Impact of visual rotations on heading direction and center of mass control during steady state gait.

Visual information is essential to navigate the environment and maintain postural stability during gait. Visual field rotations alter the perceived heading direction and center of mass (CoM) trajectory. This interaction, referred to as visual coupling, is poorly characterized during steady-state gait. Moreover, it is unclear how visual field rotations affect CoM control relative to the continuously changing base of support (BoS). This study aimed to characterize the role of visual information in heading and mediolateral (ML) balance control during unperturbed, steady-state gait. Sixteen healthy participants walked on an instrumented treadmill, naïve to sinusoidal low-frequency (0.1 Hz) rotations of the virtual environment. Rotations had a 1) high (CMH) or 2) low amplitude (CML), or were 3) periodical left-right manipulations (PM) with 10 second intervals. Coupling between CoM trajectory and visual manipulations was in-phase and showed strong cross-correlations on group level (CML: 0.88, CMH: 0.91 and PM: 0.95) and moderate to strong on individual level (CML: 0.52 ± 0.15, CMH: 0.56 ± 0.17 and PM: 0.80 ± 0.07). Higher manipulation amplitudes induced stronger CoM trajectory deviations. The margin of stability (MoSML), characterizing ML balance control, decreased towards the deviation direction and increased at the opposite side. Furthermore, a pelvis and feet reorientation towards the manipulation direction was observed. We concluded that visual information is continuously used to determine and adjust heading direction during steady-state gait. To facilitate these adjustments, the body was reorientated and the CoM-ML shifted closer to the lateral BoS boundary towards the adjusted heading direction, while preserving CoM excursion.

Is the Walking Adaptability Ladder test for Kids (WAL-K) reliable and valid in ambulatory children with Cerebral Palsy?

PURPOSE: Walking adaptability is essential for children to participate in daily life. We studied whether the Walking Adaptability Ladder test for Kids (WAL-K) is reliable and valid for assessing walking adaptability in 6-12 year old ambulatory children with Cerebral Palsy (CP). MATERIALS AND METHODS: Thirty-six children with CP (26 GMFCS-level I, 10 GMFCS-level II) completed the single and double run of the WAL-K. Intra- and inter-rater reliability were determined by Intraclass Correlation Coefficients (ICCs). Construct validity was determined by comparing WAL-K scores between 122 typically developing (TD) and CP children taking age into account, comparing WAL-K scores between CP children in GMFCS-levels I and II, and correlating WAL-K scores with scores of the 10 times 5 m Sprint Test (10 × 5mST). RESULTS: ICCs for reliability varied between 0.997 and 1.000. WAL-K scores were significantly higher (i.e., worse) in CP children compared to TD children (p < 0.001), and in children in GMFCS-level II compared to GMFCS-level I (p = 0.001). Significant positive correlations were found between the WAL-K and 10 × 5 mST (single run r = .89, double run r = .84). CONCLUSIONS: The WAL-K shows to be a promising reliable, valid, and easy-to-use tool for assessing walking adaptability in children with CP. Responsiveness to change has yet to be evaluated.

Walking adaptability is an essential skill for children to participate in daily life, yet there is no validated clinical test for children with Cerebral Palsy (CP).We recently developed the Walking Adaptability Ladder test for Kids (WAL-K) and we here tested its reliability and validity in children with CP.Application of the WAL-K in children with CP yielded excellent intra- and inter-rater reliability and a good construct validity.The WAL-K shows to be a promising reliable, valid, and easy-to-use tool to assess walking adaptability in children with CP.

The effect of functional calibration methods on gait kinematics in adolescents with idiopathic rotational deformity of the femur.

BACKGROUND: Due to anatomical deviations, assumptions of the conventional calibration method for gait analysis may be violated in individuals with rotational deformities of the femur. Functional calibration methods were compared with conventional methods in this group for 1) localization of the hip joint center and orientation of the knee axis, and 2) gait kinematics. METHODS: Twenty-four adolescents with idiopathic rotational deformity of the femur underwent gait analysis and a CT scan. During standing, distance between hip joint centers and knee axis orientation were compared between calibration methods, with CT serving as reference for hip joint center estimation. Gait kinematics were compared using statistical parametric mapping. FINDINGS: The conventional calibration method estimated the hip joint center closer to the CT reference (4±12 mm more lateral) than the functional calibration method (26 ± 20 mm more lateral). Orientation of the knee joint axis was 2.6° less internal in the functional calibration method. During gait, statistical parametric mapping revealed significantly more hip flexion, less external hip rotation during the swing phase, less knee varus-valgus motion, and larger knee flexion angles when applying the functional method. INTERPRETATION: Functional calibration methods were less accurate in determining the hip joint center location than the conventional calibration method and resulted in a knee joint axis that was less internally rotated. Importantly, there was less knee joint angle crosstalk during gait when using the functional method. Although differences between methods on gait kinematics were within clinically acceptable limits for the sagittal plane, relatively larger differences on transversal hip kinematics may hold clinical importance.

Multisensory Stimulation and Priming (MuSSAP) in 4-10 Months Old Infants with a Unilateral Brain Lesion: A Pilot Randomised Clinical Trial.

Aim: To explore the effect of an Early Intensive-Upper Limb intervention (EI-UL) compared to EI-UL with integrated Multisensory Stimulation And Priming (MuSSAP) training on improving manual ability in infants with a unilateral brain lesion. Method: A pilot randomised clinical trial with pre- and postintervention and follow-up measurements (T0, T1, and T2) was conducted. Sixteen infants with a unilateral brain lesion (corrected age is 4-10 months) received home-based intervention with video coaching. Eight infants received EI-UL and eight infants received EI-UL with integrated MuSSAP training. Primary outcome was the Hand Assessment for Infants (HAI) score. Additionally, effects were explored on initiation of goal-directed movements in both groups and on attention in the EI-UL with integrated MuSSAP training group. Results: No significant group differences in HAI scores were found. Overall, HAI 'Affected hand score' increased between T0 and T1 (p = 0.001, Cohen's d = 1.04) and between T0 and T2 (p < 0.001, Cohen's d = 1.28); and the HAI 'Both Hands Measure' increased between T0 and T1 (p < 0.001, Cohen's d = 1.72) and between T0 and T2 (p < 0.001, Cohen's d = 1.81). At the start of the intervention, six infants (three in both groups) did not demonstrate initiation of goal-directed contralesional upper limb movements. During the intervention one infant receiving EI-UL and all three infants receiving EI-UL with integrated MuSSAP training started to initiate goal-directed movements. Conclusion: The results suggest manual ability of infants with unilateral brain lesion improved with both interventions. We hypothesize that the integrated MuSSAP training may facilitate attention and initiation of contralesional upper limb goal-directed movements. This trial is registered with NCT05533476).

Translation and validation of the System Usability Scale to a Dutch version: D-SUS.

PURPOSE: The System Usability Scale (SUS) is the most commonly used questionnaire to assess usability of healthcare innovations but is not available in Dutch (D-SUS). This study aims to translate the SUS to Dutch and to determine its internal consistency, test-retest reliability, and construct validity in healthcare innovations focused on rehabilitation technologies. METHODS: Translation of the SUS was performed according to the WHO recommendations. Fifty-four participants filled out the D-SUS and Dutch Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) twice. Internal consistency was assessed by Cronbach's alpha. Test-retest reliability was evaluated by Gwet's agreement coefficient (Gwet's AC2) on item scale, and Pearson correlation coefficient (PCC) for the overall D-SUS scores. Construct validity was assessed with the PCC between the D-SUS and D-QUEST overall scores (Netherlands Trial Register, ID: NL9169). RESULTS: After translation, Cronbach's alpha was 0.74. Gwet's AC2 was 0.68 and the PCC between the first and second overall D-SUS scores was 0.75. No significant difference in D-SUS score between the two measurements was found. Repeatability coefficient was 18.4. The PCC between the D-SUS and D-QUEST overall scores was 0.49. CONCLUSIONS: The D-SUS is a valid and reliable tool for usability assessment of healthcare innovations, specifically rehabilitation technologies.

Successful implementation of new rehabilitation technologies is partially dependent on good system usability.The System Usability Scale is translated to Dutch (D-SUS) to evaluate usability of healthcare innovations in the Netherlands.The D-SUS is a reliable and valid method to measure usability of rehabilitation technologies and eHealth applications.

Parents' experiences with a home-based upper limb training program using a video coaching approach for infants and toddlers with unilateral cerebral palsy: a qualitative interview study.

BACKGROUND: Although early home-based upper limb training programs are promising, in-depth understanding of parents' experiences with these programs is still limited. We developed an early home-based upper limb training program for infants and toddlers (8-36 months) with or at risk of unilateral cerebral palsy using video coaching for parents. The aim of this qualitative study was to evaluate parents' experiences with the home-based training program using a video coaching approach in order to optimize implementation strategies. METHODS: We held semi-structured interviews with parents of 13 children with unilateral cerebral palsy, who participated in our program in the period from 2014 - 2017. On average, parents had delivered two training periods of the program at the time of the interviews. Interviews were analyzed using inductive thematic content analysis. RESULTS: We identified three overarching interacting themes that shaped the experiences of parents with the program: 1) Parental learning comprising the subthemes parents' training competencies and the facilitative and reinforcing role of video coaching, 2) Parental load comprising the subthemes flexibility of the program, supportive network, competing demands, and child's mood and functional capacities, and 3) Parental perseverance comprising the subthemes beliefs and expectancies and seeing child's functional improvements. CONCLUSIONS: For successful implementation of an early home-based upper limb training program using video coaching, support in delivering home-training from a therapist or from others within parents' social network, is needed to relieve parental load. Seeing functional improvements of their child on the videos increased parents' motivation to continue with the training. Positively phrased feedback from an occupational therapist stimulated parents' perseverance and training competency.

The effects of a visuo-motor and cognitive dual task on walking adaptability in children with and without Developmental Coordination Disorder.

BACKGROUND: Children with Developmental Coordination Disorder (DCD-C) have motor coordination deficits which lead to difficulties in sports and play activities that require adaptations of the walking pattern. Sports and play often involve performing dual tasks, which affects performance in DCD-C more than in typically developing children (TD-C). So far, testing the impact of dual tasking on walking adaptability in DCD-C has received little scientific attention. RESEARCH QUESTION: We tested the hypothesis that 6-12 year old DCD-C will show lower levels of walking adaptability than TD-C, and that due to problems with automatization this difference will increase when they are forced to divide their attention between tasks when a concurrent visuo-motor or cognitive task is added. METHODS: Twenty-six DCD-C and sixty-nine TD-C were included in this cross-sectional study. They performed a challenging walking adaptability (WA) task on a treadmill as a single, a visuo-motor dual and a cognitive dual task at a pace of 3.5 km/h. Repeated measures ANCOVAs were performed with condition (single/dual task) as within-subjects factor, group (TD/DCD) as between-subjects factor, and age as covariate. RESULTS: DCD-C performed poorer on the WA task than TD-C. The group differences increased when a concurrent visuo-motor task was added, but not when adding a concurrent cognitive task. A significant effect of age was found with younger children performing worse on all tasks. SIGNIFICANCE: The results highlight the problems DCD-C have with walking adaptability and dual tasks, which capacities are essential for full participation in sports and play activities. Future research should investigate whether DCD-C may benefit from task-specific walking adaptability training.

Reliability and construct validity of the Walking Adaptability Ladder Test for Kids (WAL-K): a new clinical test for measuring walking adaptability in children.

PURPOSE: Walking adaptability is essential for children to participate in daily life, but no objective measurement tools exist. We determined psychometric properties of the Walking Adaptability Ladder test for Kids (WAL-K) in 6-12 year old children. MATERIALS AND METHODS: In total, 122 typically developing (TD) children and 26 children with Developmental Coordination Disorder (DCD) completed the single and double run conditions of the WAL-K. Intra-rater, inter-rater and test-retest reliability were determined by ICCs and Smallest Detectable Change (SDC) in 53 TD children. Construct validity was determined by comparing WAL-K scores between 69 TD and all DCD children and correlating these scores with age and MABC-2 scores. RESULTS: ICCs for reliability varied between 0.76 and 0.99. Compared to the first test performance, WAL-K scores were lower (i.e., better) at retest. SDCs for test-retest reliability varied between 20.8 and 26.1% of the mean scores. WAL-K scores were significantly higher (i.e., worse) in DCD children compared to TD children (p < 0.001). Significant negative correlations were found with MABC-2 (-0.52 and -0.60) and age (-0.61 and -0.68). CONCLUSIONS: The WAL-K shows to be a valid, reliable and easy-to-use tool for measuring walking adaptability in children. Adding an extra practice trial may reduce the observed learning effect.Implications for rehabilitationWalking adaptability is an essential skill for children to participate in daily life, but no objective measurement tools are available.The Walking Adaptability Ladder test for Kids (WAL-K) is a new measurement tool for evaluating walking adaptability in children.The WAL-K shows to be a reliable and valid measurement tool for evaluating walking adaptability in 6-12 year old children.

Walking adaptability improves after treadmill training in children with Developmental Coordination Disorder: A proof-of-concept study.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) have motor coordination deficits leading to difficulties in sports and play that require adaptations of the walking pattern. Children with DCD indeed demonstrate poorer walking adaptability (WA) compared to typically developing children, but it remains elusive whether WA can be improved by training. RESEARCH QUESTION: Does augmented-reality treadmill training lead to improvements in WA in children with DCD? METHODS: Seventeen children with DCD were included in this proof-of-concept intervention study. They received a six-session training on the C-mill, a treadmill on which gait adjustments can be evoked by projected visual context. The effect of the training was evaluated before (M1), directly after training (M2) and after 6 months follow-up (M3) using the WAL-K (single and double run) and WA-tasks on the C-mill (as a single and with concurrent visuo-motor and cognitive task). In addition, parents completed a questionnaire on their perception of the training. Linear Mixed Model analyses were performed to assess the differences in WAL-K scores and success rates on the WA-tasks between M1-M2 and M1-M3. RESULTS: Children significantly improved on the WAL-K double run and on all three WA-tasks between M1-M2 and M1-M3. Children did not improve on the WAL-K single run. Parents found the training useful and fun for their child and indicated that their child fell less frequently. SIGNIFICANCE: The results show that C-mill training had positive and task-specific effects on WA in children with DCD, which effects generalized to an overground task and were retained at 6 months follow-up. This may help children with DCD to better participate in daily activities. Future research should include a control group to examine the effectiveness of the training program compared to receiving no training and may also examine the effect of the training on participation in daily life.

Validation of new measures of arm coordination impairment in Wheelchair Rugby.

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.

Fitts' Law is Applicable to Trunk Coordination Measurements in a Sitting Position.

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.

Gait Stability Training in a Virtual Environment Improves Gait and Dynamic Balance Capacity in Incomplete Spinal Cord Injury Patients.

Many patients with incomplete spinal cord injury (iSCI) have impaired gait and balance capacity, which may impact daily functioning. Reduced walking speed and impaired gait stability are considered important underlying factors for reduced daily functioning. With conventional therapy, patients are limited in training gait stability, but this can be trained on a treadmill in a virtual environment, such as with the Gait Real-time Analysis Interactive Lab (GRAIL). Our objective was to evaluate the effect of 6-weeks GRAIL-training on gait and dynamic balance in ambulatory iSCI patients. In addition, the long-term effect was assessed. Fifteen patients with chronic iSCI participated. The GRAIL training consisted of 12 one-hour training sessions during a 6-week period. Patients performed 2 minute walking tests on the GRAIL in a self-paced mode at the 2nd, and 3rd (baseline measurements) and at the 12th training session. Ten patients performed an additional measurement after 6 months. The primary outcome was walking speed. Secondary outcomes were stride length, stride frequency, step width, and balance confidence. In addition, biomechanical gait stability measures based on the position of the center of mass (CoM) or the extrapolated center of mass (XCoM) relative to the center of pressure (CoP) or the base of support (BoS) were derived: dynamic stability margin (DSM), XCoM-CoP distance in anterior-posterior (AP) and medial-lateral (ML) directions, and CoM-CoP inclination angles in AP and ML directions. The effect of GRAIL-training was tested with a one-way repeated measures ANOVA (α = 0.05) and post-hoc paired samples t-tests (α = 0.017). Walking speed was higher after GRAIL training (1.04 m/s) compared to both baseline measurements (0.85 and 0.93 m/s) (p < 0.001). Significant improvements were also found for stride length (p < 0.001) and stability measures in AP direction (XCoM-CoPAP (p < 0.001) and CoM-CoPAP-angle (p < 0.001)). Stride frequency (p = 0.27), step width (p = 0.19), and stability measures DSM (p = 0.06), XCoM-CoPML (p = 0.97), and CoM-CoPML-angle (p = 0.69) did not improve. Balance confidence was increased after GRAIL training (p = 0.001). The effects were remained at 6 months. Increased walking speed, stride length, AP gait stability, and balance confidence suggest that GRAIL-training improves gait and dynamic balance in patients with chronic iSCI. In contrast, stability measures in ML direction did not respond to GRAIL-training.

Validity and reliability of the mixing ability test as masticatory performance outcome in children with spastic cerebral palsy and children with typical development: A pilot study.

BACKGROUND: The mixing ability test (MAT) as an outcome measure of masticatory performance is largely used in studies with adults, but not yet with children. OBJECTIVE: This study aimed to test the construct validity and the test-retest reliability of the MAT in children with spastic cerebral palsy (CP) and children with typical development (TD). METHOD: The results of the MAT were correlated with tongue movements, mandible movements, relative muscle contraction and clinical observation measured with ultrasound, 3D kinematics, electromyography (EMG) and relevant items of the mastication observation and evaluation (MOE) instrument, respectively. Moreover, the between-groups effect was tested. Test-retest reliability was calculated with an intra-class correlation coefficient (ICC) and standard error of measurement (SEM). RESULTS: Twenty-one children (seven children with spastic CP and 14 children with TD) participated in this study. The MAT scores showed moderate to good correlations with some variables of the tongue movements, horizontal mandible movements and occlusion duration, relative muscle contraction of the left temporalis and all six MOE items (-0.80 < r < 0.49). The MAT scores were significantly higher for children with CP (mean 22.6; SD 2.4) compared to children with TD (mean 19.9; SD 1.9). The test-retest reliability had an ICC of 0.7 and a SEM of 1.16 (±5% of the mean score). CONCLUSION: These results indicate that the MAT is suitable and complementary to ultrasound, 3D kinematics, EMG and observation to compare the masticatory performance between children with CP and children with TD, with an acceptable test-retest reliability.

Construct Validity of the Trunk Impairment Classification System in Relation to Objective Measures of Trunk Impairment.

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.

Reproducibility of 3D kinematics and surface electromyography measurements of mastication.

The aim of this study was to determine the measurement reproducibility for a procedure evaluating the mastication process and to estimate the smallest detectable differences of 3D kinematic and surface electromyography (sEMG) variables. Kinematics of mandible movements and sEMG activity of the masticatory muscles were obtained over two sessions with four conditions: two food textures (biscuit and bread) of two sizes (small and large). Twelve healthy adults (mean age 29.1 years) completed the study. The second to the fifth chewing cycle of 5 bites were used for analyses. The reproducibility per outcome variable was calculated with an intraclass correlation coefficient (ICC) and a Bland-Altman analysis was applied to determine the standard error of measurement relative error of measurement and smallest detectable differences of all variables. ICCs ranged from 0.71 to 0.98 for all outcome variables. The outcome variables consisted of four bite and fourteen chewing cycle variables. The relative standard error of measurement of the bite variables was up to 17.3% for 'time-to-swallow', 'time-to-transport' and 'number of chewing cycles', but ranged from 31.5% to 57.0% for 'change of chewing side'. The relative standard error of measurement ranged from 4.1% to 24.7% for chewing cycle variables and was smaller for kinematic variables than sEMG variables. In general, measurements obtained with 3D kinematics and sEMG are reproducible techniques to assess the mastication process. The duration of the chewing cycle and frequency of chewing were the best reproducible measurements. Change of chewing side could not be reproduced. The published measurement error and smallest detectable differences will aid the interpretation of the results of future clinical studies using the same study variables.

Adolescent idiopathic scoliosis and spinal fusion do not substantially impact on postural balance.

BACKGROUND: The spinal curvature in patients with Adolescent Idiopathic Scoliosis (AIS) causes an asymmetry of upper body postural alignment, which might affect postural balance. However, the currently available studies on balance in AIS patients are not consistent. Furthermore, it is not known whether potential deficits are similar between patients with single and double curves. Finally, the effects of a corrective posterior spinal fusion on postural balance have not yet been well established. METHODS: Postural balance was tested on a force plate, in 26 female subjects with AIS (12-18 years old; preoperative Cobb-angle: 42-71°; single curve n = 18, double curve n = 6) preoperatively, at 3 months and 1 year postoperatively. We also conducted a balance assessment in 18 healthy age-matched female subjects. Subjects were tested during quiet double-leg standing in four conditions (eyes open/closed; foam/solid surface), while standing on one leg, while performing a dynamic balance (weight shifting) task and while performing a reaching task in four directions. RESULTS: AIS subjects did not demonstrate greater COP velocities than controls during the double-leg standing tasks. In the reaching task, however, they achieved smaller COP displacements than healthy controls, except in the anterior direction. AIS patients with double curves had significantly greater COP velocities in all test conditions compared to those with a single curve (p < 0.05). For the AIS group, a slight increase in COP velocities was observed in the foam eyes closed and right leg standing condition at 3 months post surgery. At 1-year post surgery, however, there were no significant differences in any of the outcome measures compared to the pre-surgery assessment, irrespective of the curve type. CONCLUSIONS: Postural balance in AIS patients scheduled for surgery was similar to healthy age matched controls, except for a poorer reaching capacity. The latter finding may be related to their reduced range of motion of the spine. Patients with double curves demonstrated poorer balance than those with a single curve, despite the fact that they have a more symmetrical trunk posture. Postural balance one year after surgery did not improve as a result of the better spinal alignment, neither did the reduced range of trunk motion inherent to fusion negatively affect postural balance.

Ultrasound Imaging for Analyzing Lateral Tongue Movements during Mastication in Adults with Cerebral Palsy Compared with Adults without Oral Motor Disabilities.

Described here is an ultrasound technique used to study tongue movements, particularly lateral tongue movements, during mastication. A method to analyze spatial and temporal tongue movements was developed, and the feasibility of using this method was evaluated. Biplane ultrasound images of tongue movements of four adults without oral motor disability and two adults with oral motor disability as a result of cerebral palsy, were acquired. Tongue movements were analyzed in the coronal and sagittal planes using B-mode and M-mode ultrasonography. Inter-rater and intra-rater agreement for manual tracing of tongue contours was good (ICC = 0.81 and 0.84, respectively). There were significant differences between the two adult groups in movement frequency in the horizontal direction in both coronal and sagittal planes. In the coronal plane, differences in movement frequency and range of vertical movement were detected. Data obtained from sagittal images, with the exception of vertical frequency, indicated no differences between the groups. The protocol developed in this study (using B-mode and M-mode) proved to be valid and reliable. By using this protocol with individuals with and without oral motor disability, we were able to illustrate the clinical application of our protocol to evaluation of differences in tongue movements during mastication.

Validity and reliability of the Mastication Observation and Evaluation (MOE) instrument.

The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective assessment of a child's mastication process. It contains 14 items and was developed over three Delphi rounds. The present study concerns the further development of the MOE using the COSMIN (Consensus based Standard for the Selection of Measurement Instruments) and investigated the instrument's internal consistency, inter-observer reliability, construct validity and floor and ceiling effects. Consumption of three bites of bread and biscuit was evaluated using the MOE. Data of 59 healthy children (6-48 mths) and 38 children (bread) and 37 children (biscuit) with cerebral palsy (24-72 mths) were used. Four items were excluded before analysis due to zero variance. Principal Components Analysis showed one factor with 8 items. Internal consistency was >0.70 (Chronbach's alpha) for both food consistencies and for both groups of children. Inter-observer reliability varied from 0.51 to 0.98 (weighted Gwet's agreement coefficient). The total MOE scores for both groups showed normal distribution for the population. There were no floor or ceiling effects. The revised MOE now contains 8 items that (a) have a consistent concept for mastication and can be scored on a 4-point scale with sufficient reliability and (b) are sensitive to stages of chewing development in young children. The removed items are retained as part of a criterion referenced list within the MOE.

Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of the Nijmegen Falls Prevention Program (NFPP) for persons with osteoporosis and a fall history in a randomized controlled trial. Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength. A decrease in the number of falls therefore is expected to be particularly beneficial for these persons. DESIGN: Randomized controlled trial. SETTING: Hospital. PARTICIPANTS: Persons with osteoporosis and a fall history (N=96; mean ± SD age, 71.0±4.7y; 90 women). INTERVENTION: After baseline assessment, participants were randomly assigned to the exercise (n=50; participated in the NFPP for persons with osteoporosis [5.5wk]) or control group (n=46; usual care). MAIN OUTCOME MEASURES: Primary outcome measure was fall rate, measured by using monthly fall calendars for 1 year. Secondary outcomes were balance confidence (Activity-specific Balance Confidence Scale), quality of life (QOL; Quality of Life Questionnaire of the European Foundation for Osteoporosis), and activity level (LASA Physical Activity Questionnaire, pedometer), assessed posttreatment subsequent to the program and after 1 year of follow-up. RESULTS: The fall rate in the exercise group was 39% lower than for the control group (.72 vs 1.18 falls/person-year; risk ratio, .61; 95% confidence interval, .40-.94). Balance confidence in the exercise group increased by 13.9% (P=.001). No group differences were observed in QOL and activity levels. CONCLUSION: The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence. Therefore, it is a valuable new tool to improve mobility and independence of persons with osteoporosis.

Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study.

BACKGROUND: Osteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the data of young adults and using stringent safety criteria. METHODS: Young adults performed sideways and forward MA falls from a kneeling position on both a judo mat and a mattress as well as from a standing position on a mattress. Hip impact forces and kinematic data were collected. For each condition, the highest hip impact force was compared with two safety criteria based on the femoral fracture load and the use of a hip protector. RESULTS: The highest hip impact force during the various fall conditions ranged between 1426 N and 3132 N. Sideways falls from a kneeling and standing position met the safety criteria if performed on the mattress (max 1426 N and 2012 N, respectively) but not if the falls from a kneeling position were performed on the judo mat (max 2219 N). Forward falls only met the safety criteria if performed from a kneeling position on the mattress (max 2006 N). Hence, forward falls from kneeling position on a judo mat (max 2474 N) and forward falls from standing position on the mattress (max 3132 N) did not meet both safety criteria. CONCLUSIONS: Based on the data of young adults and safety criteria, the MA fall training was expected to be safe for persons with osteoporosis if appropriate safety measures are taken: during the training persons with osteoporosis should wear hip protectors that could attenuate the maximum hip impact force by at least 65%, perform the fall exercises on a thick mattress, and avoid forward fall exercises from a standing position. Hence, a modified MA fall training might be useful to reduce hip fracture risk in persons with osteoporosis.