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Williams GKR, Vicinanza D, Attias M, Armand S. Causal interactions and dynamic stability between limbs while walking with imposed leg constraints. Front Hum Neurosci 2024; 18:1367952. [PMID: 39301539 PMCID: PMC11410618 DOI: 10.3389/fnhum.2024.1367952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/15/2024] [Indexed: 09/22/2024] Open
Abstract
Aim To investigate the dynamics of the motor control system during walking by examining the complexity, stability, and causal relationships of leg motions. Specifically, the study focuses on gait under both bilateral and unilateral constraints induced by a passive exoskeleton designed to replicate gastrocnemius contractures. Methods Kinematic data was collected as 10 healthy participants walked at a self-selected speed. A new Complexity-Instability Index (CII) of the leg motions was defined as a function of the Correlation Dimension and the Largest Lyapunov Exponent. Causal interactions between the leg motions are explored using Convergent Cross Mapping. Results Normal walking is characterized by a high mutual drive of each leg to the other, where CII is lowest for both legs (complexity of each leg motion is low and stability high). The effect of the bilateral emulated contractures is a reduced drive of each leg to the other and an increased CII for both legs. With unilateral emulated contracture, the mechanically constrained leg strongly drives the unconstrained leg, and CII was significantly higher for the constrained leg compared to normal walking. Conclusion Redundancy in limb motions is used to support causal interactions, reducing complexity and increasing stability in our leg dynamics during walking. The role of redundancy is to allow adaptability above being able to satisfy the overall biomechanical problem; and to allow the system to interact optimally. From an applied perspective, important characteristics of functional movement patterns might be captured by these nonlinear and causal variables, as well as the biomechanical aspects typically studied.
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Affiliation(s)
- Genevieve K R Williams
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, United Kingdom
| | - Domenico Vicinanza
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
| | - Michael Attias
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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2
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Chu Kwan W, Partanen A, Narayanan U, Waspe AC, Drake JM. Biomechanical testing of ex vivo porcine tendons following high intensity focused ultrasound thermal ablation. PLoS One 2024; 19:e0302778. [PMID: 38713687 DOI: 10.1371/journal.pone.0302778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/12/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION Magnetic resonance-guided focused ultrasound (MRgFUS) has been demonstrated to be able to thermally ablate tendons with the aim to non-invasively disrupt tendon contractures in the clinical setting. However, the biomechanical changes of tendons permitting this disrupting is poorly understood. We aim to obtain a dose-dependent biomechanical response of tendons following magnetic resonance-guided focused ultrasound (MRgFUS) thermal ablation. METHODS Ex vivo porcine tendons (n = 72) were embedded in an agar phantom and randomly assigned to 12 groups based on MRgFUS treatment. The treatment time was 10, 20, or 30s, and the applied acoustic power was 25, 50, 75, or 100W. Following each MRgFUS treatment, tendons underwent biomechanical tensile testing on an Instron machine, which calculated stress-strain curves during tendon elongation. Rupture rate, maximum treatment temperature, Young's modulus and ultimate strength were analyzed for each treatment energy. RESULTS The study revealed a dose-dependent response, with tendons rupturing in over 50% of cases when energy delivery exceeded 1000J and 100% disruption at energy levels beyond 2000J. The achieved temperatures during MRgFUS were directly proportional to energy delivery. The highest recorded temperature was 56.8°C ± 9.34 (3000J), while the lowest recorded temperate was 18.6°C ± 0.6 (control). The Young's modulus was highest in the control group (47.3 MPa ± 6.5) and lowest in the 3000J group (13.2 MPa ± 5.9). There was no statistically significant difference in ultimate strength between treatment groups. CONCLUSION This study establishes crucial thresholds for reliable and repeatable disruption of tendons, laying the groundwork for future in vivo optimization. The findings prompt further exploration of MRgFUS as a non-invasive modality for tendon disruption, offering hope for improved outcomes in patients with musculotendinous contractures.
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Affiliation(s)
| | | | - Unni Narayanan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam C Waspe
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- The Hospital for Sick Children, Toronto, Ontario, Canada
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3
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Fanstone R, Price P. Global perspectives on risk factors for major joint burn contractures: A literature review. Burns 2024; 50:537-549. [PMID: 37977897 DOI: 10.1016/j.burns.2023.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
Contractures are a frequent consequence of burn injuries, yet our knowledge of associated risk factors is limited. This paper provides an extensive review of relevant literature from both High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). Ninety-four papers (up to June 2019) and eight subsequent publications (up to March 2022) were included, 76% of which were from HICs. The majority of publications were either descriptive studies (4 from HICs, 9 from LMICs) or papers citing putative risk factors (37 from HICs, 10 from LMICs). Seventeen publications (all from HICs) reported on the effects of individual non-surgical therapeutic interventions, often with conflicting results. Two published systematic reviews emphasised the poor quality of evidence available. Only fifteen studies (3 from LMICs) examined potential contracture risk factors with statistical comparisons of outcomes; significant findings from these included demographic, burn, comorbidities, and treatment risk factors. LMIC papers included socioeconomic and healthcare system factors as potential risks for contracture; these were rarely considered in HIC publications. Methodological issues identified from this review of literature included differences in contracture definitions, populations studied, standards of care, joints included and the timing and nature of contracture assessments.This review is the first to collate existing knowledge on risk factors for burn contractures from both HIC and LMIC settings, revealing a surprising lack of robust evidence for many accepted risk factors. In LMICs, where burns are particularly common, universal health provision is lacking and specialist burn care is both scarce and difficult to access; consequently, socioeconomic factors may have more immediate impact on contracture outcomes than specific burn treatments or therapies. Much more work is indicated to fully understand the relative impacts of risk factors in different settings so that context-appropriate contracture prevention strategies can be developed.
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Affiliation(s)
- RuthAnn Fanstone
- Centre for Global Burn Injury Policy and Research, Swansea University, UK.
| | - Patricia Price
- Centre for Global Burn Injury Policy and Research, Swansea University, UK
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Kaya Keles CS, Ates F. How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy-a narrative review. Front Bioeng Biotechnol 2023; 11:1287385. [PMID: 38116195 PMCID: PMC10728775 DOI: 10.3389/fbioe.2023.1287385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study reviews the relationship between muscle-tendon biomechanics and joint function, with a particular focus on how cerebral palsy (CP) affects this relationship. In healthy individuals, muscle size is a critical determinant of strength, with muscle volume, cross-sectional area, and moment arm correlating with knee and ankle joint torque for different isometric/isokinetic contractions. However, in CP, impaired muscle growth contributes to joint pathophysiology even though only a limited number of studies have investigated the impact of deficits in muscle size on pathological joint function. As muscles are the primary factors determining joint torque, in this review two main approaches used for muscle force quantification are discussed. The direct quantification of individual muscle forces from their relevant tendons through intraoperative approaches holds a high potential for characterizing healthy and diseased muscles but poses challenges due to the invasive nature of the technique. On the other hand, musculoskeletal models, using an inverse dynamic approach, can predict muscle forces, but rely on several assumptions and have inherent limitations. Neither technique has become established in routine clinical practice. Nevertheless, identifying the relative contribution of each muscle to the overall joint moment would be key for diagnosis and formulating efficient treatment strategies for patients with CP. This review emphasizes the necessity of implementing the intraoperative approach into general surgical practice, particularly for joint correction operations in diverse patient groups. Obtaining in vivo data directly would enhance musculoskeletal models, providing more accurate force estimations. This integrated approach can improve the clinicians' decision-making process and advance treatment strategies by predicting changes at the muscle and joint levels before interventions, thus, holding the potential to significantly enhance clinical outcomes.
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5
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Chu Kwan W, den Otter-Moore I, Partanen A, Piorkowska K, Waspe AC, Drake JM. Noninvasive magnetic resonance-guided focused ultrasound for tendon disruption: an in vivo Animal study. Int J Hyperthermia 2023; 40:2260129. [PMID: 37743063 DOI: 10.1080/02656736.2023.2260129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE Surgical resection of the tendon is an effective treatment for severe contracture. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is a non-invasive ultrasonic therapy which produces a focal increase in temperature, subsequent tissue ablation and disruption. We evaluated MRgFUS as a clinically translatable treatment modality to non-invasively disrupt in vivo porcine tendons. MATERIAL AND METHODS In vivo Achilles tendons (n = 28) from 15-20kg Yorkshire pigs (n = 16) were randomly assigned to 4 treatment groups of 600, 900, 1200 and 1500 J. Pretreatment range of motion (ROM) of the ankle joint was measured with the animal under general anesthesia. Following MRgFUS treatment, success of tendon rupture, ROM increase, temperature, thermal dosage, skin burn, and histology analyses were performed. RESULTS Rupture success was found to be 29%, 86%, 100% and 100% for treatment energies of 600, 900, 1200 and 1500 J respectfully. ROM difference at 90° flexion showed a statistically significant change in ROM between 900 J and 1200 J from 16° to 27°. There was no statistical significance between other groups, but there was an increase in ROM as more energy was delivered in the treatment. For each of the respective treatment groups, the maximal temperatures were 58.4 °C, 63.3 °C, 67.6 °C, and 69.9 °C. The average areas of thermal dose measured were 24.3mm2, 53.2mm2, 77.8mm2 and 91.6mm2. The average areas of skin necrosis were 5.4mm2, 21.8mm2, 37.2mm2, and 91.4mm2. Histologic analysis confirmed tissue ablation and structural collagen fiber disruption. CONCLUSIONS This study demonstrated that MRgFUS is able to disrupt porcine tendons in vivo without skin incisions.
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Affiliation(s)
| | | | | | | | - Adam C Waspe
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M Drake
- The Hospital for Sick Children, Toronto, Ontario, Canada
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6
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Hirano D, Goto Y, Shoji H, Taniguchi T. Relationship between hand stereotypies and purposeful hand use and factors causing skin injuries and joint contractures in individuals with Rett syndrome. Early Hum Dev 2023; 183:105821. [PMID: 37429197 DOI: 10.1016/j.earlhumdev.2023.105821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Skin injuries and joint contractures in the upper limbs are observed in approximately 50 % of individuals with Rett syndrome, respectively. AIMS To investigate the relationship between stereotypic hand movements and purposeful hand skills, items related to these, and factors that cause upper extremity skin injuries and joint contractures in individuals with Rett syndrome. STUDY DESIGN We conducted a cross-sectional observational study in 2020 with families belonging to either of the two largest Rett syndrome organizations in Japan. SUBJECTS In 2020, we sent a questionnaire to 194 Japanese families. OUTCOME MEASURES We used descriptive statistics to indicate frequency in each question. We analysed the association between hand stereotypies and purposeful hand use, their associations with each questionnaire item, and the relationship between the occurrence of skin injuries and joint contractures. RESULTS We acquired information from 72 cases. We found correlations between stereotypy frequency with reaching and between purposeful hand use with intellectual development grade and hand function. Hand and finger skin injuries and elbow and finger joint contractures were associated with wringing/washing, grasping, locomotion, reaching, and intellectual development grade. We identified cut-off points for the occurrence of elbow and finger joint contractures of 10 years 6 months, ability to roll over, finger feeds only, and understanding of simple words. CONCLUSIONS Direct interventions can reduce hand stereotypies and increase purposeful hand use, while related items can be addressed with indirect interventions. Evaluations of factors that cause skin injuries and joint contractures can prevent their occurrence.
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Affiliation(s)
- Daisuke Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 4-1-26 Akasaka, Minato, Tokyo 107-8402, Japan; Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara, Tochigi 324-8501, Japan.
| | - Yoshinobu Goto
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 4-1-26 Akasaka, Minato, Tokyo 107-8402, Japan; Department of Physiology, Faculty of Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan; Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa, Fukuoka 831-8501, Japan
| | - Hiroaki Shoji
- Laboratory of Physiology, College of Education, Ibaraki University, 2-1-1 Bunkyo, Mito, Ibaraki 310-8512, Japan
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 4-1-26 Akasaka, Minato, Tokyo 107-8402, Japan; Department of Occupational Therapy, School of Health Sciences at Narita, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
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7
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Geusebroek G, van Dieën JH, Hoozemans MJM, Noort W, Houdijk H, Maas H. Constant force muscle stretching induces greater acute deformations and changes in passive mechanical properties compared to constant length stretching. J Biomech 2023; 154:111594. [PMID: 37182406 DOI: 10.1016/j.jbiomech.2023.111594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
Stretching is applied to lengthen shortened muscles in pathological conditions such as joint contractures. We investigated (i) the acute effects of different types of stretching, i.e. constant length (CL) and constant force (CF) stretching, on acute deformations and changes in passive mechanical properties of medial gastrocnemius muscle (MG) and (ii) the association of acute muscle-tendon deformations or changes in mechanical properties with the impulse or maximal strain of stretching. Forty-eight hindlimbs from 13 male and 12 female Wistar rats (13 weeks old, respectively 424.6 ± 35.5 and 261.8 ± 15.6 g) were divided into six groups (n = 8 each). The MG was initially stretched to a length at which the force was 75%, 95%, or 115% of the force corresponding to estimated maximal dorsiflexion and held at either CF or CL for 30 min. Before and after the stretching protocol, the MG peak force and peak stiffness were assessed by lengthening the passive muscle to the length corresponding to maximal ankle dorsiflexion. Also, the muscle belly length and tendon length were measured. CF stretching affected peak force, peak stiffness, muscle belly length, and tendon length more than CL stretching (p < 0.01). Impulse was associated only with the decrease in peak force, while maximal strain was associated with the decrease in peak force, peak stiffness, and the increase in muscle belly length. We conclude that CF stretching results in greater acute deformations and changes in mechanical properties than CL stretching, which appears to be dependent predominantly on the differences in imposed maximal strain.
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Affiliation(s)
- G Geusebroek
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - J H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - M J M Hoozemans
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - W Noort
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - H Houdijk
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - H Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
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Trompetto C, Marinelli L, Mori L, Bragazzi N, Maggi G, Cotellessa F, Puce L, Vestito L, Molteni F, Gasperini G, Farina N, Bissolotti L, Sciarrini F, Millevolte M, Balestrieri F, Restivo DA, Chisari C, Santamato A, Del Felice A, Manganotti P, Serrati C, Currà A. Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief. Toxins (Basel) 2023; 15:toxins15050335. [PMID: 37235369 DOI: 10.3390/toxins15050335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/31/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
By blocking the release of neurotransmitters, botulinum toxin A (BoNT-A) is an effective treatment for muscle over-activity and pain in stroke patients. BoNT-A has also been reported to increase passive range of motion (p-ROM), the decrease of which is mainly due to muscle shortening (i.e., muscle contracture). Although the mechanism of action of BoNT-A on p-ROM is far from understood, pain relief may be hypothesized to play a role. To test this hypothesis, a retrospective investigation of p-ROM and pain was conducted in post-stroke patients treated with BoNT-A for upper limb hypertonia. Among 70 stroke patients enrolled in the study, muscle tone (Modified Ashworth Scale), pathological postures, p-ROM, and pain during p-ROM assessment (Numeric Rating Scale, NRS) were investigated in elbow flexors (48 patients) and in finger flexors (64 patients), just before and 3-6 weeks after BoNT-A treatment. Before BoNT-A treatment, pathological postures of elbow flexion were found in all patients but one. A decreased elbow p-ROM was found in 18 patients (38%). Patients with decreased p-ROM had higher pain-NRS scores (5.08 ± 1.96, with a pain score ≥8 in 11% of cases) than patients with normal p-ROM (0.57 ± 1.36) (p < 0.001). Similarly, pathological postures of finger flexion were found in all patients but two. A decreased finger p-ROM was found in 14 patients (22%). Pain was more intense in the 14 patients with decreased p-ROM (8.43 ± 1.74, with a pain score ≥ 8 in 86% of cases) than in the 50 patients with normal p-ROM (0.98 ± 1.89) (p < 0.001). After BoNT-A treatment, muscle tone, pathological postures, and pain decreased in both elbow and finger flexors. In contrast, p-ROM increased only in finger flexors. The study discusses that pain plays a pivotal role in the increase in p-ROM observed after BoNT-A treatment.
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Affiliation(s)
- Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Division of Neurorehabilitation, Department of Neuroscience, 16132 Genoa, GE, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Division of Clinical Neurophysiology, Department of Neuroscience, 16132 Genoa, GE, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Division of Neurorehabilitation, Department of Neuroscience, 16132 Genoa, GE, Italy
| | - Nicola Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
| | - Giulia Maggi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Division of Neurorehabilitation, Department of Neuroscience, 16132 Genoa, GE, Italy
| | - Filippo Cotellessa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Division of Neurorehabilitation, Department of Neuroscience, 16132 Genoa, GE, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Division of Neurorehabilitation, Department of Neuroscience, 16132 Genoa, GE, Italy
| | - Lucilla Vestito
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, Italy
- IRCCS Ospedale Policlinico San Martino, Division of Neurorehabilitation, Department of Neuroscience, 16132 Genoa, GE, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, 23845 Costa Masnaga, LC, Italy
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, 23845 Costa Masnaga, LC, Italy
| | - Nico Farina
- Villa Beretta Rehabilitation Center, 23845 Costa Masnaga, LC, Italy
| | - Luciano Bissolotti
- Rehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, BS, Italy
| | | | - Marzia Millevolte
- Clinica di Neuroriabilitazione, AOU Ospedali Riuniti, 60030 Ancona, AN, Italy
| | - Fabrizio Balestrieri
- SOSD Gravi Cerebrolesioni Acquisite, AUSL Toscana Centro, 50141 Florence, FI, Italy
| | | | - Carmelo Chisari
- Section of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, 56124 Pisa, PI, Italy
| | - Andrea Santamato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, 71122 Foggia, FG, Italy
| | - Alessandra Del Felice
- Department of Neuroscience, University of Padua, 35122 Padua, PD, Italy
- Padua Neuroscience Center, University of Padua, 35122 Padua, PD, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital, University of Trieste, 34127 Trieste, TS, Italy
| | - Carlo Serrati
- Department of Neurology, Imperia Hospital, 18100 Imperia, IM, Italy
| | - Antonio Currà
- Academic Neurology Unit, Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, 04019 Terracina, LT, Italy
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Murata C, Kataoka H, Aoki H, Nakashima S, Nakagawa K, Goto K, Yamashita J, Okita S, Takahashi A, Honda Y, Sakamoto J, Okita M. The Relationship Between Physical Activity and Limited Range of Motion in the Older Bedridden Patients. Can Geriatr J 2023; 26:1-8. [PMID: 36865402 PMCID: PMC9953499 DOI: 10.5770/cgj.26.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background The purpose of this study is to examine the association between physical activity and contracture in older patients confined to bed in long-term care (LTC) facilities. Methods Patients wore ActiGraph GT3X+ for 8 hours on their wrists, and vector magnitude (VM) counts were obtained as the amount of activity. The passive range of motion (ROM) of joints was measured. The severity of ROM restriction classified, as the tertile value of the reference ROM of each joint, was scored 1-3 points. Spearman's rank correlation coefficients (Rs) were used to measure the association between the VM counts per day and ROM restrictions. Results The sample comprised 128 patients with a mean (SD) age of 84.8 (8.8) years. The mean (SD) of VM was 84574.6 (115195.2) per day. ROM restriction was observed in most joints and movement directions. ROMs in all joints and movement directions, except wrist flexion and hip abduction, were significantly correlated with VM. Furthermore, the VM and ROM severity scores showed a significant negative correlation (Rs = -0.582, p < .0001). Conclusions A significant correlation between the physical activity and ROM restrictions indicates that a decrease in the amount of physical activity could be one of the causes of contracture.
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Affiliation(s)
- Chiaki Murata
- Department of Rehabilitation, Social Medical Corporation Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Hideki Kataoka
- Department of Rehabilitation, Social Medical Corporation Nagasaki Memorial Hospital, Nagasaki, Japan,Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Aoki
- Department of Rehabilitation, Social Medical Corporation Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Shunpei Nakashima
- Department of Rehabilitation, Social Medical Corporation Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Koichi Nakagawa
- Department of Rehabilitation, Social Medical Corporation Nagasaki Memorial Hospital, Nagasaki, Japan,Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kyo Goto
- Department of Rehabilitation, Social Medical Corporation Nagasaki Memorial Hospital, Nagasaki, Japan,Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junichiro Yamashita
- Department of Rehabilitation, Social Medical Corporation Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Seima Okita
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ayumi Takahashi
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuichiro Honda
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Minoru Okita
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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10
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Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins (Basel) 2022; 14:toxins14110772. [PMID: 36356022 PMCID: PMC9692445 DOI: 10.3390/toxins14110772] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
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11
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Nakagawa K, Kataoka H, Murata C, Goto K, Yamashita J, Honda Y, Sakamoto J, Origuchi T, Okita M. Relationship Between Muscle Quality or Stiffness Measured by Ultrasonography and Range of Motion in Hospitalized Older Adults. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1858-1866. [PMID: 35717351 DOI: 10.1016/j.ultrasmedbio.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/24/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
Older adults who require nursing care have joint contractures characterized by limited range of motion (ROM). The present study investigated age-related muscle changes using ultrasonography and the relationship between ROM and muscle changes in older adults. Twenty-two healthy young adults (mean age: 23.3 y) and 60 hospitalized older adults (mean age: 86.1 y) participated. ROM of hip abduction was measured using a goniometer. Echo intensity (EI), reflecting interstitial fibrous tissue or fat within adductor longus (ADDl) was measured using B-mode ultrasonography, and strain ratio (SR), reflecting ADDl stiffness, was measured by strain elastography. The Mann-Whitney U-test and Spearman's correlation test were used for analysis. The ROM and SR of older adults were significantly lower than those of young adults (both p values <0.001). The EI was significantly higher in older adults than in young adults (p < 0.001). In older adults, the SR was moderately correlated with ROM (ρ = 0.49, p < 0.001). In conclusion, limited ROM and increase in interstitial fibrous tissue or fat and stiffness occur with aging, and the SR measured by strain elastography is useful for investigating the effect of muscle stiffness on the ROM of hospitalized older adults.
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Affiliation(s)
- Koichi Nakagawa
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Hideki Kataoka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Chiaki Murata
- Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Kyo Goto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | | | - Yuichiro Honda
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tomoki Origuchi
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Minoru Okita
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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12
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Diong J, Carden PC, O'Sullivan K, Sherrington C, Reed DS. Eccentric exercise improves joint flexibility in adults: A systematic review update and meta-analysis. Musculoskelet Sci Pract 2022; 60:102556. [PMID: 35390669 DOI: 10.1016/j.msksp.2022.102556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/27/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Eccentric exercise is thought to improve joint flexibility, but the size of the effect is not known. We aimed to quantify the overall effect of eccentric exercise on joint flexibility in adults. DESIGN Systematic review, meta-analysis. DATA SOURCES AMED, CINAHL, MEDLINE, EMBASE, SportDiscus. PARTICIPANTS Adults. INTERVENTION Eccentric exercise compared to no intervention or to a different intervention. OUTCOME MEASURES Joint range of motion or muscle fascicle length. DATA EXTRACTION AND SYNTHESIS Descriptive data of included trials and estimates of effect sizes were extracted. Standardised mean differences (SMD) of range of motion or fascicle length outcomes were meta-analysed using random effects models. Overall quality of evidence was assessed using the GRADE scale. RESULTS 32 trials (1122 participants, 108 lost to follow-up) were included in the systematic review. The mean (SD) PEDro score was 5.2 (1.3). Four trials reported insufficient data for meta-analysis. Data from 27 trials (911 participants, 82 lost to follow-up) were meta-analysed. Eccentric exercise improved joint flexibility in adults (pooled random effects Hedges' g SMD = 0.54, 95% CI 0.34 to 0.74). The true effect size is different across studies and 50% of the variance in observed effects is estimated to reflect variance in true effects rather than sampling error (I2 = 50%, Q = 67.6, d.f. = 34, p = 0.001). Overall quality of evidence ranged from 'low' to 'high'. CONCLUSION Eccentric exercise improves joint flexibility in adults. The overall standardised mean effect of eccentric exercise was moderately large, and the narrow width of the 95% confidence interval indicates the effect was estimated with good precision. REGISTRATION Open Science Foundation (https://osf.io/mkdqr); PROSPERO registration CRD42020151303.
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Affiliation(s)
- Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
| | - Peter C Carden
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Kieran O'Sullivan
- Ageing Research Centre and Sports and Human Performance Centre, School of Allied Health, University of Limerick, Ireland
| | - Catherine Sherrington
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Institute of Musculoskeletal Health, The University of Sydney and Sydney Local Health District, NSW, Australia
| | - Darren S Reed
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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13
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Tariq H, Collins K, Tait D, Dunn J, Altaf S, Porter S. Factors associated with joint contractures in adults: a systematic review with narrative synthesis. Disabil Rehabil 2022; 45:1755-1772. [PMID: 35544581 DOI: 10.1080/09638288.2022.2071480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults. METHODS A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Two independent reviewers screened studies against the eligibility criteria, performed data extraction, and assessed the quality of evidence. A narrative synthesis by domain and sub-domain was undertaken. The protocol was registered on PROSPERO: CRD42019145079. RESULTS Forty-seven studies were included in the review. Identified factors were broadly classified into three major domains: sociodemographic factors, physical factors, and proxies for bed confinement. Sociodemographic factors were not associated with joint contractures. Functional ability, pain, muscle weakness, physical mobility, and bed confinement provided the most consistent evidence of association with joint contractures. The evidence regarding the relationship between spasticity and joint contractures remains unclear. Other factors might be important, but there was insufficient evidence to make inferences. CONCLUSIONS The review identified and collated evidence on factors associated with joint contractures, which can be utilised to develop effective prevention and management strategies. Implications for rehabilitationClinical interventions based on the timely identification of risks related to joint contractures in vulnerable adults have the potential to prevent or ameliorate their development or progression.Quality and consistency of care for vulnerable adults would be enhanced by developing effective joint contracture prevention and rehabilitation strategies based on the evidence presented in this review.As many vulnerable adults are located in the community or non-acute care settings, strategies should target these loci of care.Structured risk assessments that can support non-physiotherapy staff working in these loci of care to identify risks related to joint contractures would provide an important resource for risk management.
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Affiliation(s)
- Hina Tariq
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Kathryn Collins
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Desiree Tait
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Joel Dunn
- Dorset Healthcare University Foundation Trust, Poole, UK
| | - Shafaq Altaf
- Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Sam Porter
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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14
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Chen YC, Lin KC, Yeh SH, Wang CH, Pan AW, Chen HL, Chen CJ. Associations among quality of life, activities, and participation in elderly residents with joint contractures in long-term care facilities: a cross-sectional study. BMC Geriatr 2022; 22:197. [PMID: 35279091 PMCID: PMC8917858 DOI: 10.1186/s12877-022-02870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Joint contractures and degenerative osteoarthritis are the most common joint diseases in the elderly population, can lead to limited mobility in elderly individuals, can exacerbate symptoms such as pain, stiffness, and disability, and can interfere with social participation and quality of life, thus affecting mental health. However, relevant studies on this topic are very limited. This study describes the associations of joint contracture categories and sites in elderly residents in long-term care facilities with their quality of life, activities, and participation. METHODS Elderly individuals with joint contractures who were residents in long-term care facilities were recruited. The World Health Organization (WHO) Quality of Life and the WHO Disability Assessment Schedule 2.0 were used to survey the participants. Correlations, multiple linear regressions, and multiple analyses of variance, with joint contractures as the response variable, were used in the statistical analysis. RESULTS The final statistical analysis included 232 participants. The explanatory power of contracture sites on activities and participation had a moderate strength of association (η2 = .113). Compared with elderly residents with joint contractures and osteoarthritis isolated to the upper limbs, those with joint contractures and osteoarthritis in both the upper and lower limbs had significantly worse activity and participation limitations. No significant differences in activity and participation were found between elderly residents with joint contractures affecting only the upper limbs and those with joint contractures affecting only the lower limbs (F1,226 = 2.604 and F1,226 = 0.674, nonsignificant). Osteoarthritis had the greatest impact on activity limitations and participation restrictions among elderly residents with joint contractures affecting both the upper and lower limbs (F1,226 = 6.251, p = .014). CONCLUSIONS Elderly residents in long-term care facilities belonging to minority groups, with a history of stroke, and with osteoarthritis are at a high risk of developing activity limitations and participation restrictions. Moreover, compared with other contraction sites, regardless of osteoarthritis, joint contractures affecting both the upper and lower limbs were associated with the greatest activity limitations and participation restrictions. TRIAL REGISTRATION This study has been registered in the Chinese Clinical Trial Registry, registration number and date: ChiCTR2000039889 (13/11/2020).
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Affiliation(s)
- Yi-chang Chen
- Department of Rehabilitation, Jenteh Junior College of Medicine, Nursing and Management, 79-9, Sha-Luen Hu Xi-Zhou Li Hou-Loung Town, Miaoli County, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu-Zhou Road, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 7 Chung-shan South Road, Taipei, Taiwan
| | - Shu-Hui Yeh
- Institute of Long-term Care, Mackay Medical College, 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist, New Taipei City, Taiwan
| | - Chih-Hung Wang
- Graduate Institute of Education, National Changhua University of Education, 1 Jin-De Road, Changhua City, Taiwan
| | - Ay-Woan Pan
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu-Zhou Road, Taipei, Taiwan
| | - Hao-Ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu-Zhou Road, Taipei, Taiwan
| | - Chen-Jung Chen
- Department of Nursing, Mackay Medical College, 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist, New Taipei City, Taiwan
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15
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Cruz-Montecinos C, Pérez-Alenda S, Cerda M, Maas H. Modular reorganization of gait in chronic but not in artificial knee joint constraint. J Neurophysiol 2021; 126:516-531. [PMID: 34133242 DOI: 10.1152/jn.00418.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. The aims of this study were to investigate 1) the effects of an artificial knee joint constraint on the modular organization of gait in healthy subjects; and 2) the differences in modular organization between healthy subjects with an artificial knee joint constraint and people with a similar but chronic knee joint constraint. Eleven healthy subjects and eight people with a chronic knee joint constraint walked overground at 1 m/s. The healthy subjects also walked with a constraint limiting knee joint movement to 20°. The total variance accounted (tVAF) for one to four synergies and modular organization were assessed using surface electromyography from 11 leg muscles. The distribution of number of synergies were not significantly different between groups. The tVAF and the motor modules were not significantly affected by the artificial knee constraint. A higher tVAF for one and two synergies, as well as merging of motor modules were observed in the chronic knee constraint group. We conclude that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that merging of motor modules may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.NEW & NOTEWORTHY It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. This study showed that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that modular reorganization may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mauricio Cerda
- Integrative Biology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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16
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PrEvention of Posttraumatic contractuRes with Ketotifen 1 (PERK 1): A Randomized Clinical Trial. J Orthop Trauma 2020; 34:e442-e448. [PMID: 32639394 DOI: 10.1097/bot.0000000000001878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the use of ketotifen fumarate (KF) to reduce posttraumatic contractures after elbow fractures and/or dislocations. DESIGN Randomized clinical trial. SETTING Three hospitals in Calgary, Canada, including one Level 1 trauma center. PARTICIPANTS Adults (n = 151) sustaining operative or nonoperatively managed isolated distal humerus or proximal radius ± ulna fractures or elbow dislocations within 7 days of injury. INTERVENTIONS KF 5 mg (n = 74) or lactose placebo (PL, n = 77) orally twice daily for 6 weeks. MAIN OUTCOMES Primary outcome elbow flexion-extension arc range of motion (ROM) at 12 weeks postrandomization. Safety measures including serious adverse events and radiographic fracture line disappearance from 2 to 52 weeks postrandomization. RESULTS The elbow ROM (mean, confidence interval) was not significantly different between KF (122 degrees, 118-127 degrees) and PL (124 degrees, 119-130 degrees) groups (P = 0.56). There was a significant difference in elbow ROM at 12 weeks postrandomization comparing operative (117 degrees, 112-122 degrees) versus nonoperative groups (128 degrees, 124-133 degrees) irrespective of intervention (P = 0.0011). There were 11 serious adverse events (KF = 6, PL = 5) that were those expected in an elbow fracture population potentially taking KF. There was no statistically significant difference in the rates of these events between the groups. The disappearance of fracture lines over the course of time was similar between groups. There was one nonunion in each group. CONCLUSIONS In a population of operative and nonoperatively managed elbow fractures and/or dislocations KF did not reduce posttraumatic contractures. The administration of KF in this population was not found to result in a significantly higher number of major adverse events when compared with placebo. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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17
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Herbert RD, Taylor JL, Lord SR, Gandevia SC. Prevalence of motor impairment in residents of New South Wales, Australia aged 55 years and over: cross-sectional survey of the 45 and Up cohort. BMC Public Health 2020; 20:1353. [PMID: 32887600 PMCID: PMC7650517 DOI: 10.1186/s12889-020-09443-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The population prevalence of many diseases is known. However, little is known of the population prevalence of motor impairments. METHODS The aim of this study was to determine the point prevalence of specific motor impairments (weakness, fatigue, contracture, impaired balance and impaired coordination) in the population aged 55 years and older resident in New South Wales, Australia in 2018. 55,210 members of the 45 and Up cohort were invited to participate in a follow-up survey that included questions on motor impairment. Responses were received from 20,141 people (36%). Calibrated estimates of prevalence of specific motor impairments, and of having at least one motor impairment, were obtained using survey weights based on the known multivariate distributions of age, gender and geographical location (28 regions) in the population. RESULTS More than one-third of adults aged over 55 residing in New South Wales have difficulty using their hands, arms or legs. The prevalence of each motor impairment (muscle weakness, fatigue, contracture, impaired balance or impaired coordination) in this population is between 4 and 12%. The prevalence of at least one of these impairments is 21%. The prevalence of at least one impairment in people aged 85 and over is 42%. Women consistently had more difficulty using hands, arms and legs, and more motor impairment, than men. Difficulty using hands, arms and legs and the prevalence of all motor impairments, especially poor balance, greatly increased with age. CONCLUSION The prevalence of specific motor impairments in older Australian adults is high - comparable to that of the most prevalent diseases. There may be merit in considering motor impairment as a significant public health problem in its own right.
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Affiliation(s)
- R D Herbert
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia.
- University of New South Wales, Sydney, Australia.
| | - J L Taylor
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia
- Edith Cowan University, Perth, Australia
| | - S R Lord
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia
- University of New South Wales, Sydney, Australia
| | - S C Gandevia
- Neuroscience Research Australia (NeuRA), Barker St, Randwick, NSW, 2031, Australia
- University of New South Wales, Sydney, Australia
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18
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Klingshirn H, Müller M, Beutner K, Hirt J, Strobl R, Grill E, Meyer G, Saal S. Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial. BMC Geriatr 2020; 20:270. [PMID: 32758147 PMCID: PMC7405353 DOI: 10.1186/s12877-020-01655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. Methods The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. Conclusion The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial. Trial registration German clinical trials register, DRKS00010037. Registered 12 February 2016.
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Affiliation(s)
- Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Katrin Beutner
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Julian Hirt
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,German Centre for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr 15, 81377, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,German Centre for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr 15, 81377, Munich, Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Susanne Saal
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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19
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Implementing a Protocol of Ankle ROM Goniometry Measurement in the Neuroscience ICU. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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D'Souza A, Bolsterlee B, Herbert RD. Intramuscular Fat in the Medial Gastrocnemius Muscle of People Who Have Had a Stroke. Front Bioeng Biotechnol 2020; 8:613. [PMID: 32582684 PMCID: PMC7296139 DOI: 10.3389/fbioe.2020.00613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/19/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: To compare intramuscular fat fraction in people who have ankle contractures following stroke with the intramuscular fat fraction in control participants. Design: mDixon MRI images were used to quantify intramuscular fat fractions in the medial gastrocnemius muscles of people who had experienced a hemiparetic stroke (n = 14, mean age 60 ± 13 years) and control participants (n = 18, mean age 66 ± 12 years). Results: Intramuscular fat fractions were similar in the paretic and non-paretic sides of stroke patients (mean on paretic side 14.5%, non-paretic side 12.8%, difference 1.6%, 95% confidence interval −0.7 to 4.1%). The intramuscular fat fraction on the paretic side was higher than in the control group (mean intramuscular fat fraction in control muscles 7.6%; difference 7.8%, 95% confidence interval 4.6–10.9%). The difference between intramuscular fat fractions in non-paretic and control legs increased with age. Body mass index was similar in stroke patients and controls. There was no association between medial gastrocnemius intramuscular fat fraction and dorsiflexion range. Conclusion: Muscles of stroke patients had elevated intramuscular fat fractions compared to muscles from control participants which were not explained by differences in body mass index. There is no clear relationship between intramuscular fat in the medial gastrocnemius muscle and dorsiflexion range of motion.
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Affiliation(s)
- Arkiev D'Souza
- NeuRA, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Bart Bolsterlee
- NeuRA, Randwick, NSW, Australia.,Graduate School of Biomedical Engineering, University of New South Wales, Randwick, NSW, Australia
| | - Robert D Herbert
- NeuRA, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, Randwick, NSW, Australia
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21
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Effect of chronic stretching interventions on the mechanical properties of muscles in patients with stroke: A systematic review. Ann Phys Rehabil Med 2020; 63:222-229. [DOI: 10.1016/j.rehab.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 01/01/2023]
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22
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Ademola A, Hildebrand KA, Schneider PS, Mohtadi NGH, White NJ, Bosse MJ, Garven A, Walker REA, Sajobi TT. PrEvention of posttraumatic contractuRes with Ketotifen 2 (PERK 2) - protocol for a multicenter randomized clinical trial. BMC Musculoskelet Disord 2020; 21:123. [PMID: 32093652 PMCID: PMC7041204 DOI: 10.1186/s12891-020-3139-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Injuries and resulting stiffness around joints, especially the elbow, have huge psychological effects by reducing quality of life through interference with normal daily activities such as feeding, dressing, grooming, and reaching for objects. Over the last several years and through numerous research results, the myofibroblast-mast cell-neuropeptide axis of fibrosis had been implicated in post-traumatic joint contractures. Pre-clinical models and a pilot randomized clinical trial (RCT) demonstrated the feasibility and safety of using Ketotifen Fumarate (KF), a mast cell stabilizer to prevent elbow joint contractures. This study aims to evaluate the efficacy of KF in reducing joint contracture severity in adult participants with operately treated elbow fractures and/or dislocations. Methods/design A Phase III randomized, controlled, double-blinded multicentre trial with 3 parallel groups (KF 2 mg or 5 mg or lactose placebo twice daily orally for 6 weeks). The study population consist of adults who are at least 18 years old and within 7 days of injury. The types of injuries are distal humerus (AO/OTA type 13) and/or proximal ulna and/or proximal radius fractures (AO/OTA type 2 U1 and/or 2R1) and/or elbow dislocations (open fractures with or without nerve injury may be included). A stratified randomization scheme by hospital site will be used to assign eligible participants to the groups in a 1:1:1 ratio. The primary outcome is change in elbow flexion-extension range of motion (ROM) arc from baseline to 12 weeks post-randomization. The secondary outcomes are changes in ROM from baseline to 6, 24 & 52 weeks, PROMs at 2, 6, 12, 24 & 52 weeks and impact of KF on safety including serious adverse events and fracture healing. Descriptive analysis for all outcomes will be reported and ANCOVA be used to evaluate the efficacy KF over lactose placebo with respect to the improvement in ROM. Discussion The results of this study will provide evidence for the use of KF in reducing post-traumatic joint contractures and improving quality of life after joint injuries. Trial registration This study was prospectively registered (July 10, 2018) with ClinicalTrials.gov reference: NCT03582176.
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Affiliation(s)
- Ayoola Ademola
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Kevin A Hildebrand
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Prism S Schneider
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Nicholas G H Mohtadi
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Neil J White
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Michael J Bosse
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, USA
| | | | - Richard E A Walker
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Prehabilitation for patient positioning: pelvic exercises assist in minimizing inter-fraction sacral slope variability during radiation therapy. Med Oncol 2019; 37:3. [PMID: 31713056 DOI: 10.1007/s12032-019-1322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
Reproducible patient positioning is essential for precision in radiation therapy (RT) delivery. We tested the hypothesis that a structured daily pre-treatment stretching regimen is both feasible and effective for minimizing variability in positioning, as measured by sacral slope angles (SSA). Eight female subjects undergoing pelvic radiotherapy performed a structured daily hip exercise regimen (extension and external rotation) immediately prior to both simulation imaging and daily treatment, throughout their RT course. This exercising cohort was compared to a retrospective review of 20 subjects (17 women and 3 men) undergoing RT, who had usual care. SSA measurements from daily pre-treatment imaging were compared to SSA measurements from the simulation CT. The average variation in SSA among the intervention subjects was 0.91° (± 0.58°), with a range among subjects of 0.57°-1.27°. The average variation for the control subjects was 2.27° (± 1.43°), ranging 1.22°-5.09°. The difference between the two groups was statistically significant (p = 0.0001). There was a statistically significant SSA variation between groups at each week of treatment. There was no significant variation among the intervention subjects between week 1 and later weeks, whereas subjects in the control group demonstrated significant SSA variation between week 1 and later weeks. We demonstrated a significant decrease in the variability of SSA by implementing a simple pre-treatment exercise program, while control subjects exhibited increasing variation in SSA over the course of treatment. We conclude that there is a potential benefit of prehabilitation during pelvic RT; however, a larger randomized control trial is required to confirm the findings.Clinical Trial: This research project was approved by the University of Massachusetts Medical School IRB (IRB ID H00012353) on January 21, 2017. The study is listed on ClinicalTrials.gov, provided by the U.S. National Library of Medicine, found with identifier NCT03242538.
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Oosterwijk AM, Disseldorp LM, van der Schans CP, Mouton LJ, Nieuwenhuis MK. Joint flexibility problems and the impact of its operationalisation. Burns 2019; 45:1819-1826. [PMID: 31679794 DOI: 10.1016/j.burns.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 12/08/2018] [Accepted: 03/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dissatisfaction is being voiced with the generally used way joint flexibility problems are defined (operationalised), i.e. as a range of motion (ROM) one or more degrees lower than normative ROM of healthy subjects. Other, specifically more function-related operationalisations have been proposed. The current study evaluated the effect of applying different operationalisations of joint flexibility problems on its prevalence. METHOD ROM data of 95 joints affected by burns of 23 children were used, and data on 18 functional activities (Burn Outcome Questionnaire (BOQ)). Five methods were used to operationalise joint flexibility problems: (1) ROM below normative ROM, (2) ROM below normative ROM minus 1SD, (3) ROM below normative ROM minus 2SD, (4) ROM below functional ROM, and (5) a score of 2 or more on the Likert Scale (BOQ). RESULTS Prevalence of joint flexibility problems on a group level ranged from 13 to 100% depending on the operationalisation used. Per joint and movement direction, prevalence ranged from 40% to 100% (Method 1) and 0% to 80% (Methods 2-4). 18% of the children received '2' on the Likert Scale (Method 5). CONCLUSION The operationalisation of joint flexibility problems substantially influences prevalence, both on group and joint level. Changing to a function-related operationalisation seems valuable; however, international consensus is required regarding its adoption. TRIAL REGISTRATION The study is registered in the National Academic Research and Collaborations Information System of the Netherlands (OND1348800).
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Affiliation(s)
- A M Oosterwijk
- Hanze University of Applied Sciences Groningen, Research group Healthy Ageing, Allied Health Care and Nursing, Het Wiebenga, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; Association of Dutch Burn Centres, Burn Centre Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - L M Disseldorp
- Hanze University of Applied Sciences Groningen, Research group Healthy Ageing, Allied Health Care and Nursing, Het Wiebenga, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; Association of Dutch Burn Centres, Burn Centre Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Health Psychology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - C P van der Schans
- Hanze University of Applied Sciences Groningen, Research group Healthy Ageing, Allied Health Care and Nursing, Het Wiebenga, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Health Psychology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - L J Mouton
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - M K Nieuwenhuis
- Association of Dutch Burn Centres, Burn Centre Martini Hospital, Van Swietenplein 1, 9728 NT Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Shamsi M, Vaisi-Raygani A, Rostami A, Mirzaei M. The effect of adding TENS to stretch on improvement of ankle range of motion in inactive patients in intensive care units: a pilot trial. BMC Sports Sci Med Rehabil 2019; 11:15. [PMID: 31428432 PMCID: PMC6694557 DOI: 10.1186/s13102-019-0129-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/24/2019] [Indexed: 12/04/2022]
Abstract
Background Patients hospitalized in intensive care units (ICUs) are susceptible to joint contracture and diminished range of motion. This is due to immobility as well as other underlying factors such as brain damage. Joint contracture causes functional disorders thereby diminishing the quality of life of patients following the intensive care period. Recent studies have introduced transcutaneous electrical nerve stimulation (TENS) as a new method for preventing and treating joint contracture. This study was performed to determine the effect of adding TENS to stretch on the range of ankle motion in patients hospitalized in ICUs. Methods Thirty-six patients admitted to the ICU ward of the hospital who were not able to move their legs voluntarily were assigned randomly into experimental (n = 18) and control (n = 18) groups. The intervention group received TENS along with manual stretch in the ankle three times a week for 2 weeks. The control group only received stretch in the ankle for the same time. The extent of dorsiflexion and plantar flexion of the ankle was measured using a standard goniometer. Both groups were evaluated before and one and 2 weeks after the intervention. The obtained data were analyzed by SPSS 21 through analysis of covariance and repeated measures ANOVA tests. Results In both groups, the increase in the ankle range of motion parameters was significant over time (means ranged over 44–48 for plantar flexion and means ranged over 5–11 for dorsiflexion, P < 0.001 for all of time points). The increase in ankle plantar and dorsiflexion in experimental group was significantly more than control group (mean between-group differences ranged over 1.35–3.57 within 95% CI of 1.04 to 4.01, P < 0.001). Conclusion Adding TENS to stretch may provide more improvement in ankle dorsiflexion and plantar flexion. Trial registration Trial registration: This study was registered in the Iranian Clinical Trial Center with the code IRCT2017010814333N64, registered 20 January 2017.
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Affiliation(s)
- MohammadBagher Shamsi
- 1School of Allied Medical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aliakbar Vaisi-Raygani
- 2Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Asghar Rostami
- 2Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.,3Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Mirzaei
- 1School of Allied Medical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Kaya CS, Bilgili F, Akalan NE, Temelli Y, Ateş F, Yucesoy CA. Intraoperative experiments combined with gait analyses indicate that active state rather than passive dominates the spastic gracilis muscle's joint movement limiting effect in cerebral palsy. Clin Biomech (Bristol, Avon) 2019; 68:151-157. [PMID: 31212210 DOI: 10.1016/j.clinbiomech.2019.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In cerebral palsy, spastic muscle's passive forces are considered to be high but have not been assessed directly. Although activated spastic muscle's force-joint angle relations were studied, this was independent of gait relevant joint positions. The aim was to test the following hypotheses intraoperatively: (i) spastic gracilis passive forces are high even in flexed knee positions, (ii) its active state forces attain high amplitudes within the gait relevant knee angle range, and (iii) increase with added activations of other muscles. METHODS Isometric forces (seven children with cerebral palsy, gross motor function classification score = II) were measured during surgery from knee flexion to full extension, at hip angles of 45° and 20° and in four conditions: (I) passive state, after gracilis was stimulated (II) alone, (III) simultaneously with its synergists, and (IV) also with an antagonist. FINDINGS Directly measured peak passive force of spastic gracilis was only a certain fraction of the peak active state forces (maximally 26%) measured in condition II. Conditions III and IV caused gracilis forces to increase (for hip angle = 45°, by 32.8% and 71.9%, and for hip angle = 20°, by 24.5% and 45.1%, respectively). Gait analyses indicated that intraoperative data for knee angles 61-17° and 33-0° (for hip angles 45° and 20°, respectively) are particularly relevant, where active state force approximates its peak values. INTERPRETATION Active state muscular mechanics, rather than passive, of spastic gracilis present a capacity to limit joint movement. The findings can be highly relevant for diagnosis and orthopaedic surgery in individuals with cerebral palsy.
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Affiliation(s)
- Cemre S Kaya
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Fuat Bilgili
- Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
| | - N Ekin Akalan
- Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey; Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul Kültür University, Istanbul, Turkey
| | - Yener Temelli
- Istanbul Faculty of Medicine, Department of Orthopaedics and Traumatology, Istanbul University, Istanbul, Turkey
| | - Filiz Ateş
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey; Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey.
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Abstract
BACKGROUND Joint contractures are a major complication in patients with spinal cord injuries. Positioning, stretching, and physical therapy are advocated to prevent and treat contractures; however, many patients still develop them. Joint motion (exercise) is crucial to correct contractures. Transcutaneous carbon dioxide (CO2) therapy was developed recently, and its effect is similar to that of exercise. This therapy may be an alternative or complementary approach to exercise. QUESTION/PURPOSES Using an established model of spinal cord injury in rats with knee flexion contractures, we sought to clarify whether transcutaneous CO2 altered (1) contracture, as measured by ROM; (2) muscular and articular factors contributing to the loss of ROM; (3) fibrosis and fibrosis-related gene expression in muscle; and (4) the morphology of and fibrosis-related protein expression in the joint capsule. METHODS Thirty-six Wistar rats were divided into three equal groups: caged control, those untreated after spinal cord injury, and those treated with CO2 after spinal cord injury. The rats were treated with CO2 from either the first day (prevention) or 15th day (treatment) after spinal cord injury for 2 or 4 weeks. The hindlimbs of rats in the treated group were exposed to CO2 gas for 20 minutes once daily. Knee extension ROM was measured with a goniometer and was measured again after myotomy. We calculated the muscular and articular factors responsible for contractures by subtracting the post-myotomy ROM from that before myotomy. We also quantified histologic muscle fibrosis and evaluated fibrosis-related genes (collagen Type 1, α1 and transforming growth factor beta) in the biceps femoris muscle with real-time polymerase chain reaction. The synovial intima's length was measured, and the distribution of fibrosis-related proteins (Type I collagen and transforming growth factor beta) in the joint capsule was observed with immunohistochemistry. Knee flexion contractures developed in rats after spinal cord injuries at all timepoints. RESULTS CO2 therapy improved limited-extension ROM in the prevention group at 2 weeks (22° ± 2°) and 4 weeks (29° ± 1°) and in the treatment group at 2 weeks (31° ± 1°) compared with untreated rats after spinal cord injuries (35° ± 2°, mean difference, 13°; 39° ± 1°, mean difference, 9°; and 38° ± 1°, mean difference, 7°, respectively) (95% CI, 10.50-14.86, 8.10-10.19, and 4.73-9.01, respectively; all p < 0.001). Muscular factors decreased in treated rats in the prevention group at 2 weeks (8° ± 2°) and 4 weeks (14°± 1°) and in the treatment group at 2 weeks (14 ± 1°) compared with untreated rats (15° ± 1°, 4.85-9.42; 16° ± 1°, 1.24-3.86; and 17° ± 2°, 1.16-5.34, respectively; all p < 0.05). The therapy improved articular factors in the prevention group at 2 weeks (4° ± 1°) and 4 weeks (6° ± 1°) and in the treatment group at 2 weeks (8° ± 1°) compared with untreated rats (10° ± 1°, 4.05-7.05; 12° ± 1°, 5.18-8.02; and 11° ± 2°, 1.73-5.50, respectively; all p < 0.05). CO2 therapy decreased muscle fibrosis in the prevention group at 2 weeks (p < 0.001). The expression of collagen Type 1, α1 mRNA in the biceps femoris decreased in treated rats in the prevention group at 2 and 4 weeks compared with untreated rat (p = 0.002 and p = 0.008, respectively), although there was little difference in the expression of transforming growth factor beta (p > 0.05). CO2 therapy did not improve shortening of the synovial intima at all timepoints (all p > 0.05). CO2 therapy decreased transforming growth factor beta immunolabeling in joint capsules in the rats in the prevention group at 2 weeks. The staining intensity and Type I collagen pattern showed no differences among all groups at all timepoints. CONCLUSION CO2 therapy may be useful for preventing and treating contractures after spinal cord injuries. CO2 therapy particularly appears to be more effective as a prevention and treatment strategy in early-stage contractures before irreversible degeneration occurs, as shown in a rat model. CLINICAL RELEVANCE Our findings support the idea that CO2 therapy may be able to improve the loss of ROM after spinal cord injury.
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Matozinho CVO, Teixeira-Salmela LF, Samora GAR, Sant'Anna R, Faria CDCM, Scianni A. Incidence and potential predictors of early onset of upper-limb contractures after stroke. Disabil Rehabil 2019; 43:678-684. [PMID: 31328966 DOI: 10.1080/09638288.2019.1637949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the incidence and potential predictors of upper-limb contractures, three months after stroke. DESIGN Prospective cohort study. METHODS Consecutive sample of individuals with hemiparesis due to stroke, admitted to a public hospital in Brazil. Contractures were measured by passive range of motion of lateral shoulder rotation, elbow extension, and wrist extension with a gravity inclinometer. Potential predictors included measures of muscle strength, spasticity of the upper-limb muscles, upper-limb function, dexterity, and pain. Measurements were obtained within four weeks and at three months after the stroke. A binomial regression analysis was employed. RESULTS Out of the 76 individuals with hemiparesis, 28% developed at least one contracture on their paretic upper limb. The incidence of contracture varied across the joints from 6% to 16% and the wrist was the most affected joint. Individuals with moderate stroke showed higher incidence of contracture, compared with those with mild stroke. Dexterity (OR 0.009, 95% confidence intervals (95% CI) 0.00-0.19) and pain (OR 6.417, 95% CI 1.22-33.83) were significant predictors of shoulder, elbow, and wrist contractures. CONCLUSIONS Individuals with mild and moderate stroke developed upper-limb contractures three months after the onset of the stroke, with an incidence of 28%. The predictors were the presence of pain and loss of dexterity. These impairments should be earlier targeted during rehabilitation interventions.Implications for rehabilitationThe incidence of upper limb contracture 3 months after the stroke is high after mild to moderate stroke.Wrist contractures are the most common upper limb contracture.The presence of pain and loss of dexterity significantly contribute to the development of upper limb contractures.Health professionals should target on the control of pain and improvement of upper-limb dexterity to prevent contractures.
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Affiliation(s)
| | | | - Giane A R Samora
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Christina D C M Faria
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Scianni
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Saal S, Klingshirn H, Beutner K, Strobl R, Grill E, Müller M, Meyer G. Improved participation of older people with joint contractures living in nursing homes: feasibility of study procedures in a cluster-randomised pilot trial. Trials 2019; 20:411. [PMID: 31288846 PMCID: PMC6617884 DOI: 10.1186/s13063-019-3522-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acquired joint contractures have a significant impact on functioning and quality of life in nursing home residents. There is very limited evidence on measures for prevention and treatment of disability due to joint contractures. We have developed the PECAN intervention (Participation Enabling CAre in Nursing) to improve social participation in nursing home residents. A cluster-randomised pilot trial was conducted to assess the feasibility of study procedures in preparation for a main trial according to the UK Medical Research Council (MRC) framework. METHODS Nursing homes in two regions of Germany were randomly allocated either to the intervention or optimised standard care (control group). All residents with joint contractures aged > 65 years were eligible for the study. The residents' data were collected through structured face-to-face interviews by blinded assessors at baseline, after 3 and 6 months. The primary outcome was social participation, measured by a subscale of the PaArticular Scales. Secondary outcomes included activities and instrumental activities of daily living, health-related quality of life, falls and fall-related consequences. Data on the trial feasibility were collected via documentation forms. RESULTS Seven out of 12 nursing homes agreed to participate and remained in the trial. Of 265 residents who fulfilled the inclusion criteria, 129 were randomised either to the intervention (n = 64) or control group (n = 65) and analysed. A total of 109 (85%) completed the trial after 6 months. The mean age was 85.7 years (SD 7.0), 80% were women. The severity of the residents' disability differed across the clusters. The completion rate was high (> 95%), apart from the Instrumental Activities of Daily Living Scale. Some items of the PaArticular Scales were not easily understood by residents. The frequency of falls did not differ between study groups. CONCLUSION Our data confirmed the feasibility of the overall study design. We also revealed the need to improve the procedures for the recruitment of residents and for data collection before implementation into a main trial. The next step will be an adequately powered main trial to assess the effectiveness and cost-effectiveness of the intervention. TRIAL REGISTRATION German clinical trials register, ID: DRKS00010037 . Registered on 12 February 2016.
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Affiliation(s)
- Susanne Saal
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University, Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig -Maximilians-University Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University, Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig -Maximilians-University Munich, Marchioninistr 15, 81377 Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig- Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig -Maximilians-University Munich, Marchioninistr 15, 81377 Munich, Germany
- German Center for Vertigo and Balance Disorders, Ludwig- Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University, Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
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Edwards L, Ellis B, Donnellan C, Osman H, Haboubi N, Jones M, Sunman W, Pinnington L, Phillips MF. Prevalence of unmet needs for spasticity management in care home residents in the East Midlands, United Kingdom: a cross-sectional observational study. Clin Rehabil 2019; 33:1819-1830. [PMID: 31266351 DOI: 10.1177/0269215519859621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To establish the prevalence of unmet need for spasticity management in care home residents in two counties of the United Kingdom. DESIGN Cross-sectional observational study with a six-month follow-up arm for participants with identified unmet needs. SETTING 22 care homes in Derbyshire and Nottinghamshire. SUBJECTS 60 care home residents with upper motor neuron syndrome-related spasticity. INTERVENTIONS No intervention. When unmet needs around spasticity management were identified, the participant's general practitioner was advised of these in writing. MAIN MEASURES Resistance to Passive Movement Scale to assess spasticity; recording of (a) the presence of factors which may aggravate spasticity, (b) potential complications of spasticity, (c) spasticity-related needs and (d) current interventions to manage spasticity. Two assessors judged the presence or absence of needs for spasticity management and whether these needs were met by current care. RESULTS Out of 60 participants, 14 had no spasticity-related needs; 46 had spasticity-related needs; 11 had needs which were being met by current care and 35 participants had spasticity-related needs at baseline which were not being met by their current care. These were most frequently related to the risk of contracture development or problems with skin hygiene or integrity in the upper limb. In total, 6 participants had one or more pressure sores and 35 participants had one or more established joint contractures. A total of 31 participants were available for follow-up. Informing general practitioners of unmet needs resulted in no change to spasticity management in 23/31 cases. CONCLUSION Care home residents in this study had high levels of unmet need for spasticity management.
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Affiliation(s)
- Laura Edwards
- University of Nottingham, Division of Medical Sciences and Graduate Entry Medicine, Derby, UK
| | | | - Clare Donnellan
- Linden Lodge Neuro-Rehabilitation Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hanan Osman
- The Walton Centre NHS Foundation Trust and The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Naseer Haboubi
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Jones
- Derby Clinical Trials Support Unit, University Hospitals of Derby and Burton, Derby, UK
| | - Wayne Sunman
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lorraine Pinnington
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
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Diong J, Gandevia SC, Nguyen D, Foo Y, Kastre C, Andersson K, Butler JE, Héroux ME. Small amounts of involuntary muscle activity reduce passive joint range of motion. J Appl Physiol (1985) 2019; 127:229-234. [DOI: 10.1152/japplphysiol.00168.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
When assessing passive joint range of motion in neurological conditions, concomitant involuntary muscle activity is generally regarded small enough to ignore. This assumption is untested. If false, many clinical and laboratory studies that rely on these assessments may be in error. We determined to what extent small amounts of involuntary muscle activity limit passive range of motion in 30 able-bodied adults. Subjects were seated with the knee flexed 90° and the ankle in neutral, and predicted maximal plantarflexion torque was determined using twitch interpolation. Next, with the knee flexed 90° or fully extended, the soleus muscle was continuously electrically stimulated to generate 1, 2.5, 5, 7.5, and 10% of predicted maximal torque, in random order, while the ankle was passively dorsiflexed to a torque of 9 N·m by a blinded investigator. A trial without stimulation was also performed. Ankle dorsiflexion torque-angle curves were obtained at each percent of predicted maximal torque. On average (mean, 95% confidence interval), each 1% increase in plantarflexion torque decreases ankle range of motion by 2.4° (2.0 to 2.7°; knee flexed 90°) and 2.3° (2.0 to 2.5°; knee fully extended). Thus 5% of involuntary plantarflexion torque, the amount usually considered small enough to ignore, decreases dorsiflexion range of motion by ~12°. Our results indicate that even small amounts of involuntary muscle activity will bias measures of passive range and hinder the differential diagnosis and treatment of neural and nonneural mechanisms of contracture. NEW & NOTEWORTHY The soleus muscle in able-bodied adults was tetanically stimulated while the ankle was passively dorsiflexed. Each 1% increase in involuntary plantarflexion torque at the ankle decreases the range of passive movement into dorsiflexion by >2°. Thus the range of ankle dorsiflexion decreases by ~12° when involuntary plantarflexion torque is 5% of maximum, a torque that is usually ignored. Thus very small amounts of involuntary muscle activity substantially limit passive joint range of motion.
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Affiliation(s)
- Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, New South Wales, Australia
| | - David Nguyen
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Yanni Foo
- Faculty of Health Sciences, The University of Sydney, New South Wales, Australia
| | | | | | - Jane E. Butler
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, New South Wales, Australia
| | - Martin E. Héroux
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, New South Wales, Australia
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Eschmann H, Héroux ME, Cheetham JH, Potts S, Diong J. Thumb and finger movement is reduced after stroke: An observational study. PLoS One 2019; 14:e0217969. [PMID: 31188859 PMCID: PMC6561636 DOI: 10.1371/journal.pone.0217969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/22/2019] [Indexed: 12/23/2022] Open
Abstract
Hand motor impairment is common after stroke but there are few comprehensive data on amount of hand movement. This study aimed to compare the amount of thumb and finger movement over an extended period of time in people with stroke and able-bodied people. Fifteen stroke subjects and 15 able-bodied control subjects participated. Stroke subjects had impaired hand function. Movement of the thumb and index finger was recorded using stretch sensors worn on the affected hand (stroke subjects) or the left or right hand (control subjects) for ∼4 hours during the day. A digit movement was defined as a monotonic increase or decrease in consecutive sensor values. Instantaneous digit position was expressed as a percentage of maximal digit flexion. Mixed linear models were used to compare the following outcomes between groups: (1) average amplitude of digit movement, (2) digit cadence and average digit velocity, (3) percentage of digit idle time and longest idle time. Amplitude of digit movement was not different between groups. Cadence at the thumb (between-group mean difference, 95% CI, p value: -0.6 movements/sec, -1.0 to -0.2 movements/sec, p = 0.003) and finger (-0.5 movements/sec, -0.7 to -0.3 movements/sec, p<0.001) was lower in stroke than control subjects. Digit velocity was not different between groups. Thumb idle time was not different between groups, but finger idle time was greater in stroke than control subjects (percentage of idle time: 6%, 1 to 11%, p = 0.02; longest idle time: 375 sec, 29 to 721 sec, p = 0.04). Rehabilitation after stroke should encourage the performance of functional tasks that involve movements at faster cadences, and encourage more frequent movement of the digits with shorter periods of inactivity.
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Affiliation(s)
- Helleana Eschmann
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Martin E. Héroux
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
- University of New South Wales, Randwick, NSW, Australia
| | - James H. Cheetham
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Stephanie Potts
- Physiotherapy Department, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Joanna Diong
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
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Nguyen N, Thalhammer R, Beutner K, Saal S, Servaty R, Klingshirn H, Icks A, Freyberg K, Vomhof M, Mansmann U, Le L, Müller M, Meyer G. Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]. Trials 2019; 20:305. [PMID: 31142350 PMCID: PMC6542100 DOI: 10.1186/s13063-019-3384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. METHODS/DESIGN This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. DISCUSSION We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. TRIAL REGISTRATION DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.
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Affiliation(s)
- Natalie Nguyen
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Regina Thalhammer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Susanne Saal
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Ricarda Servaty
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Kristina Freyberg
- Department of Medical Controlling, University Hospital Bonn, Bonn, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
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Doğan M, Koçak M, Onursal Kılınç Ö, Ayvat F, Sütçü G, Ayvat E, Kılınç M, Ünver Ö, Aksu Yıldırım S. Functional range of motion in the upper extremity and trunk joints: Nine functional everyday tasks with inertial sensors. Gait Posture 2019; 70:141-147. [PMID: 30875600 DOI: 10.1016/j.gaitpost.2019.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/01/2019] [Accepted: 02/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional range of motion is defined as the required range of motions for individuals to maintain maximal independence, along with optimal conditions for activities of daily living. Intervention plans for rehabilitation are directed towards the acquisition of anatomical range of motion. However, this isn't always possible based on person's etiology, prognosis, or severity of disease. RESEARCH QUESTION The aim of this study is to determine functional range of motion during different unilateral, bilateral symmetrical and bimanual asymmetrical tasks of activities of daily living. METHODS Participants completed nine basic activities of daily living (hand to head, hanging jacket, eating, wallet placement to back pocket, washing hands and face, removing belt, water pouring, brushing teeth) linked according to International Classification of Functioning, Disability and Health, while joint kinematics of the trunk and upper extremity were recorded with inertial measurement units. Peak values of mean joint angles were determined for each activities of daily living. MVN BIOMECH Awinda MTW2-3A7G6 sensors (Xsens Technologies B.V. Enschede, Netherlands) were used for 3D kinematic analysis of activities. RESULTS Forty-six healthy subjects (right-dominant) were included in this study. Range of motion requirements of all activities were defined 37.85° extension, 91.18° flexion, 1.25° adduction, 39.45° abduction, 63.6° internal rotation, 21.8° external rotation in the dominant shoulder, 124.17° flexion in the dominant elbow, 40.29° extension, 23.66° flexion, 18.31° supination, 12.56° pronation, 18.27 ulnar deviation and, 18.36° radial deviation in the dominant wrist. Maximum trunk range of motions were found to be 29.75° flexion in C7-T1, 10.74° flexion in T12-L1, and 24.16° flexion in L5-S1. SIGNIFICANCE It is thought that the results of this research will contribute to the determination of normative data needed for surgical interventions, technological rehabilitation devices and task-spesific rehabilitation programs which based patient's motor skill level.
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Affiliation(s)
- Mert Doğan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - Mertcan Koçak
- Department of Mechatronics Engineering, Faculty of Engineering, Izmır Katip Celebi University, Izmir, Turkey
| | - Özge Onursal Kılınç
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Fatma Ayvat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Gülşah Sütçü
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ender Ayvat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Muhammed Kılınç
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Özgür Ünver
- Department of Machine Engineering, Faculty of Engineering, Hacettepe University, Ankara, Turkey
| | - Sibel Aksu Yıldırım
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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Multilobed propeller flap for reconstruction of popliteal fossa contractures: Case report. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Weech-Maldonado R, Pradhan R, Dayama N, Lord J, Gupta S. Nursing Home Quality and Financial Performance: Is There a Business Case for Quality? INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958018825191. [PMID: 30739511 PMCID: PMC6376502 DOI: 10.1177/0046958018825191] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 01/31/2023]
Abstract
This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three dimensions of Donabedian's structure-process-outcomes framework: structure Registered Nurse (RN) hours per resident day, Licensed Practical Nurse (LPN) hours per resident day, Certified Nursing Assistant (CNA) hours per resident day, RN skill mix), process (facility-acquired restraints, facility-acquired catheters, pressure ulcer prevention, and restorative ambulation), and outcomes (facility-acquired contractures, facility-acquired pressure ulcers, hospitalizations per resident, rehospitalizations, and health deficiencies). Control variables included size, average acuity index, market competition, per capita income, and Medicare Advantage penetration rate. This study found that the operating margin was lower in nursing homes that reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggest that there is a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.
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Affiliation(s)
| | - Rohit Pradhan
- University of Arkansas for Medical Sciences, Little Rock, USA
| | - Neeraj Dayama
- University of Arkansas for Medical Sciences, Little Rock, USA
| | | | - Shivani Gupta
- The University of Southern Mississippi, Hattiesburg, MS, USA
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Kataoka H, Nakashima S, Aoki H, Goto K, Yamashita J, Honda Y, Kondo Y, Hirase T, Sakamoto J, Okita M. Electrical Stimulation in Addition to Passive Exercise Has a Small Effect on Spasticity and Range of Motion in Bedridden Elderly Patients: A Pilot Randomized Crossover Study. Health (London) 2019. [DOI: 10.4236/health.2019.118084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Le Sant G, Nordez A, Hug F, Andrade R, Lecharte T, McNair PJ, Gross R. Effects of stroke injury on the shear modulus of the lower leg muscle during passive dorsiflexion. J Appl Physiol (1985) 2019; 126:11-22. [DOI: 10.1152/japplphysiol.00968.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Contractures are common complications of a stroke. The spatial location of the increased stiffness among plantar flexors and its variability among survivors remain unknown. This study assessed the mechanical properties of the lower leg muscles in stroke survivors during passive dorsiflexions. Stiffness was estimated through the measurement of the shear modulus. Two experiments were independently conducted, in which participants lay supine: with the knee extended ( experiment 1, n = 13 stroke survivors and n = 13 controls), or with the knee flexed at 90° ( experiment 2, n = 14 stroke survivors and n = 14 controls). The shear modulus of plantar flexors [gastrocnemius medialis (three locations), gastrocnemius lateralis (three locations), soleus (two locations), flexor digitorum longus, flexor hallucis longus), peroneus longus] and dorsiflexors (tibialis anterior and extensor digitorum longus) was measured using ultrasound shear wave elastography during passive dorsiflexions (2°/s). At the same ankle angle, stroke survivors displayed higher shear modulus than controls for gastrocnemius medialis and gastrocnemius lateralis (knee extended) and soleus (knee flexed). Very low shear modulus was found for the other muscles. The adjustment for muscle slack angle suggested that the increased shear modulus was arising from consequences of contractures. The stiffness distribution between muscles was consistent across participants with the highest shear modulus reported for the most distal regions of gastrocnemius medialis (knee extended) and soleus (knee flexed). These results provide a better appreciation of stiffness locations among plantar flexors of stroke survivors and can provide evidence for the implementation of clinical trials to evaluate targeted interventions applied on these specific muscle regions.NEW & NOTEWORTHY The shear modulus of 13 muscle regions was assessed in stroke patients using elastography. When compared with controls, shear modulus was increased in the gastrocnemius muscle (GM) when the knee was extended and in the soleus (SOL) when the knee was flexed. The distal regions of GM and SOL were the most affected. These changes were consistent in all the stroke patients, suggesting that the regions are a potential source of the increase in joint stiffness.
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Affiliation(s)
- Guillaume Le Sant
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- School of Physiotherapy, Institut Régional de Formation aux Métiers de Rééducation et de Réadaptation Pays de la Loire, Nantes, France
| | - Antoine Nordez
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - François Hug
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
- Institut Universitaire de France, Paris, France
| | - Ricardo Andrade
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- Universidade de Lisboa, Faculdade de Motricdade Humana, Centro Interdisciplinar de Performance Humana, Lisbon, Portugal
| | - Thomas Lecharte
- School of Physiotherapy, Institut Régional de Formation aux Métiers de Rééducation et de Réadaptation Pays de la Loire, Nantes, France
| | - Peter J. McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Raphaël Gross
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- Gait Analysis Laboratory, Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
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Rating scales for shoulder and elbow range of motion impairment: Call for a functional approach. PLoS One 2018; 13:e0200710. [PMID: 30067776 PMCID: PMC6070201 DOI: 10.1371/journal.pone.0200710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 05/28/2018] [Indexed: 11/19/2022] Open
Abstract
Background To evaluate the effect of (new) treatments or analyse prevalence and risk factors of contractures, rating scales are used based on joint range of motion. However, cut-off points for levels of severity vary between scales, and it seems unclear how cut-off points relate to function. The purpose of this study was to compare severity ratings of different rating scales for the shoulder and elbow and relate these with functional range of motion. Methods Often used contracture severity rating scales in orthopedics, physiotherapy, and burns were included. Functional range of motion angles for the shoulder and elbow were derived from a recent synthesis published by our group. Shoulder flexion and elbow flexion range of motion data of patients three months after a burn injury were rated with each of the scales to illustrate the effects of differences in classifications. Secondly, the shoulder and elbow flexion range of motion angles were related to the required angles to perform over 50 different activities of daily living tasks. Results Eighteen rating scales were included (shoulder: 6, elbow: 12). Large differences in the number of severity levels and the cut-off points between scales were determined. Rating the measured range of motions with the different scales showed substantial inconsistency in the number of joints without impairment (shoulder: 14–36%, elbow: 26–100%) or with severe impairment (shoulder: < 10%–29%, elbow 0%–17%). Cut-off points of most scales were not related to actual function in daily living. Conclusion There is an urgent need for rating scales that express the severity of contractures in terms of loss of functionality. This study proposes a direction for a solution.
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Cloodt E, Rosenblad A, Rodby-Bousquet E. Demographic and modifiable factors associated with knee contracture in children with cerebral palsy. Dev Med Child Neurol 2018; 60:391-396. [PMID: 29318610 DOI: 10.1111/dmcn.13659] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Abstract
AIM To identify the prevalence of knee contracture and its association with gross motor function, age, sex, spasticity, and muscle length in children with cerebral palsy (CP). METHOD Cross-sectional data for passive knee extension were analysed in 3 045 children with CP (1 756 males, 1 289 females; mean age 8y 1mo [SD 3.84]). CP was classified using the Gross Motor Function Classification System (GMFCS) levels I (n=1 330), II (n=508), III (n=280), IV (n=449), and V (n=478). Pearson's χ2 test and multiple binary logistic regression were applied to analyse the relationships between knee contracture and GMFCS level, sex, age, spasticity, hamstring length, and gastrocnemius length. RESULTS Knee contracture greater than or equal to 5 degrees occurred in 685 children (22%). The prevalence of knee contracture was higher in older children and in those with higher GMFCS levels. Odds ratios (ORs) for knee contracture were significantly higher for children at GMFCS level V (OR=13.17), with short hamstring muscles (OR=9.86), and in the oldest age group, 13 years to 15 years (OR=6.80). INTERPRETATION Knee contracture is associated with higher GMFCS level, older age, and shorter muscle length; spasticity has a small effect. Maintaining muscle length, especially of the hamstrings, is important for reducing the risk of knee contracture. WHAT THIS PAPER ADDS Knee contracture occurs in children with cerebral palsy at all Gross Motor Function Classification System (GMFCS) levels. Knee contracture in children is associated with short hamstring muscles, higher GMFCS level, and older age. Short hamstring muscles present a greater risk for knee contracture than spasticity.
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Affiliation(s)
- Erika Cloodt
- Department of Health Sciences Lund, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Andreas Rosenblad
- Centre for Clinical Research Västerås, Uppsala University, Region Västmanland, Västerås, Sweden
| | - Elisabet Rodby-Bousquet
- Centre for Clinical Research Västerås, Uppsala University, Region Västmanland, Västerås, Sweden.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
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Abstract
PURPOSE Earlier, we reported development and initial testing of a rapid, low burden measure of wheelchair seated posture (the Seated Posture Scale [SPS]) for research and clinical use. The purpose of this study was to test the intrarater reliability, interrater reliability, and criterion related validity of the SPS. DESIGN We used a descriptive design to test and develop the instrument. METHODS We used the method described by Walter, Donner, and Eliasziw to determine 46 participants were needed, from two Veterans Administration nursing homes or CLCs (community living centers). Using a digital goniometer to score rapidly and with two trained raters, we scored individual participants simultaneously and again in succession. For criterion related concurrent validity, we also scored each participant with Section 2 of the Seated Postural Control Measure for Adults. Intrarater reliability, interrater reliability, and criterion related, concurrent validity were assessed using kappa statistics for individual instrument items (and corresponding 95% confidence intervals where appropriate) and intraclass correlation coefficients (ICC) for total scores. FINDINGS The intrarater intraclass correlation coefficient (ICC) was .995; interrater ICC was .80; interrater reliability kappas ranged from -.03 to .80. Criterion-related, concurrent validity kappas ranged from .13 to .91. ICC for total scores was .85. CONCLUSION The SPS has sufficient preliminary validity and reliability to support measurement of wheelchair-seated posture in outcomes research and clinical use. CLINICAL RELEVANCE In the future, rehabilitation nurses may use the SPS to improve management of wheelchair seated posture, to improve clinical outcomes, particularly for those who do not reposition themselves.
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Saal S, Meyer G, Beutner K, Klingshirn H, Strobl R, Grill E, Mann E, Köpke S, Bleijlevens MHC, Bartoszek G, Stephan AJ, Hirt J, Müller M. Development of a complex intervention to improve participation of nursing home residents with joint contractures: a mixed-method study. BMC Geriatr 2018; 18:61. [PMID: 29490617 PMCID: PMC5831216 DOI: 10.1186/s12877-018-0745-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 02/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Joint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures. METHODS The development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes. RESULTS Graphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners. CONCLUSIONS In view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial. TRIAL REGISTRATION German clinical trials register, reference number DRKS00010037 (12 February 2016).
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Affiliation(s)
- Susanne Saal
- Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Katrin Beutner
- Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eva Mann
- Institute for General, Family and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, Nursing research group, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Michel H C Bleijlevens
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Living Lab on Ageing and Long-Term Care, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Gabriele Bartoszek
- Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.,University of Applied Sciences for Social Work, Education and Nursing, Dürerstraße 25, 01307, Dresden, Germany
| | - Anna-Janina Stephan
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Julian Hirt
- Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Martin Müller
- Institute of Health and Nursing Sciences, Medical Faculty, University of Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.,Faculty of Applied Health and Social Sciences, Rosenheim University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
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Oosterwijk A, Nieuwenhuis M, van der Schans C, Mouton L. Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review. Physiother Theory Pract 2018; 34:505-528. [DOI: 10.1080/09593985.2017.1422206] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A.M Oosterwijk
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
- Association of Dutch Burn Centers, Burn Center Martini Hospital, Groningen, the Netherlands
- Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M.K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center Martini Hospital, Groningen, the Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C.P van der Schans
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
- Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - L.J Mouton
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Kaya CS, Temelli Y, Ates F, Yucesoy CA. Effects of inter-synergistic mechanical interactions on the mechanical behaviour of activated spastic semitendinosus muscle of patients with cerebral palsy. J Mech Behav Biomed Mater 2018; 77:78-84. [DOI: 10.1016/j.jmbbm.2017.08.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 11/26/2022]
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Wong K, Trudel G, Laneuville O. Intra-articular collagenase injection increases range of motion in a rat knee flexion contracture model. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 12:15-24. [PMID: 29317799 PMCID: PMC5743116 DOI: 10.2147/dddt.s144602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives A knee joint contracture, a loss in passive range of motion (ROM), can be caused by prolonged immobility. In a rat knee immobilization flexion contracture model, the posterior capsule was shown to contribute to an irreversible limitation in ROM, and collagen pathways were identified as differentially expressed over the development of a contracture. Collagenases purified from Clostridium histolyticum are currently prescribed to treat Dupuytren’s and Peyronie’s contractures due to their ability to degrade collagen. The potential application of collagenases to target collagen in the posterior capsule was tested in this model. Materials and methods Rats had one hind leg immobilized, developing a knee flexion contracture. After 4 weeks, the immobilization device was removed, and the rats received one 50 µL intra-articular injection of 0.6 mg/mL purified collagenase. Control rats were injected with only the buffer. After 2 weeks of spontaneous remobilization following the injections, ROM was measured with a rat knee arthrometer, and histological sections were immunostained with antibodies against rat collagen types I and III. Results/conclusion Compared with buffer-injected control knees, collagenase-treated knees showed increased ROM in extension by 8.0°±3.8° (p-value <0.05). Immunohistochemical analysis revealed an increase in collagen type III staining (p<0.01) in the posterior capsule of collagenase-treated knees indicating an effect on the extracellular matrix due to the collagenase. Collagen I staining was unchanged (p>0.05). The current study provides experimental evidence for the pharmacological treatment of knee flexion contractures with intra-articular collagenase injection, improving the knee ROM.
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Affiliation(s)
- Kayleigh Wong
- Bone and Joint Research Laboratory, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario
| | - Guy Trudel
- Department of Medicine, Bone and Joint Research Laboratory, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario
| | - Odette Laneuville
- Department of Biology, Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
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Lengthening of knee flexor muscles by percutaneous needle tenotomy: Description of the technique and preliminary results. PLoS One 2017; 12:e0182062. [PMID: 29112966 PMCID: PMC5675412 DOI: 10.1371/journal.pone.0182062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/12/2017] [Indexed: 11/27/2022] Open
Abstract
Background Knee flexion contractures occur frequently in non-ambulatory, aged persons and persons with central nervous system lesions, rendering positioning and nursing care difficult. There are often risks associated with surgical interventions. Objective To evaluate the effectiveness of percutaneous needle tenotomy to lengthen the knee flexor muscles and improve passive function. Methods This was a retrospective study of all patients who underwent percutaneous needle tenotomy between 2012 and 2014. Tenotomy was carried out in the semi-tendinosus, biceps femoris and gracillis muscles under local anesthesia. The procedure took no more than 40 minutes. Range of motion (ROM) was evaluated immediately post-operatively and 3 months later. Results Thirty-four needle tenotomies were carried out. Mean lack of knee extension was 94.2° (range 35–120°) pre-op, (range 15–90°; p<0.05) immediately post-op and 50.1° (range 10–90°; p<0.05) three months later, thus a mean increase of 44.1° knee extension (range 0–90°). All care and positioning objectives were achieved. There were no complications and procedure-related pain was rated as 3-4/ 10. Conclusions Needle tenotomy was well tolerated and yielded a significant increase in ROM with no unwanted effects. All objectives were achieved. This technique could be used in an ambulatory care setting or within institutions for severely disabled individuals.
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Attias M, Bonnefoy-Mazure A, De Coulon G, Cheze L, Armand S. Influence of different degrees of bilateral emulated contractures at the triceps surae on gait kinematics: The difference between gastrocnemius and soleus. Gait Posture 2017; 58:176-182. [PMID: 28797961 DOI: 10.1016/j.gaitpost.2017.07.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 07/21/2017] [Accepted: 07/28/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ankle plantarflexion contracture results from a permanent shortening of the muscle-tendon complex. It often leads to gait alterations. The objective of this study was to compare the kinematic adaptations of different degrees of contractures and between isolated bilateral gastrocnemius and soleus emulated contractures using an exoskeleton. METHODS Eight combinations of contractures were emulated bilaterally on 10 asymptomatic participants using an exoskeleton that was able to emulate different degrees of contracture of gastrocnemius (biarticular muscle) and soleus (monoarticular muscle), corresponding at 0°, 10°, 20°, and 30° ankle plantarflexion contracture (knee-flexed and knee-extended). Range of motion was limited by ropes attached for soleus on heel and below the knee and for gastrocnemius on heel and above the knee. A gait analysis session was performed to evaluate the effect of these different emulated contractures on the Gait Profile Score, walking speed and gait kinematics. RESULTS Gastrocnemius and soleus contractures influence gait kinematics, with an increase of the Gait Profile Score. Significant differences were found in the kinematics of the ankles, knees and hips. Contractures of soleus cause a more important decrease in the range of motion at the ankle than the same degree of gastrocnemius contractures. Gastrocnemius contractures cause greater knee flexion (during the stance phase) and hip flexion (during all the gait cycle) than the same level of soleus contractures. CONCLUSION These results can support the interpretation of the Clinical Gait Analysis data by providing a better understanding of the effect of isolate contracture of soleus and gastrocnemius on gait kinematics.
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Affiliation(s)
- M Attias
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland; HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland; Univ Lyon, Université Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France.
| | - A Bonnefoy-Mazure
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland
| | - G De Coulon
- Pediatric Orthopaedic Service, Department of Child and Adolescent, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | - L Cheze
- Univ Lyon, Université Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - S Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland
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Muzaffar T, Rather AH, Haque KU, Ahmad SJ. To Evaluate the Effectiveness of TBTS - A Novel Device to do Self-Stretching of Gastroc-Soleus Muscle in Patients with Equinus Deformity. J Clin Diagn Res 2017; 11:YC01-YC04. [PMID: 28764279 DOI: 10.7860/jcdr/2017/27626.10093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/11/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Various methods have been used for management of equinus deformity. However, stretching gastroc-soleus muscle and achilles tendon is a difficult task. It is labour intensive, which makes the provision of treatment difficult for many patients. AIM To study the effectiveness of Tension Bar Tendon Stretch (TBTS) compared to conventional stretching in patients with equinus deformity in terms of improvement in equinus angle and spasticity. MATERIALS AND METHODS A prospective randomised case control study was done on 16 patients of both the sexes in the age group four years to 56 years. Patients were stratified based on presence or absence of spasticity. Patients were further randomly allotted to the study or control group. Study group received stretching with TBTS in addition to the conventional rehabilitation programme. Patients were assessed in terms of improvement in equinus deformity and spasticity (modified Ashworth scale). These indices were measured at 0 month (pre-treatment), 1 month (post-treatment), and 6 months (follow up). RESULTS Equinus deformity in patients with spastic equinus changed from 22.4° to 12° in study group while in control group change was from 21° to 17°. The difference was statistically significant with p-value of 0.001. Non-spastic (post accidental) changed from 30° to 15° in study group while in control group change was from 31° to 23° with p-value of 0.001. Modified Ashworth Score (MAS) was assessed only in spastic equinus, while in study group MAS changed from 2.8 to 1.5 and MAS change was 2.6 to 2 in control group; this difference after six months of therapy was statistically significant with a p-value of 0.001. CONCLUSION TBTS can be an effective tool in rehabilitation of patients having equinus deformity; it provides an effective and patient controlled stretching and no need for a physical therapist. TBTS is a novel but simple instrument that can be made locally by the patient or the family.
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Affiliation(s)
- Tufail Muzaffar
- Senior Resident, Department of Physical Medicine and Rehabilitation, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Abdul Hamid Rather
- Assistant Professor, Department of Physical Medicine and Rehabilitation, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Kaleem Ul Haque
- Senior Resident, Department of Physical Medicine and Rehabilitation, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Sheikh Javeed Ahmad
- Assistant Professor, Department of Physical Medicine and Rehabilitation, SKIMS, Srinagar, Jammu and Kashmir, India
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Steplewski A, Fertala J, Beredjiklian PK, Abboud JA, Wang MLY, Namdari S, Barlow J, Rivlin M, Arnold WV, Kostas J, Hou C, Fertala A. Blocking collagen fibril formation in injured knees reduces flexion contracture in a rabbit model. J Orthop Res 2017; 35:1038-1046. [PMID: 27419365 DOI: 10.1002/jor.23369] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/13/2016] [Indexed: 02/04/2023]
Abstract
Post-traumatic joint contracture is a frequent orthopaedic complication that limits the movement of injured joints, thereby severely impairing affected patients. Non-surgical and surgical treatments for joint contracture often fail to improve the range of motion. In this study, we tested a hypothesis that limiting the formation of collagen-rich tissue in the capsules of injured joints would reduce the consequences of the fibrotic response and improve joint mobility. We targeted the formation of collagen fibrils, the main component of fibrotic deposits formed within the tissues of injured joints, by employing a relevant rabbit model to test the utility of a custom-engineered antibody. The antibody was delivered directly to the cavities of injured knees in order to block the formation of collagen fibrils produced in response to injury. In comparison to the non-treated control, mechanical tests of the antibody-treated knees demonstrated a significant reduction of flexion contracture. Detailed microscopic and biochemical studies verified that this reduction resulted from the antibody-mediated blocking of the assembly of collagen fibrils. These findings indicate that extracellular processes associated with excessive formation of fibrotic tissue represent a valid target for limiting post-traumatic joint stiffness. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1038-1046, 2017.
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Affiliation(s)
- Andrzej Steplewski
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107
| | - Jolanta Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107
| | - Pedro K Beredjiklian
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107.,Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107.,Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Mark L Y Wang
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107.,Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Surena Namdari
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107.,Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Jonathan Barlow
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107.,Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Michael Rivlin
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107.,Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - William V Arnold
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107.,Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - James Kostas
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107
| | - Cheryl Hou
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107
| | - Andrzej Fertala
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Curtis Building, 1015 Walnut Street, Philadelphia, Pennsylvania 19107
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Le Sant G, Nordez A, Andrade R, Hug F, Freitas S, Gross R. Stiffness mapping of lower leg muscles during passive dorsiflexion. J Anat 2017; 230:639-650. [PMID: 28251615 DOI: 10.1111/joa.12589] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 12/19/2022] Open
Abstract
It is challenging to differentiate the mechanical properties of synergist muscles in vivo. Shear wave elastography can be used to quantify the shear modulus (i.e. an index of stiffness) of a specific muscle. This study assessed the passive behavior of lower leg muscles during passive dorsiflexion performed with the knee fully extended (experiment 1, n = 22) or with the knee flexed at 90° (experiment 2, n = 20). The shear modulus measurements were repeated twice during experiment 1 to assess the inter-day reliability. During both experiments, the shear modulus of the following plantar flexors was randomly measured: gastrocnemii medialis (GM) and lateralis (GL), soleus (SOL), peroneus longus (PL), and the deep muscles flexor digitorum longus (FDL), flexor hallucis longus (FHL), tibialis posterior (TP). Two antagonist muscles tibialis anterior (TA), and extensor digitorum longus (EDL) were also recorded. Measurements were performed in different proximo-distal regions for GM, GL and SOL. Inter-day reliability was adequate for all muscles (coefficient of variation < 15%), except for TP. In experiment 1, GM exhibited the highest shear modulus at 80% of the maximal range of motion (128.5 ± 27.3 kPa) and was followed by GL (67.1 ± 24.1 kPa). In experiment 2, SOL exhibited the highest shear modulus (55.1 ± 18.0 kPa). The highest values of shear modulus were found for the distal locations of both the GM (80% of participants in experiment 1) and the SOL (100% of participants in experiment 2). For both experiments, deep muscles and PL exhibited low levels of stiffness during the stretch in young asymptomatic adults, which was unknown until now. These results provide a deeper understanding of passive mechanical properties and the distribution of stiffness between and within the plantar flexor muscles during stretching between them and thus could be relevant to study the effects of aging, disease progression, and rehabilitation on stiffness.
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Affiliation(s)
- Guillaume Le Sant
- University of Nantes, Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, Nantes, France.,School of Physiotherapy, IFM3R, Nantes, France
| | - Antoine Nordez
- University of Nantes, Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, Nantes, France
| | - Ricardo Andrade
- University of Nantes, Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, Nantes, France.,Faculdade de Motricidade Humana, CIPER, Universidade de Lisboa, Lisbon, Portugal
| | - François Hug
- University of Nantes, Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, Nantes, France.,School of Health and Rehabilitation Sciences, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Australia
| | - Sandro Freitas
- Faculdade de Motricidade Humana, CIPER, Universidade de Lisboa, Lisbon, Portugal.,Benfica Lab, Sport Lisboa e Benfica, Lisboa, Portugal
| | - Raphaël Gross
- University of Nantes, Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, Nantes, France.,Gait Analysis Laboratory, Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
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