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Hulshof CM, Schallig W, van den Noort JC, Streekstra GJ, Kleipool RP, Gg Dobbe J, Maas M, Harlaar J, van der Krogt MM. Skin marker-based versus bone morphology-based coordinate systems of the hindfoot and forefoot. J Biomech 2024; 166:112001. [PMID: 38527409 DOI: 10.1016/j.jbiomech.2024.112001] [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] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 03/27/2024]
Abstract
Segment coordinate systems (CSs) of marker-based multi-segment foot models are used to measure foot kinematics, however their relationship to the underlying bony anatomy is barely studied. The aim of this study was to compare marker-based CSs (MCSs) with bone morphology-based CSs (BCSs) for the hindfoot and forefoot. Markers were placed on the right foot of fifteen healthy adults according to the Oxford, Rizzoli and Amsterdam Foot Model (OFM, RFM and AFM, respectively). A CT scan was made while the foot was loaded in a simulated weight-bearing device. BCSs were based on axes of inertia. The orientation difference between BCSs and MCSs was quantified in helical and 3D Euler angles. To determine whether the marker models were able to capture inter-subject variability in bone poses, linear regressions were performed. Compared to the hindfoot BCS, all MCSs were more toward plantar flexion and internal rotation, and RFM was also oriented toward more inversion. Compared to the forefoot BCS, OFM and RFM were oriented more toward dorsal and plantar flexion, respectively, and internal rotation, while AFM was not statistically different in the sagittal and transverse plane. In the frontal plane, OFM was more toward eversion and RFM and AFM more toward inversion compared to BCS. Inter-subject bone pose variability was captured with RFM and AFM in most planes of the hindfoot and forefoot, while this variability was not captured by OFM. When interpreting multi-segment foot model data it is important to realize that MCSs and BCSs do not always align.
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Affiliation(s)
- Chantal M Hulshof
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Wouter Schallig
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Geert J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Roeland P Kleipool
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Johannes Gg Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2 2628 CD, Delft, the Netherlands; Department of Orthopedics & Sports Medicine, Erasmus MC, Doctor Molewaterplein 40 3015 GD, Rotterdam, the Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118 1081 HZ, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
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Schallig W, van den Noort JC, Piening M, Streekstra GJ, Maas M, van der Krogt MM, Harlaar J. The Amsterdam Foot Model: a clinically informed multi-segment foot model developed to minimize measurement errors in foot kinematics. J Foot Ankle Res 2022; 15:46. [PMID: 35668453 PMCID: PMC9172122 DOI: 10.1186/s13047-022-00543-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Foot and ankle joint kinematics are measured during clinical gait analyses with marker-based multi-segment foot models. To improve on existing models, measurement errors due to soft tissue artifacts (STAs) and marker misplacements should be reduced. Therefore, the aim of this study is to define a clinically informed, universally applicable multi-segment foot model, which is developed to minimize these measurement errors. Methods The Amsterdam foot model (AFM) is a follow-up of existing multi-segment foot models. It was developed by consulting a clinical expert panel and optimizing marker locations and segment definitions to minimize measurement errors. Evaluation of the model was performed in three steps. First, kinematic errors due to STAs were evaluated and compared to two frequently used foot models, i.e. the Oxford and Rizzoli foot models (OFM, RFM). Previously collected computed tomography data was used of 15 asymptomatic feet with markers attached, to determine the joint angles with and without STAs taken into account. Second, the sensitivity to marker misplacements was determined for AFM and compared to OFM and RFM using static standing trials of 19 asymptomatic subjects in which each marker was virtually replaced in multiple directions. Third, a preliminary inter- and intra-tester repeatability analysis was performed by acquiring 3D gait analysis data of 15 healthy subjects, who were equipped by two testers for two sessions. Repeatability of all kinematic parameters was assessed through analysis of the standard deviation (σ) and standard error of measurement (SEM). Results The AFM was defined and all calculation methods were provided. Errors in joint angles due to STAs were in general similar or smaller in AFM (≤2.9°) compared to OFM (≤4.0°) and RFM (≤6.7°). AFM was also more robust to marker misplacement than OFM and RFM, as a large sensitivity of kinematic parameters to marker misplacement (i.e. > 1.0°/mm) was found only two times for AFM as opposed to six times for OFM and five times for RFM. The average intra-tester repeatability of AFM angles was σ:2.2[0.9°], SEM:3.3 ± 0.9° and the inter-tester repeatability was σ:3.1[2.1°], SEM:5.2 ± 2.3°. Conclusions Measurement errors of AFM are smaller compared to two widely-used multi-segment foot models. This qualifies AFM as a follow-up to existing foot models, which should be evaluated further in a range of clinical application areas. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00543-6.
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Affiliation(s)
- Wouter Schallig
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands. .,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands. .,Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.,Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Marjolein Piening
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands.,Amsterdam UMC location University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mario Maas
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.,Amsterdam UMC location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands.,Department of Orthopedics & Sports Medicine , ErasmusMC, Rotterdam, the Netherlands
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van den Noort JC, van der Leeden M, Stapper G, Wirth W, Maas M, Roorda LD, Lems WF, Dekker J, van der Esch M. Muscle weakness is associated with non-contractile muscle tissue of the vastus medialis muscle in knee osteoarthritis. BMC Musculoskelet Disord 2022; 23:91. [PMID: 35086518 PMCID: PMC8796405 DOI: 10.1186/s12891-022-05025-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/23/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quadriceps weakness is assumed to be associated with compositional properties of the vastus medialis muscle in patients with knee osteoarthritis (OA). METHODS The aim was to determine the association of non-contractile muscle tissue in the vastus medialis muscle, measured with routine MRI, with muscle extensor strength in patients with knee OA. Sagittal T1-weighted 3T MRI of 94 patients with knee OA, routinely acquired in clinical practice were used for analysis. Using the MRI's, the amount of non-contractile muscle tissue in the vastus medialis muscle was measured, expressed as a percentage of (non)-contractile tissue, dichotomized into a low and a high non-contractile percentage group. Muscle strength was assessed by isokinetic measurement of knee extensors and by conduction of the Get-Up and Go (GUG) test. In regression analyses, associations of percentage of non-contractile muscle tissue with muscle strength and GUG time were determined and controlled for sex, age, BMI and radiographic severity. RESULTS A high percentage of non-contractile muscle tissue (> 11.2%) was associated with lower muscle strength (B = -0.25, P = 0.006) and with longer GUG time (B = 1.09, P = 0.021). These associations were specifically confounded by sex and BMI, because these two variables decreased the regression coefficient (B) with > 10%. CONCLUSIONS A high percentage of non-contractile muscle tissue in the vastus medialis muscle measured by clinical T1-weighted 3T MRI is associated with muscle weakness. The association is confounded by sex and BMI. Non-contractile muscle tissue seems to be an important compositional property of the vastus medialis muscle underlying quadriceps weakness.
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Affiliation(s)
- Josien C van den Noort
- Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Medical Imaging Quantification Center (MIQC), Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands. .,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands.
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Gerard Stapper
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, Netherlands
| | - Wolfgang Wirth
- Institute of Anatomy, PMU, Salzburg, Austria.,Chondrometrics GmbH, Ainring, Germany
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Medical Imaging Quantification Center (MIQC), Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, Netherlands
| | - Willem F Lems
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands.,Department of Rheumatology, Amsterdam Rehabilitation Center Reade, Amsterdam, Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, EMGO Institute for Health and Care Research, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, Netherlands.,Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands
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Bakker NF, Schrijvers JC, van den Noort JC, Hall M, van der Krogt MM, Harlaar J, van der Esch M. A most painful knee does not induce interlimb differences in knee and hip moments during gait in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 89:105455. [PMID: 34454328 DOI: 10.1016/j.clinbiomech.2021.105455] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 06/14/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with knee osteoarthritis can adapt their gait to unload the most painful knee joint in order to try to reduce pain and improve physical function. However, these gait adaptations can cause higher loads on the contralateral joints. The aim of the study was to investigate the interlimb differences in knee and hip frontal plane moments during gait in patients with knee osteoarthritis and in healthy controls. METHODS Forty patients with knee osteoarthritis and 19 healthy matched controls were measured during comfortable treadmill walking. Frontal plane joint moments were obtained of both hip and knee joints. Differences in interlimb moments within each group were assessed using statistical parametric mapping and discrete gait parameters. FINDINGS No interlimb differences were observed in patients with knee osteoarthritis and control subjects at group level. Furthermore, the patients presented similar interlimb variability as the controls. In a small subgroup (n = 12) of patients, the moments in the most painful knee were lower than in the contralateral knee, while the other patients (n = 28) showed higher moments in the most painful knee compared to the contralateral knee. However, no interlimb differences in the hip moments were observed within the subgroups. INTERPRETATION Patients with knee osteoarthritis do not have interlimb differences in knee and hip joint moments. Patients and healthy subjects demonstrate a similar interlimb variability in the moments of the lower extremities. In this context, differences in knee pain in patients with knee osteoarthritis did not induce any interlimb differences in the frontal plane knee and hip moments.
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Affiliation(s)
- Nienke F Bakker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Jim C Schrijvers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Medical Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Delft University of Technology, Department of Biomechanical Engineering, Delft, the Netherlands; Erasmus Medical Center, Department of Orthopedics, Rotterdam, the Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; Centre of Expertise Urban vitality, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
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Schallig W, van den Noort JC, Maas M, Harlaar J, van der Krogt MM. Marker placement sensitivity of the Oxford and Rizzoli foot models in adults and children. J Biomech 2021; 126:110629. [PMID: 34320419 DOI: 10.1016/j.jbiomech.2021.110629] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Understanding the effect of individual marker misplacements is important to improve the repeatability and aid to the interpretation of multi-segment foot models like the Oxford and Rizzoli Foot Models (OFM, RFM). Therefore, this study aimed to quantify the effect of controlled anatomical marker misplacement on multi-segment foot kinematics (i.e. marker placement sensitivity) as calculated by OFM and RFM in a range of foot sizes. Ten healthy adults and nine children were included. A combined OFM and RFM marker set was placed on their right foot and a static standing trial was collected. Each marker was replaced ± 10 mm in steps of 1 mm over the three axes of a foot coordinate system. For each replacement the change in segment orientation (tibia, hindfoot, midfoot, forefoot) was calculated with respect to the reference pose in which no markers were replaced. A linear fit was made to calculate the sensitivity of segment orientation to marker misplacement in °/mm. Additionally, the effect of foot size on the sensitivity was determined using linear regressions. For every foot segment of both models, at least one marker had a sensitivity ≥ 1.0°/mm. Highest values were found for the markers at the posterior aspect of the calcaneus in OFM (1.5°/mm) and the basis of the second metatarsal in RFM (1.4°/mm). Foot size had a small effect on 40% of the sensitivity values. This study identified markers of which consistent placement is critical to prevent clinically relevant errors (>5°). For more repeatable multi-segment models, the role of these markers within the models' definitions needs to be reconsidered.
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Affiliation(s)
- Wouter Schallig
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mario Maas
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Orthopedics and Sports Medicine, ErasmusMC, Rotterdam, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
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Meinders E, Booij MJ, van den Noort JC, Harlaar J. How to compare knee kinetics at different walking speeds? Gait Posture 2021; 88:225-230. [PMID: 34119777 DOI: 10.1016/j.gaitpost.2021.06.004] [Citation(s) in RCA: 3] [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: 12/19/2020] [Revised: 04/25/2021] [Accepted: 06/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking speed is a confounding factor in biomechanical analyses of gait, but still many studies compare gait biomechanics at comfortable walking speed (CWS) that is likely to differ between groups or conditions. To identify gait deviation unrelated to walking speed, methods are needed to correct biomechanical data over the gait cycle for walking speed. RESEARCH QUESTION How to compare knee kinetics over the gait cycle at different walking speeds? METHODS 22 asymptomatic subjects walked on a dual-belt treadmill at CWS and 4 fixed speeds. Knee moments in sagittal (KFM) and frontal plane (KAM) were calculated via inverse dynamics. The net moment differences between CWS and fixed speed were expressed as a root-mean-square error (RMSE) normalized to the range of the variable. Two methods to correct for walking speed were compared. In method 1, KFM and KAM values were estimated based on interpolation between speeds at each percentage of the gait cycle. In method 2, principal component analysis was used to extract speed related features to reconstruct KFM and KAM at the speed of interest. The accuracy of both methods was tested using a leave-one-out cross validation. RESULTS Walking speed influenced the magnitude and shape of KFM and KAM. To account for these speed influences using both methods, leave-one-out cross validation showed low normalized RMSE (< 5 %), with little difference between the two methods. RMSE for both reconstruction methods were up to 60 % lower than the RMSE between CWS and fixed speed. SIGNIFICANCE Both methods could accurately correct knee kinetics over the gait cycle for the effects of walking speed. Walking speed dependency should be incorporated in each gait laboratory's reference dataset to be able to identify gait deviations unrelated to gait speed.
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Affiliation(s)
- Evy Meinders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Dept. Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, Netherlands.
| | - Marjolein J Booij
- Amsterdam UMC, Vrije Universiteit Amsterdam, Dept. Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Dept. Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, Netherlands; Amsterdam UMC, Univ. of Amsterdam, Dept. Radiology and Nuclear Medicine, Medical Imaging Quantification Center, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands.
| | - Jaap Harlaar
- Delft University of Technology, Dept BioMechanical Engineering, Mekelweg 2, Delft, Netherlands; Erasmus Medical Center, Dept Orthopedics, Rotterdam, Netherlands.
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Schallig W, Streekstra GJ, Hulshof CM, Kleipool RP, Dobbe JGG, Maas M, Harlaar J, van der Krogt MM, van den Noort JC. The influence of soft tissue artifacts on multi-segment foot kinematics. J Biomech 2021; 120:110359. [PMID: 33730563 DOI: 10.1016/j.jbiomech.2021.110359] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/11/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Abstract
Movement of skin markers with respect to their underlying bone (i.e. soft tissue artifacts (STAs)) might corrupt the accuracy of marker-based movement analyses. This study aims to quantify STAs in 3D for foot markers and their effect on multi-segment foot kinematics as calculated by the Oxford and Rizzoli Foot Models (OFM, RFM). Fifteen subjects with asymptomatic feet were seated on a custom-made loading device on a computed tomography (CT) table, with a combined OFM and RFM marker set on their right foot. One unloaded reference CT-scan with neutral foot position was performed, followed by 9 loaded CT-scans at different foot positions. The 3D-displacement (i.e. STA) of each marker in the underlying bone coordinate system between the reference scan and other scans was calculated. Subsequently, segment orientations and joint angles were calculated from the marker positions according to OFM and RFM definitions with and without STAs. The differences in degrees were defined as the errors caused by the marker displacements. Markers on the lateral malleolus and proximally on the posterior aspect of the calcaneus showed the largest STAs. The hindfoot-shank joint angle was most affected by STAs in the most extreme foot position (40° plantar flexion) in the sagittal plane for RFM (mean: 6.7°, max: 11.8°) and the transverse plane for OFM (mean: 3.9°, max: 6.8°). This study showed that STAs introduce clinically relevant errors in multi-segment foot kinematics. Moreover, it identified marker locations that are most affected by STAs, suggesting that their use within multi-segment foot models should be reconsidered.
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Affiliation(s)
- Wouter Schallig
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Geert J Streekstra
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Chantal M Hulshof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Roeland P Kleipool
- Amsterdam UMC, University of Amsterdam, Medical Biology, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Johannes G G Dobbe
- Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Mario Maas
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
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8
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Schrijvers JC, van den Noort JC, van der Esch M, Harlaar J. Neuromechanical assessment of knee joint instability during perturbed gait in patients with knee osteoarthritis. J Biomech 2021; 118:110325. [PMID: 33601186 DOI: 10.1016/j.jbiomech.2021.110325] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/20/2020] [Accepted: 01/31/2021] [Indexed: 01/02/2023]
Abstract
Knee joint instability is frequently reported by patients with knee osteoarthritis (KOA). Objective metrics to assess knee joint instability are lacking, making it difficult to target therapies aiming to improve stability. Therefore, the aim of this study was to compare responses in neuromechanics to perturbations during gait in patients with self-reported knee joint instability (KOA-I) versus patients reporting stable knees (KOA-S) and healthy control subjects. Forty patients (20 KOA-I and 20 KOA-S) and 20 healthy controls were measured during perturbed treadmill walking. Knee joint angles and muscle activation patterns were compared using statistical parametric mapping and discrete gait parameters. Furthermore, subgroups (moderate versus severe KOA) based on Kellgren and Lawrence classification were evaluated. Patients with KOA-I generally had greater knee flexion angles compared to controls during terminal stance and during swing of perturbed gait. In response to deceleration perturbations the patients with moderate KOA-I increased their knee flexion angles during terminal stance and pre-swing. Knee muscle activation patterns were overall similar between the groups. In response to sway medial perturbations the patients with severe KOA-I increased the co-contraction of the quadriceps versus hamstrings muscles during terminal stance. Patients with KOA-I respond to different gait perturbations by increasing knee flexion angles, co-contraction of muscles or both during terminal stance. These alterations in neuromechanics could assist in the assessment of knee joint instability in patients, to provide treatment options accordingly. Furthermore, longitudinal studies are needed to investigate the consequences of altered neuromechanics due to knee joint instability on the development of KOA.
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Affiliation(s)
- Jim C Schrijvers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Medical Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands; Delft University of Technology, Department of Biomechanical Engineering, Delft, The Netherlands; Erasmus Medical Center, Department of Orthopedics, Rotterdam, The Netherlands
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9
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Schallig W, van den Noort JC, McCahill J, Stebbins J, Leardini A, Maas M, Harlaar J, van der Krogt MM. Comparing the kinematic output of the Oxford and Rizzoli Foot Models during normal gait and voluntary pathological gait in healthy adults. Gait Posture 2020; 82:126-132. [PMID: 32920448 DOI: 10.1016/j.gaitpost.2020.08.126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/14/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Oxford Foot Model (OFM) and Rizzoli Foot Model (RFM) are the two most frequently used multi-segment models to measure foot kinematics. However, a comprehensive comparison of the kinematic output of these models is lacking. RESEARCH QUESTION What are the differences in kinematic output between OFM and RFM during normal gait and typical pathological gait patterns in healthy adults?. METHODS A combined OFM and RFM marker set was placed on the right foot of ten healthy subjects. A static standing trial and six level walking trials were collected for normal gait and for four voluntarily adopted gait types: equinus, crouch, toe-in and toe-out. Joint angles were calculated for every trial for the hindfoot relative to shank (HF-SH), forefoot relative to hindfoot (FF-HF) and hallux relative to forefoot (HX-FF). Average static joint angles of both models were compared between models. After subtracting these offsets, the remaining dynamic angles were compared using statistical parametric mapping repeated measures ANOVAs and t-tests. Furthermore, range of motion was compared between models for every angle. RESULTS For the static posture, RFM compared to OFM measured more plantar flexion (Δ = 6°) and internal rotation (Δ = 7°) for HF-SH, more plantar flexion (Δ = 34°) and inversion (Δ = 13°) for FF-HF and more dorsal flexion (Δ = 37°) and abduction (Δ = 12°) for HX-FF. During normal walking, kinematic differences were found in various parts of the gait cycle. Moreover, range of motion was larger in the HF-SH for OFM and in FF-HF and HX-FF for RFM. The differences between models were not the same for all gait types. Equinus and toe-out gait demonstrated most pronounced differences. SIGNIFICANCE Differences are present in kinematic output between OFM and RFM, which also depend on gait type. Therefore, kinematic output of foot and ankle studies should be interpreted with careful consideration of the multi-segment foot model used.
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Affiliation(s)
- Wouter Schallig
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jennifer McCahill
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Julie Stebbins
- Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Maas
- Amsterdam UMC, University of Amsterdam, Radiology and Nuclear Medicine, Medical Imaging Quantification Center (MIQC), Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
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10
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Schrijvers JC, van den Noort JC, van der Esch M, Dekker J, Harlaar J. Objective parameters to measure (in)stability of the knee joint during gait: A review of literature. Gait Posture 2019; 70:235-253. [PMID: 30909003 DOI: 10.1016/j.gaitpost.2019.03.016] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Instability of the knee joint during gait is frequently reported by patients with knee osteoarthritis or an anterior cruciate ligament rupture. The assessment of instability in clinical practice and clinical research studies mainly relies on self-reporting. Alternatively, parameters measured with gait analysis have been explored as suitable objective indicators of dynamic knee (in)stability. RESEARCH QUESTION This literature review aimed to establish an inventory of objective parameters of knee stability during gait. METHODS Five electronic databases (Pubmed, Embase, Cochrane, Cinahl and SPORTDiscuss) were systematically searched, with keywords concerning knee, stability and gait. Eligible studies used an objective parameter(s) to assess knee (in)stability during gait, being stated in the introduction or methods section. Out of 10717 studies, 89 studies were considered eligible. RESULTS Fourteen different patient populations were investigated with kinematic, kinetic and/or electromyography measurements during (challenged) gait. Thirty-three possible objective parameters were identified for knee stability, of which the majority was based on kinematic (14 parameters) or electromyography (12 parameters) measurements. Thirty-nine studies used challenged gait (i.e. external perturbations, downhill walking) to provoke knee joint instability. Limited or conflicting results were reported on the validity of the 33 parameters. SIGNIFICANCE In conclusion, a large number of different candidates for an objective knee stability gait parameter were found in literature, all without compelling evidence. A clear conceptual definition for dynamic knee joint stability is lacking, for which we suggest : "The capacity to respond to a challenge during gait within the natural boundaries of the knee". Furthermore biomechanical gait laboratory protocols should be harmonized, to enable future developments on clinically relevant measure(s) of knee stability during gait.
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Affiliation(s)
- Jim C Schrijvers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Joost Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Delft University of Technology, Department of Biomechanical Engineering, Delft, the Netherlands
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11
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Cudejko T, van der Esch M, Schrijvers J, Richards R, van den Noort JC, Wrigley T, van der Leeden M, Roorda LD, Lems W, Harlaar J, Dekker J. The immediate effect of a soft knee brace on dynamic knee instability in persons with knee osteoarthritis. Rheumatology (Oxford) 2018; 57:1735-1742. [PMID: 29931372 DOI: 10.1093/rheumatology/key162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/12/2022] Open
Abstract
Objectives Wearing a soft knee brace has been shown to reduce self-reported knee instability in persons with knee OA. There is a need to assess whether a soft knee brace has a beneficial effect on objectively assessed dynamic knee instability as well. The aims of the study were to evaluate the effect of a soft knee brace on objectively assessed dynamic knee instability and to assess the difference in effect between a non-tight and a tight soft knee brace in persons with knee OA. Methods Thirty-eight persons with knee OA and self-reported knee instability participated in a laboratory study. A within-subject design was used comparing no brace vs brace and comparing a non-tight vs a tight brace. The primary outcome measure was dynamic knee instability, expressed by the perturbation response (PR). The PR reflects deviation in the mean knee varus-valgus angle during level walking after a controlled mechanical perturbation. Linear mixed-effect model analysis was used to evaluate the effect of a brace on dynamic knee instability. Results Wearing a brace significantly reduced the PR compared with not wearing a brace (B = -0.16, P = 0.01). There was no difference between a non-tight and a tight brace (B = -0.03, P = 0.60). Conclusion This study is the first to report that wearing a soft knee brace reduces objectively assessed dynamic knee instability in persons with knee OA. Wearing a soft brace results in an objective improvement of knee instability beyond subjectively reported improvement. Trial registration Nederlands Trial register (trialregister.nl) NTR6363.
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Affiliation(s)
- Tomasz Cudejko
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jim Schrijvers
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Academic Medical Center, Amsterdam, The Netherlands
| | - Rosie Richards
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Academic Medical Center, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Academic Medical Center, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Musculoskeletal Imaging Quantification Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Tim Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Willem Lems
- Jan van Breemen Research Institute, VU University Medical Center, Amsterdam.,Amsterdam Rheumatology & Immunology Centre, Amsterdam Medical Center, Reade, VU University Medical Center, Amsterdam
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Academic Medical Center, Amsterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Academic Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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12
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Karatsidis A, Richards RE, Konrath JM, van den Noort JC, Schepers HM, Bellusci G, Harlaar J, Veltink PH. Validation of wearable visual feedback for retraining foot progression angle using inertial sensors and an augmented reality headset. J Neuroeng Rehabil 2018; 15:78. [PMID: 30111337 PMCID: PMC6094564 DOI: 10.1186/s12984-018-0419-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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] [Received: 01/29/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022] Open
Abstract
Background Gait retraining interventions using real-time biofeedback have been proposed to alter the loading across the knee joint in patients with knee osteoarthritis. Despite the demonstrated benefits of these conservative treatments, their clinical adoption is currently obstructed by the high complexity, spatial demands, and cost of optical motion capture systems. In this study we propose and evaluate a wearable visual feedback system for gait retraining of the foot progression angle (FPA). Methods The primary components of the system are inertial measurement units, which track the human movement without spatial limitations, and an augmented reality headset used to project the visual feedback in the visual field. The adapted gait protocol contained five different target angles ranging from 15 degrees toe-out to 5 degrees toe-in. Eleven healthy participants walked on an instrumented treadmill, and the protocol was performed using both an established laboratory visual feedback driven by optical motion capture, and the proposed wearable system. Results and conclusions The wearable system tracked FPA with an accuracy of 2.4 degrees RMS and ICC=0.94 across all target angles and subjects, when compared to an optical motion capture reference. In addition, the effectiveness of the biofeedback, reflected by the number of steps with FPA value ±2 degrees from the target, was found to be around 50% in both wearable and laboratory approaches. These findings demonstrate that retraining of the FPA using wearable inertial sensing and visual feedback is feasible with effectiveness matching closely an established laboratory method. The proposed wearable setup may reduce the complexity of gait retraining applications and facilitate their transfer to routine clinical practice.
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Affiliation(s)
- Angelos Karatsidis
- Xsens Technologies B.V, Pantheon 6, Enschede, 7521 PR, The Netherlands. .,Department of Biomedical Signals and Systems (BSS), Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Rosie E Richards
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Jason M Konrath
- Xsens Technologies B.V, Pantheon 6, Enschede, 7521 PR, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Academic Medical Center, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - H Martin Schepers
- Xsens Technologies B.V, Pantheon 6, Enschede, 7521 PR, The Netherlands
| | - Giovanni Bellusci
- Xsens Technologies B.V, Pantheon 6, Enschede, 7521 PR, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems (BSS), Technical Medical Centre, University of Twente, Enschede, The Netherlands
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13
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Cudejko T, van der Esch M, van den Noort JC, Rijnhart JJM, van der Leeden M, Roorda LD, Lems W, Waddington G, Harlaar J, Dekker J. Decreased Pain and Improved Dynamic Knee Instability Mediate the Beneficial Effect of Wearing a Soft Knee Brace on Activity Limitations in Patients With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2018; 71:1036-1043. [PMID: 30099859 PMCID: PMC6771793 DOI: 10.1002/acr.23722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate whether improvement of proprioception, pain, or dynamic knee instability mediates the effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis (OA). METHODS We conducted an analysis of data for 44 patients with knee OA who were enrolled in a laboratory-based trial evaluating the effect of wearing a commercially available soft knee brace. Activity limitations were assessed with the 10-meter walk test and the Get Up and Go test. Knee joint proprioception was assessed by an active joint position sense test; pain was assessed on a numeric rating scale (NRS) (range 0-10); pressure pain threshold (PPT) was assessed with a hand-held pressure algometer; dynamic knee instability was expressed by the perturbation response, i.e., a measure reflecting a deviation in mean knee varus-valgus angle after a controlled mechanical perturbation on a treadmill, with respect to level walking. Mediation analysis was conducted using the product of coefficients approach. Confidence intervals were calculated with a bootstrap procedure. RESULTS A decrease in pain (scored on an NRS) and a decrease in dynamic knee instability mediated the effect of wearing a soft knee brace on the reduction of activity limitations (P < 0.05), while changes in proprioception and PPT did not mediate this effect (P > 0.05). CONCLUSION This study shows that decreased pain and reduced dynamic knee instability are pathways by which wearing a soft knee brace decreases activity limitations in patients with knee OA.
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Affiliation(s)
- Tomasz Cudejko
- VU Medical Center, Amsterdam Movement Sciences and Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
| | | | - Josien C van den Noort
- VU Medical Center, Amsterdam Movement Sciences and Musculoskeletal Imaging Quantification Center, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Marike van der Leeden
- VU Medical Center, Amsterdam Movement Sciences and Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands
| | - Willem Lems
- Jan van Breemen Research Institute, Reade and Amsterdam Rheumatology and Immunology Centre, Amsterdam, The Netherlands
| | - Gordon Waddington
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Jaap Harlaar
- VU University Medical Center, Amsterdam Movement Sciences and Amsterdam and Delft University of Technology, Delft, The Netherlands
| | - Joost Dekker
- VU Medical Center, Amsterdam Movement Sciences and VU University Medical Center, Amsterdam, The Netherlands
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14
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Richards R, van der Esch M, van den Noort JC, Harlaar J. The learning process of gait retraining using real-time feedback in patients with medial knee osteoarthritis. Gait Posture 2018; 62:1-6. [PMID: 29494998 DOI: 10.1016/j.gaitpost.2018.02.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 10/27/2017] [Revised: 12/05/2017] [Accepted: 02/20/2018] [Indexed: 02/02/2023]
Abstract
The objective of this study was to investigate the learning process of knee osteoarthritis (KOA) patients learning to change their foot progression angle (FPA) over a six-week toe-in gait training program. Sixteen patients with medial KOA completed a six-week toe-in gait training program with real-time biofeedback. Patients walked on an instrumented treadmill while receiving real-time feedback on their foot progression angle (FPA) with reference to a target angle. The FPA difference (difference between target and actual FPA) was analyzed during i) natural walking, ii) walking with feedback, iii) walking without feedback and iv) walking with a dual-task at the start and end of the training program. Self-reported difficulty and abnormality and time spent walking and training were also analyzed. The FPA difference during natural walking was significantly decreased from median 6.9 to median 3.6° i.e. by 3.3° in week six (p < 0.001); adding feedback reduced FPA difference to almost zero. However the dual-task condition increased the FPA difference at week one compared to the feedback condition (median difference: 1.8°, p = 0.022), but after training this effect was minimized (median difference: 0.6°, p = 0.167). Self-reported abnormality and difficulty decreased from median 5 to 3 and from median 6 to 3 on the NRS respectively (p < 0.05). Patients with medial KOA could reduce the FPA difference during natural walking after the gait retraining program, with some evidence of a reduction in the cognitive demand needed to achieve this. Automation of adaptions might need support from more permanent feedback using wearable technologies.
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Affiliation(s)
- Rosie Richards
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands.
| | | | - Josien C van den Noort
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands; Academic Medical Center, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands.
| | - Jaap Harlaar
- VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands; Delft University of Technology, Delft, Netherlands.
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15
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van Beek N, Stegeman DF, van den Noort JC, (H.E.J.) Veeger D, Maas H. Activity patterns of extrinsic finger flexors and extensors during movements of instructed and non-instructed fingers. J Electromyogr Kinesiol 2018; 38:187-196. [DOI: 10.1016/j.jelekin.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 12/15/2022] Open
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16
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Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, Twisk J, Steultjens M, Woodburn J, Harlaar J, Dekker J. The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis. Arthritis Res Ther 2017; 19:260. [PMID: 29191237 PMCID: PMC5709997 DOI: 10.1186/s13075-017-1456-0] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/18/2017] [Indexed: 01/12/2023] Open
Abstract
Background We aimed to (i) evaluate the immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence, and (ii) to assess the difference in effect between a non-tight and a tight soft brace in patients with knee osteoarthritis (OA). Methods Forty-four patients with knee OA and self-reported knee instability participated in the single-session, laboratory, experimental study. A within-subject design was used, comparing a soft brace with no brace, and comparing a non-tight with a tight soft brace. The outcome measures were pain, self-reported knee instability and knee confidence during level and perturbed walking on the treadmill and activity limitations (10-m walk test and the get up and go (GUG) test). Linear mixed-effect model analysis for continuous outcomes and logistic generalized estimating equations for categorical outcomes were used to evaluate the effect of wearing a soft brace. Results Wearing a soft brace significantly reduced pain during level walking (B − 0.60, P = 0.001) and perturbed walking (B − 0.80, P < 0.001), reduced the time to complete the 10-m walk (B − 0.23, P < 0.001) and the GUG tests (B − 0.23, P = 0.004), reduced self-reported knee instability during level walking (OR 0.41, P = 0.002) and perturbed walking (OR 0.36, P < 0.001), and reduced lack of confidence in the knees during level walking (OR 0.45, P < 0.001) and perturbed walking (OR 0.56, P < 0.001), compared with not wearing a soft brace. There was no difference in effects between a non-tight and tight brace, except for the 10-m walk test. Wearing a tight brace significantly reduced the time to complete the 10-m walk test in comparison with wearing a non-tight brace (B − 0.11, P = 0.03). Conclusion The results of this study indicate that a soft brace is an efficacious intervention targeting pain, activity limitations, self-reported knee instability, and knee confidence in the immediate term in patients with knee OA. Further studies are needed evaluating the mode of action based on exerted pressure, and on the generalization to functioning in daily life. Trial registration trialregister.nl, NTR6363. Retrospectively registered on 15 May 2017.
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Affiliation(s)
- Tomasz Cudejko
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands.
| | - Marike van der Leeden
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Musculoskeletal Imaging Quantification Center (MIQC), Academic Medical Center, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Centre Reade, Dr. J. van Breemenstraat 2, 1056 AB Amsterdam, P.O. Box 58271, 1040 HG, Amsterdam, The Netherlands
| | - Willem Lems
- Amsterdam Rheumatology & Immunology Center, Amsterdam Medical Center, Reade, VU University Medical Center, Amsterdam, The Netherlands.,Jan van Breemen Research Institute, Reade, Amsterdam, The Netherlands
| | - Jos Twisk
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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17
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van den Noort JC, Sloot LH, Bruijn SM, Harlaar J. How to measure responses of the knee to lateral perturbations during gait? A proof-of-principle for quantification of knee instability. J Biomech 2017; 61:111-122. [DOI: 10.1016/j.jbiomech.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/15/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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18
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van den Noort JC, Verhagen R, van Dijk KJ, Veltink PH, Vos MCPM, de Bie RMA, Bour LJ, Heida CT. Quantification of Hand Motor Symptoms in Parkinson's Disease: A Proof-of-Principle Study Using Inertial and Force Sensors. Ann Biomed Eng 2017; 45:2423-2436. [PMID: 28726022 PMCID: PMC5622175 DOI: 10.1007/s10439-017-1881-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/05/2017] [Indexed: 01/19/2023]
Abstract
This proof-of-principle study describes the methodology and explores and demonstrates the applicability of a system, existing of miniature inertial sensors on the hand and a separate force sensor, to objectively quantify hand motor symptoms in patients with Parkinson’s disease (PD) in a clinical setting (off- and on-medication condition). Four PD patients were measured in off- and on- dopaminergic medication condition. Finger tapping, rapid hand opening/closing, hand pro/supination, tremor during rest, mental task and kinetic task, and wrist rigidity movements were measured with the system (called the PowerGlove). To demonstrate applicability, various outcome parameters of measured hand motor symptoms of the patients in off- vs. on-medication condition are presented. The methodology described and results presented show applicability of the PowerGlove in a clinical research setting, to objectively quantify hand bradykinesia, tremor and rigidity in PD patients, using a single system. The PowerGlove measured a difference in off- vs. on-medication condition in all tasks in the presented patients with most of its outcome parameters. Further study into the validity and reliability of the outcome parameters is required in a larger cohort of patients, to arrive at an optimal set of parameters that can assist in clinical evaluation and decision-making.
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Affiliation(s)
- Josien C van den Noort
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Musculoskeletal Imaging Quantification Center, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Rens Verhagen
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Kees J van Dijk
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Peter H Veltink
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Michelle C P M Vos
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lo J Bour
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ciska T Heida
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
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Richards R, van den Noort JC, Dekker J, Harlaar J. Gait Retraining With Real-Time Biofeedback to Reduce Knee Adduction Moment: Systematic Review of Effects and Methods Used. Arch Phys Med Rehabil 2017; 98:137-150. [DOI: 10.1016/j.apmr.2016.07.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/01/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
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van den Noort JC, van Beek N, van der Kraan T, Veeger DHEJ, Stegeman DF, Veltink PH, Maas H. Variable and Asymmetric Range of Enslaving: Fingers Can Act Independently over Small Range of Flexion. PLoS One 2016; 11:e0168636. [PMID: 27992598 PMCID: PMC5167409 DOI: 10.1371/journal.pone.0168636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/05/2016] [Indexed: 12/25/2022] Open
Abstract
The variability in the numerous tasks in which we use our hands is very large. However, independent movement control of individual fingers is limited. To assess the extent of finger independency during full-range finger flexion including all finger joints, we studied enslaving (movement in non-instructed fingers) and range of independent finger movement through the whole finger flexion trajectory in single and multi-finger movement tasks. Thirteen young healthy subjects performed single- and multi-finger movement tasks under two conditions: active flexion through the full range of movement with all fingers free to move and active flexion while the non-instructed finger(s) were restrained. Finger kinematics were measured using inertial sensors (PowerGlove), to assess enslaving and range of independent finger movement. Although all fingers showed enslaving movement to some extent, highest enslaving was found in adjacent fingers. Enslaving effects in ring and little finger were increased with movement of additional, non-adjacent fingers. The middle finger was the only finger affected by restriction in movement of non-instructed fingers. Each finger showed a range of independent movement before the non-instructed fingers started to move, which was largest for the index finger. The start of enslaving was asymmetrical for adjacent fingers. Little finger enslaving movement was affected by multi-finger movement. We conclude that no finger can move independently through the full range of finger flexion, although some degree of full independence is present for smaller movements. This range of independent movement is asymmetric and variable between fingers and between subjects. The presented results provide insight into the role of finger independency for different types of tasks and populations.
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Affiliation(s)
- Josien C. van den Noort
- Biomedical Signals and Systems, MIRA Institute, University of Twente, Enschede, the Netherlands
- Department of Rehabilitation medicine, VU University medical center, MOVE Research Institute Amsterdam, the Netherlands
- * E-mail:
| | - Nathalie van Beek
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - Thomas van der Kraan
- Donders Institute, Department of Neurology and Clinical Neurophysiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - DirkJan H. E. J. Veeger
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - Dick F. Stegeman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
- Donders Institute, Department of Neurology and Clinical Neurophysiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Peter H. Veltink
- Biomedical Signals and Systems, MIRA Institute, University of Twente, Enschede, the Netherlands
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
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van den Noort JC, Kortier HG, van Beek N, Veeger DHEJ, Veltink PH. Measuring 3D Hand and Finger Kinematics-A Comparison between Inertial Sensing and an Opto-Electronic Marker System. PLoS One 2016; 11:e0164889. [PMID: 27812139 PMCID: PMC5094774 DOI: 10.1371/journal.pone.0164889] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
Objective analysis of hand and finger kinematics is important to increase understanding of hand function and to quantify motor symptoms for clinical diagnosis. The aim of this paper is to compare a new 3D measurement system containing multiple miniature inertial sensors (PowerGlove) with an opto-electronic marker system during specific finger tasks in three healthy subjects. Various finger movements tasks were performed: flexion, fast flexion, tapping, hand open/closing, ab/adduction and circular pointing. 3D joint angles of the index finger joints and position of the thumb and index were compared between systems. Median root mean square differences of the main joint angles of interest ranged between 3.3 and 8.4deg. Largest differences were found in fast and circular pointing tasks, mainly in range of motion. Smallest differences for all 3D joint angles were observed in the flexion tasks. For fast finger tapping, the thumb/index amplitude showed a median difference of 15.8mm. Differences could be explained by skin movement artifacts caused by relative marker movements of the marker system, particularly during fast tasks; large movement accelerations and angular velocities which exceeded the range of the inertial sensors; and by differences in segment calibrations between systems. The PowerGlove is a system that can be of value to measure 3D hand and finger kinematics and positions in an ambulatory setting. The reported differences need to be taken into account when applying the system in studies understanding the hand function and quantifying hand motor symptoms in clinical practice.
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Affiliation(s)
- Josien C. van den Noort
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
- * E-mail:
| | - Henk G. Kortier
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Nathalie van Beek
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, the Netherlands
| | - DirkJan H. E. J. Veeger
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, the Netherlands
| | - Peter H. Veltink
- Biomedical Signals and Systems Group, MIRA Research Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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Kerkum YL, Harlaar J, Buizer AI, van den Noort JC, Becher JG, Brehm MA. An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion. Gait Posture 2016; 46:104-11. [PMID: 27131186 DOI: 10.1016/j.gaitpost.2016.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 10/27/2015] [Revised: 02/04/2016] [Accepted: 03/02/2016] [Indexed: 02/02/2023]
Abstract
Ankle-Foot Orthoses (AFOs) are commonly prescribed to promote gait in children with cerebral palsy (CP). The AFO prescription process is however largely dependent on clinical experience, resulting in confusing results regarding treatment efficacy. To maximize efficacy, the AFO's mechanical properties should be tuned to the patient's underlying impairments. This study aimed to investigate whether the efficacy of a ventral shell AFO (vAFO) to reduce knee flexion and walking energy cost could be improved by individually optimizing AFO stiffness in children with CP walking with excessive knee flexion. Secondarily, the effect of the optimized vAFO on daily walking activity was investigated. Fifteen children with spastic CP were prescribed with a hinged vAFO with adjustable stiffness. Effects of a rigid, stiff, and flexible setting on knee angle and the net energy cost (EC) [Jkg(-1)m(-1)] were assessed to individually select the optimal stiffness. After three months, net EC, daily walking activity [stridesmin(-1)] and knee angle [deg] while walking with the optimized vAFO were compared to walking with shoes-only. A near significant 9% (p=0.077) decrease in net EC (-0.5Jkg(-1)m(-1)) was found for walking with the optimized vAFO compared to shoes-only. Daily activity remained unchanged. Knee flexion in stance was reduced by 2.4° (p=0.006). These results show that children with CP who walk with excessive knee flexion show a small, but significant reduction of knee flexion in stance as a result of wearing individually optimized vAFOs. Data suggest that this also improves gait efficiency for which an individual approach to AFO prescription is emphasized.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Sloot LH, van den Noort JC, van der Krogt MM, Bruijn SM, Harlaar J. Can Treadmill Perturbations Evoke Stretch Reflexes in the Calf Muscles? PLoS One 2015; 10:e0144815. [PMID: 26669665 PMCID: PMC4682928 DOI: 10.1371/journal.pone.0144815] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Disinhibition of reflexes is a problem amongst spastic patients, for it limits a smooth and efficient execution of motor functions during gait. Treadmill belt accelerations may potentially be used to measure reflexes during walking, i.e. by dorsal flexing the ankle and stretching the calf muscles, while decelerations show the modulation of reflexes during a reduction of sensory feedback. The aim of the current study was to examine if belt accelerations and decelerations of different intensities applied during the stance phase of treadmill walking can evoke reflexes in the gastrocnemius, soleus and tibialis anterior in healthy subjects. Muscle electromyography and joint kinematics were measured in 10 subjects. To determine whether stretch reflexes occurred, we assessed modelled musculo-tendon length and stretch velocity, the amount of muscle activity, as well as the incidence of bursts or depressions in muscle activity with their time delays, and co-contraction between agonist and antagonist muscle. Although the effect on the ankle angle was small with 2.8±1.0°, the perturbations caused clear changes in muscle length and stretch velocity relative to unperturbed walking. Stretched muscles showed an increasing incidence of bursts in muscle activity, which occurred after a reasonable electrophysiological time delay (163-191 ms). Their amplitude was related to the muscle stretch velocity and not related to co-contraction of the antagonist muscle. These effects increased with perturbation intensity. Shortened muscles showed opposite effects, with a depression in muscle activity of the calf muscles. The perturbations only slightly affected the spatio-temporal parameters, indicating that normal walking was retained. Thus, our findings showed that treadmill perturbations can evoke reflexes in the calf muscles and tibialis anterior. This comprehensive study could form the basis for clinical implementation of treadmill perturbations to functionally measure reflexes during treadmill-based clinical gait analysis.
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Affiliation(s)
- Lizeth H. Sloot
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Josien C. van den Noort
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Marjolein M. van der Krogt
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Sjoerd M. Bruijn
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands
- Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Jaap Harlaar
- Dept. of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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Kerkum YL, Buizer AI, van den Noort JC, Becher JG, Harlaar J, Brehm MA. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion. PLoS One 2015; 10:e0142878. [PMID: 26600039 PMCID: PMC4658111 DOI: 10.1371/journal.pone.0142878] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/28/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05) was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power. Trial Registration Dutch Trial Register NTR3418
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Affiliation(s)
- Yvette L. Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Josien C. van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G. Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van den Noort JC, Wiertsema SH, Hekman KM, Schönhuth CP, Dekker J, Harlaar J. Measurement of scapular dyskinesis using wireless inertial and magnetic sensors: Importance of scapula calibration. J Biomech 2015; 48:3460-8. [DOI: 10.1016/j.jbiomech.2015.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/19/2015] [Accepted: 05/24/2015] [Indexed: 11/27/2022]
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Kerkum YL, Houdijk H, Brehm MA, Buizer AI, Kessels MLC, Sterk A, van den Noort JC, Harlaar J. The Shank-to-Vertical-Angle as a parameter to evaluate tuning of Ankle-Foot Orthoses. Gait Posture 2015; 42:269-74. [PMID: 26050873 DOI: 10.1016/j.gaitpost.2015.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 09/24/2014] [Revised: 03/31/2015] [Accepted: 05/19/2015] [Indexed: 02/02/2023]
Abstract
The effectiveness of an Ankle-Foot Orthosis footwear combination (AFO-FC) may be partly dependent on the alignment of the ground reaction force with respect to lower limb joint rotation centers, reflected by joint angles and moments. Adjusting (i.e. tuning) the AFO-FC's properties could affect this alignment, which may be guided by monitoring the Shank-to-Vertical-Angle. This study aimed to investigate whether the Shank-to-Vertical-Angle during walking responds to variations in heel height and footplate stiffness, and if this would reflect changes in joint angles and net moments in healthy adults. Ten subjects walked on an instrumented treadmill and performed six trials while walking with bilateral rigid Ankle-Foot Orthoses. The AFO-FC heel height was increased, aiming to impose a Shank-to-Vertical-Angle of 5°, 11° and 20°, and combined with a flexible or stiff footplate. For each trial, the Shank-to-Vertical-Angle, joint flexion-extension angles and net joint moments of the right leg at midstance were averaged over 25 gait cycles. The Shank-to-Vertical-Angle significantly increased with increasing heel height (p<0.001), resulting in an increase in knee flexion angle and internal knee extensor moment (p<0.001). The stiff footplate reduced the effect of heel height on the internal knee extensor moment (p=0.030), while the internal ankle plantar flexion moment increased (p=0.035). Effects of heel height and footplate stiffness on the hip joint were limited. Our results support the potential to use the Shank-to-Vertical-Angle as a parameter to evaluate AFO-FC tuning, as it is responsive to changes in heel height and reflects concomitant changes in the lower limb angles and moments.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Han Houdijk
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands; Heliomare Rehabilitation, Research and Development, Wijk aan Zee, The Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Manon L C Kessels
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Arjan Sterk
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Kerkum YL, Brehm MA, van Hutten K, van den Noort JC, Harlaar J, Becher JG, Buizer AI. Acclimatization of the gait pattern to wearing an ankle-foot orthosis in children with spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2015; 30:617-22. [PMID: 25854606 DOI: 10.1016/j.clinbiomech.2015.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/10/2014] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle-foot orthoses can be prescribed to improve gait in children with cerebral palsy. Before evaluating the effects of ankle-foot orthoses on gait, a period to adapt or acclimatize is usually applied. It is however unknown whether an acclimatization period is actually needed to reliably evaluate the effect of a new orthosis on gait. This study aimed to investigate whether specific gait parameters in children with cerebral palsy would change within an acclimatization period after being provided with new ankle-foot orthoses. METHODS Ten children with cerebral palsy, walking with excessive knee flexion in midstance (8 boys; mean (SD) 10.2 (1.9) years; Gross Motor Function Classification System levels I-II) were provided with ventral shell ankle-foot orthoses. The orthoses were worn in combination with the child's own shoes and tuned, based on ground reaction force alignment with respect to the lower limb joints. Directly after tuning (T0) and four weeks later (T1), 3D-gait analysis was performed using an optoelectronic motion capture system and a force plate. From this assessment, ten spatiotemporal, kinematic and kinetic gait parameters were derived for the most affected leg. Differences in parameters between T0 and T1 were analyzed using paired t-tests or Wilcoxon signed rank tests (P<0.05). FINDINGS Over the course of four weeks, no significant differences (P ≥ 0.080) were observed for any investigated parameter. INTERPRETATION These results imply that the biomechanical effect of ventral shell ankle-foot orthoses on gait in independent walking children with cerebral palsy is immediately apparent, i.e., there is no further change after acclimatization.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kim van Hutten
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Josien C van den Noort
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jules G Becher
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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van den Noort JC, Steenbrink F, Roeles S, Harlaar J. Real-time visual feedback for gait retraining: toward application in knee osteoarthritis. Med Biol Eng Comput 2014; 53:275-86. [PMID: 25480419 DOI: 10.1007/s11517-014-1233-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
Abstract
Real-time visual feedback might be effective for gait retraining in patients with knee osteoarthritis, to potentially relieve symptoms and postpone knee replacement. In this study, we investigated the effect of various types of real-time visual feedback on a kinetic and a kinematic gait parameter and the different kinematic strategies adopted to reduce knee load. Seventeen healthy subjects walked on an instrumented treadmill while receiving real-time visual kinetic feedback aimed at minimizing the external knee adduction moment (KAdM, reflecting the knee load) or kinematic feedback on the hip internal rotation angle (HIR, a gait modification to reduce the KAdM). Four types of visual feedback (bar, polar plot, color change, graph) were provided. The KAdM decreased by 50 % with kinetic feedback, while kinematic feedback resulted in an HIR increase of 8° but no decrease in KAdM. The degree of change was not influenced by the type of visual feedback. The kinematic changes that reduced KAdM were increased toe-in, increased step width, and decreased hip adduction. Real-time visual feedback can effectively modify gait parameters. Feedback of the KAdM may be more effective in reducing the KAdM than controlling a kinematic parameter that is assumed to unload the knee.
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Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands,
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Balemans ACJ, van Wely L, Middelweerd A, van den Noort JC, Becher JG, Dallmeijer AJ. Daily stride rate activity and heart rate response in children with cerebral palsy. J Rehabil Med 2014; 46:45-50. [PMID: 24202082 DOI: 10.2340/16501977-1237] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Astrid C J Balemans
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, EMGO Institute for Health and Care Research, Amsterdam, VU University Medical Center, Amsterdam, 1007 MB Amsterdam, The Netherlands.
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van den Noort JC, Schaffers I, Snijders J, Harlaar J. The effectiveness of voluntary modifications of gait pattern to reduce the knee adduction moment. Hum Mov Sci 2013; 32:412-24. [DOI: 10.1016/j.humov.2012.02.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 02/13/2012] [Accepted: 02/19/2012] [Indexed: 10/26/2022]
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Kerkum YL, Harlaar J, Buizer AI, van den Noort JC, Becher JG, Brehm MA. Optimising Ankle Foot Orthoses for children with cerebral palsy walking with excessive knee flexion to improve their mobility and participation; protocol of the AFO-CP study. BMC Pediatr 2013; 13:17. [PMID: 23374998 PMCID: PMC3568048 DOI: 10.1186/1471-2431-13-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] [Received: 01/14/2013] [Accepted: 01/24/2013] [Indexed: 11/30/2022] Open
Abstract
Background Ankle-Foot-Orthoses with a ventral shell, also known as Floor Reaction Orthoses (FROs), are often used to reduce gait-related problems in children with spastic cerebral palsy (SCP), walking with excessive knee flexion. However, current evidence for the effectiveness (e.g. in terms of walking energy cost) of FROs is both limited and inconclusive. Much of this ambiguity may be due to a mismatch between the FRO ankle stiffness and the patient’s gait deviations. The primary aim of this study is to evaluate the effect of FROs optimised for ankle stiffness on the walking energy cost in children with SCP, compared to walking with shoes alone. In addition, effects on various secondary outcome measures will be evaluated in order to identify possible working mechanisms and potential predictors of FRO treatment success. Method/Design A pre-post experimental study design will include 32 children with SCP, walking with excessive knee flexion in midstance, recruited from our university hospital and affiliated rehabilitation centres. All participants will receive a newly designed FRO, allowing ankle stiffness to be varied into three configurations by means of a hinge. Gait biomechanics will be assessed for each FRO configuration. The FRO that results in the greatest reduction in knee flexion during the single stance phase will be selected as the subject’s optimal FRO. Subsequently, the effects of wearing this optimal FRO will be evaluated after 12–20 weeks. The primary study parameter will be walking energy cost, with the most important secondary outcomes being intensity of participation, daily activity, walking speed and gait biomechanics. Discussion The AFO-CP trial will be the first experimental study to evaluate the effect of individually optimised FROs on mobility and participation. The evaluation will include outcome measures at all levels of the International Classification of Functioning, Disability and Health, providing a unique set of data with which to assess relationships between outcome measures. This will give insights into working mechanisms of FROs and will help to identify predictors of treatment success, both of which will contribute to improving FRO treatment in SCP in term. Trial registration This study is registered in the Dutch Trial Register as NTR3418.
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Affiliation(s)
- Yvette L Kerkum
- Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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van den Noort JC, Ferrari A, Cutti AG, Becher JG, Harlaar J. Gait analysis in children with cerebral palsy via inertial and magnetic sensors. Med Biol Eng Comput 2012; 51:377-86. [PMID: 23224902 DOI: 10.1007/s11517-012-1006-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
3D kinematic measurements in children with cerebral palsy (CP) to assess gait deviations can only be performed in gait laboratories using optoelectronic systems. Alternatively, an inertial and magnetic measurement system (IMMS) can be applied for ambulatory motion-tracking. A protocol named Outwalk has recently been developed to measure the 3D kinematics during gait with IMMS. This study preliminary validated the application of IMMS, based on the Outwalk protocol, in gait analysis of six children with CP and one typically developing child. Reference joint kinematics were simultaneously obtained from a laboratory-based system and protocol. On average, the root mean square error (RMSE) of Outwalk/IMMS, compared to the reference, was less than 17° in the transversal plane, and less than 10° in the sagittal and frontal planes. The greatest differences were found in offsets in the knee and ankle rotation, and in the hip flexion. These offset differences were mainly caused by a different anatomical calibration in the protocols. When removing the offsets, RMSE was always less than 4°. Therefore, IMMS is suitable for gait analysis of major joint angles in a laboratory-free setting. Further studies should focus on improvement of anatomical calibrations of IMMS that can be performed in children with CP.
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Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands.
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van den Noort JC, van der Esch M, Steultjens MP, Dekker J, Schepers HM, Veltink PH, Harlaar J. The knee adduction moment measured with an instrumented force shoe in patients with knee osteoarthritis. J Biomech 2012; 45:281-8. [DOI: 10.1016/j.jbiomech.2011.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 10/14/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
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van der Esch M, Steultjens MPM, Harlaar J, van den Noort JC, Knol DL, Dekker J. Lateral Trunk Motion and Knee Pain in Osteoarthritis of the Knee: a cross-sectional study. BMC Musculoskelet Disord 2011; 12:141. [PMID: 21714891 PMCID: PMC3142539 DOI: 10.1186/1471-2474-12-141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 06/29/2011] [Indexed: 11/25/2022] Open
Abstract
Background Patients with osteoarthritis of the knee may change their gait in an attempt to reduce loading of the affected knee, thereby reducing pain. Especially changes in lateral trunk motion may be potentially effective, since these will affect the position of the centre of mass relative to the knee, enabling minimization of the load on the knee and thereby knee pain. The aim of the study was to test the hypothesis that a higher level of knee pain is associated with higher lateral trunk motion in patients with knee OA. Methods Fifty-two patients with OA of the knee were tested. Lateral trunk motion was measured during the stance phase of walking with an optoelectronic motion analysis system and a force plate. Knee pain was measured with the VAS and the WOMAC pain questionnaire. Regression analyses were performed to assess the relationship between lateral trunk motion and knee pain. Results It was shown that in bivariate analyses knee pain was not associated with lateral trunk motion. In regression analyses, pain was associated with more lateral trunk motion. In addition, more lateral trunk motion was associated with younger age, being female, higher self-reported knee stiffness and higher maximum walking speed. Conclusion Pain is associated with lateral trunk motion. This association is weak and is influenced by age, gender, self-reported stiffness and maximum walking speed.
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van den Noort JC, Scholtes VA, Becher JG, Harlaar J. Evaluation of the catch in spasticity assessment in children with cerebral palsy. Arch Phys Med Rehabil 2010; 91:615-23. [PMID: 20382296 DOI: 10.1016/j.apmr.2009.12.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether the catch in clinical spasticity assessment in cerebral palsy (CP) is the consequence of a sudden velocity-dependent increase in muscle activity, resulting from hyperexcitability of the stretch reflex in spasticity. DESIGN Cross-sectional study. SETTING A special school for children with physical disabilities. PARTICIPANTS Children with CP (N=20; age range, 5-14y; mean weight +/- SD, 35+/-14kg; mean length +/- SD, 139+/-19cm). INTERVENTIONS Spasticity assessment tests (using slow and fast passive stretch) were performed in the medial hamstrings, soleus, and medial gastrocnemius muscles of the children by 2 experienced examiners. MAIN OUTCOME MEASURES Surface electromyography (EMG) was recorded and joint motion was simultaneously measured using 2 inertial sensors. The encounter of a catch by the examiner was compared with the presence of a sudden increase in muscle activity ("burst"). The average rectified value (ARV) of the EMG signal was calculated for each test. RESULTS The study shows a sudden increase in muscle activity in fast passive stretch, followed by a catch (hamstrings 100%, soleus 95%, gastrocnemius 84%). The ARV in slow passive stretch was significantly lower. CONCLUSIONS The results confirm that in children with CP, an increase in muscle activity is primarily responsible for a catch in fast passive muscle stretch.
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Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, Vrije Universiteit University Medical Center, 1007 MB Amsterdam, The Netherlands.
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van den Noort JC, Scholtes VA, Harlaar J. Evaluation of clinical spasticity assessment in cerebral palsy using inertial sensors. Gait Posture 2009; 30:138-43. [PMID: 19525113 DOI: 10.1016/j.gaitpost.2009.05.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 04/28/2009] [Accepted: 05/18/2009] [Indexed: 02/02/2023]
Abstract
Spasticity is clinically assessed using goniometry to measure the joint angle of the catch (AOC) during fast passive muscle stretch. The precision and accuracy of the goniometric AOC measurements are questionable, because of the inevitable joint repositioning after occurrence of the catch. This study aims to evaluate the use of goniometry in estimating the AOC in spasticity assessment of the medial hamstrings, soleus and gastrocnemius in twenty children with Cerebral palsy (CP), using inertial sensors (IS) as reference system. The IS were initially validated with an optoelectronic system to measure 3d-orientation and proved to be accurate within 1 degree. To evaluate the precision and accuracy of the goniometry, the joint angle measured with the goniometer after repositioning was compared to the joint angle measured simultaneously with the IS, and to the true AOC, detected and measured with the IS during the fast muscle stretch. Results showed that goniometry is an imprecise method to measure the true AOC in spasticity assessment. The error is mainly due to joint repositioning after the fast muscle stretch. For spasticity assessment, it is advised to apply inertial sensors when a precise measurement of the angle of catch is required.
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Affiliation(s)
- Josien C van den Noort
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands.
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