Ambreen Chohan

Children's Use of the Bearing Angle in Interceptive Actions

The authors investigated the effect of ball velocity and walking direction on childrens adherence to the constant bearing angle (CBA) strategy. Children (N = 20) approached a moving ball to manually intercept it at a predefined target area. Results revealed that 10- to 12-year-olds adhered more than 5- to 7-year-olds to the CBA strategy. Younger children deviated more than older children from smaller angles of approach and lower ball velocities. The present findings suggest that younger children have difficulty adjusting to task requirements because they fail to couple walking velocity with ball velocity. The improvement seen with increasing age suggests that compliance with the CBA strategy may be attributed to older childrens enhanced coincidence anticipation.

Biomechanical differences between experienced and inexperienced wheelchair users during sport

Background: During functional wheelchair movement there are several types of stroke pattern that a manual wheelchair user (MWCU) can utilize in order to propel. Objectives: To examine the biomechanical differences between disabled (WCU) and able-bodied (NWCU) children whilst taking part in functional activities at the Cheetahs Wheelchair Sports Club. Study Design: A multiple measures cohort study. Methods: Eleven participants were divided into two groups; WCU (n = 7) and NWCU (n = 4). All subjects were asked to perform three functional tasks; 30-second agility test, 1-minute distance test and a 10-metre sprint test. Upper body kinematics were recoded using a XSens MVN BIOMECH motion capture suit. Results: NWCU outperformed the WCU in all of the tasks, however, no significant differences between the group’s results were found. Nevertheless, significant differences were found in the maximum shoulder flexion angle for both right and left with NWCU utilizing more flexion and near significant differences in the NWCU overall shoulder range for right and left. Conclusions: In order to increase function in young MWCU then more specific-based sessions should be implemented targeting the exploitation of large shoulder ranges during propulsion, consequently resulting in more efficient movement. Clinical relevance Employing a propulsion technique which uses larger ranges of shoulder motion and decreased pushrim frequency results in an optimal cost-effect balance without predisposing MWCU to overuse injuries.

Postural adjustments and bearing angle use in interceptive actions

The experiment investigates the effect of ball velocity and walking direction on the adherence to the bearing angle (BA) strategy in adults. Adult participants (N=12) approached a moving ball in order to manually intercept it at a predefined target area. Results revealed that during locomotion the BA strategy was implemented, but on reaching the point of interception, this strategy broke down and the BA strategy of the wrist compensated for the movement requirements relative to the ball velocity and approach angle. Larger deviations from the BA occurred when the angle of approach was decreased and when the ball velocity increased. When the BA strategy was adhered to, postural adjustments were reduced. Increased movements occurred in a proximal–distal direction with an increasing approach angle and a faster ball velocity.

The effect of proprioceptive knee bracing on knee stability during three different sport related movement tasks in healthy subjects and the implications to the management of Anterior Cruciate Ligament (ACL) injuries.

INTRODUCTION Proprioceptive knee braces have been shown to improve knee mechanics, however much of the work to date has focused on tasks such as slow step down tasks rather than more dynamic sporting tasks. OBJECTIVE This study aimed to explore if such improvements in stability may be seen during faster sports specific tasks as well as slower tasks. METHOD Twelve subjects performed a slow step down, single leg drop jump and pivot turn jump with and without a silicone web brace. 3D kinematics of the knee were collected using a ten camera Qualisys motion analysis system. Reflective markers were placed on the foot, shank, thigh and pelvis using the Calibrated Anatomical Systems Technique. A two way ANOVA with repeated measures was performed with post-hoc pairwise comparison to explore the differences between the two conditions and three tasks. RESULTS Significant differences were seen in the knee joint angles and angular velocities in the sagittal, coronal and transverse planes between the tasks. The brace showed a reduction in knee valgum and internal rotation across all tasks, with the most notable effect during the single leg drop jump and pivot turn jump. The transverse plane also showed a significant reduction in the external rotation knee angular velocity when wearing the brace. DISCUSSION The brace influenced the knee joint kinematics in coronal and transverse planes which confirms that such braces can have a significant effect on knee control during dynamic tasks. Further studies are required exploring the efficacy of proprioceptive braces in athletic patient cohort.

Do people who consciously attend to their movements have more self-reported knee pain? An exploratory cross-sectional study:

Objectives: This study explored the relationship between propensity for conscious control of movement (assessed by the Movement-Specific Reinvestment Scale) and self-reported knee pain. Design: Cross-sectional study. Setting: General population. Subjects: Adults aged 18 to 55 years of age. Measures: Participants completed the movement-specific reinvestment scale and a self-report questionnaire on knee pain at the same time on one occasion. Results: Data was collected on 101 adults of whom 34 (33.7%) self-reported knee pain. Mean scores on the conscious motor processing subscale of the movement-specific reinvestment scale, but not the movement self-consciousness subscale, were significantly higher for participants who reported knee pain within the previous year compared with those who did not (mean difference 3.03; t-test 2.66, df = 97, P = 0.009; 95% confidence interval (CI) 0.77 to 5.30). The association between self-reported knee pain and propensity for conscious motor processing was still observed, even after controlling for movement self-consciousness subscale scores, age, gender and body mass index (adjusted odds ratio 1.16, 95% CI 1.04 to 1.30). Conclusions: Propensity for conscious control of movement may play a role in knee pain.

Do orthotic walkers affect knee and hip function during gait

Background and Aim: Much previous research on orthotic walkers has focussed on their ability to offload structures in the foot and ankle; however, little is known about their effects on lower limb mechanics. This study aimed to determine effects of two orthotic walkers on the biomechanics of the knee and hip joints compared to standardised footwear. Technique: A total of 10 healthy participants walked under three conditions: Walker A (Össur, Iceland), Walker B (DJO Global, USA) and standardised footwear (Hotter, UK). Kinematic and kinetic data were collected using a Qualisys motion analysis system (Qualisys Medical AB, Sweden) and force plates (AMTI, Boston, MA, USA). Significant differences were seen in hip kinematics and knee moments between walkers and standardised footwear and in knee kinematics between Walker A and standardised footwear. Discussion: Both walkers show significant kinematic and kinetic differences compared with standardised footwear; however, Walker A appeared to produce greater deviation, including potentially damaging greater hyperextension moments at the knee. Clinical relevance Further research is needed into the effects of orthotic walkers on knee and hip joint mechanics, which should help to inform future designs of walker, with greater focus on obtaining a more normal gait pattern.

Can the use of Proprioceptive Knee Braces have Implications in the Management of Osteoarthritic Knees: An exploratory study?

Background: Use of proprioceptive knee braces to control symptomology by altering neuromuscular control mechanisms has been shown in patellofemoral pain. Although their potential in patients with knee osteoarthritis is vast, little research has examined their efficacy. Objectives: This study examines the effect of a proprioceptive knee brace on lower limb kinematics and kinetics in healthy participants and in participants with OA. Methods: Thirteen healthy participants were asked to perform a 10-cm step-down task with and without a proprioceptive brace. Data were collected using a 10-camera Qualisys system. Individuals with osteoarthritis completed the Knee injury and Osteoarthritis Outcome Score before and after 4 weeks of intervention. Results: During step-down reductions in knee maximum internal rotation, transverse range of movement, transverse plane angular velocity and maximum internal rotation angular velocity was seen. Ankle plantar flexion and inversion angular velocity decreased while inversion and maximum supination angular velocity increased. Improvements in Knee injury and Osteoarthritis Outcome Score were noted across all parameters with brace use. Conclusion: Positive changes in kinematic variables in multiple planes can be achieved with proprioceptive bracing alongside improved patient outcome. These changes occur at the knee but analysis of other weight bearing joints should not be overlooked in future studies. This study supports the concept of neuromuscular reinforcement and re-education through proprioceptive bracing and its application in the management in knee osteoarthritis. Clinical relevance Proprioception can alter symptoms and biomechanics embraced and adjacent lower limb joints. The results of this study highlights the potential uses of non-mechanical bracing in the treatment of osteoarthritis and other potential to bridge the osteoarthritis treatment gap. Furthermore, large-scale research is needed to match disease subset to brace type.

Determination of Ankle and Metatarsophalangeal Stiffness During Walking and Jogging

Forefoot stiffness has been shown to influence joint biomechanics. However, little or no data exist on metatarsophalangeal stiffness. Twenty-four healthy rearfoot strike runners were recruited from a staff and student population at the University of Central Lancashire. Five repetitions of shod, self-selected speed level walking, and jogging were performed. Kinetic and kinematic data were collected using retroreflective markers placed on the lower limb and foot to create a 3-segment foot model using the calibrated anatomical system technique. Ankle and metatarsophalangeal moments and angles were calculated. Stiffness values were calculated using a linear best fit line of moment versus of angle plots. Paired t tests were used to compare values between walking and jogging conditions. Significant differences were seen in ankle range of motion, but not in metatarsophalangeal range of motion. Maximum moments were significantly greater in the ankle during jogging, but these were not significantly different at the metatarsophalangeal joint. Average ankle joint stiffness exhibited significantly lower stiffness when walking compared with jogging. However, the metatarsophalangeal joint exhibited significantly greater stiffness when walking compared with jogging. A greater understanding of forefoot stiffness may inform the development of footwear, prosthetic feet, and orthotic devices, such as ankle foot orthoses for walking and sporting activities.

The relationship between vibratory perception and joint position sense testing at the knee

Background: Proprioception may be defined as a specialised sensory modality that gives information about joint position sense (JPS), kinaesthesia and vibratory perception. Vibratory Perception Threshold (VPT) testing has been suggested as an alternative means for assessing proprioception at the knee, as it is believed to travel through the same type of large afferent nerve fibres as JPS. Methods: This study examines the strength of relationship between vibration sense and JPS at the knee in healthy participants and determines the minimum number of trials required for each method to attain constant stable data. Stability was determined by 3 consecutive cumulative standard deviations varying less than 5%. Twenty healthy adults (11 females, 9 males) were tested for VPT at five lower limb positions and JPS at two angles of knee flexion (20° and 60°) using Active Angle Reproduction (AAR). Results: Results showed no significant correlations between VPT and JPS, suggesting the two modalities measure different facets of proprioception. VPT (at all 5 sites) and AAR 20° required 4 repetitions to attain data stability, whereas AAR 60° required five repetitions. There were significant differences (p<0.005) between the five sites tested for VPT with increasing thresholds at more proximal sites. No significant differences were seen between the two angles tested for JPS. Conclusions: The two testing modalities are not interchangeable when testing proprioception, requiring at least 4 repetitions to attain consistent stable data. These findings have implications for clinicians and researchers, encouraging the use of broader proprioceptive assessments and increased repetitions.

Relationships between vibratory perception and joint position sense at the knee

Purpose: The purpose of this studywas to investigate disease specific and respiratory function measures that may influence physical activity levels and exercise capacity in people with Huntington’s disease. Relevance: Huntington’s disease (HD) is a neurodegenerative condition resulting in motor, cognitive and behavioural dysfunction. As with Parkinson’s disease and multiple sclerosis,physiotherapy management focuses on maintaining functional ability as long as possible. Ability to function and participate in activities of daily life will depend upon the pathophysiology of the condition as well as respiratory function. There is limited evidence concerning factors that influence physical activity levels and exercise capacity in people with HD. The results of this study will enable physiotherapists to use an evidence-based approach to the assessment and management of patients’ problems. Participants: Eighteen (7 female; mean (SD) age 51.2 (13.6) patients with HD were selected from a HD research and management clinic. Inclusion criteria were: symptomatic of HD;able to walk with or without assistance. Methods: A cross-sectional observational method was used. Descriptive data collected were: age; total functional capacity (TFC) from standardised questionnaire. Dependant variables measured were: physical activity level (MET-minutes/week)from International Physical Activity Questionnaire (IPAQ)short form; exercise capacity (meters) measured by six minute walk test (6 MWT). Independent variables measured were: Forced Vital Capacity in litres (FVC), a global measure of respiratory function measured following American Thoracic Society Guidelines; Unified Huntington’s Disease Rating Scale-Total Motor Score (UHDRS-TMS), a disease specific measure of motor function. Analysis: Data were analysed using Pearson’s correlations and where appropriate stepwise linear regression. Results: Descriptive data of all variables are as follows: mean (SD) TFC was 4.35 (2.4) (available range 0–14, higher scores indicate greater functional level); IPAQ median 328MET-minutes/week (low activity level); 6MWT mean (SD) was 191.95 meters (105.78); UHDRS-TMS mean (SD) 61.73 (12.02) (available range 0–120, higher scores indicating decreased motor function); FVC mean (SD) 2.19 L (1.00). FVC correlated with 6MWTand IPAQ (r = 0.44, 0.61 respectively); UHDRS correlated negatively with 6MWT and IPAQ (r =−0.63, r =−0.42 respectively). Linear regression results: UHDRS-TMS predicted 6MWT (R2 = 0.40, 6MWT= 536.1–5.6 (UHDRS-TMS), FVC was excluded; FVC predicted IPAQ (R2 = 0.37, IPAQ=−135.2 + 225.6 (FVC), UHDRS-TMS was excluded. Conclusions: In patients with HD, 6MWT is more influenced by UHDRS-TMS than respiratory function, however respiratory function predicted self-reported physical activity level. Slow gait due to motor function impairment may curtail 6MWTcompletion, while respiratory function may limit daily activities. Based on this study, it appears that the ability to function and participate in activities is multifactorial which requires consideration for physiotherapy management of people with neurodegenerative conditions. The results of this study are limited to patients who reported low activity levels and lowTFC scores; but are part of a larger study which will increase the power of the study. Implications: Ability to function and participate in activities is dependent on underlying disease process and respiratory function, and both elements should be considered when assessing and developing management strategies for people with neurodegenerative conditions.Purpose: To investigate the effects of three cueing devices (visual, auditory, and somatosensory) on movement and muscular control during gait initiation in people with Parkinson’s disease who experience freezing and to ascertain the acceptability of these cueing devices to novice users. Relevance: Over six million people worldwide are affected by Parkinson’s disease. It is estimated that thirty percent may experience freezing (an inability to produce effective steps) and have difficulty initiating gait, and maintaining gait whilst negotiating obstacles. This limits their capacity for physical activity and ability to participate in usual activities, and can result in social isolation. Various sensory cues have been shown to improve on-going gait in people with Parkinson’s Disease, but there is limited evidence on their effectiveness for people with gait initiation difficulties. Jiang and Norman (2006) found that transverse line visual cues improved gait initiation, while auditory cues had no effect. Dibble et al. (2004), using auditory and cutaneous cues during maximal speed gait initiation found an adverse effect on movement outcomes. Portable cueing devices are commercially available, however their influence in gait initiation and acceptability to users is currently unknown. InformaWPT2011, Research Report Abstracts eS773 tion on their effectiveness would enable physical therapists to provide better informed advice to potential purchasers. Participants: Twenty participants with idiopathic Parkinson’s disease and a history of freezing of gait (evaluated using item 14 of the Unified Parkinson’s Disease Rating Scale) were recruited; 14 males and 6 females, mean age 68 years and 11.5 years since diagnosis. Methods: An experimental trial of five randomised conditions: laser cane, sound metronome, vibrating metronome, walking stick and uncued. After using each cue participants’ opinions were obtained via a questionnaire. Motion data were collected using a 10 camera motion analysis system, force platforms and surface Electromyography. Analysis: Questionnaire responses from twelve participants who experienced freezing during testing were analysed using a Wilcoxon signed ranks test. Motion data from these participants were analysed using one-way ANOVA tests with post-hoc pair-wise comparisons to test for differences between conditions. Results: Significant differences were seen in step length, Centre of Mass and Centre of Pressure movement in the anterior/ posterior and medial/lateral directions between freezing and non-freezing episodes. The post hoc pair-wise comparisons showed significant improvements in the Centre of Mass and Centre of Pressure movement when using the laser cane and the walking stick and greater step length when using the laser cane. Participants rated the perceived effectiveness of the devices, theWilcoxon test showed a significant improvement in satisfaction when using the laser cane for both starting and maintaining walking (p < 0.05). Conclusions: The laser cane was overall the most effective cueing device for people with Parkinson’s disease and gait initiation difficulties in both user’s perception and efficacy tested in the gait laboratory. However the longer term effectiveness and acceptability of cueing devices at home and outdoors requires further investigation. Implications: This study would support the use of the laser cane as a relatively cheap intervention for people with Parkinson’s disease who experience spontaneous freezing.Purpose: This study investigated the effect of an elasticated tubular bandage and neutral patella taping on the threedimensional mechanics of the knee during slow step descent in a group of subjects suffering from Patellofemoral Pain Syndrome (PFPS). Relevance: A number of studies have demonstrated that subjects with patellofemoral pain syndrome have poor eccentric control at the knee. Most previous studies have focused on the use of taping, braces or neoprene knee sleeves; this is the first study to investigate the effect of the low cost alternative of an elasticated tubular bandage on eccentric control during step descent in a PFPS population. Participants: Ten subjects (4 men:6 women) with a diagnosis of patellofemoral pain syndrome referred to a Primary Care Musculoskeletal physiotherapy service (NHS Central Lancashire) for treatment were recruited (Mean: age = 28; Modified Functional Index Questionnaire score = 26; Visual Analogue Scale for Usual Pain in the past week = 29 mm). Inclusion criteria were; presence of traumatic or idiopathic peripatellar pain and pain provoked by deep squatting, kneeling, ascending or descending stairs; alone or in combination. Exclusion criteria; any history of knee surgery. Methods: Slow step descent was used to assess the control of the knee under three randomised conditions: (a) no intervention, (b) elasticated tubular bandage, and (c) neutral patella taping. Kinematic and kinetic data were collected using a ten camera Oqus (Qualisys) motion analysis system and two AMTI force platforms. The segments of the lower limbs were modelled in six-degrees of freedom and joint kinematics and moments were calculated at the knee. Post testing, subjects were asked to rank the test conditions in order of preference. Analysis: A repeated measures (RM) ANOVA was performed together with post hoc pairwise comparison for the coronal and transverse plane knee angles and moments about the knee, comparing the three randomised conditions. A further RMANOVA was conducted to investigate differences in the sagittal plane knee angular velocity in order to confirm that observed differences were not artefacts of descent velocity. Significance was set to P≤0.05. Results: The coronal plane knee range of motion was significantly reduced with taping (P = 0.032) and the tubular bandage (P = 0.006). No significant differences were seen in any other plane or for knee angular velocity or moments. Subjects ranking preference of the test conditionswas evenly split between the two interventions: neutral patella taping (N=5) and elasticated tubular bandage (N= 4); only one subject stated they would prefer to have nothing on their knee. Conclusions: The use of an elasticated tubular bandage and a neutral patella taping technique actually produced a measurable change in the control mechanism of the knee and resulted in subjects with PFPS demonstrating greater knee control and less pain during a step descent when compared to no intervention. The tubular bandage had the greatest mechanical effect, reducing movement in the coronal plane by 30% when compared to no intervention. Implications: An elasticated tubular bandage and neutral patellar taping may represent low cost, convenient interventions in the management of mild Patellofemoral Pain Syndrome.Purpose: Patients with juvenile idiopathic arthritis (JIA) are less physically active than healthy peers. Therefore we developed an internet-based intervention to improve physical activity (PA). The aim of the study was to examine the effectiveness of the program in improving PA. Relevance: Evidence is accumulating that PA is effective in the primary and secondary prevention of several chronic conditions. PA is also associated with a reduction in all-cause mortality. There is evidence that in youth aged 6-16 years, PA controls body weight, reduces blood pressure in hypertensive youth, improves aerobic capacity, muscular strength, endurance and skeletal health, reduces anxiety and depression and improves self concept. PA also has a positive effect on academic performance, concentration, memory and classroom behavior. For children with JIA and other chronic diseases it is recognized that they could take advantage of the same health benefits. Participants: All patients with JIA, registered in the University Medical Center Groningen, the Netherlands and aged 8-12 years, were selected for this study. Inclusion criteria were a diagnosis of JIA, a good comprehension of the Dutch language and the availability of a home-based computer with an internet connection. Methods: PA was determined by activity-related energy expenditure (AEE), PA level, time spent on moderate to vigorous PA and the number of days with 1 hour or more of moderate to vigorous PAand was assessed with a 7-day activity diary. Aerobic exercise capacity was assessed by means of a Bruce treadmill test and recorded as maximum endurance time. Disease activity was assessed by using the JIA core set. Adherence was electronically monitored. Analysis: Descriptive statistics were used for patients characteristics. The Kolmogorov-Smirnov test was used to test variables for normality of distribution. Paired samples t-test was used for within group differences. Results: Out of 59 patients 33 eligible patients were included and randomized in an intervention (n = 17, mean±SD age 10.6±1.5 years) and control waiting list group (n = 16, mean±SD age 10.8±1.4 years). All patients completed baseline and t = 1 testing. PA significantly improved in both groups. Maximum endurance time significantly improved in the intervention but not in the control group. In a subgroup analysis for patients with low PA (intervention n = 7 and control n = 5), PA improved in the intervention but not in the control group. The intervention was safe, feasible and showed a good adherence. Conclusions: An internet-based program for children with JIA, aged 8-12 years, directed at promoting PA in daily life, effectively improves PA in those patients with low PA levels. It can also improve endurance while it is safe, feasible and has a good adherence. Implications: PA in JIA can be improved through internet based interventions. Similar programs can be developed for other chronic conditions.Purpose: The specific objectives were to: 1) describe the level of pain intensity, disability, activity limitation, kinesiophobia and physical capacity in patients with predominantly peripherally m ...