Exergames to improve Rehabilitation after Anterior Cruciate Ligament Injury: Systematic review and GRADE evidence synthesis

Introduction Exergames are a fun, engaging, and interactive form of exercise that has been used in rehabilitation. This systematic review aimed to evaluate the effectiveness of exergames compared to usual rehabilitation after anterior cruciate ligament reconstruction. Method We performed a Systematic Review and GRADE evidence synthesis. The PRISMA guidelines for systematic reviews were followed. MEDLINE® (Medical Literature Analysis and Retrieval System Online), CINAHL® (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, SCOPUS, SciELO (Scientific Electronic Library Online), Cochrane Central Register of Controlled Trials, and PEDro (Physiotherapy Evidence Database) were searched from their first record to May 2021. Randomised controlled trials using exergames as an intervention were included. Results Initial literature searches yielded 794 non-duplicated records. After exclusion based on title, abstract, and full text review, five articles were included for analysis. Compared with the control group, the participants in the exergames group showed differences in proprioception and flexion angle difference. Conclusion Although there is no conclusive evidence that favours exergames over traditional rehabilitation, they did not aggravate the effects of rehabilitation. Nonetheless, exergames can be safe and motivating.info:eu-repo/semantics/publishedVersio

Epidemiology of injuries in high-level youth sport in Luxembourg [Abstract]

peer reviewe

The effect of the Apos Therapy system on knee biomechanics in recreational athletes at risk of a non-contact anterior cruciate ligament injury

An anterior cruciate ligament (ACL) injury is a catastrophicincident in sports, resulting in an extended period away from athletic participation and even potentially ending a playing career. The disparity between positive laboratory results of neuromuscular training programs and the actual effects on injury outcomes among high-risk populations suggests a missing link in current intervention programs. One proposed explanation for such a gap betweenlaboratory results and incidence outcomes may be related to the time-consuming, complex and difficult implementation of the techniques found to be successful in reducinglower limb movement mechanics and neuromuscularrisk factors. A novel option is to explore whether different unstable devices and unstable footwear designs may induce positive biomechanical and neuromusculareffects. The overall aim of this thesis was to determine the effect of an unstable device (AposTherapy system) on knee biomechanics and muscular recruitment patterns while performing functional tasks. To accomplish the research, four separate trials were conductedseparatly.Firstly, a repeatability trial with 11 healthy physically active (male and female)participants was conducted todetermine the reliability of the outcome measures for future studies. Secondly, as theAposTherapy system has not previously been trialled within the ‘at-risk’ female population, a feasibility study investigating whether using theAposTherapy interventionduring a six-week period was feasible was conducted. This was followed by a randomised clinical trial amongst 32 female recreational athletes who were indicated to have a high-risk(2D FPPA > 8.4º)indication for sustaining a non-contact ACL injury. Threegroups (control and two active intervention groups) were assessed at a six-week outcome point to determine changes in biomechanical outcomes. The results demonstrated positive biomechanical and clinical outcomes specifically in reducing the maximum knee valgus angle during a singleleg landing task while only using the AposTherapy system for walking. Furthermore, a significant reduction in maximum hip adduction momentsduring study tasks was observed when theAposTherapy system use was coupled with additional exercise. The thesis concluded with preliminary study investigating five individuals who were deemed at risk of a second non-contact ACL on their contralateral limb following primary ACL reconstruction(ACLR)surgery.There was a significant reduction in knee valgus angle during the single leg landingand single leg squat taskswhile only using theAposTherapy system for walking in the study with individuals who have had ACLR surgery.In summary, the results of this thesis showed that theAposTherapy system gave significant improvements in overall stability, with future studies needed to examine a larger-scale application especially in post-ACL reconstruction rehabilitation programs to mitigate the risk of a second ACL injury when athletesreturn to sport activities. However, more research should also focus on developing more affordable unstable footwear devices which could be incorporated in larger-scale prevention programs in the future

The biomechanics of human locomotion

Includes bibliographical references. The thesis on CD-ROM includes Animate, GaitBib, GaitBook and GaitLab, four quick time movies which focus on the functional understanding of human gait. The CD-ROM is available at the Health Sciences Library

Task-orientated rehabilitation can improve knee function and satisfaction in patients 12 months after knee replacement surgery for osteoarthritis

End-stage osteoarthritis (OA) requires joint replacement surgery. Although total knee arthroplasty (TKA) usually relieves pain, some patients are disappointed with their mobility, which may result from an abnormal gait. Post-operative physiotherapy following TKA is essential, although little consensus exists regarding longer-term rehabilitation. Typical rehabilitation has an internal focus on specific muscles and joints, but task-orientated rehabilitation (TOR) may be more effective. This study tested the hypothesis that TOR can improve gait and patient reported functional outcome following TKA. Seventy six patients were studied 12 months after TKA during follow up at the Royal National Orthopaedic Hospital, Stanmore. Patient reported functional outcome was assessed using the Oxford Knee Score (OKS) and gait characteristics were measured using inertial measurement units (IMUs). A subset of 21 patients, exhibiting abnormal gait, entered a 4-week TOR programme, based on daily walking and stair climbing. Patients were re-assessed with OKS and IMUs, and gait quantity compared pre- and post-intervention using pedometers. A subset of 4 patients’ baseline gaits was compared to 5 controls, and to their own gait following the TOR, while subjected to differing treadmill conditions. Multiple regression analysis showed that stride duration significantly predicted OKS (p<0.0001, n=76). Higher OKS was observed in patients who have shorter stride duration, which was in turn a result of greater RoM of the leg joints and segments in the sagittal plane. TKA patients’ response to the varying treadmill conditions was similar, but inferior in the gait parameters’ values as compared to the healthy participants. Following TOR, 21 patients exhibited a significantly higher OKS (p=0.001, n=21). Stride duration, thigh, knee and calf sagittal range of motion and knee flexion in stance significantly increased in both limbs following TOR. In conclusion, the results indicate that there is scope to improve rehabilitation of patients after TKA. TOR improves gait quality and therefore has the potential to improve satisfaction in TKA patients

Analysis of the backpack loading efects on the human gait

Gait is a simple activity of daily life and one of the main abilities of the human being. Often during leisure, labour and sports activities, loads are carried over (e.g. backpack) during gait. These circumstantial loads can generate instability and increase biomechanicalstress over the human tissues and systems, especially on the locomotor, balance and postural regulation systems. According to Wearing (2006), subjects that carry a transitory or intermittent load will be able to find relatively efficient solutions to compensate its effects.info:eu-repo/semantics/publishedVersio

Body sensor networks: smart monitoring solutions after reconstructive surgery

Advances in reconstructive surgery are providing treatment options in the face of major trauma and cancer. Body Sensor Networks (BSN) have the potential to offer smart solutions to a range of clinical challenges. The aim of this thesis was to review the current state of the art devices, then develop and apply bespoke technologies developed by the Hamlyn Centre BSN engineering team supported by the EPSRC ESPRIT programme to deliver post-operative monitoring options for patients undergoing reconstructive surgery. A wireless optical sensor was developed to provide a continuous monitoring solution for free tissue transplants (free flaps). By recording backscattered light from 2 different source wavelengths, we were able to estimate the oxygenation of the superficial microvasculature. In a custom-made upper limb pressure cuff model, forearm deoxygenation measured by our sensor and gold standard equipment showed strong correlations, with incremental reductions in response to increased cuff inflation durations. Such a device might allow early detection of flap failure, optimising the likelihood of flap salvage. An ear-worn activity recognition sensor was utilised to provide a platform capable of facilitating objective assessment of functional mobility. This work evolved from an initial feasibility study in a knee replacement cohort, to a larger clinical trial designed to establish a novel mobility score in patients recovering from open tibial fractures (OTF). The Hamlyn Mobility Score (HMS) assesses mobility over 3 activities of daily living: walking, stair climbing, and standing from a chair. Sensor-derived parameters including variation in both temporal and force aspects of gait were validated to measure differences in performance in line with fracture severity, which also matched questionnaire-based assessments. Monitoring the OTF cohort over 12 months with the HMS allowed functional recovery to be profiled in great detail. Further, a novel finding of continued improvements in walking quality after a plateau in walking quantity was demonstrated objectively. The methods described in this thesis provide an opportunity to revamp the recovery paradigm through continuous, objective patient monitoring along with self-directed, personalised rehabilitation strategies, which has the potential to improve both the quality and cost-effectiveness of reconstructive surgery services.Open Acces