How does external lateral stabilization constrain normal gait, apart from improving medio-lateral gait stability?

Background: The effect of external lateral stabilization on medio-lateral gait stability has been investigated previously. However, existing lateral stabilization devices not only constrain lateral motions but also transverse and frontal pelvis rotations. This study aimed to investigate the effect of external lateral stabilization with and without constrained transverse pelvis rotation on mechanical and metabolic gait features. Methods: We undertook two experiments with 11 and 10 young adult subjects, respectively. Kinematic, kinetic and breath-by-breath oxygen consumption data were recorded during three walking conditions (normal walking (Normal), lateral stabilization with (Free) and without transverse pelvis rotation (Restricted)) and at three speeds (0.83, 1.25 and 1.66 m s(-1)) for each condition. In the second experiment, we reduced the weight of the frame, and allowed for longer habituation time to the stabilized conditions. Results: External lateral stabilization significantly reduced the amplitudes of the transverse and frontal pelvis rotations, in addition to medio-lateral, anterior-posterior, and vertical pelvis displacements, transverse thorax rotation, arm swing, step length and step width. The amplitudes of free vertical moment, anterior-posterior drift over a trial, and energy cost were not significantly influenced by external lateral stabilization. The removal of pelvic rotation restrictions by our experimental set-ups resulted in normal frontal pelvis rotation in Experiment 1 and significantly higher transverse pelvis rotation in Experiment 2, although transverse pelvis rotation still remained significantly less than in the Normal condition. Step length increased with the increased transverse pelvis rotation. Conclusion: Existing lateral stabilization set-ups not only constrain medio-lateral motions (i.e. medio-lateral pelvis displacement) but also constrain other movements such as transverse and frontal pelvis rotations, which leads to several other gait changes such as reduced transverse thorax rotation, and arm swing. Our new set-ups allowed for normal frontal pelvis rotation and more transverse pelvis rotation (yet less than normal). However, this did not result in more normal thorax rotation and arm swing. Hence, to provide medio-lateral support without constraining other gait variables, more elaborate set-ups are needed.</p

Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care.

Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior.This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes.Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303).Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances.The Netherlands National Trial Register NTR3961 . Registered 18 April 2013

Dataset: Technical development in junior speed skaters

Longitudinal and cross-sectional data of technique development during a 1500m for junior speed skaters. Observational data from healthy people. Data from male and female skaters in the age of 16 to 21 years. Data is available under restrictions, upon request (see contact)

Dataset: Technical development in junior speed skaters

Longitudinal and cross-sectional data of technique development during a 1500m for junior speed skaters. Observational data from healthy people. Data from male and female skaters in the age of 16 to 21 years. Data is available under restrictions, upon request (see contact)

Dataset: Adjustments in end-effector trajectory and underlying joint angle synergies after a target switch: Order of adjustment is flexible

The data files were used to perform the analyses for the paper: 'Adjustments in end-effector trajectory and underlying joint angle synergies after a target switch: Order of adjustment is flexible'

Technical development in junior speed skaters

Longitudinal and cross-sectional data of technique development during a 1500m for junior speed skaters. Observational data from healthy people.,Data categories: Other Material collected: Other Experimental data: Other Sex: Female, Male Age: 16-21 Year

Supplementary Material for: Vastly Different Exercise Programs Similarly Improve Parkinsonian Symptoms: A Randomized Clinical Trial

Objectives: To directly compare the effects of agility exergaming (EXE) and stationary cycling (CYC) exercise training on Parkinson’s disease (PD) patients’ mobility and clinical symptoms. Design: Randomized clinical trial. Setting: Outpatient physiotherapy clinic in a hospital. Participants: Seventy-four stage 2–3, nondemented PD patients were included in this study. Intervention: The groups were as follows: EXE (n = 25), CYC (n = 25), and a wait-listed control group (CON; n = 24). The EXE and CYC groups exercised 5×/week for 5 weeks, matched at 80% of the age-predicted maximal heart rate. Main Outcomes: The primary outcome was the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (UPDRS-II) score. Secondary outcomes were Parkinson’s Disease Quastionnaire-39 (PDQ-39), the Beck Depression Inventory (BDI), the Schwab and England Activities of Daily Living (SE-ADL) scale, Euro-Quality of Life-5 Dimensions (EQ-5D) questionnaire, the Berg Balance Scale (BBS), the Balance Evaluation Systems Test (BESTest), the Tinetti Assessment Tool (TAT), the Dynamic Gait Index, the 6-min walk test (6MWT), and standing posturography. Results: After treatment, UPDRS-II scores improved (mean change: EXE, –4.5 points; CYC, –3.2 points). The results for the other outcomes (EXE and CYC, respectively) were: PDQ, 13 and 17%; BDI, –2.5 and –2.1 points; 6MWT, 129.6 and 141.6 m; and EQ-5D, 12 and 9% (all p &lt; 0.05, but there was no difference between groups). EXE vs. CYC resulted in improved SE-ADL (8.4 and 4.0 points, effect size [ES]: 0.12), BBS (8.8 and 4.2 points, ES: 0.44), and 2 measures of posturography (ES: 0.11 and 0.21) (p &lt; 0.05). BESTtest, TAT, the Dynamic Gait Index, and 4 out of 6 posturography measures did not change (p &gt; 0.05). Conclusion: Two highly different exercise programs resulted in similar improvement of most motor and clinical symptoms in PD patients