Background The gait modification strategies Trunk Lean and Medial Thrust have been shown to reduce the external knee adduction moment (EKAM) in patients with knee osteoarthritis which could contribute to reduced progression of the disease. Which strategy is most optimal differs between individuals, but the underlying mechanism that causes this remains unknown. Research question Which gait parameters determine the optimal gait modification strategy for individual patients with knee osteoarthritis? Methods Forty-seven participants with symptomatic medial knee osteoarthritis underwent 3-dimensional motion analysis during comfortable gait and with two gait modification strategies: Medial Thrust and Trunk Lean. Kinematic and kinetic variables were calculated. Participants were then categorized into one of the two subgroups, based on the modification strategy that reduced the EKAM the most for them. Multiple logistic regression analysis with backward elimination was used to investigate the predictive nature of dynamic parameters obtained during comfortable walking on the optimal modification gait strategy. Results For 68.1 % of the participants, Trunk Lean was the optimal strategy in reducing the EKAM. Baseline characteristics, kinematics and kinetics did not differ significantly between subgroups during comfortable walking. Changes to frontal trunk and tibia angles correlated significantly with EKAM reduction during the Trunk Lean and Medial Thrust strategies, respectively. Regression analysis showed that MT is likely optimal when the frontal tibia angle range of motion and peak knee flexion angle in early stance during comfortable walking are high (R2Nagelkerke = 0.12). Significance Our regression model based solely on kinematic parameters from comfortable walking contained characteristics of the frontal tibia angle and knee flexion angle. As the model explains only 12.3 % of variance, clinical application does not seem feasible. Direct assessment of kinetics seems to be the most optimal strategy for selecting the most optimal gait modification strategy for individual patients with knee osteoarthritis.
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Objective: To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics. Design: Thirty patients with symptomatic medial knee osteoarthritis underwent 3-dimensional gait analysis. Participants received verbal instructions on two gait strategies (Trunk Lean and Medial Thrust) in randomized order after comfortable walking was recorded. The peaks and impulse of the EKAM and strategy-specific kinematic and kinetic variables were calculated for all conditions. Results: Early stance EKAM peak was significantly reduced during Medial Thrust (29%). During Trunk Lean, early and late stance EKAM peak and EKAM impulse reduced significantly (38%, 21% and 25%, respectively). In 79% of the subjects, the Trunk Lean condition was significantly more effective in reducing EKAM peak than Medial Thrust. Peak ankle dorsi and plantar flexion, knee flexion and hip extension and adduction moments were not significantly increased. Conclusions: Medial Thrust and Trunk Lean reduced the EKAM during gait in patients with knee osteoarthritis. Individual selection of the most effective gait modification strategy seems vital to optimally reduce dynamic knee loading during gait. No detrimental effects on external ankle and hip moments or knee flexion moments were found for these conditions.
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Background: The progression of medial knee osteoarthritis seems closely related to a high external knee adduction moment, which could be reduced through gait retraining. We aimed to determine the retraining strategy that reduces this knee moment most effective during gait, and to determine if the same strategy is the most effective for everyone. Methods: Thirty-seven healthy participants underwent 3D gait analysis. After normalwalking was recorded, participants received verbal instructions on four gait strategies (Trunk Lean, Medial Thrust, Reduced Vertical Acceleration, Toe Out). Knee adduction moment and strategy-specific kinematics were calculated for all conditions. Findings: The overall knee adduction moment peak was reduced by Medial Thrust (−0.08 Nm/Bw·Ht) and Trunk Lean (−0.07 Nm/Bw·Ht), while impulse was reduced by 0.03 Nms/Bw·Ht in both conditions. Toeing out reduced late stance peak and impulse significantly but overall peakwas not affected. Reducing vertical acceleration at initial contact did not reduce the overall peak. Strategy-specific kinematics (trunk lean angle, knee adduction angle, first peak of the vertical ground reaction force, foot progression angle) showed that multiple parameters were affected by all conditions. Medial Thrust was the most effective strategy in 43% of the participants, while Trunk Lean reduced external knee adduction moment most in 49%. With similar kinematics, the reduction of the knee adduction moment peak and impulse was significantly different between these groups. Interpretation: Although Trunk Lean and Medial Thrust reduced the external knee adduction moment overall, individual selection of gait retraining strategy seems vital to optimally reduce dynamic knee load during gait.
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This review evaluates the reliability and validity of ultrasound to quantify muscles in older adults. The databases PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for studies. In 17 studies, the reliability (n = 13) and validity (n = 8) of ultrasound to quantify muscles in community-dwelling older adults (≥60 years) or a clinical population were evaluated. Four out of 13 reliability studies investigated both intra-rater and inter-rater reliability. Intraclass correlation coefficient (ICC) scores for reliability ranged from -0.26 to 1.00. The highest ICC scores were found for the vastus lateralis, rectus femoris, upper arm anterior, and the trunk (ICC = 0.72 to 1.000). All included validity studies found ICC scores ranging from 0.92 to 0.999. Two studies describing the validity of ultrasound to predict lean body mass showed good validity as compared with dual-energy X-ray absorptiometry (r(2) = 0.92 to 0.96). This systematic review shows that ultrasound is a reliable and valid tool for the assessment of muscle size in older adults. More high-quality research is required to confirm these findings in both clinical and healthy populations. Furthermore, ultrasound assessment of small muscles needs further evaluation. Ultrasound to predict lean body mass is feasible; however, future research is required to validate prediction equations in older adults with varying function and health.
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Lichamelijke zwakte is een belangrijk onderdeel van kwetsbaarheid en komt veel voor bij oudere volwassenen. Terwijl vrouwen een hogere prevalentie en een eerder begin van kwetsbaarheid kennen zijn sekseverschillen in de ontwikkeling van lichamelijke zwakte nauwelijks bestudeerd. Daarom hebben we in spieren de veranderingen onderzocht die onderscheid maken tussen fitte en zwakke ouderen voor elk geslacht afzonderlijk. Mannen (n = 28) en vrouwen (n = 26) van 75 jaar en ouder werden gegroepeerd op basis van hun fysieke prestatiecriteria. Er werd gebruik gemaakt van spierbiopten genomen uit de vastus lateralis-spier voor genexpressie- en histologisch onderzoek. Er werden paarsgewijze vergelijkingen gemaakt tussen de sterkste en de zwakste groepen voor elk geslacht afzonderlijk, en potentiële geslachts-specifieke effecten werden beoordeeld. Zwakke vrouwen toonden een hogere expressie van ontstekingsroutes, infiltratie van NOX2-immuuncellen, samen met een hogere VCAM1-expressie. Zwakke mannen werden gekenmerkt door een kleinere diameter van type 2 (snelle) spiervezels en lagere expressie van PRKN. Zwakte-geassocieerde genexpressie-veranderingen in de spieren waren verschillend van veroudering-geassocieerde genexpressie-veranderingen, wat erop wijst dat de pathofysiologie van fysieke zwakte niet noodzakelijkerwijs afhankelijk is van veroudering. We concluderen dat zwakte-geassocieerde veranderingen in de spieren sekse-specifiek zijn. Aanbevolen wordt om bij onderzoek naar kwetsbaarheid rekening te houden met sekseverschillen, omdat deze verschillen een grote impact kunnen hebben over de ontwikkeling van (farmaceutische) interventies tegen kwetsbaarheid.
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Achtergrond - De progressie van knieartrose lijkt gerelateerd te zijn aan een hoog extern knieadductiemoment (EKAM), dat gereduceerd kan worden door een aangepast gangpatroon. Doel - Ten eerste is onderzocht welke van vier loopstrategieën het EKAM maximaal verlaagt ten opzichte van comfortabel gaan. Vervolgens is vastgesteld of een maximale EKAM-verlaging altijd wordt gerealiseerd door dezelfde loopstrategie, en of dit kan worden verklaard op basis van de mate waarin de houdingsaanpassing plaatsvindt. Methode - Bij 37 gezonde proefpersonen werd een 3D-ganganalyse gedaan. Na het registreren van het normale gangpatroon werden vier loopstrategieën geïnstrueerd en geregistreerd (Trunk Lean [TL], Medial Thrust [MT], Reduced Vertical Acceleration [RVA] en Toe Out [TO]). Het EKAM en diverse strategiespecifieke kinematica werden berekend voor alle condities. Resultaten - Alle loopstrategieën reduceerden de algehele piek van het EKAM. Hierbij bleken TL en MT de EKAM-piek het meest te reduceren, respectievelijk -35% en -30%. Ook de EKAM-impuls was significant verlaagd door deze strategieën. TO reduceerde de EKAM-puls in de late standfase significant. Er waren duidelijke individuele verschillen zichtbaar. MT verlaagde het EKAM het meest in 43% van de deelnemers, terwijl bij 49% van de deelnemers TL tot de meeste reductie leidde. Hoewel de instructies in beide groepen leidden tot vergelijkbare aanpassing van de kinematica, was de reductie van het EKAM bij uitvoering van dezelfde strategie significant verschillend tussen deze twee groepen. Interpretatie - Hoewel TL en MT het meest effectief waren om het EKAM te reduceren, lijkt individuele selectie van de meest optimale loopstrategie essentieel.
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Within this study the aim is to measure running workload and relevant running technique key points on varying cadence in recreational runners using a custom build sensor system ‘Nodes’. Seven participants ran on a treadmill at a self-chosen comfortable speed. Cadence was randomly guided by a metronome using 92%, 96%, 100%, 104%, and 108% of the preferred cadence in 2-min trials. Workload was measured by collecting the heart rate and the rating of perceived exertion (RPE 1 to 10) scores. Heart rate data shows that the 100% cadence trial was most economical with a relative heart rate of 99.2%. The 108% cadence trial had the lowest relative RPE score with 96.2%. The sample rate of the Nodes system during this experiment was too low to analyze the key points. Three requirements are proposed for the further engineering of a wearable running system, (i) sampling frequency of minimal 50 Hz, (ii) step-by-step analysis, and (iii) collecting workload in the heart rate and RPE.
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Acne vulgaris is considered one of the most common medical skin conditions globally, affecting approximately 85% of individuals worldwide. While acne is most prevalent among adolescents between 15 to 24 years old, it is not uncommon in adults either. Acne addresses a number of different challenges, causing a multidimensional disease burden. These challenges include clinical sequelae, such as post inflammatory hyperpigmentation (PIH) and the chance of developing lifelong disfiguring scars, psychological aspects such as deficits in health related quality of life, chronicity of acne, economic factors, and treatment-related issues, such as antimicrobial resistance. The multidimensionality of the disease burden stipulates the importance of an effective and timely treatment in a well organised care system. Within the Netherlands, acne care provision is managed by several types of professional care givers, each approaching acne care from different angles: (I) general practitioners (GPs) who serve as ‘gatekeepers’ of healthcare within primary care; (II) dermatologists providing specialist medical care within secondary care; (III) dermal therapists, a non-physician medical professional with a bachelor’s degree, exclusively operating within the Australian and Dutch primary and secondary health care; and (IV) beauticians, mainly working within the cosmetology or wellness domain. However, despite the large variety in acne care services, many patients experience a delay between the onset of acne and receiving an effective treatment, or a prolonged use of care, which raises the question whether acne related care resources are being used in the most effective and (cost)efficient way. It is therefore necessary to gain insights into the organization and quality of Dutch acne health care beyond conventional guidelines and protocols. Exploring areas of care that may need improvement allow Dutch acne healthcare services to develop and improve the quality of acne care services in harmony with patient needs.
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Movement is an essential part of our lives. Throughout our lifetime, we acquire many different motor skills that are necessary to take care of ourselves (e.g., eating, dressing), to work (e.g., typing, using tools, care for others) and to pursue our hobbies (e.g., running, dancing, painting). However, as a consequence of aging, trauma or chronic disease, motor skills may deteriorate or become “lost”. Learning, relearning, and improving motor skills may then be essential to maintain or regain independence. There are many different ways in which the process of learning a motor skill can be shaped in practice. The conceptual basis for this thesis was the broad distinction between implicit and explicit forms of motor learning. Physiotherapists and occupational therapists are specialized to provide therapy that is tailored to facilitate the process of motor learning of patients with a wide range of pathologies. In addition to motor impairments, patients suffering from neurological disorders often also experience problems with cognition and communication. These problems may hinder the process of learning at a didactic level, and make motor learning especially challenging for those with neurological disorders. This thesis focused on the theory and application of motor learning during rehabilitation of patients with neurological disorders. The overall aim of this thesis was to provide therapists in neurological rehabilitation with knowledge and tools to support the justified and tailored use of motor learning in daily clinical practice. The thesis is divided into two parts. The aim of the first part (Chapters 2‐5) was to develop a theoretical basis to apply motor learning in clinical practice, using the implicit‐explicit distinction as a conceptual basis. Results of this first part were used to develop a framework for the application of motor learning within neurological rehabilitation (Chapter 6). Afterwards, in the second part, strategies identified in first part were tested for feasibility and potential effects in people with stroke (Chapters 7 and 8). Chapters 5-8 are non-final versions of an article published in final form in: Chapter 5: Kleynen M, Moser A, Haarsma FA, Beurskens AJ, Braun SM. Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study. Disabil Rehabil. 2017 Aug;39(17):1729-1737. doi: 10.1080/09638288.2016.1207111. Chapter 6: Kleynen M, Beurskens A, Olijve H, Kamphuis J, Braun S. Application of motor learning in neurorehabilitation: a framework for health-care professionals. Physiother Theory Pract. 2018 Jun 19:1-20. doi: 10.1080/09593985.2018.1483987 Chapter 7: Kleynen M, Wilson MR, Jie LJ, te Lintel Hekkert F, Goodwin VA, Braun SM. Exploring the utility of analogies in motor learning after stroke: a feasibility study. Int J Rehabil Res. 2014 Sep;37(3):277-80. doi: 10.1097/MRR.0000000000000058. Chapter 8: Kleynen M, Jie LJ, Theunissen K, Rasquin SM, Masters RS, Meijer K, Beurskens AJ, Braun SM. The immediate influence of implicit motor learning strategies on spatiotemporal gait parameters in stroke patients: a randomized within-subjects design. Clin Rehabil. 2019 Apr;33(4):619-630. doi: 10.1177/0269215518816359.
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