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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Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.
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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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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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Falls are common after stroke. This article presents a literature review of the incidence and risk factors of falls and the consequences for professionals working with stroke patients. It is important to consider the specific problems after stroke. Depression and cognitive impairments were found to be risk factors for fall incidents after stroke. In the relevant literature many different risk factors and circumstances are described. When patients move from bed to chair, walk to the bathroom and the first few days after the patient is discharged to another setting, - all these circumstances showed high percentages of falling. A fall during hospital stay is a significant risk factor for future fall incidents. A reliable index to measure the fall risk is not (yet) available. But scores on the Barthel Index and the Timed-Up-and-Go test can be used as fall risk indicators. Fear of falling is an important complication after a fall and therefore it is recommended prior to discharge to inquire about the patients self efficacy in maintaining balance. Few intervention studies use the number of falls as an outcome measure. Exercising balance following a mass training protocol seems to diminish the risk of falling.
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De ontwikkeling van de Verpleegkundige Revalidatierichtlijn Beroerte heeft geresulteerd in uitwerking van elf themas met in totaal 210 aanbevelingen die verpleegkundigen kunnen gebruiken in de dagelijkse zorg van patiënten met een beroerte. Met een groot deel van deze aanbevelingen kunnen verpleegkundigen meteen aan de slag in de praktijk, maar voor een aantal aanbevelingen zou een verdere vertaalslag moeten plaatsvinden naar de praktijk. In totaal 71 aanbevelingen zijn van redelijk hoog niveau (A of B). Meer dan de helft van de aanbevelingen (138) is van lagere niveaus. Uiteraard is er behoefte aan verdere ontwikkeling van verschillende interventies en is verder onderzoek nodig naar effecten van deze interventies. Door middel van de Verpleegkundige Revalidatierichtlijn Beroerte kunnen verpleegkundigen effectiever en efficiënter handelen. Op deze wijze zet deze richtlijn een nieuwe standaard voor verpleegkundigen en mogelijkerwijze andere professionals die dagelijks zorgen voor patiënten met een beroerte.
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Uit de publicatie: "Dit artikel beschrijft het ontwikkelproces van een telemetriesysteem om de loopactiviteiten van mensen na een beroerte betrouwbaar te meten en hierover feedback te geven aan de patiënt en de fysiotherapeut op afstand. Het FESTA (FEedback to STimulate Activity)-systeem bestaat uit een accelerometer en een intelligent docking station. De patiënt moet overdag de accelerometer op de onderrug dragen en ’s avonds in het docking station plaatsen. Het docking station berekent uit de meetgegevens een aantal loopparameters en vergelijkt deze met het door de fysiotherapeut gestelde doel. De informatie wordt per e-mail naar de fysiotherapeut gestuurd en de patiënt ontvangt motiverende feedback op een display. De eerste reacties van de gebruikers op het prototype zijn positief, ook al valt er nog wel wat te verbeteren."
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Inaugurele rede uitgesproken bij de aanvaarding van het ambt van lector aan Hogeschool van Hall Larenstein, 16 juni 2023. Partners uit verschillende sectoren werken samen met het lectoraat Duurzame Paardenhouderij en Paardensport om bruggen te slaan tussen wetenschap, praktijk en diverse stakeholders. De focus ligt op het ontwikkelen van transitietrajecten naar een duurzame paardensector en het laten zien van de bijdrage die de sector kan leveren aan een duurzaam en diervriendelijk Nederland. Het lectoraat richt zich op drie onderzoekslijnen: - duurzame omgang met paarden - duurzaam ondernemen - een duurzame omgeving voor paard en mens Door de integrale benadering van kennisdeling en samenwerking met nationale en internationale kennispartners, praktijkorganisaties, ondernemers en paardensporters, streeft het lectoraat naar blijvende gedragsverandering en duurzame ontwikkeling. Het lectoraat sluit bovendien aan bij de transities van Hogeschool Van Hall Larenstein, waarbij onder andere de mogelijkheden voor biodiversiteit, natuurinclusie en klimaatadaptatie op paardenbedrijven worden verkend. Daarnaast worden nieuwe inzichten omtrent de welzijnsgerichte omgang met paarden toegepast, waarbij het paardenerf dienst kan doen als natuurlijke overgang tussen bebouwde omgeving en natuur, met positieve gevolgen voor biodiversiteit en (dieren)welzijn.
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