Egbert Otten

Abnormal landing strategies after ACL reconstruction

The objective was to analyze muscle activity and movement patterns during landing of a single leg hop for distance after anterior cruciate ligament (ACL) reconstruction. Nine (six males, three females) ACL‐reconstructed patients 6 months after surgery and 11 (eight males, three females) healthy control subjects performed the hop task. Electromyographic signals from lower limb muscles were analyzed to determine onset time before landing. Biomechanical data were collected using an Optotrak Motion Analysis System and force plate. Matlab was used to calculate kinetics and joint kinematics. Side‐to‐side differences in ACL‐reconstructed patients and healthy subjects as well as differences between the patients and control group were analyzed. In ACL‐reconstructed limbs, significantly earlier onset times were found for all muscles, except vastus medialis, compared with the uninvolved side. The involved limbs had significantly reduced knee flexion during the take‐off and increased plantarflexion at initial contact. The knee extension moment was significantly lower in the involved limb. In the control group, significantly earlier onset times were found for the semitendinosus, vastus lateralis and medial gastrocnemius of the non‐dominant side compared with the dominant side. Muscle onset times are earlier and movement patterns are altered in the involved limb 6 months after ACL reconstruction.

The development of postural adjustments during reaching in 6-to 18-month-old infants - Evidence for two transitions

Abstract The present study focused on the developmental changes of postural adjustments accompanying reaching movements in healthy infants. We made a longitudinal study of ten infants between 6 and 18 months of age. During each session multiple surface electromyograms of arm, neck, trunk and leg muscles at the right side of the body were recorded during right-handed reaching movements in two positions (”upright sitting” in an infant chair and ”long-leg” sitting without support). Simultaneously the whole session was recorded on video. Comparable data were present from the same infants at 3–5 months. Additionally, 18 infants (8–15 months) were assessed once during similar reaching tasks, but in these infants electromyographic activity of the trunk and neck muscles at both sides of the body were recorded. Our data revealed two transitions in the development of postural adjustments. The first transition was present around 6 months of age. At this age the postural muscles were infrequently activated during reaching movements. At 8 months ample postural activity reappeared and the infants developed the ability to adapt the postural adjustments to task-specific constraints such as arm movement velocity or the sitting position at the onset of the reaching movement. The second transition occurred between 12 and 15 months. Before 15 months the infants did not show consistent anticipatory postural activity, but from 15 months onwards they did, particularly in the neck muscles.

Balance control on a moving platform in unilateral lower limb amputees

OBJECTIVE To study balance control on a moving platform in lower limb amputees. DESIGN Observational cohort study. PARTICIPANTS Unilateral transfemoral and transtibial amputees and able-bodied control subjects. INTERVENTIONS Balance control on a platform that moved in the anteroposterior direction was tested with eyes open, blindfolded and while performing a dual task. MAIN OUTCOME MEASURES Weight bearing symmetry, anteroposterior ground reaction force and centre of pressure shift. RESULTS Compared to able-bodied subjects, in amputees the anteroposterior ground reaction force was larger in the prosthetic and non-affected limb, and the centre of pressure displacement was increased in the non-affected limb and decreased in the prosthetic limb. In amputees body weight was loaded more on the non-affected limb. Blindfolding or adding a dual task did not influence the outcome measures importantly. CONCLUSION The results of this study indicate that experienced unilateral amputees with a high activity level compensate for the loss of ankle strategy by increasing movements and loading in the non-affected limb. The ability to cope with balance perturbations is limited in the prosthetic limb. To enable amputees to manage all possible balance disturbances in real life in a safe manner, we recommend to improve muscle strength and control in the non-affected limb and to train complex balance tasks in challenging environments during rehabilitation.

Uphill and downhill walking in unilateral lower limb amputees

OBJECTIVE To study adjustment strategies in unilateral amputees in uphill and downhill walking. DESIGN Observational cohort study. SUBJECTS Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects. METHODS In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured. RESULTS In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body. CONCLUSION Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability.

Aging causes a reorganization of cortical and spinal control of posture

Classical studies in animal preparations suggest a strong role for spinal control of posture. In humans it is now established that the cerebral cortex contributes to postural control of unperturbed and perturbed standing. The age-related degeneration and accompanying functional changes in the brain, reported so far mainly in conjunction with simple manual motor tasks, may also affect the mechanisms that control complex motor tasks involving posture. This review outlines the age-related structural and functional changes at spinal and cortical levels and provides a mechanistic analysis of how such changes may be linked to the behaviorally manifest postural deficits in old adults. The emerging picture is that the age-related reorganization in motor control during voluntary tasks, characterized by differential modulation of spinal reflexes, greater cortical activation and cortical disinhibition, is also present during postural tasks. We discuss the possibility that this reorganization underlies the increased coactivation and dual task interference reported in elderly. Finally, we propose a model for future studies to unravel the structure-function-behavior relations in postural control and aging.

Proprioceptive deficits after ACL injury: are they clinically relevant?

Objective To establish the clinical relevance of proprioceptive deficits reported after anterior cruciate ligament (ACL) injury. Material and methods A literature search was done in electronic databases from January 1990 to June 2009. Inclusion criteria for studies were ACL deficient (ACL-D) and ACL reconstruction (ACL-R) articles written in English, Dutch or German and calculation of correlation(s) between proprioception tests and clinical outcome measures. Clinical outcome measures were muscle strength, laxity, hop test, balance, patient-reported outcome, objective knee score rating, patient satisfaction or return to sports. Studies included in the review were assessed on their methodological quality. Results In total 1161 studies were identified of which 24 met the inclusion criteria. Pooling of all data was not possible due to substantial differences in measurement techniques and data analysis. Most studies failed to perform reliability measurements of the test device used. In general, the correlation between proprioception and laxity, balance, hop tests and patient outcome was low. Four studies reported a moderate correlation between proprioception, strength, balance or hop test. Conclusion There is limited evidence that proprioceptive deficits as detected by commonly used tests adversely affect function in ACL-D and ACL-R patients. Development of new tests to determine the relevant role of the sensorimotor system is needed. These tests should ideally be used as screening tests for primary and secondary prevention of ACL injury.

A three-dimensional study of loads across the fracture for different fracture sites of the mandible

The loads across the fracture depend on variables such as position of the fracture and the bite point. Up to now, no study has described systematically the influence of these two variables on these loads. The aim of this study was to describe and compare value and direction of the loads across the fracture for different positions of fractures in the mandible. In a three-dimensional model, bending and torsion moments and shear forces were compared for five mandibular fractures. The fractures were located in, respectively, the angle, posterior body, anterior body, canine and symphysis region. Positive bending moments were defined to give compression at the border, negative bending moments to give compression at the alveolar side of the mandible. The angle and posterior body fracture have high positive bending moments, small torsion moments and high shear forces. The anterior body, canine and symphysis fracture have high negative bending moments and high torsion moments with similar maximum values. The number of bite points with negative bending moments were different for all fractures. These bite points were always located on the fractured side. It is concluded that mandibular fractures can be divided roughly into two groups with similar load patterns across the fracture. One group consists of angle and posterior body fractures, the other group consists of anterior body, canine and symphysis fractures.

Three-dimensional visualization of the temporomandibular joint: A computerized multisectional autopsy study of disc position and configuration

To demonstrate disc position and disc configuration of the temporomandibular joint, three-dimensional multisectional computer reconstructions were made of 20 autopsy specimens (11 female, 9 male; mean age, 40.4 years). The presence of a distinct occlusion was the only criterion for selection. Normal disc position was found in 13 joints, partial anterior disc position was found in 5 joints, and complete anterior disc position was seen in 2 joints. Fifteen joints had biconcave disc configuration and 5 joints had deformed discs. Considering the high incidence of disc position deviating from the normal superior position, it is suggested that in some cases a so-called abnormal disc position can be regarded as within the limits of anatomic and physiological variability.

ACL injury prevention, more effective with a different way of motor learning?

PurposeWhat happens to the transference of learning proper jump-landing technique in isolation when an individual is expected to perform at a competitive level yet tries to maintain proper jump-landing technique? This is the key question for researchers, physical therapists, athletic trainers and coaches involved in ACL injury prevention in athletes. The need for ACL injury prevention is clear, however, in spite of these ongoing initiatives and reported early successes, ACL injury rates and the associated gender disparity have not diminished. One problem could be the difficulties with the measurements of injury rates and the difficulties with the implementation of thorough large scale injury prevention programs. A second issue could be the transition from conscious awareness during training sessions on technique in the laboratory to unexpected and automatic movements during a training or game involves complicated motor control adaptations. The purpose of this paper is to highlight the issue of motor learning in relation to ACL injury prevention and to post suggestions for future research.ConclusionACL injury prevention programs addressing explicit rules regarding desired landing positions by emphasizing proper alignment of the hip, knee, and ankle are reported in the literature. This may very well be a sensible way, but the use of explicit strategies may be less suitable for the acquisition of the control of complex motor skills (Maxwell et al. J Sports Sci 18:111–120, 2000). Sufficient literature on motor learning and it variations point in that direction.

Postural challenge affects motor cortical activity in young and old adults

When humans voluntarily activate a muscle, intracortical inhibition decreases. Such a decrease also occurs in the presence of a postural challenge and more so with increasing age. Here, we examined age-related changes in motor cortical activity during postural and non-postural contractions with varying levels of postural challenge. Fourteen young (age 22) and twelve old adults (age 70) performed three conditions: (1) voluntary contraction of the soleus muscle in sitting and (2) leaning forward while standing with and (3) without being supported. Subthreshold transcranial magnetic stimulation was applied to the soleus motor area suppressing ongoing EMG, as an index of motor cortical activity. The area of EMG suppression was ~60% smaller (p<0.05) in unsupported vs. supported leaning and sitting, with no difference between these latter two conditions (p>0.05). Even though in absolute terms young compared with old adults leaned farther (p=0.018), there was no age effect or an age by condition interaction in EMG suppression. Leaning closer to the maximum without support correlated with less EMG suppression (rho=-0.44, p=0.034). We conclude that the critical factor in modulating motor cortical activity was postural challenge and not contraction aim or posture. Age did not affect the motor control strategy as quantified by the modulation of motor cortical activity, but the modulation appeared at a lower task difficulty with increasing age.