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VAN Oorschot W, VAN Ee IR, Keijsers N. A DEDICATED AMPUTEE SPORTS PROGRAMME IMPROVES PHYSICAL FUNCTIONING AND SPORTS PARTICIPATION. J Rehabil Med Clin Commun 2023; 6:12392. [PMID: 37964806 PMCID: PMC10642343 DOI: 10.2340/jrmcc.v6.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 11/16/2023]
Abstract
Objective People with a lower-limb amputation often have a sedentary lifestyle and increasing physical activity is important to optimize their health and quality of life. To achieve this the Amputee Parateam programme was developed. Amputee Parateam is a sports programme that addresses important physical, environmental, and social barriers for sports participation. This programme was evaluated in terms of various aspects of physical functioning and health. Design Repeated measures design. Patients Thirteen participants with a lower-limb amputation, with a median age of 51 (interquartile range (IQR) 40-63). Methods Measurements were performed at T0 (baseline), T1 (after 6 weeks) and T2 (follow-up after 12 months). Outcome measures were walking ability, functional mobility, daily activity, health-related quality of life, and adherence to sports at follow-up. Results Walking ability and functional ability significantly improved between T0 and T1. Adherence to sports at follow-up was high, with 11/13 participants still practicing sports weekly. There were no significant changes in daily activity or health-related quality of life. Conclusions The Amputee Parateam programme successfully improved walking ability and functional mobility and resulted in a high adherence to sports among the participants. However, these improvements in physical capacity did not lead to less sedentary behaviour in daily life.
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Buurke TJW, van de Venis L, Keijsers N, Nonnekes J. The effect of walking with reduced trunk motion on dynamic stability in healthy adults. Gait Posture 2023; 103:113-118. [PMID: 37156163 DOI: 10.1016/j.gaitpost.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/13/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Most people with Parkinson's disease (PD) walk with a smaller mediolateral base of support (BoS) compared to healthy people, but the underlying mechanisms remain unknown. Reduced trunk motion in people with PD might be related to this narrow-based gait. Here, we study the relationship between trunk motion and narrow-based gait in healthy adults. According to the extrapolated center of mass (XCoM) concept, a decrease in mediolateral XCoM excursion would require a smaller mediolateral BoS to maintain a constant margin of stability (MoS) and remain stable. RESEARCH QUESTION As proof of principle, we assessed whether walking with reduced trunk motion results in a smaller step width in healthy adults, without altering the mediolateral MoS. METHODS Fifteen healthy adults walked on a treadmill at preferred comfortable walking speed in two conditions. First, the 'regular walking' condition without any instructions, and second, the 'reduced trunk motion' condition with the instruction: 'Keep your trunk as still as possible'. Treadmill speed was kept the same in the two conditions. Trunk kinematics, step width, mediolateral XCoM excursion and mediolateral MoS were calculated and compared between the two conditions. RESULTS Walking with the instruction to keep the trunk still significantly reduced trunk kinematics. Walking with reduced trunk motion resulted in significant decreases in step width and mediolateral XCoM excursion, but not in the mediolateral MoS. Furthermore, step width and mediolateral XCoM excursion were strongly correlated during both conditions (r = 0.887 and r = 0.934). SIGNIFICANCE This study shows that walking with reduced trunk motion leads to a gait pattern with a smaller BoS in healthy adults, without altering the mediolateral MoS. Our findings indicate a strong coupling between CoM motion state and the mediolateral BoS. We expect that people with PD who walk narrow-based, have a similar mediolateral MoS as healthy people, which will be further investigated.
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Affiliation(s)
- Tom J W Buurke
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; KU Leuven, Department of Movement Sciences, Leuven, Belgium.
| | - Lotte van de Venis
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Noël Keijsers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, The Netherlands; Sint Maartenskliniek, Department of Research, Nijmegen, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Department of Sensorimotor Neuroscience, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, The Netherlands; Sint Maartenskliniek, Department of Research, Nijmegen, the Netherlands
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Buurke TJW, van de Venis L, den Otter R, Nonnekes J, Keijsers N. Comparison of ground reaction force and marker-based methods to estimate mediolateral center of mass displacement and margins of stability during walking. J Biomech 2023; 146:111415. [PMID: 36542905 DOI: 10.1016/j.jbiomech.2022.111415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/19/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Dynamic balance control during human walking can be described by the distance between the mediolateral (ML) extrapolated center of mass (XCoM) position and the base of support, the margin of stability (MoS). The ML center of mass (CoM) position during treadmill walking can be estimated based on kinematic data (marker-based method) and a combination of ground reaction forces and center of pressure positions (GRF-based method). Here, we compare a GRF-based method with a full-body marker-based method for estimating the ML CoM, ML XCoM and ML MoS. Fifteen healthy adults walked on a dual-belt treadmill at comfortable walking speed for three minutes. Kinetic and kinematic data were collected and analyzed using a GRF-based and marker-based method to compare the ML CoM, ML XCoM and ML MoS. High correlation coefficients (r > 0.98) and small differences (Root Mean Square Difference < 0.0072 m) in ML CoM and ML XCoM were found between the GRF-based and marker-based methods. The GRF-based method resulted in larger ML XCoM excursion (0.0118 ± 0.0074 m) and smaller ML MoS values (0.0062 ± 0.0028 m) than the marker-based method, but these differences were consistent across participants. In conclusion, the GRF-based method is a valid method to determine the ML CoM, XCoM and MoS. One should be aware of higher ML XCoM and smaller ML MoS values in the GRF-based method when comparing absolute values between studies. The GRF-based method strongly reduces measurement times and can be used to provide real-time CoM-CoP feedback during treadmill gait training.
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Affiliation(s)
- Tom J W Buurke
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; KU Leuven, Department of Movement Sciences, Leuven, Belgium.
| | - Lotte van de Venis
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Rob den Otter
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, the Netherlands; Sint Maartenskliniek, Department of Research, Nijmegen, the Netherlands
| | - Noël Keijsers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, the Netherlands; Sint Maartenskliniek, Department of Research, Nijmegen, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Department of Sensorimotor Neuroscience, Nijmegen, the Netherlands
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Tosserams A, Keijsers N, Kapelle W, Kessels RPC, Weerdesteyn V, Bloem BR, Nonnekes J. Evaluation of Compensation Strategies for Gait Impairment in Patients With Parkinson Disease. Neurology 2022; 99:e2253-e2263. [PMID: 36008154 PMCID: PMC9694838 DOI: 10.1212/wnl.0000000000201159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Compensation strategies are essential in Parkinson disease (PD) gait rehabilitation. However, besides external cueing, these strategies have rarely been investigated systematically. We aimed to perform the following: (1) establish the patients' perspective on the efficacy and usability of 5 different compensation strategies; (2) quantify the efficacy of these strategies on spatiotemporal gait parameters; and (3) explore associations between the effects of specific strategies and patient characteristics. METHODS We recruited persons with PD and self-reported disabling gait impairments for this laboratory-based, within-subject study. Clinimetrics included the following: questionnaires (New Freezing of Gait Questionnaire, Vividness of Movement Imagery Questionnaire, Goldsmiths Musical Sophistication Index), cognitive assessments (Attentional Network Test and Montreal Cognitive Assessment [MoCA], Brixton), and physical examinations (Movement Disorders Society Unified Parkinson's Disease Rating Scale [MDS-UPDRS III], Mini-Balance Evaluation Systems Test, tandem gait, and rapid turns test). Gait assessment consisted of six 3-minute trials of continuous walking around a 6-m walkway. Trials comprised the following: (1) baseline gait; (2) external cueing; (3) internal cueing; (4) action observation; (5) motor imagery; and (6) adopting a new walking pattern. Spatiotemporal gait parameters were acquired using 3-dimensional motion capture analysis. Strategy efficacy was determined by the change in gait variability compared with baseline gait. Associated patient characteristics were explored using regression analyses. RESULTS A total of 101 participants (50 men; median [range] age: 66 [47-91] years) were included. The effects of the different strategies varied greatly among participants. While participants with higher baseline variability showed larger improvements using compensation strategies, participants without freezing of gait, with lower MDS-UPDRS III scores, higher balance capacity, and better performance in orienting attention also showed greater improvements in gait variability. Higher MoCA scores were associated with greater efficacy of external cueing. DISCUSSION Our findings support the use of compensation strategies in gait rehabilitation for PD but highlight the importance of a personalized approach. Even patients with high gait variability are able to improve through the application of compensation strategies, but certain levels of cognitive and functional reserve seem necessary to optimally benefit from them.
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Affiliation(s)
- Anouk Tosserams
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - Noël Keijsers
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Willanka Kapelle
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Roy P C Kessels
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Vivian Weerdesteyn
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- From the Departments of Rehabilitation (A.T., N.K., W.K., V.W., J.N.), and Neurology (A.T., W.K., B.R.B.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; Department of Research (N.K., V.W.), Sint Maartenskliniek; Departments of Sensorimotor Neuroscience (N.K.), and Neuropsychology and Rehabilitation Psychology (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Klimmendaal Rehabilitation Center (R.P.C.K.), Arnhem; Tactus Addication Care (R.P.C.K.), Deventer; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
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Boekesteijn R, Smolders J, Busch V, Keijsers N, Geurts A, Smulders K. Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures. PeerJ 2022; 10:e14054. [PMID: 36193431 PMCID: PMC9526408 DOI: 10.7717/peerj.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023] Open
Abstract
Background Inertial sensors hold the promise to objectively measure functional recovery after total knee (TKA) and hip arthroplasty (THA), but their value in addition to patient-reported outcome measures (PROMs) has yet to be demonstrated. This study investigated recovery of gait after TKA and THA using inertial sensors, and compared results to recovery of self-reported scores of pain and function. Methods PROMs and gait parameters were assessed before and at two and fifteen months after TKA (n = 24) and THA (n = 24). Gait parameters were compared with healthy individuals (n = 27) of similar age. Gait data were collected using inertial sensors on the feet, lower back, and trunk. Participants walked for two minutes back and forth over a 6m walkway with 180° turns. PROMs were obtained using the Knee Injury and Osteoarthritis Outcome Scores and Hip Disability and Osteoarthritis Outcome Score. Results Gait parameters recovered to the level of healthy controls after both TKA and THA. Early improvements were found in gait-related trunk kinematics, while spatiotemporal gait parameters mainly improved between two and fifteen months after TKA and THA. Compared to the large and early improvements found in of PROMs, these gait parameters showed a different trajectory, with a marked discordance between the outcome of both methods at two months post-operatively. Conclusion Sensor-derived gait parameters were responsive to TKA and THA, showing different recovery trajectories for spatiotemporal gait parameters and gait-related trunk kinematics. Fifteen months after TKA and THA, there were no remaining gait differences with respect to healthy controls. Given the discordance in recovery trajectories between gait parameters and PROMs, sensor-derived gait parameters seem to carry relevant information for evaluation of physical function that is not captured by self-reported scores.
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Affiliation(s)
- Ramon Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands,Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Smolders
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Vincent Busch
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander Geurts
- Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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Nonnekes J, Hofstad C, de Greef-Rotteveel A, van der Wielen H, van Gelder JH, Plaats C, Altmann V, Krause F, Keijsers N, Geurts A, Louwerens JWK. Management of gait impairments in people with Charcot-Marie-Tooth disease: A treatment algorithm. J Rehabil Med 2021; 53:jrm00194. [PMID: 33880570 PMCID: PMC8814859 DOI: 10.2340/16501977-2831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Gait impairments in people with Charcot-Marie-Tooth disease are the combined result of ankle-foot deformities, muscle weakness, and somatosensory impairments. People with Charcot-Marie-Tooth disease often experience pain and difficulties when walking, especially barefoot. They also trip and fall frequently and have a lower than normal gait speed and distance. Because these gait impairments and related complaints are disabling, clinical management aimed at improving gait is important. Management involves both conservative and surgical treatment options, each with limited scientific evidence. However, a treatment algorithm that describes both conservative and surgical treatment options is currently lacking. This study sets out a step-wise treatment algorithm, based on evidence, if available, and otherwise reflecting practice-based experience. The treatment algorithm will be of value in daily clinical practice, and will serve as a template for future research. LAY ABSTRACT Treatment of gait impairments in people with Charcot-Marie-Tooth disease is crucial, because it is a source of great disability. However, many clinicians find it difficult to treat these gait impairments in their daily clinical practice. This challenge is compounded by a lack of clear treatment protocols that take the whole spectrum of treatment options into account. As a result, there is wide variation in clinical practice. To address the widely felt need for a treatment algorithm, we present here a stepwise approach to the management of gait impairments in patients with Charcot-Marie-Tooth disease.
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Affiliation(s)
- Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, 6541GX Nijmegen, The Netherlands. E-mail:
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Nonnekes J, Keijsers N, Witteveen A, Geurts A. Improved Gait Capacity after Bilateral Achilles Tendon Lengthening for Irreducible Pes Equinus Due to Hereditary Spastic Paraplegia: a Case Report. J Rehabil Med Clin Commun 2021; 4:1000059. [PMID: 34276903 PMCID: PMC8192886 DOI: 10.2340/20030711-1000059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
Objective Toe walking due to progressive shortening of the calf muscles is common in people with hereditary spastic paraplegia. Achilles tendon lengthening is a treatment option, but clinicians are often hesitant to use this procedure, as it may result in weakening of the calf muscles and, subsequently, in reduced ankle power and knee instability during the stance phase of gait. We report here a case report supporting that these negative side-effects can be avoided in well-selected people with hereditary spastic paraplegia. Method Bilateral Achilles tendon lengthening, combined with bilateral tenotomy of the tibialis posterior and toe flexors, was performed in a 29-year-old woman with uncomplicated hereditary spastic paraplegia who experienced progressive gait instability due to shortening of the soleus and gastrocnemius muscles (resulting in irreducible pes equinus). Results Bilateral Achilles tendon lengthening resulted in improvement in both subjective and objective outcomes. Self-selected gait speed improved from 0.75 m/s before surgery to 1.07 m/s after surgery (p < 0.001). Knee instability during the stance phase did not occur post-surgery. The ankle moment trajectories normalized after surgery, while peak ankle powers increased. Conclusion Correction of bilateral irreducible pes equinus by Achilles tendon lengthening may improve gait capacity in well-selected subjects with hereditary spastic paraplegia.
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Affiliation(s)
- Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation.,Sint Maartenskliniek, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Noël Keijsers
- Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Alexander Geurts
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation.,Sint Maartenskliniek, Department of Rehabilitation, Nijmegen, The Netherlands
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Nonnekes J, Kamps M, den Boer J, van Duijnhoven H, Lem F, Louwerens JWK, Keijsers N, Geurts ACH. Tarsal fusion for pes equinovarus deformity improves gait capacity in chronic stroke patients. J Neuroeng Rehabil 2019; 16:102. [PMID: 31375133 PMCID: PMC6679466 DOI: 10.1186/s12984-019-0572-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 07/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background Gait impairments are common and disabling in chronic stroke patients. Pes equinovarus deformity is one of the primary motor deficits underlying reduced gait capacity after stroke. It predisposes to stance-phase instability and subsequent ankle sprain or falls. This instability is most pronounced when walking barefoot. Tarsal fusion is a recommended treatment option for varus deformity, but scientific evidence is sparse. We therefore evaluated whether a tarsal fusion improved barefoot walking capacity in chronic stroke patients with pes equinovarus deformity. Methods Ten patients with a pes equinovarus deformity secondary to supratentorial stroke underwent surgical correction involving a tarsal fusion of one or more joints. Instrumented gait analysis was performed pre- and postoperatively using a repeated-measures design. Primary outcome measure was gait speed. Results Walking speed significantly improved by 32% after surgery (0.38 m/s ± 0.20 to 0.50 m/s ± 0.17, p = 0.007). Significant improvement was also observed when looking at cadence (p = 0.028), stride length (p = 0.016), and paretic step length (p = 0.005). Step length on the nonparetic side did not change. Peak ankle moment increased significantly on the nonparetic side (p = 0.021), but not on the paretic side (p = 0.580). In addition, functional ambulation scores increased significantly (p = 0.008), as did satisfaction with gait performance (p = 0.017). Conclusions Tarsal fusion for equinovarus deformity in chronic stroke patients improves gait capacity, and the degree of improvement is of clinical relevance. Our results suggest that the improved gait capacity may be related to better prepositioning and loading of the paretic foot, leading to larger paretic step length and nonparetic ankle kinetics.
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Affiliation(s)
- Jorik Nonnekes
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Rehabilitation, Nijmegen, The Netherlands. .,Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Maartje Kamps
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Rehabilitation, Nijmegen, The Netherlands
| | - Jasper den Boer
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Rehabilitation, Nijmegen, The Netherlands.,Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Hanneke van Duijnhoven
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Rehabilitation, Nijmegen, The Netherlands
| | - Frits Lem
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Noël Keijsers
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Rehabilitation, Nijmegen, The Netherlands.,Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Rehabilitation, Nijmegen, The Netherlands.,Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
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Muijzer-Witteveen H, Sibum N, van Dijsseldonk R, Keijsers N, van Asseldonk E. Questionnaire results of user experiences with wearable exoskeletons and their preferences for sensory feedback. J Neuroeng Rehabil 2018; 15:112. [PMID: 30470238 PMCID: PMC6260663 DOI: 10.1186/s12984-018-0445-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wearable exoskeletons can be a powerful tool for the facilitation of ambulation of complete Spinal Cord Injury (SCI) subjects, which has several psychological and physical advantages. However, exoskeleton control is difficult for this group of users and requires a long period of training. People with SCI not only lack the motor control, but also miss the sensory information from below the level of the lesion, which is for example very important in their perception of body posture and makes balancing with an exoskeleton difficult. It is hypothesized that through sensory substitution part of the missing sensory information can be provided and might thereby improve the control of an exoskeleton. However, it is not known which information would be most important to receive while using an exoskeleton and how this feedback should be provided. METHODS To investigate the preferences of users of an exoskeleton, a questionnaire was filled out by 10 SCI subjects who underwent a training program with a commercial exoskeleton (ReWalk). The questionnaire consisted of questions about the use of the exoskeleton to identify which information is missing and which instructions from the therapists were needed to be able to control the exoskeleton. The second part of the questionnaire focused on the possibilities of sensory feedback and preferences for stimulation methods (auditory, vibrotactile or visual) and feedback timing (discrete or continuous) were investigated. Furthermore, six options for feedback parameters (step initiation, continuous and discrete gait phases, foot position and mediolateral and anteroposterior weight shift) were proposed and the respondents were asked to indicate their preferences. RESULTS Three feedback parameters (feedback about mediolateral and anteroposterior weight shift and feedback about step initiation) were considered as possibly helpful by the respondents. Furthermore, there were slight preferences for the use of vibrotactile (over auditory and visual) and discrete (over continuous) feedback. CONCLUSIONS The answers of the respondents on the optimal feedback parameters were rather variable and therefore it is recommended to let the users choose their preferred feedback system during a training session with several feedback options. However, there are slight preferences for the use of vibrotactile stimulation provided in a discrete way.
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Affiliation(s)
- Heidi Muijzer-Witteveen
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, the Netherlands.
| | - Nienke Sibum
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, the Netherlands
| | | | - Noël Keijsers
- Research, Sint Maartenskliniek, Hengstdal 3, Nijmegen, 6574 NA, the Netherlands
| | - Edwin van Asseldonk
- Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, the Netherlands
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Nonnekes J, Benda N, van Duijnhoven H, Lem F, Keijsers N, Louwerens JWK, Pieterse A, Renzenbrink B, Weerdesteyn V, Buurke J, Geurts ACH. Management of Gait Impairments in Chronic Unilateral Upper Motor Neuron Lesions. JAMA Neurol 2018; 75:751-758. [DOI: 10.1001/jamaneurol.2017.5041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Nathalie Benda
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Hanneke van Duijnhoven
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frits Lem
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Noël Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| | | | - Allan Pieterse
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, the Netherlands
- Biomedical Signals and Systems, MIRA–Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
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Heesterbeek P, Keijsers N, Jacobs W, Verdonschot N, Wymenga A. Posterior cruciate ligament recruitment affects antero-posterior translation during flexion gap distraction in total knee replacement. An intraoperative study involving 50 patients. Acta Orthop 2010; 81:471-7. [PMID: 20809745 PMCID: PMC2917571 DOI: 10.3109/17453674.2010.501743] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Because of the oblique orientation of the posterior cruciate ligament (PCL), flexion gap distraction could lead to anterior movement of the tibia, which would influence the tibiofemoral contact point. This would affect the kinematics of the TKR. We assessed the flexion gap parameters when the knee is distracted during implantation of a PCL-retaining TKR. Furthermore, the effects of PCL elevation (steep or flat) and collateral ligament releases on the flexion gap parameters were determined. METHODS During a ligament-guided TKR procedure in 50 knees, the flexion gap was distracted with a double-spring tensor with 200N after the tibia had been cut. The flexion gap height, anterior tibial translation, and femoral rotation were measured intraoperatively using a CT-free navigation system. RESULTS During flexion gap distraction, the greatest displacement was seen in anterior-posterior direction. Mean ratio between increase in gap height and tibial translation was 1 to 1.9, and was highest for knees with a steep PCL (1 to 2.3). Knees with a flat PCL and knees with a ligament release had a larger increase in PCL elevation when the gap was distracted. INTERPRETATION When the PCL is tensioned, every extra mm that the flexion gap is distracted can be expected to move the tibia anteriorly by at least 1.7 mm (flat PCL), or more if there is a steep PCL. This changes the tibiofemoral contact point, which may have consequences for polyethylene wear.
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Affiliation(s)
- Petra Heesterbeek
- Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen,Correspondence:
| | - Noël Keijsers
- Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen
| | - Wilco Jacobs
- Department of Research, Development and Education, Sint Maartenskliniek, Nijmegen
| | | | - Ate Wymenga
- Department of Orthopaedics, Sint Maartenskliniek, NijmegenThe Netherlands
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