Analysis of healthy sitting behavior: Interface pressure distribution and subcutaneous tissue oxygenation

Pressure ulcers are a large problem in individuals who use a wheelchair for their mobility and have limited trunk stability and motor function. Because no relation between interface pressure and pressure ulcer development has been established and no clinical threshold for pressure ulcer development can be given, looking at the sitting behavior of nondisabled individuals is important. Nondisabled individuals do not develop pressure ulcers because they continuously shift posture. We analyzed the sitting behavior of 25 nondisabled male subjects by using a combination of interface pressure measurement and subcutaneous tissue oxygenation measurement by means of the Oxygen to See. These subjects shifted posture on average 7.8 +/- 5.2 times an hour. These posture shifts were merely a combination of posture shifts in the frontal and sagittal plane. Subcutaneous oxygen saturation increased on average 2.2% with each posture adjustment, indicating a positive effect of posture shifts on tissue viability. The results of this study can be used as a reference for seating interventions aimed at preventing pressure ulcers. Changing the sitting load at least every 8 minutes is recommended for wheelchair users

The influence of a user-adaptive prosthetic knee on planned gait termination

The added value of user-adaptive prosthetic knees has been predominantly evaluated in level walking or ramp/stair negotiation. Previous studies indicate that the activity pattern of individuals with an amputation mainly consists of short periods of continuous walking, indicating that a high percentage of ambulatory activity involves gait termination. The potential added value of user-adaptive prosthetic knees in gait termination has not been studied yet. Ten individuals with an amputation were measured with their own non-microprocessor controlled prosthetic knee and with the Rheo Knee II (a user-adaptive prosthetic knee). Spatiotemporal, kinematic and kinetic variables were measured. We found that the Rheo Knee II had no effect on the studied outcome parameters when compared to the non-microprocessor controlled prosthetic knee. We also found that the intact leg was responsible for producing the deceleration forces irrespective whether the last step was made by the intact or prosthetic leg. In conclusion we found that the prosthetic leg is limited in producing deceleration forces. Although user-adaptive prosthetic knees claim to increase stance stability, the added value of the Rheo Knee II on the studied outcome parameters is limited

The effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida : A systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a reference framework

BACKGROUND: To date no review has been published that analyzes the efficacy of assistive devices on the walking ability of ambulant children and adolescents with spina bifida and, differentiates between the effects of treatment on gait parameters, walking capacity, and walking performance. OBJECTIVES: To review the literature for evidence of the efficacy of orthotic management, footwear, and walking aids on gait and walking outcomes in ambulant children and adolescents with spina bifida. STUDY DESIGN: Systematic literature review. METHODS: A systematic literature search was performed to identify studies that evaluated the effect of any type of lower limb orthoses, orthopedic footwear, or walking aids in ambulant children (≤18 years old) with spina bifida. Outcome measures and treatment results for gait parameters, walking capacity, and walking performance were identified using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as the reference framework. RESULTS: Six case-crossover studies met the criteria and were included in this systematic review. Four studies provided indications of the efficacy of the ankle-foot orthosis in improving a number of kinematic and kinetic properties of gait, stride characteristics, and the oxygen cost of walking. Two studies indicated that walking with forearm crutches may have a favorable effect on gait. The evidence level of these studies was low, and none of the studies assessed the efficacy of the intervention on walking capacity and walking performance. CONCLUSIONS: Some data support the efficacy of using ankle-foot orthosis and crutches for gait and walking outcomes at the body functions and structures level of the ICF-CY. Potential benefits at the activities and participation level have not been investigated. CLINICAL RELEVANCE: This is the first evidence-based systematic review of the efficacy of assistive devices for gait and walking outcomes for children with spina bifida. The ICF-CY is used as a reference framework to differentiate the effects of treatment on gait parameters, walking capacity, and walking performance

Cervical Muscle Dysfunction in the Chronic Whiplash Associated Disorder Grade II (WAD-II)

Study Design: In a cross-sectional study, surface electromyography\ud measurements of the upper trapezius\ud muscles were obtained during different functional tasks in\ud patients with a chronic whiplash associated disorder\ud Grade II and healthy control subjects. - \ud Objectives: To investigate whether muscle dysfunction\ud of the upper trapezius muscles, as assessed by surface\ud electromyography, can be used to distinguish patients\ud with whiplash associated disorder Grade II from\ud healthy control subjects. - \ud Summary of Background Information: In the whiplash\ud associated disorder, there is need to improve the diagnostic\ud tools. Whiplash associated disorder Grade II is\ud characterized by the presence of “musculoskeletal signs.”\ud Surface electromyography to assess these musculoskeletal\ud signs objectively may be a useful tool. - \ud Methods: Normalized smoothed rectified electromyography\ud levels of the upper trapezius muscles of patients\ud with whiplash associated disorder Grade II (n 5 18) and\ud healthy control subjects (n 5 19) were compared during\ud three static postures, during a unilateral dynamic manual\ud exercise, and during relaxation after the manual exercise.\ud Coefficients of variation were computed to identify the\ud measurement condition that discriminated best between\ud the two groups. - \ud Results: The most pronounced differences between\ud patients with whiplash associated disorder Grade II and\ud healthy control subjects were found particularly in situations\ud in which the biomechanical load was low. Patients\ud showed higher coactivation levels during physical exercise\ud and a decreased ability to relax muscles after physical\ud exercise. - \ud Conclusions: Patients with whiplash associated disorder\ud Grade II can be distinguished from healthy control\ud subjects according to the presence of cervical muscle\ud dysfunction, as assessed by surface electromyography of\ud the upper trapezius muscles. Particularly the decreased\ud ability to relax the trapezius muscles seems to be a promising\ud feature to identify patients with whiplash associated\ud disorder Grade II. Assessment of the muscle (dys)function\ud by surface electromyography offers a refinement of the\ud whiplash associated disorder classification and provides\ud an indication to a suitable therapeutic approach. [Key\ud words: whiplash associated disorder, muscle dysfunction,\ud surface electromyography, upper trapezius muscle,\ud static, dynamic, relaxation

The effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida: A systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a reference framework

To date no review has been published that analyzes the efficacy of assistive devices on the walking ability of ambulant children and adolescents with spina bifida and, differentiates between the effects of treatment on gait parameters, walking capacity, and walking performance. To review the literature for evidence of the efficacy of orthotic management, footwear, and walking aids on gait and walking outcomes in ambulant children and adolescents with spina bifida. Systematic literature review. A systematic literature search was performed to identify studies that evaluated the effect of any type of lower limb orthoses, orthopedic footwear, or walking aids in ambulant children (≤18 years old) with spina bifida. Outcome measures and treatment results for gait parameters, walking capacity, and walking performance were identified using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as the reference framework. Six case-crossover studies met the criteria and were included in this systematic review. Four studies provided indications of the efficacy of the ankle-foot orthosis in improving a number of kinematic and kinetic properties of gait, stride characteristics, and the oxygen cost of walking. Two studies indicated that walking with forearm crutches may have a favorable effect on gait. The evidence level of these studies was low, and none of the studies assessed the efficacy of the intervention on walking capacity and walking performance. Some data support the efficacy of using ankle-foot orthosis and crutches for gait and walking outcomes at the body functions and structures level of the ICF-CY. Potential benefits at the activities and participation level have not been investigated. This is the first evidence-based systematic review of the efficacy of assistive devices for gait and walking outcomes for children with spina bifida. The ICF-CY is used as a reference framework to differentiate the effects of treatment on gait parameters, walking capacity, and walking performanc

The effect of fear of movement on muscle activation in posttraumatic neck pain disability

Studies using surface electromyography have demonstrated a reorganization of muscle activation patterns of the neck and shoulder muscles in patients with posttraumatic neck pain disability. The neurophysiologically oriented "pain adaptation" model explains this reorganization as a useful adaptation to prevent further pain and injury. The cognitive-behavioral-oriented "fear avoidance" model suggests that fear of movement, in addition to the effects of pain, modulates the muscle activation level. We analyzed the extent to which pain and fear of movement influenced the activation patterns of the upper trapezius muscle during the transition from acute to chronic posttraumatic neck pain.\ud \ud Ninety-two people with an acute traumatic neck injury after a motor vehicle accident were followed up for 24 weeks. Visual analog scale ratings of pain intensity, response on the Tampa Scale of Kinesophobia-fear of movement, and surface electromyography of the upper trapezius muscles during a submaximal isometric physical task were obtained at 1, 4, 8, 12, and 24 weeks after the motor vehicle accident.\ud \ud Multilevel analysis revealed that an increased level of both fear of movement (t value=-2.19, P=0.030) and pain intensity (t value=-2.94, P=0.004) were independently associated with a decreased level of muscle activation. Moreover, the results suggest that the association between fear of movement and lower muscle activity level is stronger in patients reporting high pain intensity (t value=2.15, P=0.033). The contribution of pain intensity to the muscle activation level appeared to decrease over time after the trauma (t value=2.58, P=0.011). The results support both the "pain adaptation" and the "fear avoidance" models. It is likely that the decrease in muscle activation level is aimed at "avoiding" the use of painful muscles

Does the Duncan-Ely test predict abnormal activity of the rectus femoris in stroke survivors with a stiff knee gait?

Objective: To determine the diagnostic value of the Duncan-Ely test in predicting abnormal rectus femoris activity during gait in stroke survivors walking with a stiff knee gait. Design: Cross-sectional diagnostic study. Subjects: A total of 95 patients with chronic stroke. Methods: During physical examination, the Duncan-Ely test was performed and scored. Surface electromyography of the rectus femoris was then recorded during dynamic gait. To determine the diagnostic value, the results of the Duncan-Ely test and surface electromyography recordings (gold standard) were compared. Results: The Duncan-Ely test had a sensitivity of 73%, a specificity of 29%, a positive predictive value of 60%, and a negative predictive value of 42%. The area under the curve was 0.488 ([AQ1] CI 0.355–0.621, p = 0.862), showing that the Duncan-Ely test is not better than random guessing. Conclusion: The Duncan-Ely test has no predictive value for determining abnormal activity of the rectus femoris during gait. Using this test can lead to incorrect identification of abnormal rectus femoris activity, which might hamper the selection of optimal treatment options. We recommend stopping use of the Duncan-Ely test to predict rectus femoris overactivity during swing, and instead use surface electromyography