could be shown. CONCLUSIONS: No statistical significant improvements or changes in hip and knee joint could be shown in this study. Only a more symmetric knee flexion during stand phase and a less hip flexion during stand phase might be hints for a positive affection of iPNS for knee and hip joint. It seems that the positive effect of iPNS is only based on the improvement in ankle dorsiflexion according to the recent literature.

The Association Between Protein Intake by Source and Osteoporotic Fracture in Older Men: A Prospective Cohort Study.

Dietary protein is a potentially modifiable risk factor for fracture. Our objectives were to assess the association of protein intake with incident fracture among older men and whether these associations varied by protein source or by skeletal site. We studied a longitudinal cohort of 5875 men (mean age 73.6 ± 5.9 years) in the Osteoporotic Fractures in Men (MrOS) study. At baseline, protein intake was assessed as percent of total energy intake (TEI) with mean intake from all sources = 16.1%TEI. Incident clinical fractures were confirmed by physician review of medical records. There were 612 major osteoporotic fractures, 806 low-trauma fractures, 270 hip fractures, 193 spine fractures, and 919 non-hip non-spine fractures during 15 years of follow-up. We used Cox proportional hazards models with age, race, height, clinical site, TEI, physical activity, marital status, osteoporosis, gastrointestinal surgery, smoking, oral corticosteroids use, alcohol consumption, and calcium and vitamin D supplements as covariates to compute hazard ratios (HRs) with 95% confidence intervals (CIs), all expressed per unit (SD = 2.9%TEI) increase. Higher protein intake was associated with a decreased risk of major osteoporotic fracture (HR = 0.92; 95% CI, 0.84 to 1.00) with a similar association found for low-trauma fracture. The association between protein and fracture varied by protein source; eg, increased dairy protein and non-dairy animal protein were associated with a decreased risk of hip fracture (HR = 0.80 [95% CI, 0.65 to 0.98] and HR = 0.84 [95% CI, 0.72 to 0.97], respectively), whereas plant-source protein was not (HR = 0.99 [95% CI, 0.78 to 1.24]). The association between protein and fracture varied by fracture site; total protein was associated with a decreased risk of hip fracture (HR = 0.84 [95% CI, 0.73 to 0.95]), but not clinical spine fracture (HR = 1.06 [95% CI, 0.92 to 1.22]). In conclusion, those with high protein intake (particularly high animal protein intake) as a percentage of TEI have a lower risk of major osteoporotic fracture. © 2016 American Society for Bone and Mineral Research.

Low intensity laser and LED therapies associated with lateral decubitus position and flexion exercises of the lower limbs in patients with lumbar disk herniation: clinical randomized trial.

UNLABELLED: The objective of this study is to evaluate the effectiveness of laser and LED therapies, associated with lateral decubitus position and flexion exercises of the lower limbs in patients with lumbar disk herniation (LDH). It is a randomized blinded clinical trial. Fifty-four subjects with LDH L4-L5 and L5-S1 were selected and randomly allocated into groups: laser 904 nm, placebo, and LED 945 nm. The numbers of subjects for each group that completed the treatment were 18, 13, and 18, respectively. Twelve points over the lumbar spine region (L2 to S1) and eight points on the injured thigh in the path of the lumbar roots L5 and S1 were irradiated. Irradiation parameters for each point were as follows: laser wavelength 904 ± 10 nm, average power 0.038 ± 20 % W, irradiated area 0.16 cm(2), energy per point 4 J, and treatment time per point 104 s; LED wavelength 945 ± 15 nm, power 0.1 W, irradiated area 1.0cm(2), energy per point 4 J, and treatment time per point 40 s. Lateral decubitus opposite to the side of the radicular was the standard position for all patients. After phototherapy and laser placebo sessions, the subjects performed sequences of flexion exercises of the lower limbs (ten per session) for 15 daily sessions. VARIABLES STUDIED: pain intensity assessed by visual analog scale (VAS), degree of flexion of the affected hip measured by the universal goniometer and functional capacity assessed by the Oswestry Disability Index. The three groups had statistically significant improvement in lumbar and radicular pain, in hip mobility, and in the functional disability index (p ≤ 0.001). There was a statistically significant difference (p = 0.024) in radicular pain between the groups, gait claudication and Oswestry Disability Index. We can conclude that in the treatment of L4-L5 and L5-S1 LDH with radiculopathy, LED, associated with lateral decubitus position and flexion exercises of the lower limbs, showed better therapeutic performance for radicular pain, gait claudication, and functional disability.

Improvements in kinematics, muscle activity and pain during functional tasks in females with patellofemoral pain following a single patterned electrical stimulation treatment.

BACKGROUND: Individuals with patellofemoral pain present with altered hip muscle activation, faulty movement patterns, and pain during functional tasks. Examining new treatment options to address these impairments may better treat those with patellofemoral pain. The purpose of this study was to determine if patterned electrical stimulation to the lower extremity affects muscle activity, movement patterns, and pain following a single treatment. METHODS: Fifteen females with patellofemoral pain were randomized to receive a single 15-minute treatment of either a patterned electrical neuromuscular stimulation or a sham. Peak kinematics of the knee, hip, and trunk, electromyography and pain were examined pre and post-intervention during a single leg squat and lateral step-down task. Group means and pre/post reduced kinematic values were also plotted during the entire task with 90% confidence intervals to identify differences in movement strategies. FINDINGS: No baseline differences were found in peak kinematics between groups. No pre to post-intervention differences in peak knee, hip and trunk kinematics were found, however differences were seen when the quality of movement across the entire tasks was assessed. The electrical stimulation group had improved knee flexion and hip abduction during the lateral step-down. A significant improvement in gluteus medius activation following patterned electrical neuromuscular stimulation occurred during the step-down (P=0.039). Significant pain improvements were also seen in both the single leg squat (P=0.025) and lateral step-down (P=0.006). INTERPRETATION: A single treatment of patterned electrical neuromuscular stimulation improved muscle activation, lower extremity kinematics during functional tasks, and pain.

The effect of chronic mild hyponatremia on bone mineral loss evaluated by retrospective national Danish patient data.

PURPOSE: To evaluate the effect of chronic mild hyponatremia ([Na+]=130-137mmol/L) on bone mineral content (BMC) and bone mineral density (BMD) loss through multiple, serial dual-energy X-ray absorptiometry (DXA) scans. METHODS: Utilizing biochemical and DXA scan data from two Danish regions between 2004 and 2011, supplemented with national Danish patient diagnosis and prescription reimbursement databases, a retrospective cohort study was performed. All subjects with more than one DXA scan were included, then stratified into "normonatremia" ([Na(+)]=[137.00-147.00] mmol/L) and "mild hyponatremia" ([Na(+)]=[130.00-137.00[mmol/L) based on mean and confidence interval (CI) values calculated from all plasma sodium measurements between each subject's first and last DXA scan. Baseline, follow-up and delta values for hip and lumbar spine BMC and BMD were estimated between groups, then adjusted for comorbidity and medication use. RESULTS: Hip and lumbar spine groups had 884 and 1069 patients with "normonatremia" versus 58 and 58 patients with "mild hyponatremia", respectively. Mild hyponatremia was associated with lower BMC and BMD in nearly all regions of the hip, and with worse losses in the trochanteric, femoral neck and total hip regions. Mild hyponatremia had limited effect on the lumbar spine. CONCLUSIONS: Chronic mild hyponatremia seems to greatly affect bone in the hip, while the effect is limited in the lumbar spine. We suggest further retrospective study of patients with moderate (P-Na=120-130mmol/L) to severe hyponatremia (P-Na<120mmol/L) and prospective studies to further examine the association.

BIOMECHANICS OF THERAPEUTIC RIDING DURING THE DISEASES OF I-II DEGREE DYSPLASTIC LUMBAR AND STATIC (SHORT LEG) SCOLIOSIS.

The goal of the paper is to substantiate the essence of ridetherapy biomechanics as the pathogenetic therapeutic and prophylactic method at lumbar dysplastic (the I and II degrees) and static (short-legged induced) scoliosis. Uneven lower extremities caused by any reason and asymmetric support induce the change in the arrangement of trochantin to the vertebra and correspondingly the uneven loading of lumbar muscles. The asymmetric strength of lumbar muscles evoked by the change in rotator condition becomes the cause of the formation of scoliosis primary arc which, in its turn, causes a compensatory spinal curvature. In case of dysplastic scoliosis a leading role belongs to the beginning of dystrophic changes in intervertebral discs and its further decentration. At riding position the lower extremities are completely disengaged from the antigravity redistribution, the child is in direct contact with vibrations and jolts coming from the horseback; the antigravity loading is distributed on the muscles of the torso and thus, it creates an opportunity to purposefully affect the correction of the spine. During scoliosis the pathogenic essence of ridetherapy is due to the comprehensiveness of its procedures, expressed in the fact that during one procedure several factors are influenced simultaneously: nucleus pulpous, the torso and iliopsoas muscles, the antigravity system, etc. According to the clinical-functional and radiographic studies carried out in the dynamics on 11-16 years old adolescents it has been established that in those groups where the rehabilitation was conducted in a complex with ridetherapy the authentically higher results were obtained as compared to the groups where the rehabilitation was held using therapeutic exercises and massage.

Surface peroneal nerve stimulation in lower limb hemiparesis: effect on quantitative gait parameters.

OBJECTIVE: The objective of this study was to evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation vs. usual care via quantitative gait analysis. DESIGN: This study is a randomized controlled clinical trial. SETTING: The setting of this study is a teaching hospital of an academic medical center. PARTICIPANTS: One hundred ten chronic stroke survivors (>12 wks poststroke) with unilateral hemiparesis participated in this study. INTERVENTIONS: The subjects were randomized to a surface peroneal nerve stimulation device or usual care intervention. The subjects were treated for 12 wks and followed up for 6-mo posttreatment. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and kinetic parameters of gait were the main outcome measures. RESULTS: Cadence (F3,153 = 5.81, P = 0.012), stride length (F3,179 = 20.01, P < 0.001), walking speed (F3,167 = 18.2, P < 0.001), anterior-posterior ground reaction force (F3,164 = 6.61, P = 0.004), peak hip power in preswing (F3,156 = 8.76, P < 0.001), and peak ankle power at push-off (F3,149 = 6.38, P = 0.005) all improved with respect to time. However, peak ankle ankle dorsiflexion in swing (F3,184 = 4.99, P = 0.031) worsened. In general, the greatest change for all parameters occurred during the treatment period. There were no significant treatment group × time interaction effects for any of the spatiotemporal, kinematic, or kinetic parameters. CONCLUSIONS: Gait training with peroneal nerve stimulation and usual care was associated with improvements in peak hip power in preswing and peak ankle power at push-off, which may have resulted in improved cadence, stride length, and walking speed; however, there were no differences between treatment groups. Both treatment groups also experienced a decrease in peak ankle ankle dorsiflexion in swing, although the clinical implications of this finding are unclear.

Reliability of sagittal pelvic position assessments in standing, sitting and during hip flexion using palpation meter.

The objective of this study was to investigate reliability of assessing sagittal pelvic position using the palpation meter (PALM) in healthy subjects while sitting, standing and while in different hip flexion angles in standing. Twenty healthy subjects were assessed two times by the same examiner, with a 48-h interval between test sessions. Reliability indices of PALM measures (intraclass correlation coefficient, ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were calculated. ICC values showed excellent intra-rater reliability for measurements of sagittal pelvic position in standing and sitting position and for both standing hip flexion angles (ICC = .89-.96). SEM values ranged from .5° (hip flexion 90°) to 1.5° (sitting position). SDC values ranged from 1.5° (hip flexion 90°) to 4.0° (sitting position). The results of this study showed excellent intra-rater reliability for assessing sagittal pelvic position in standing, sitting and hip flexion in healthy subjects using the PALM.

A semi-active hybrid neuroprosthesis for restoring lower limb function in paraplegics.

Through the application of functional electrical stimulation (FES) individuals with paraplegia can regain lost walking function. However, due to the rapid onset of muscle fatigue, the walking duration obtained with an FES-based neuroprosthesis is often relatively short. The rapid muscle fatigue can be compensated for by using a hybrid system that uses both FES and an active orthosis. In this paper, we demonstrate the initial testing of a semi-active hybrid walking neuroprosthesis. The semi-active hybrid orthosis (SEAHO) supports a user during the stance phase and standing while the electric motors attached to the hip section of the orthosis are used to generate hip flexion/extension. FES in SEAHO is mainly used to actuate knee flexion/extension and plantar flexion of the foot. SEAHO is controlled by a finite state machine that uses a recently developed nonlinear controller for position tracking control of the hip motors and cues from the hip angle to actuate FES and other components.

Effects of intramuscular trunk stimulation on manual wheelchair propulsion mechanics in 6 subjects with spinal cord injury.

OBJECTIVE: To quantify the effects of stabilizing the paralyzed trunk and pelvis with electrical stimulation on manual wheelchair propulsion. DESIGN: Single-subject design case series with subjects acting as their own concurrent controls. SETTING: Hospital-based clinical biomechanics laboratory. PARTICIPANTS: Individuals (N=6; 4 men, 2 women; mean age ± SD, 46 ± 10.8y) who were long-time users (6.1 ± 3.9y) of implanted neuroprostheses for lower extremity function and had chronic (8.6 ± 2.8y) midcervical- or thoracic-level injuries (C6-T10). INTERVENTIONS: Continuous low-level stimulation to the hip (gluteus maximus, posterior adductor, or hamstrings) and trunk extensor (lumbar erector spinae and/or quadratus lumborum) muscles with implanted intramuscular electrodes. MAIN OUTCOME MEASURES: Pushrim kinetics (peak resultant force, fraction effective force), kinematics (cadence, stroke length, maximum forward lean), and peak shoulder moment at preferred speed over 10-m level surface; speed, pushrim kinetics, and subjective ratings of effort for level 100-m sprints and up a 30.5-m ramp of approximately 5% grade. RESULTS: Three of 5 subjects demonstrated reduced peak resultant pushrim forces (P≤.014) and improved efficiency (P≤.048) with stimulation during self-paced level propulsion. Peak sagittal shoulder moment remained unchanged in 3 subjects and increased in 2 others (P<.001). Maximal forward trunk lean also increased by 19% to 26% (P<.001) with stimulation in these 3 subjects. Stroke lengths were unchanged by stimulation in all subjects, and 2 showed extremely small (5%) but statistically significant increases in cadence (P≤.021). Performance measures for sprints and inclines were generally unchanged with stimulation; however, subjects consistently rated propulsion with stimulation to be easier for both surfaces. CONCLUSIONS: Stabilizing the pelvis and trunk with low levels of continuous electrical stimulation to the lumbar trunk and hip extensors can positively impact the mechanics of manual wheelchair propulsion and reduce both perceived and physical measures of effort.

Hip bone loss is attenuated with 1000 IU but not 400 IU daily vitamin D3: a 1-year double-blind RCT in postmenopausal women.

Few year-long vitamin D supplementation trials exist that match seasonal changes. The aim of this study was to determine whether daily oral vitamin D3 at 400 IU or 1000 IU compared with placebo affects annual bone mineral density (BMD) change in postmenopausal women in a 1-year double-blind placebo controlled trial in Scotland. White women aged 60 to 70 years (n = 305) were randomized to one of two doses of vitamin D or placebo. All participants started simultaneously in January/February 2009, attending visits at bimonthly intervals with 265 (87%) women attending the final visit and an additional visit 1 month after treatment cessation. BMD (Lunar iDXA) and 1,25-dihydroxyvitamin D[1,25(OH)2 D], N-terminal propeptide of type 1 collagen [P1NP], C-terminal telopeptide of type I collagen [CTX], and fibroblast growth factor-23 [FGF23] were measured by immunoassay at the start and end of treatment. Circulating PTH, serum Ca, and total 25-hydroxyvitamin D [25(OH)D] (latter by tandem mass spectrometry) were measured at each visit. Mean BMD loss at the hip was significantly less for the 1000 IU vitamin D group (0.05% ± 1.46%) compared with the 400 IU vitamin D or placebo groups (0.57% ± 1.33% and 0.60% ± 1.67%, respectively) (p < 0.05). Mean (± SD) baseline 25(OH)D was 33.8 ± 14.6 nmol/L; comparative 25(OH)D change for the placebo, 400 IU, and 1000 IU vitamin D groups was -4.1 ± 11.5 nmol/L, +31.6 ± 19.8 nmol/L, and +42.6 ± 18.9 nmol/L, respectively. Treatment did not change markers of bone metabolism, except for a small reduction in PTH and an increase in serum calcium (latter with 1000 IU dose only). The discordance between the incremental increase in 25(OH)D between the 400 IU and 1000 IU vitamin D and effect on BMD suggests that 25(OH)D may not accurately reflect clinical outcome, nor how much vitamin D is being stored.