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Sarhan OA, Imam N, Levine HB, Redfern RE, Seidenstein AD, Klein GR. Comparison of Early Post-operative Step and Stair Counts with the Direct Anterior Approach versus the Posterior Approach for Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00417-0. [PMID: 38697321 DOI: 10.1016/j.arth.2024.04.069] [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: 09/05/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate the impact of direct anterior (DAA) or posterior (PA) approaches on step and stair counts after total hip arthroplasty (THA) using a remotely monitored mobile application with a smartwatch while controlling for baseline characteristics. METHODS This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform. The primary outcomes were step and stair counts and changes from baseline through one year. Step and stair counts were available for 1,501 and 847 patients, respectively. Longitudinal regression models were created to control for baseline characteristics. RESULTS Patients in the DAA group had significantly lower BMI (P = 0.049) and comorbidities (P = 0.028), but there were no significant differences in age (P = 0.225) or sex (P = 0.315). The DAA patients had a higher average and improvement from baseline in step count at two and three weeks post-operatively after controlling for patient characteristics (P = 0.028 and P = 0.044, respectively). The average stair counts were higher for DAA patients at one month post-operatively (P = 0.035), but this difference was not significant after controlling for patient demographics. Average stair ascending speeds and changes from baseline were not different between DAA and PA patients. Descending stair speed was higher at two weeks post-operatively for DAA patients, but was no longer higher after controlling for baseline demographics. DISCUSSION After controlling for baseline characteristics, DAA patients demonstrate earlier improvement in step count than PA patients after THA. However, patient selection and surgeon training may continue to influence outcomes through a surgical approach.
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Affiliation(s)
| | - Nareena Imam
- Rothman Orthopaedic Institute; Philadelphia, PA USA
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2
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Hodge PE, Rabak OJ, Perriman DM, Scarvell JM, Smith PN, Lynch JT. Are Kinematics an Indicator of Outcome After Total Knee Arthroplasty? J Arthroplasty 2024; 39:343-349.e1. [PMID: 37572724 DOI: 10.1016/j.arth.2023.08.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND A proportion of total knee arthroplasty (TKA) patients are dissatisfied postoperatively, particularly with their ability to perform higher-demand activities including deep-kneeling and step-up where kinematic parameters are more demanding. The purpose of this study was to examine the relationship between knee kinematics of step-up and deep-kneeling and patient-reported outcome measures following TKA. METHODS Sixty-four patients were included at minimum 1-year follow-up. Participants performed a step-up and deep-kneeling task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Associations between kinematics and patient-reported outcome measures, including Oxford Knee Score, American Knee Society Score, surgical satisfaction, and pain were assessed using log-transformed step-wise linear regressions. RESULTS A higher total Oxford Knee Score was associated with more external rotation and more adduction at maximal flexion during kneeling and more external rotation and minimum flexion during step-up. Improved American Knee Society Score was associated with increased internal-external rotation during step-up. Improved surgical satisfaction was associated with greater maximum flexion and more external rotation at maximal flexion during deep-kneeling and more femoral internal rotation at terminal extension during step-up. An improved pain score was associated with greater maximum flexion and more femoral external rotation during deep-kneeling, as well as greater internal femoral rotation during step-up. CONCLUSION The ability to move through full flexion/extension range and end-of-range rotation is important kinematic parameters that influence patient-reported outcome measures. Implant designs and postoperative rehabilitation should continue to focus on achieving these kinematic targets for enhanced outcomes after TKA.
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Affiliation(s)
- Phillipa E Hodge
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Owen J Rabak
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Diana M Perriman
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Jennie M Scarvell
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Paul N Smith
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
| | - Joseph T Lynch
- The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia
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3
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Brown CB, Barrett TS, Long C, Corbridge S, Braeger A, Zollinger BJ, Harrison K, Poulsen SL, Boman T, Dakin CJ, Harper SA. Step edge highlighters and illuminance changes influence stair descent in a real-world setting. Ergonomics 2023; 66:1219-1228. [PMID: 36314061 DOI: 10.1080/00140139.2022.2141347] [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] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Studies investigating the effect of tread edge highlighters on descent speed differ, but collectively report the potential benefit of reduced fall risk. Here we examine the impact of adding high-contrast black vinyl striping to the front edge of each step's tread and its impact on descending gait speed (intervention), while controlling for illumination. Descending gait speed was estimated from 5,824 video observations using the stairway length and entry and exit times. A second stairway was unaltered (control) to compare to the intervention. Stair users were primarily 18-30 years old with a small percentage being middle-aged and older adults. Descending gait speed was significantly slower on the intervention stairway (Linear mixed effects model: standardised coefficient = -0.07, 95% CI = [-0.12, -0.02], p = .010) compared to the control and may be impacted by illuminance. We propose that the slowed gait speed could be due to changes in gait kinematics (e.g. foot clearance) and may reduce fall-risk. Practitioner summary: Tread-edge contrast enhancement could be a low-cost means to reduce fall-risk on stairways, but its impact on gait kinematics is not well understood. We found that contrast enhancement reduced descending gait speed, but descending gait speed's impact on fall risk reduction ultimately requires further investigation.
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Affiliation(s)
- Chayston B Brown
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Tyson S Barrett
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Christopher Long
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Samantha Corbridge
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Alex Braeger
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Brevin J Zollinger
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Kenneth Harrison
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Shandon L Poulsen
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Travis Boman
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Christopher J Dakin
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT, USA
| | - Sara A Harper
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT, USA
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4
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Berardi V, Rosenberg BD, Srivastava S, Estrada-Rand N, Frederick J. Stair versus elevator use in a university residence hall setting. J Am Coll Health 2023; 71:997-1002. [PMID: 34314658 DOI: 10.1080/07448481.2021.1920602] [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] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/09/2021] [Accepted: 04/18/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Determine the temporal and spatial characteristics of stairs versus elevator use in a university residence hall to inform future physical activity promotion efforts. PARTICIPANTS All residents and visitors for a single, four-story residence hall dormitory building located on a college campus in Orange, CA. METHODS Smart mat systems capable of detecting pedestrian traffic were placed in front of the stairs and elevators on each floor plus a basement. Generalized additive mixed models (GAMMs) were used to compare stair versus elevator usage at different times of the day and on different floors. RESULTS Stair versus elevator use varied much more throughout the day on floors nearest to the ground floor, with stair use most common in the morning. Overall, the elevator was used more frequently on higher floors, with less variation throughout the day. CONCLUSION To be most effective, future stair promotion interventions should target residents on higher floors and in the morning.
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Affiliation(s)
- Vincent Berardi
- Department of Psychology, Chapman University, Orange, California, USA
| | | | - Sophie Srivastava
- Department of Psychology, Chapman University, Orange, California, USA
| | - Noah Estrada-Rand
- Department of Psychology, Chapman University, Orange, California, USA
| | - Julia Frederick
- Department of Psychology, Chapman University, Orange, California, USA
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5
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Ghiani A, Van Hout LR, Driessen JG, Brenner E. Where do people look when walking up and down familiar staircases? J Vis 2023; 23:7. [PMID: 36633872 PMCID: PMC9840440 DOI: 10.1167/jov.23.1.7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Many activities in daily life do not impose strict requirements on gaze. We investigated gaze when walking up and down staircases within one's own house. We anticipated that using a variety of staircases in different environments and not informing participants that stair climbing was the focus of investigation might provide a description of gaze behavior that is closer to that used in our daily life than doing so under circumstances in which the focus is explicitly and exclusively directed at the stairs. We analyzed several measures, including the order in which participants fixated the steps. We confirmed that people often look at the steps sequentially, but found that they often made fixations back to steps they had already fixated. They also regularly skipped looking at several steps to fixate further ahead. On average, they directed their gaze at about half the steps. They looked further ahead when ascending than when descending staircases. Overall, the results are similar to those found under highly constrained laboratory conditions, although we do report some differences. One such difference is a tendency to fixate fewer steps. Another is that participants fixated steps that were less far ahead when descending staircases. We also introduced some new analyses that may help understand gaze behavior during stair climbing.
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Affiliation(s)
- Andrea Ghiani
- Department of Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands.,
| | - Liz R. Van Hout
- Department of Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands,
| | - Joost G. Driessen
- Department of Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands,
| | - Eli Brenner
- Department of Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands.,
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6
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Blasimann A, Busch A, Henle P, Bruhn S, Vissers D, Baur H. Neuromuscular Control During Stair Descent and Artificial Tibial Translation After Acute ACL Rupture. Orthop J Sports Med 2022; 10:23259671221123299. [PMID: 36263309 PMCID: PMC9575465 DOI: 10.1177/23259671221123299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) rupture has direct effect on passive and
active knee stability and, specifically, stretch-reflex excitability. Purpose/Hypothesis: The purpose of this study was to investigate neuromuscular activity in
patients with an acute ACL deficit (ACL-D group) compared with a matched
control group with an intact ACL (ACL-I group) during stair descent and
artificially induced anterior tibial translation. It was hypothesized that
neuromuscular control would be impaired in the ACL-D group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Surface electromyographic (EMG) activity of the vastus medialis (VM), vastus
lateralis (VL), biceps femoris (BF), and semitendinosus (ST) muscles was
recorded bilaterally in 15 patients with ACL-D (mean, 13.8 days [range, 7-21
days] since injury) and 15 controls with ACL-I during stair descent and
artificially induced anterior tibial translation. The movements of stair
descent were divided into preactivity, weight acceptance, and push-off
phases. Reflex activity during anterior tibial translation was split into
preactivity and short, medium, and late latency responses. Walking on a
treadmill was used for submaximal EMG normalization. Kruskal-Wallis test and
post hoc analyses with Dunn-Bonferroni correction were used to compare
normalized root mean square values for each muscle, limb, movement, and
reflex phase between the ACL-D and ACL-I groups. Results: During the preactivity phase of stair descent, the hamstrings of the involved
leg of the ACL-D group showed 33% to 51% less activity compared with the
matched leg and contralateral leg of the ACL-I group (P
< .05). During the weight acceptance and push-off phases, the VL revealed
a significant reduction (approximately 40%) in the involved leg of the ACL-D
group compared with the ACL-I group. At short latency, the BF and ST of the
involved leg of the ACL-D group showed a significant increase in EMG
activity compared with the uninvolved leg of the ACL-I group, by a factor of
2.2 to 4.6. Conclusion: In the acute phase after an ACL rupture, neuromuscular alterations were found
mainly in the hamstrings of both limbs during stair descent and reflex
activity. The potential role of prehabilitation needs to be further
studied.
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Affiliation(s)
- Angela Blasimann
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Angela Blasimann, MSc, Department of Health Professions, Bern
University of Applied Sciences, Murtenstrasse 10, CH-3008 Bern, Switzerland
()
| | - Aglaja Busch
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland.,University Outpatient Clinic, Sports Medicine & Sports
Orthopedics, University of Potsdam, Potsdam, Germany
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Lindenhof Group AG, Bern,
Switzerland.,Department of Orthopaedic Surgery and Traumatology, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Bruhn
- Institute of Sports Science, University of Rostock, Rostock,
Germany
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of
Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Heiner Baur
- Division of Physiotherapy, Department of Health Professions, Bern
University of Applied Sciences, Bern, Switzerland
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7
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Delsart A, Moreau M, Otis C, Frezier M, Drag M, Pelletier JP, Martel-Pelletier J, Lussier B, Del Castillo J, Troncy E. Development of Two Innovative Performance-Based Objective Measures in Feline Osteoarthritis: Their Reliability and Responsiveness to Firocoxib Analgesic Treatment. Int J Mol Sci 2022; 23. [PMID: 36233085 DOI: 10.3390/ijms231911780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
The metrological properties of two performance-based outcome measures of feline osteoarthritis (OA), namely Effort Path (Path) and Stairs Assay Compliance (Stairs), were tested. Cats naturally affected by OA (n = 32) were randomly distributed into four groups (A: 0.40, B: 0.25, C: 0.15, or D: 0.00 mg firocoxib/kg bodyweight) and assessed during baseline, treatment, and recovery periods. For Path, from an elevated walking platform, the cats landed on a pressure-sensitive mattress and jumped up onto a second elevated platform. Analysis included velocity, time to completion, peak vertical force (PVF), and vertical impulse. For Stairs, the number of steps and time to completion were recorded for 16 steps up and down in a 4 min period. Reliability was moderate to very good for Path and poor to good for Stairs. Different normalization methods are described in the manuscript. The placebo group remained stable within-time in Path, whereas treated cats trotted faster on the ramp (p < 0.0001), improved their PVF (p < 0.018) and completed the task quicker (p = 0.003). The percentage of cats completing the Stairs finish line was higher under treatment (p < 0.036), with huge effect size, the placebo group results being stable within-time. Both are promising performance-based outcome measures to better diagnose and manage feline OA pain.
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8
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Hörauf JA, Nau C, Mühlenfeld N, Verboket RD, Marzi I, Störmann P. Injury Patterns after Falling down Stairs-High Ratio of Traumatic Brain Injury under Alcohol Influence. J Clin Med 2022; 11:jcm11030697. [PMID: 35160145 PMCID: PMC8836855 DOI: 10.3390/jcm11030697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/30/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Falling down a staircase is a common mechanism of injury in patients with severe trauma, but the effect of varying fall height according to the number of steps on injury patterns in these patients has been little studied. In this retrospective study, prospectively collected data from a Level 1 Trauma Center in Germany were analyzed regarding the injury patterns of patients admitted through the trauma room with suspicion of multiple injuries following a fall down a flight of stairs between January 2016 and December 2019. In total 118 patients were examined which where consecutively included in this study. More than 80% of patients suffered a traumatic brain injury, which increased as a function of the number of stairs fallen. Therefore, the likelihood of intracranial hemorrhage increased with higher numbers of fallen stairs. Fall-associated bony injuries were predominantly to the face, skull and the spine. In addition, there was a high coincidence of staircase falls and alcohol intake. Due to a frequent coincidence of staircase falls and alcohol, the (pre-)clinical neurological assessment is complicated. As the height of the fall increases, severe traumatic brain injury should be anticipated and diagnostics to exclude intracranial hemorrhage and spinal injuries should be performed promptly to ensure the best possible patient outcome.
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9
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Nowak R, Kania T, Rutkowski R, Ekiert E. Research and TLS (LiDAR) Construction Diagnostics of Clay Brick Masonry Arched Stairs. Materials (Basel) 2022; 15:552. [PMID: 35057273 DOI: 10.3390/ma15020552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 11/23/2022]
Abstract
The study presents the terrestrial laser scanning (TLS) diagnostic of the clay brick masonry arched staircase in a historic building. Based on the measurements of the existing arched stair flights, 1:1 scale experimental models with and without stair treads were made. Strength tests of the models were carried out for different concentrated force locations in relation to the supporting structure. Force, deflections and reaction in the upper support of the run were measured during the tests. The influence of the masonry steps on the curved vault on the load capacity and stiffness of the run structure was analyzed. The conducted experimental investigations showed that the key element responsible for the actual load-bearing capacity and stiffness of this type of stair flights were the treads above the masonry arch.
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Gay JL, Cherof SA, LaFlamme CC, O’Connor PJ. Psychological Aspects of Stair Use: A Systematic Review. Am J Lifestyle Med 2022; 16:109-121. [PMID: 35185433 PMCID: PMC8848121 DOI: 10.1177/1559827619870104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/28/2019] [Revised: 06/19/2019] [Accepted: 07/26/2019] [Indexed: 08/10/2023] Open
Abstract
Stair use, a common lifestyle activity, is a moderate-to-vigorous physical activity that, despite often being brief in duration, may contribute to psychological health. A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method to summarize psychological aspects related to stair use. Included studies examined at least 1 psychological outcome in relation to either objective measures of stair use, such as time or stair height, or subjective measures of, or measures related to, stair use such as perceived difficulty using stairs. A total of 22 studies met the inclusion criteria; 12 used subjective stair use measures and 10 used objective stair use measures. The limited evidence from studies using self-reports supported that (1) perceived difficulty using stairs was positively associated with increased symptoms of anxiety and depression and (2) stair use was not associated with a reduced incidence of mental illnesses such as depression, suicide, or dementia. Studies using objective measures of stair use supported that (3) elevated symptoms of anxiety and depression are negatively associated with stair use performance. Given the widespread use of stairs, there is surprisingly little data about the extent to which, and for whom, stair use influences psychological health.
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Affiliation(s)
- Jennifer L. Gay
- Jennifer L. Gay, PhD, Department of Health Promotion and Behavior, University of Georgia, Athens, GA 30602; e-mail:
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11
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Kaur M, Ribeiro DC, Webster KE, Sole G. Association Between Knee Moments During Stair Navigation and Participant-Related Factors in Individuals With Anterior Cruciate Ligament Reconstruction: A Cross-Sectional Study. J Sport Rehabil 2021;:1-7. [PMID: 34794119 DOI: 10.1123/jsr.2021-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Altered knee joint mechanics may be related to quadriceps muscle strength, time since surgery, and sex following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to investigate the association between knee moments, with participant-related factors during stair navigation post-ACLR. DESIGN Cross-sectional study. METHODS A total of 30 participants (14 women) with ACLR, on average 7.0 (SD 4.4) years postsurgery were tested during stair ascent and descent in a gait laboratory. Motion capture was conducted using a floor-embedded force plate and 11 infrared cameras. Quadriceps concentric and eccentric muscle strength was measured with an isokinetic dynamometer at 60°/s, and peak torques recorded. Multiple regression analyses were performed between external knee flexion and adduction moments, respectively, and quadriceps peak torque, sex, and time since ACLR. RESULTS Higher concentric quadriceps strength and female sex accounted for 55.7% of the total variance for peak knee flexion moment during stair ascent (P < .001). None of the independent variables accounted for variance in knee adduction moment (P = .698). No significant associations were found for knee flexion and adduction moments during for stair descent. CONCLUSION Higher quadriceps concentric strength and sex explains major variance in knee flexion moments during stair ascent. The strong association between muscle strength and external knee flexion moments during stair ascent indicate rehabilitation tailored for quadriceps may optimize knee mechanics, particularly for women.
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12
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Kaib T, Schäfer J, Block J, Heitzmann D, Putz C, Alimusaj M, Wolf SI. Biomechanical analysis of stair ascent in persons with Chopart amputation. Prosthet Orthot Int 2020; 44:164-171. [PMID: 32169005 DOI: 10.1177/0309364619900737] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND Compared to walking on level ground, ascending stairs requires a large range of motion not only of the hip and knee joint, but also of the ankle joint. The prosthesis often worn by persons with partial foot amputation largely prevents the ankle motion needed during stair ascent. OBJECTIVES Aim of this study was to assess subjects with a Chopart amputation utilizing a clamshell device during stair ascent to identify potential biomechanical deficits. STUDY DESIGN Cross-sectional study with reference group. METHODS Six subjects with unilateral Chopart amputation and 17 unimpaired subjects underwent three-dimensional motion analysis while ascending stairs in a step-over-step manner. RESULTS During weight acceptance, the involved side showed increased external hip-flexing and reduced knee-flexing moments and the sound side a higher ankle power than in the control group. The sound side showed higher external knee-flexing, dorsi-flexing, and hip-adducting moments than the controls during weight acceptance. CONCLUSION The mechanism observed on the involved side differs from that in controls, but is comparable to the mechanisms used by subjects with transtibial amputation reported in the literature. However, compensatory movements on the sound side take place at the ankle and knee joint, differing from subjects with more proximal amputations. CLINICAL RELEVANCE This study underpins the importance of adequate foot leverage and ankle function in cases of partial foot amputation, particularly in transfer situations such as stair ascent. If ankle range of motion is adequate, prosthetic/orthotic devices combining shank leverage with a hinged spring mechanism at the ankle may be promising.
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Affiliation(s)
- T Kaib
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - J Schäfer
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.,University of Applied Science Koblenz, Remagen, Germany
| | - J Block
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dww Heitzmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - C Putz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Alimusaj
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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13
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Christe G, Rochat V, Jolles BM, Favre J. Lumbar and thoracic kinematics during step-up: Comparison of three-dimensional angles between patients with chronic low back pain and asymptomatic individuals. J Orthop Res 2020; 38:1248-1256. [PMID: 31879969 DOI: 10.1002/jor.24575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/12/2019] [Accepted: 12/21/2019] [Indexed: 02/04/2023]
Abstract
While alterations in spinal kinematics have been repeatedly observed in patients with chronic low back pain (CLBP), their exact nature is still unknown. Specifically, there is a need for comprehensive assessments of multisegment spinal angles during daily-life activities. The purpose of this exploratory study was to characterize three-dimensional angles at the lower lumbar, upper lumbar, lower thoracic, and upper thoracic joints in CLBP patients and asymptomatic controls during stepping up with three different step heights. Spinal angles of 10 patients with nonspecific CLBP (six males; 38.7 ± 7.2 years old, 22.3 ± 1.6 kg/m2 ) and 11 asymptomatic individuals (six males; 36.7 ± 5.4 years old, 22.9 ± 3.8 kg/m2 ) were measured in a laboratory using a camera-based motion capture system. Seven out of the 12 angle curves had characteristic patterns, leading to the identification of 20 characteristic peaks. Comparing peak amplitudes between groups revealed statistically significantly smaller sagittal- and frontal-plane angles in the patient group at the upper lumbar joint with the two higher steps and at the lower lumbar joint with the higher step. Significantly reduced angles were also observed in sagittal plane at the upper thoracic joint with the two smaller steps. Moreover, a higher number of significant differences between groups was detected with the two higher steps than with the smallest step. In conclusion, this study showed the value of a comprehensive description of spinal angles during step-up tasks and provided insights into the alterations with CLBP. These preliminary results support prior research suggesting that CLBP rehabilitation should facilitate larger amplitudes of motion during functional activities.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentin Rochat
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Antonellis P, Frederick CM, Gonabadi AM, Malcolm P. Modular footwear that partially offsets downhill or uphill grades minimizes the metabolic cost of human walking. R Soc Open Sci 2020; 7:191527. [PMID: 32257319 PMCID: PMC7062060 DOI: 10.1098/rsos.191527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/17/2019] [Indexed: 06/11/2023]
Abstract
Walking on different grades becomes challenging on energetic and muscular levels compared to level walking. While it is not possible to eliminate the cost of raising or lowering the centre of mass (COM), it could be possible to minimize the cost of distal joints with shoes that offset downhill or uphill grades. We investigated the effects of shoe outsole geometry in 10 participants walking at 1 m s-1 on downhill, level and uphill grades. Level shoes minimized metabolic rate during level walking (P second-order effect < 0.001). However, shoes that entirely offset the (overall) treadmill grade did not minimize the metabolic rate of walking on grades: shoes with a +3° (upward) inclination minimized metabolic rate during downhill walking on a -6° grade, and shoes with a -3° (downward) inclination minimized metabolic rate during uphill walking on a +6° grade (P interaction effect = 0.023). Shoe inclination influenced (distal) ankle joint parameters, including soleus muscle activity, ankle moment and work rate, whereas treadmill grade influenced (whole-body) ground reaction force and COM work rate as well as (distal) ankle joint parameters including tibialis anterior and plantarflexor muscle activity, ankle moment and work rate. Similar modular footwear could be used to minimize joint loads or assist with walking on rolling terrain.
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Baik JS, Ma HI, Lee PH, Taira T. Focal Task-Specific Lower Limb Dystonia Only When Walking Stairs: Is It a New Disease Entity? Front Neurol 2019; 10:1081. [PMID: 31749753 PMCID: PMC6842934 DOI: 10.3389/fneur.2019.01081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/21/2019] [Accepted: 09/25/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: Focal task-specific dystonia in the lower limb or foot often occurs only during walking, running, hiking, or cycling. Several medications and botulinum toxin injection are effective in patients with this disorder. The objective of this study was to understand the spectrum of focal task-specific dystonia in the lower limb only when walking stairs and to compare other types of task-specific dystonia. Methods: All original articles and case reports were collected and reviewed using PubMed. In addition, all video clips of published cases were evaluated, and patients' clinical findings analyzed. The present study included 12 patients described in previous studies and five new Asian patients found in the medical records. Results: Most of the patients were women, and the onset age was 42 years. Ten patients were classified as the Kicking type, including three patients with the rKicking type, and six patients were considered as the Lifting type; however, only one patient was not included in any of the types. Symptoms in most of the patients did not improve with any medications or botulinum toxin injection. The symptoms of most patients did not change over a long time. Conclusion: Most patients showed the dystonic symptom when walking downstairs rather than upstairs. Psychogenic dystonia is a disease differentially diagnosed with this dystonia. Unlike other types of focal task-specific dystonia, the response to treatment was disappointing because most of the medications and botulinum toxin injection were not effective. The prognosis is completely different from that of other types of focal task-specific dystonia.
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Affiliation(s)
- Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Hospital, Anyang, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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Bartholomae E, Johnson Z, Moore J, Ward K, Kressler J. Reducing Glycemic Indicators with Moderate Intensity Stepping of Varied, Short Durations in People with Pre-Diabetes. J Sports Sci Med 2018; 17:680-685. [PMID: 30479538 PMCID: PMC6243616] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/16/2018] [Indexed: 06/09/2023]
Abstract
Investigate the effects of short duration stair climbing/descending at a self-selected pace on post-prandial glucose responses in adults. Thirty participants (10 female) completed 4 oral glucose tolerance tests on separate days. Following glucose consumption, participants underwent seated rest (control) or walked up/down 21 stairs at a self-selected comfortable pace for 10, 3, and 1min in randomized order. Blood glucose was measured by capillary sampling from finger sticks every 15min until values for all trials converged. Area under the curve (AUC) was calculated by trapezoidal rule. In addition, cardiometabolic measurements were taken during stair exercise with a mobile metabolic cart. Results are presented as mean (SD) unless stated otherwise. All stair-climbing trials reduced peak (30min) postprandial blood glucose levels compared to the control [(1 min = 12(31), p = 0.026; 3 min = -15(25), p = 0.003; 10 min = 35(32) mg/dL, p < 0.001]. At 45min, there were significant reductions only for the 3 and 10 min trials [13(29) and 23(31) mg/dL, p = 0.023 and < 0.001 respectively], but not the 1 min trial [6(33) mg/dL, p = 0.317]. There were significant differences in AUC compared to the control only for the 3 and 10min trials [502 (1141) and 866 (1123) mg/dL·min-1, p = 0.023 and < 0.000] but not for the 1min trial [353 (1265) mg/dL·min-1, p = 0.110]. Median (interquartile range) RPEs reported for the 1, 3, and 10min trials were 1.0 (1.5), 2.0(2), and 3.0 (2.0) respectively, while VO2 was n/a, 54(12), and 59(13)% of peak, respectively. Total metabolic cost was 1.4 (0.5), 4.0 (1.0), and 11.9 (2.1) L O2, respectively. A single 1min bout of low-moderate intensity stair stepping can significantly lower peak glucose concentration, with longer bouts being more effective.
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Affiliation(s)
- Eric Bartholomae
- School of Exercise and Nutritional Sciences, San Diego State University. San Diego, CA, USA
- College of Health Solutions, Arizona State University. Tempe, AZ, USA
| | - Zachary Johnson
- School of Exercise and Nutritional Sciences, San Diego State University. San Diego, CA, USA
| | - Jeffery Moore
- School of Exercise and Nutritional Sciences, San Diego State University. San Diego, CA, USA
| | - Kathryn Ward
- School of Exercise and Nutritional Sciences, San Diego State University. San Diego, CA, USA
| | - Jochen Kressler
- School of Exercise and Nutritional Sciences, San Diego State University. San Diego, CA, USA
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Raffalt PC, Vallabhajosula S, Renz JJ, Mukherjee M, Stergiou N. Lower limb joint angle variability and dimensionality are different in stairmill climbing and treadmill walking. R Soc Open Sci 2018; 5:180996. [PMID: 30662723 PMCID: PMC6304153 DOI: 10.1098/rsos.180996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/18/2018] [Indexed: 06/09/2023]
Abstract
The present study tested if the quadratic relationship which exists between stepping frequency and gait dynamics in walking can be generalized to stairmill climbing. To accomplish this, we investigated the joint angle dynamics and variability during continuous stairmill climbing at stepping frequencies both above and below the preferred stepping frequency (PSF). Nine subjects performed stairmill climbing at 80, 90, 100, 110 and 120% PSF and treadmill walking at preferred walking speed during which sagittal hip, knee and ankle angles were extracted. Joint angle dynamics were quantified by the largest Lyapunov exponent (LyE) and correlation dimension (CoD). Joint angle variability was estimated by the mean ensemble standard deviation (meanSD). MeanSD and CoD for all joints were significantly higher during stairmill climbing but there were no task differences in LyE. Changes in stepping frequency had only limited effect on joint angle variability and did not affect joint angle dynamics. Thus, we concluded that the quadratic relationship between stepping frequency and gait dynamics observed in walking is not present in stairmill climbing based on the investigated parameters.
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Affiliation(s)
- P. C. Raffalt
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S. Vallabhajosula
- Department of Physical Therapy Education, School of Health Sciences, Elon University, Elon, NC, USA
| | - J. J. Renz
- Department of Biomechanics, College of Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - M. Mukherjee
- Department of Biomechanics, College of Education, University of Nebraska Medical Center, Omaha, NE, USA
| | - N. Stergiou
- Department of Biomechanics, College of Education, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Environmental Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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18
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Munoz Diaz E, Kaiser S, Bousdar Ahmed D. Height Error Correction for Shoe-Mounted Inertial Sensors Exploiting Foot Dynamics. Sensors (Basel) 2018; 18:E888. [PMID: 29547581 PMCID: PMC5877211 DOI: 10.3390/s18030888] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/11/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
Shoe-mounted inertial sensors are widespread deployed in satellite-denied scenarios because of the possibility to re-calibrate stepwise the estimated position. These re-calibrations, known as zero-velocity corrections, prevent an accumulated positioning error growth over time caused by the noise of current medium- and low-cost sensors. However, the error accumulated over time in the height estimation is still an issue under study. The objective of this article is to propose a height correction that is based on the dynamics of the foot. The presented algorithm analyzes the movement of the foot, which is different when walking on horizontal surfaces and stairs. The identification of horizontal surfaces and stairs is detailed in this article. For the assessment of the performance of the proposed height correction, a dataset of approximately 5 h recorded with 10 volunteers walking in a five-story building is employed. The error is evaluated using pre-defined ground truth points. We compare the height error estimated with and without applying the proposed correction and show that the height correction improves the vertical positioning accuracy up to 85.
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Affiliation(s)
- Estefania Munoz Diaz
- German Aerospace Center (DLR), Institute of Communications and Navigation, Oberpfaffenhofen, 82234 Wessling, Germany.
| | - Susanna Kaiser
- German Aerospace Center (DLR), Institute of Communications and Navigation, Oberpfaffenhofen, 82234 Wessling, Germany.
| | - Dina Bousdar Ahmed
- German Aerospace Center (DLR), Institute of Communications and Navigation, Oberpfaffenhofen, 82234 Wessling, Germany.
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19
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Abstract
OBJECTIVE The proliferation of studies using motivational signs to promote stair use continues unabated, with their oft-cited potential for increasing population-level physical activity participation. This study examined all stair use promotional signage studies since 1980, calculating pre-estimates and post-estimates of stair use. The aim of this project was to conduct a sequential meta-analysis to pool intervention effects, in order to determine when the evidence base was sufficient for population-wide dissemination. DESIGN Using comparable data from 50 stair-promoting studies (57 unique estimates) we pooled data to assess the effect sizes of such interventions. RESULTS At baseline, median stair usage across interventions was 8.1%, with an absolute median increase of 2.2% in stair use following signage-based interventions. The overall pooled OR indicated that participants were 52% more likely to use stairs after exposure to promotional signs (adjusted OR 1.52, 95% CI 1.37 to 1.70). Incremental (sequential) meta-analyses using z-score methods identified that sufficient evidence for stair use interventions has existed since 2006, with recent studies providing no further evidence on the effect sizes of such interventions. CONCLUSIONS This analysis has important policy and practice implications. Researchers continue to publish stair use interventions without connection to policymakers' needs, and few stair use interventions are implemented at a population level. Researchers should move away from repeating short-term, small-scale, stair sign interventions, to investigating their scalability, adoption and fidelity. Only such research translation efforts will provide sufficient evidence of external validity to inform their scaling up to influence population physical activity.
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Affiliation(s)
- Adrian Bauman
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Milton
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Oxford, UK
| | - Maina Kariuki
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- NSW Ministry of Health Biostatistics Training Officer Program, NSW Health, North Sydney, New South Wales, Australia
| | - Karla Fedel
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mary Lewicka
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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20
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Diaz EM, Caamano M, Sánchez FJF. Landmark-Based Drift Compensation Algorithm for Inertial Pedestrian Navigation. Sensors (Basel) 2017; 17:E1555. [PMID: 28671622 DOI: 10.3390/s17071555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/23/2017] [Accepted: 07/01/2017] [Indexed: 12/02/2022]
Abstract
The navigation of pedestrians based on inertial sensors, i.e., accelerometers and gyroscopes, has experienced a great growth over the last years. However, the noise of medium- and low-cost sensors causes a high error in the orientation estimation, particularly in the yaw angle. This error, called drift, is due to the bias of the z-axis gyroscope and other slow changing errors, such as temperature variations. We propose a seamless landmark-based drift compensation algorithm that only uses inertial measurements. The proposed algorithm adds a great value to the state of the art, because the vast majority of the drift elimination algorithms apply corrections to the estimated position, but not to the yaw angle estimation. Instead, the presented algorithm computes the drift value and uses it to prevent yaw errors and therefore position errors. In order to achieve this goal, a detector of landmarks, i.e., corners and stairs, and an association algorithm have been developed. The results of the experiments show that it is possible to reliably detect corners and stairs using only inertial measurements eliminating the need that the user takes any action, e.g., pressing a button. Associations between re-visited landmarks are successfully made taking into account the uncertainty of the position. After that, the drift is computed out of all associations and used during a post-processing stage to obtain a low-drifted yaw angle estimation, that leads to successfully drift compensated trajectories. The proposed algorithm has been tested with quasi-error-free turn rate measurements introducing known biases and with medium-cost gyroscopes in 3D indoor and outdoor scenarios.
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21
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Kendrick D, Zou K, Ablewhite J, Watson M, Coupland C, Kay B, Hawkins A, Reading R. Risk and protective factors for falls on stairs in young children: multicentre case-control study. Arch Dis Child 2016; 101:909-16. [PMID: 26662926 PMCID: PMC5050281 DOI: 10.1136/archdischild-2015-308486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/06/2015] [Indexed: 11/21/2022]
Abstract
AIM To investigate risk and protective factors for stair falls in children aged <5 years. METHODS Multicentre case-control study at hospitals, minor injury units and general practices in and around four UK study centres. Cases were children with medically attended stair fall injuries. Controls were matched on age, sex, calendar time and study centre. A total of 610 cases and 2658 controls participated. RESULTS Cases' most common injuries were bangs on the head (66%), cuts/grazes not requiring stitches (14%) and fractures (12%). Parents of cases were significantly more likely not to have stair gates (adjusted OR (AOR) 2.50, 95% CI 1.90 to 3.29; population attributable fraction (PAF) 21%) or to leave stair gates open (AOR 3.09, 95% CI 2.39 to 4.00; PAF 24%) both compared with having closed stair gates. They were more likely not to have carpeted stairs (AOR 1.52, 95% CI 1.09 to 2.10; PAF 5%) and not to have a landing part-way up their stairs (AOR 1.34, 95% CI 1.08 to 1.65; PAF 18%). They were more likely to consider their stairs unsafe to use (AOR 1.46, 95% CI 1.07 to 1.99; PAF 5%) or to be in need of repair (AOR 1.71, 95% CI 1.16 to 2.50; PAF 5%). CONCLUSION Structural factors including having landings part-way up the stairs and keeping stairs in good repair were associated with reduced stair fall injury risk. Family factors including having stair gates, not leaving gates open and having stair carpets were associated with reduced injury risk. If these associations are causal, addressing these factors in housing policy and routine child health promotion could reduce stair fall injuries.
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Affiliation(s)
- D Kendrick
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - K Zou
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - J Ablewhite
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - M Watson
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - C Coupland
- Division of Primary Care, School of Medicine, Nottingham, UK
| | - B Kay
- Emergency Department, Bristol Children's Hospital, Bristol, UK
| | - A Hawkins
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Research Unit Level 2, Newcastle upon Tyne, UK
| | - R Reading
- Jenny Lind Paediatric Department, Norfolk and Norwich University Hospital, Norfolk Community Health and Care NHS Trust, Norwich, UK
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22
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Hodgin KL, Graham DJ. Mirror, Mirror by the Stairs: The Impact of Mirror Exposure on Stair versus Elevator Use in College Students. Front Public Health 2016; 4:80. [PMID: 27200333 PMCID: PMC4843211 DOI: 10.3389/fpubh.2016.00080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/11/2016] [Indexed: 11/13/2022] Open
Abstract
Previous research has indicated that self-awareness-inducing mirrors can successfully incite behaviors that align with one's personal values, such as helping others. Other research has found a large discrepancy between the high percentage of young adults who report valuing the healthfulness of physical activity (PA) and the low percentage who actually meet PA participation standards. However, few studies have examined how mirror exposure and both perceived and actual body size influence highly valued PA participation among college students. The present study assessed stair versus elevator use on a western college campus and hypothesized that mirror exposure would increase the more personally healthy transportation method of stair use. In accordance with previous research, it was also hypothesized that males and those with a lower body mass index (BMI) would be more likely to take the stairs, and that body size distorting mirrors would impact the stair-elevator decision. One hundred sixty-seven students (51% male) enrolled in an introductory psychology course were recruited to take a survey about their "transportation choices" at an indoor campus parking garage. Participants were individually exposed to either no mirror, a standard full-length mirror, or a full-length mirror manipulated to make the reflected body size appear either slightly thinner or slightly wider than normal before being asked to go to the fourth floor of the garage for a survey. Participants' choice of floor-climbing method (stairs or elevator) was recorded, and they were administered an Internet-based survey assessing demographic information, BMI, self-awareness, perceived body size, and other variables likely to be associated with stair use. Results from logistic regression analyses revealed that participants who were not exposed to a mirror [odds ratios (OR) = 0.37, 95% CI: 0.14-0.96], males (OR = 0.33, 95% CI: 0.13-0.85), those with lower BMI (OR = 0.84, 95% CI: 0.71-0.99), those with higher exercise participation (OR = 1.09, 95% CI: 1.02-1.18), and those engaging in more unhealthy weight-control behaviors (OR = 1.55, 95% CI: 1.14-2.11) showed increased odds of taking the stairs. Implications and future directions are discussed.
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Affiliation(s)
| | - Dan J Graham
- Colorado State University , Fort Collins, CO , USA
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23
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Abstract
BACKGROUND Alterations in knee kinematics after partial meniscectomy have been linked to the increased risk of osteoarthritis in this population. Understanding differences in kinematics during static versus dynamic activities of increased demand can provide important information regarding the possible underlying mechanisms of these alterations. HYPOTHESIS Differences in the following 2 kinematics measures will increase with activity demand: (1) the offset toward external tibial rotation for the meniscectomized limb compared with the contralateral limb during stance and (2) the difference in knee flexion angle at initial foot contact between the meniscectomized and contralateral limbs. STUDY DESIGN Controlled laboratory study. METHODS This study compared side-to-side differences in knee flexion and rotation angles during static and dynamic activities. Thirteen patients (2 female) were tested in a motion capture laboratory at 6 ± 2 months after unilateral, arthroscopic, partial medial meniscectomy during a static reference pose and during 3 dynamic activities: walking, stair ascent, and stair descent. RESULTS The meniscectomized limb demonstrated more external tibial rotation compared with the contralateral limb during dynamic activities, and there was a trend that this offset increased with activity demand (repeated-measures analysis of variance [ANOVA] for activity, P = .07; mean limb difference: static pose, -0.1° ± 3.3°, P = .5; walking, 1.2° ± 3.8°, P = .1; stair ascent, 2.0° ± 3.2°, P = .02; stair descent, 3.0° ± 3.5°, P = .005). Similarly, the meniscectomized knee was more flexed at initial contact than the contralateral limb during dynamic activities (repeated-measures ANOVA for activity P = .006; mean limb difference: reference pose, 1.0° ± 2.5°, P = .09; walking, 2.0° ± 3.9°, P = .05; stair ascent, 5.9° ± 5.3°, P = .009; stair descent, 3.5° ± 4.0°, P = .004). CONCLUSION These results suggest both a structural element and a potential muscular element for the differences in kinematics after partial medial meniscectomy and highlight the importance of challenging the knee with activities of increased demands to detect differences in kinematics from the contralateral limb. CLINICAL RELEVANCE With further investigation, these findings could help guide clinical rehabilitation of patients with torn meniscus tissue, especially in the context of the patients' increased risk of joint degeneration.
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Affiliation(s)
- Shannon N Edd
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA VA Palo Alto, Palo Alto, California, USA
| | - Nathan A Netravali
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA VA Palo Alto, Palo Alto, California, USA
| | - Julien Favre
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Nicholas J Giori
- VA Palo Alto, Palo Alto, California, USA Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA VA Palo Alto, Palo Alto, California, USA Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA
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Abstract
Although numerous studies have reported the physiological strain associated with firefighting, cardiac responses during a large-scale fire operation have not been reported and cardiac responses have not been compared based on crew assignment. The aims of this study were (1) to characterize cardiac strain during simulated high-rise firefighting, and (2) to compare the cardiac strain associated with different work assignments (fire suppression vs. search and rescue) and different modes of vertical ascent (stairs vs. elevator). Firefighters (N = 42) completed one assignment (fire suppression, search and rescue, or material support) during one of two trials that differed by ascent mode. Assignments were divided into three phases: Ascent (ascend lobby to 8th floor), Staging (remain in holding area on 8th floor), and Work (perform primary responsibilities). When comparing assignments within the same ascent mode, mean heart rate (HRmean) was higher (p = 0.031) for fire suppression than for search and rescue during Work in the stair trial (170 ± 14 vs. 155 ± 11 beats/min). Search and rescue crews experienced greater cumulative cardiac strain (HRmean × duration) during Work than did fire suppression crews (stairs: 1978 ± 366 vs. 1502 ± 190 beats; elevator: 1755 ± 514 vs. 856 ± 232 beats; p<0.05). When comparing ascent mode, HRmean and peak heart rate (HRpeak) were higher (35-57 beats/min; p≤0.001) for both fire suppression and search and rescue during Ascent and Staging phases in the stairs vs. the elevator trial. During Work, HRmean was higher (p = 0.046) for search and rescue in the stairs vs. the elevator trial (155 ± 11 vs. 138 ± 19 beats/min). HRmean and HRpeak were 47 and 34 beats/min higher (p < 0.01), respectively, when materials were transported to the staging area using the stairs compared with the elevator. Study findings suggest that high-rise firefighting results in considerable cardiac strain and that search and rescue and material support crews experienced more cardiac strain than fire suppression crews due primarily to differences in assignment duration. Furthermore, using stairs to transport firefighters and equipment to upper floors results in significantly greater cardiac strain than using the elevator.
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Affiliation(s)
- Denise L Smith
- a First Responder Health and Safety Laboratory, Department of Health and Exercise Sciences , Skidmore College , Saratoga Springs , New York
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25
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Nagata H. Case study on possible falling patterns of a fatal fall from stairs. Ind Health 2014; 52:432-438. [PMID: 25088990 PMCID: PMC4246532 DOI: 10.2486/indhealth.2014-0092] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/25/2014] [Indexed: 06/03/2023]
Abstract
Considering a fatal case of an aged individual, who died due to falling down stairs, the cause of the fatal fall was investigated through experiments. A witness, who was with the victim, when the fatal accident occurred, stated that the aged individual had miss-footed, lost balance at the top of the stairs, and fell accidently from an upper floor to a lower floor. It was very questionable whether or not this witness's statements were true. The true cause of the fatal fall was unclear, because of the witness's inconsistent statements, which showed discrepancies between the initial and later statements. The cause of a fatal fall can be presumed from external and internal damages to the body and other circumstantial evidences. But it was difficult to prove the true cause of a fatal fall only from the results of the autopsy and investigation of circumstantial evidences. The author was officially requested to conduct experiments to elucidate possible falling patterns. Judging from the experimental results, deep questions about the witness's statements arose. These experimental methods and analyses in this paper could be applied to elucidate possible falling patterns of fatal falls from stairs where the fatal causes are controversial.
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Bjerke J, Öhberg F, Nilsson KG, Stensdotter AK. Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty. J Arthroplasty 2014; 29:1499-502. [PMID: 24612738 DOI: 10.1016/j.arth.2014.01.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 02/01/2023] Open
Abstract
Subjects with total knee arthroplasty (TKA) exhibit decreased quadriceps and hamstring strength. This may bring about greater relative effort or compensatory strategies to reduce knee joint moments in daily activities. To study gait and map out the resource capacity, knee muscle strength was assessed by maximal voluntary concentric contractions, and whole body kinematics and root mean square (RMS) electromyography (EMG) of vastus lateralis and semitendinosus were recorded during stair ascent in 23 unilateral TKA-subjects ~19 months post-operation, and in 23 healthy controls. Muscle strength and gait velocity were lower in the TKA group, but no significant group differences were found in RMS EMG or forward trunk lean. The results suggest that reduced walking velocity sufficiently compensated for reduced knee muscle strength.
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Kali A, Stephen S, Sivaraman U, Kumar S, Joseph NM, Srirangaraj S, Easow JM. Bacteriophage types of methicillin-resistant Staphylococcus aureus in a tertiary care hospital. Australas Med J 2013; 6:496-503. [PMID: 24223065 DOI: 10.4066/amj.2013.1742] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Phage typing had been utilised extensively to characterise methicillin-resistant Staphylococcus aureus (MRSA) outbreak strains in the past. It is an invaluable tool even today to monitor emergence and dissemination of MRSA strains. AIMS The aim of this study was to determine the prevalent phage types of MRSA in south India and the association between phage types, antibiotic resistance pattern and risk factors. METHOD A total of 48 non-duplicate MRSA strains recovered from various clinical samples during January to December, 2010 were tested against a panel of anti-staphylococcal antibiotics. Phage typing was carried out at the National Staphylococcal Phage Typing Centre, New Delhi. Out of 48, 32 hospitalised patients were followed up for risk factors and response to empirical and post sensitivity antibiotic therapy. The risk factors were compared with a control group of 30 patients with methicillin sensitive Staphylococcus aureus (MSSA) infection. RESULTS Amongst the five prevalent phage types, 42E was most common (52%), followed by a non-typable variant (22.9%), 42E/47/54/75 (16.6%), 42E/47 (6.2%) and 47 (2%). Phage type 42E was the predominant strain in all wards and OPDs except in the ICU where 42E/47/54/75 was most common. Although not statistically significant, strain 42E/47/54/75 (n=8) showed higher resistance to all drugs, except ciprofloxacin and amikacin, and were mostly D-test positive (87.5%) compared to the 42E strain (32%). Duration of hospital stay, intravenous catheterisation and breach in skin were the most significant risk factors for MRSA infection. CONCLUSION We found MRSA strain diversity in hospital wards with differences in their antibiotic susceptibility pattern. The findings may impact infection control and antibiotic policy significantly.
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Affiliation(s)
- Arunava Kali
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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Whitchelo T, McClelland JA, Webster KE. Factors associated with stair climbing ability in patients with knee osteoarthritis and knee arthroplasty: a systematic review. Disabil Rehabil 2013; 36:1051-60. [PMID: 24093597 DOI: 10.3109/09638288.2013.829526] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE People with knee osteoarthritis (OA) report ongoing limitations in climbing stairs, even after total knee arthroplasty (TKA). The aim of this systematic review was to synthesise the available evidence of factors affecting stair climbing ability in patients with knee OA before and after TKA. METHOD A systematic search was conducted of common electronic databases. All English language abstracts where stair-climbing was assessed in patients with either knee OA or at least 6 months after TKA, and a relationship to any physical, psychological or demographic factors was reported. RESULTS Thirteen studies were included in the final review, nine investigated a knee OA population, and four investigated a TKA population. For patients with knee OA there was consistent and convincing evidence that greater stair-climbing ability was related to stronger lower limb muscles and less knee pain. For patients with TKA there was much less research, and no conclusions could be reached. CONCLUSIONS For people with knee OA there is evidence that some physical, demographic and psychosocial factors are related to stair-climbing ability. However, the evidence for similar relationships in the TKA population is scarce and needs more extensive research. Implications for Rehabilitation People with knee osteoarthritis experience difficulty when climbing stairs, and this remains challenging even after knee replacement. For people with knee osteoarthritis, a range of physical, demographic and psychosocial factors contribute to stair-climbing ability, however, evidence for similar relationships in the TKA population is scarce. Rehabilitation that is multi-faceted may be the best approach to improve stair-climbing in people with knee osteoarthritis.
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Affiliation(s)
- Tara Whitchelo
- Department of Physiotherapy, Faculty of Health Sciences, La Trobe University , Melbourne , Australia and
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Abstract
BACKGROUND Comprehensive health promotion in Western Australia has been conducted from the point of views of policy development, promotion, education and service delivery. Much of this recent work has been focused on supporting workplaces - but there has yet to be any real focus on the design of the actual physical workplace environment from a health promotion perspective. AIMS This paper is aimed at highlighting the gap in health promotion knowledge by addressing how the disciplines of architecture and health promotion can work together to challenge the regulations that dictate design practice and ultimately bridge that gap for long-term change. The overarching aim is to undertake further evidenced-based research that will inform best practice in the planning and design of workplaces to reduce sedentary behaviour and increase opportunities for physical activity. METHOD Within this wide objective this paper focuses in particular on the idea of stairs-versus-lift movement strategies within office buildings. By examining building design guidelines from a health promotion perspective we expose a central dichotomy, where health promotion posters say "Take the stairs instead" whereas the language of building design suggests that the lift is best. RESULTS From a design point of view, the National Codes of Construction (NCC), formally known as the Building Codes of Australia (BCA), the essential technical regulation for all building design and construction, primarily addresses the concepts of 'egress' and 'travel distance' for escape in the event of fire, and building access in terms of universal access. Additionally, The Property Council of Australia's Guide to Office Building Quality prioritises lift performance criteria along with the quality and experience of lift use as a major grading factor. There is no provision in either set of standards for staircase quality and experience. CONCLUSION The stairs, despite being promoted as better life choice for better health, is not promoted through these building codes nor, consequently, through the building design in actuality. It is proposed that health promotion strategies could be coupled with design-led movement strategies in workplace design so that the promotional language, such as "take the stairs instead", is balanced by the design language of the building.
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Affiliation(s)
- Sarah McGann
- Department of Architecture and Interior Architecture, Curtin University, Australia
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Abstract
Footedness is a personal quality like handedness. Footedness may be associated with moving ability during mounting, dismounting, and jumping movements. Occupational accidents have occurred during movement at different working levels, during the use of access and exit systems, and during the mounting of vehicles. Aging can also affect accident risk and body laterality. For example, falling accidents on stairs are common among the elderly. One reason for accidents may be that the structure of the access system or stair system is unsuitable for individual moving patterns depending partly on body laterality. Footedness and the way the feet are used may be contradictory to the demands of the moving situation, especially during uncommon or rapid situations. This contradiction may trigger disturbance during moving. The aims of this pilot study were (a) to review the literature briefly and (b) to describe the use of the dominant and nondominant foot by farmers and the elderly when mounting a tractor and stairs, respectively. The study also gives ideas for future studies based on both (a) and (b).
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Affiliation(s)
| | | | - Heli Kirvesoja
- c Finnish Laboratory of Applied Ergonomics SEL , Finland
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