Jaap H. van Dieën

Effects of age on force steadiness: A literature review and meta-analysis

The variability of force is indicative of the biological variability inherent in the human motor system. Previous literature showed inconsistent findings of the effect of age on the variability of force and hence a systematic review was performed. Twenty studies were included in this systematic review, of which twelve provided sufficient data to determine effect sizes for the effect of age. After determining the pooled effect size, the effect of sample size on dichotomized effect sizes (significant vs. non-significant) was determined. Also, the effect of possible determinants, age difference between age groups, dominance of investigated limb, muscle group, muscle location (proximal vs. distal and upper vs. lower extremity) and target force level on effect size (categorized as small, medium, or large) were investigated. A large pooled effect size of age was found (rtotal=0.67, 95% CI [0.61; 0.72]). No relation between sample size and effect size significance was found, indicative of no lack of power in the studies reviewed. No relations were found of associations between age difference, upper vs. lower extremity muscle location, and dominance and effect size. Significant relations of effect size with muscle group, proximal vs. distal muscle location and target force level were found. Also, an interaction effect of muscle group and target force level was suggested. The meta-analysis results are in line with motor unit loss as the main cause of the effect of ageing on force steadiness and this effect can partially explain decreased motor performance associated with ageing.

Algorithm for Turning Detection and Analysis Validated under Home-Like Conditions in Patients with Parkinson’s Disease and Older Adults using a 6 Degree-of-Freedom Inertial Measurement Unit at the Lower Back

Introduction Aging and age-associated disorders such as Parkinson’s disease (PD) are often associated with turning difficulties, which can lead to falls and fractures. Valid assessment of turning and turning deficits specifically in non-standardized environments may foster specific treatment and prevention of consequences. Methods Relative orientation, obtained from 3D-accelerometer and 3D-gyroscope data of a sensor worn at the lower back, was used to develop an algorithm for turning detection and qualitative analysis in PD patients and controls in non-standardized environments. The algorithm was validated with a total of 2,304 turns ≥90° extracted from an independent dataset of 20 PD patients during medication ON- and OFF-conditions and 13 older adults. Video observation by two independent clinical observers served as gold standard. Results In PD patients under medication OFF, the algorithm detected turns with a sensitivity of 0.92, a specificity of 0.89, and an accuracy of 0.92. During medication ON, values were 0.92, 0.78, and 0.83. In older adults, the algorithm reached validation values of 0.94, 0.89, and 0.92. Turning magnitude (difference, 0.06°; SEM, 0.14°) and duration (difference, 0.004 s; SEM, 0.005 s) yielded high correlation values with gold standard. Overall accuracy for direction of turning was 0.995. Intra class correlation of the clinical observers was 0.92. Conclusion This wearable sensor- and relative orientation-based algorithm yields very high agreement with clinical observation for the detection and evaluation of ≥90° turns under non-standardized conditions in PD patients and older adults. It can be suggested for the assessment of turning in daily life.

Low-Back Pain Patients Learn to Adapt Motor Behavior With Adverse Secondary Consequences

We hypothesize that changes in motor behavior in individuals with low-back pain are adaptations aimed at minimizing the real or perceived risk of further pain. Through reinforcement learning, pain and subsequent adaptations result in less dynamic motor behavior, leading to increased loading and impoverished sensory feedback, which contribute to cortical reorganization and proprioceptive impairments that reduce the ability to control lumbar movement in a robust manner.

Improved prediction of falls in community-dwelling older adults through phase-dependent entropy of daily-life walking

Age and age-related diseases have been suggested to decrease entropy of human gait kinematics, which is thought to make older adults more susceptible to falls. In this study we introduce a new entropy measure, called phase-dependent generalized multiscale entropy (PGME), and test whether this measure improves fall-risk prediction in community-dwelling older adults. PGME can assess phase-dependent changes in the stability of gait dynamics that result from kinematic changes in events such as heel strike and toe-off. PGME was assessed for trunk acceleration of 30 s walking epochs in a re-analysis of 1 week of daily-life activity data from the FARAO study, originally described by van Schooten et al. (2016). The re-analyzed data set contained inertial sensor data from 52 single- and 46 multiple-time prospective fallers in a 6 months follow-up period, and an equal number of non-falling controls matched by age, weight, height, gender, and the use of walking aids. The predictive ability of PGME for falls was assessed using a partial least squares regression. PGME had a superior predictive ability of falls among single-time prospective fallers when compared to the other gait features. The single-time fallers had a higher PGME (p < 0.0001) of their trunk acceleration at 60% of their step cycle when compared with non-fallers. No significant differences were found between PGME of multiple-time fallers and non-fallers, but PGME was found to improve the prediction model of multiple-time fallers when combined with other gait features. These findings suggest that taking into account phase-dependent changes in the stability of the gait dynamics has additional value for predicting falls in older people, especially for single-time prospective fallers.

Fractional Stability of Trunk Acceleration Dynamics of Daily-Life Walking: Toward a Unified Concept of Gait Stability

Over the last decades, various measures have been introduced to assess stability during walking. All of these measures assume that gait stability may be equated with exponential stability, where dynamic stability is quantified by a Floquet multiplier or Lyapunov exponent. These specific constructs of dynamic stability assume that the gait dynamics are time independent and without phase transitions. In this case the temporal change in distance, d(t), between neighboring trajectories in state space is assumed to be an exponential function of time. However, results from walking models and empirical studies show that the assumptions of exponential stability break down in the vicinity of phase transitions that are present in each step cycle. Here we apply a general non-exponential construct of gait stability, called fractional stability, which can define dynamic stability in the presence of phase transitions. Fractional stability employs the fractional indices, α and β, of differential operator which allow modeling of singularities in d(t) that cannot be captured by exponential stability. The fractional stability provided an improved fit of d(t) compared to exponential stability when applied to trunk accelerations during daily-life walking in community-dwelling older adults. Moreover, using multivariate empirical mode decomposition surrogates, we found that the singularities in d(t), which were well modeled by fractional stability, are created by phase-dependent modulation of gait. The new construct of fractional stability may represent a physiologically more valid concept of stability in vicinity of phase transitions and may thus pave the way for a more unified concept of gait stability.

A research framework for the development and implementation of interventions preventing work-related musculoskeletal disorders

Objectives Work-related musculoskeletal disorders (MSD) are highly prevalent and put a large burden on (working) society. Primary prevention of work-related MSD focuses often on physical risk factors (such as manual lifting and awkward postures) but has not been too successful in reducing the MSD burden. This may partly be caused by insufficient knowledge of etiological mechanisms and/or a lack of adequately feasible interventions (theory failure and program failure, respectively), possibly due to limited integration of research disciplines. A research framework could link research disciplines thereby strengthening the development and implementation of preventive interventions. Our objective was to define and describe such a framework for multi-disciplinary research on work-related MSD prevention. Methods We described a framework for MSD prevention research, partly based on frameworks from other research fields (ie, sports injury prevention and public health). Results The framework is composed of a repeated sequence of six steps comprising the assessment of (i) incidence and severity of MSD, (ii) risk factors for MSD, and (iii) underlying mechanisms; and the (iv) development, (v) evaluation, and (vi) implementation of preventive intervention(s). Conclusions In the present framework for optimal work-related MSD prevention, research disciplines are linked. This framework can thereby help to improve theories and strengthen the development and implementation of prevention strategies for work-related MSD.

On gait analysis estimation errors using force sensors on a smart rollator.

Gait analysis can provide valuable information on a person’s condition and rehabilitation progress. Gait is typically captured using external equipment and/or wearable sensors. These tests are largely constrained to specific controlled environments. In addition, gait analysis often requires experts for calibration, operation and/or to place sensors on volunteers. Alternatively, mobility support devices like rollators can be equipped with onboard sensors to monitor gait parameters, while users perform their Activities of Daily Living. Gait analysis in rollators may use odometry and force sensors in the handlebars. However, force based estimation of gait parameters is less accurate than traditional methods, especially when rollators are not properly used. This paper presents an evaluation of force based gait analysis using a smart rollator on different groups of users to determine when this methodology is applicable. In a second stage, the rollator is used in combination with two lab-based gait analysis systems to assess the rollator estimation error. Our results show that: (i) there is an inverse relation between the variance in the force difference between handlebars and support on the handlebars—related to the user condition—and the estimation error; and (ii) this error is lower than 10% when the variation in the force difference is above 7 N. This lower limit was exceeded by the 95.83% of our challenged volunteers. In conclusion, rollators are useful for gait characterization as long as users really need the device for ambulation.

Factors Contributing to Chronic Ankle Instability: A Systematic Review and Meta-Analysis of Systematic Reviews

BackgroundMany factors are thought to contribute to chronic ankle instability (CAI). Multiple systematic reviews have synthesised the available evidence to identify the primary contributing factors. However, readers are now faced with several systematic reviews that present conflicting findings.ObjectiveThe aim of this systematic review and meta-analysis was to establish the statistical significance and effect size of primary factors contributing to CAI and to identify likely reasons for inconsistencies in the literature.MethodsRelevant health databases were searched: CINAHL, MEDLINE, PubMed, Scopus and SPORTDiscus. Systematic reviews were included if they answered a focused research question, clearly defined the search strategy criteria and study selection/inclusion and completed a comprehensive search of the literature. Included reviews needed to be published in a peer-reviewed journal and needed to review observational studies of factors and/or characteristics of persons with CAI, with or without meta-analysis. There was no language restriction. Studies using a non-systematic review methodology (e.g. primary studies and narrative reviews) were excluded. Methodological quality of systematic reviews was assessed using the modified R-AMSTAR tool. Meta-analysis on included primary studies was performed.ResultsOnly 17% of primary studies measured a clearly defined CAI population. There is strong evidence to support the contribution of dynamic balance, peroneal reaction time and eversion strength deficits and moderate evidence for proprioception and static balance deficits to non-specific ankle instability.ConclusionsEvidence from previous systematic reviews does not accurately reflect the CAI population. For treatment of non-specific ankle instability, clinicians should focus on dynamic balance, reaction time and strength deficits; however, these findings may not be translated to the CAI population. Research should be updated with an adequately controlled CAI population.Systematic review registrationPROSPERO 2016, CRD42016032592.

Longitudinal and transversal displacements between triceps surae muscles during locomotion of the rat

ABSTRACT The functional consequences of differential muscle activation and contractile behavior between mechanically coupled synergists are still poorly understood. Even though synergistic muscles exert similar mechanical effects at the joint they span, differences in the anatomy, morphology and neural drive may lead to non-uniform contractile conditions. This study aimed to investigate the patterns of activation and contractile behavior of triceps surae muscles, to understand how these contribute to the relative displacement between the one-joint soleus (SO) and two-joint lateral gastrocnemius (LG) muscle bellies and their distal tendons during locomotion in the rat. In seven rats, muscle belly lengths and muscle activation during level and upslope trotting were measured by sonomicrometry crystals and electromyographic electrodes chronically implanted in the SO and LG. Length changes of muscle–tendon units (MTUs) and tendon fascicles were estimated based on joint kinematics and muscle belly lengths. Distances between implanted crystals were further used to assess longitudinal and transversal deformations of the intermuscular volume between the SO and LG. For both slope conditions, we observed differential timing of muscle activation as well as substantial differences in contraction speeds between muscle bellies (maximal relative speed 55.9 mm s−1). Muscle lengths and velocities did not differ significantly between level and upslope locomotion, only EMG amplitude of the LG was affected by slope. Relative displacements between SO and LG MTUs were found in both longitudinal and transversal directions, yielding an estimated maximal length change difference of 2.0 mm between their distal tendons. Such relative displacements may have implications for the force exchanged via intermuscular and intertendinous pathways. Summary: Differences in anatomy, morphology and neural drive between rat ankle plantar-flexors cause substantial intermuscular displacement during locomotion, which may affect mechanical interactions between muscle bellies and tendons.

Virtual reality balance training for elderly: Similar skiing games elicit different challenges in balance training

BACKGROUND Virtual Reality (VR) balance training may have advantages over regular exercise training in older adults. However, results so far are conflicting potentially due to the lack of challenge imposed by the movements in those games. Therefore, the aim of this study was to assess to which extent two similar skiing games challenge balance, as reflected in center of mass (COM) movements relative to their Functional Limits of Stability (FLOS). METHODS Thirty young and elderly participants performed two skiing games, one on the Wii Balance board (Wiiski), which uses a force plate, and one with the Kinect sensor (Kinski), which performs motion tracking. During gameplay, kinematics were captured using seven opto-electronical cameras. FLOS were obtained for eight directions. The influence of games and trials on COM displacement in each of the eight directions, and maximal COM speed, were tested with Generalized Estimated Equations. RESULTS In all directions with anterior and medio-lateral, but not with a posterior component, subjects showed significantly larger maximal %FLOS displacements during the Kinski game than during the Wiiski game. Furthermore, maximal COM displacement, and COM speed in Kinski remained similar or increased over trials, whereas for Wiiski it decreased. CONCLUSIONS Our results show the importance of assessing the movement challenge in games used for balance training. Similar games impose different challenges, with the control sensors and their gain settings playing an important role. Furthermore, adaptations led to a decrease in challenge in Wiiski, which might limit the effectiveness of the game as a balance-training tool.