Wim G. M. Janssen

Sensitivity of Accelerometry to Assess Balance Control During Sit-to-Stand Movement

Accelerometry has the potential to measure balance, defined as high-frequency body sway, ambulatorily in a simple and inexpensive way. The aim of this study was to determine and compare the sensitivity of accelerometric balance parameters during the sit-to-stand (STS) movement. Eleven healthy subjects (four males, 28.2 plusmn7.9 years) and 31 patients with stroke (21 males; 63.3plusmn12.8 years) were included. The healthy subjects performed STS movements in four conditions with different levels of difficulty. Data of the patients were compared 1) with healthy subjects, 2) between patient subgroups, and 3) between different phases of recovery to assess the sensitivity of accelerometry for differences in balance control. Accelerometers were attached to the trunk, and force plate measurements were simultaneously done in the healthy subjects. Main outcome measures were root mean square (rms) and area under the curve (AUC) derived from the high-frequency component of the transversal acceleration signal of the trunk. In all comparisons there was a significant difference in AUC data (p < 0.05), and AUC appeared to be more sensitive than rms. Variability in AUC was not completely or mainly the result of changes and differences in the duration of the STS movement. As a conclusion, accelerometry is a potentially valuable technique to measure balance during the STS movement.

Assessment of arm/hand functioning in children with a congenital transverse or longitudinal reduction deficiency of the upper limb

Purpose. Selection of appropriate functional tests and questionnaires to assess capacity (tests) and performance (questionnaires) of arm/hand functioning in children with congenital transverse or longitudinal (radius dysplasia) reduction deficiencies of the upper limb. Method. A PubMed Medline search was performed. Tests and questionnaires were evaluated according to three criteria: (1) items represent bimanual daily activities, (2a) quality of movement is scored (tests) or (2b) difficulty in performing a task (questionnaires), (3) instrument is attractive for children aged 4 – 12. Results. We found 14 functional tests and nine questionnaires to measure arm/hand functioning. Three tests, the Assisting Hand Assessment (AHA), Unilateral Below Elbow Test (UBET) and University of New Brunswick Test of prosthetic function (UNB Test) and two questionnaires, the Prosthetic Upper limb Functional Index (PUFI) and the childrens version of the ABILHAND (ABILHAND-Kids) met the criteria. Conclusions. Two functional tests (AHA and UBET) and two questionnaires (ABILHAND-Kids and PUFI) were considered appropriate to assess arm/hand functioning in children with congenital reduction deficiencies of the upper limb, but require further study on psychometric properties for these patient groups.

Inactive lifestyle in adults with bilateral spastic cerebral palsy

OBJECTIVE To quantify the level of everyday physical activity in adults with bilateral spastic cerebral palsy, and to study associations with personal and cerebral palsy-related characteristics. PARTICIPANTS AND METHODS Fifty-six adults with bilateral spastic cerebral palsy (mean age 36.4 (standard deviation (SD) 5.8) years, 62% male) participated in the study. Approximately 75% had high gross motor functioning. Level of everyday physical activity was measured with an accelerometry-based Activity Monitor and was characterized by: (i) duration of dynamic activities (composite measure, percentage of 24 h); (ii) intensity of activity (motility, in gravitational acceleration (g)); and (iii) number of periods of continuous dynamic activity. Outcomes in adults with cerebral palsy were compared with those for able-bodied age-mates. RESULTS Duration of dynamic activities was 8.1 (SD 3.7) % (116 min per day), and intensity of activity was 0.020 (SD 0.007) g; both outcomes were significantly lower compared with able-bodied age-mates. Of adults with cerebral palsy, 39% had at least one period of continuous dynamic activities lasting longer than 10 min per day. Gross motor functioning was significantly associated with level of everyday physical activity (Rs -0.34 to -0.48; p </= 0.01). CONCLUSION Adults with bilateral spastic cerebral palsy, especially those with low-level gross motor functioning, are at risk for an inactive lifestyle.

Cardiovascular Disease Risk Factors and the Relationships With Physical Activity, Aerobic Fitness, and Body Fat in Adolescents and Young Adults With Myelomeningocele

OBJECTIVES To describe cardiovascular disease (CVD) risk factors in adolescents and young adults with myelomeningocele (MMC) and to explore relationships with physical activity, aerobic fitness, and body fat. DESIGN Cross-sectional study. SETTING Outpatient clinic. PARTICIPANTS Adolescents and young adults (N=31) with MMC (58% men) age 16 through 30 years; 13 were ambulatory and 18 were nonambulatory. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We studied biologic and lifestyle-related CVD risk factors, including lipid and lipoprotein profiles, blood pressure, aerobic fitness (Vo(2)peak), body fat, daily physical activity, and smoking behavior. We considered subjects at increased CVD risk when 2 or more of the following risk factors clustered: systolic blood pressure, total serum cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and cigarette smoking. Relationships were studied using regression analyses. RESULTS Levels of TC, low-density lipoprotein cholesterol, and triglycerides were elevated in 29%, 38%, and 3% of the participants, respectively. HDL-C was reduced in 19%. Hypertension was found in 20%, and 19% were current cigarette smokers. Based on the clustering of risk factors, 42% of the participants were at increased CVD risk: 15% of ambulatory participants and 61% of nonambulatory participants (P=.03). Adjusted for sex and ambulatory status, participants with higher aerobic fitness tended to be more likely to have no CVD risk (odds ratio=13.0; P=.07). CVD risk was not associated to physical activity and body fat. CONCLUSIONS A large proportion of the study sample was at CVD risk, indicated by clustering of risk factors. Improving aerobic fitness in young adults with MMC may contribute in reducing CVD risk; this needs to be confirmed in future studies.

Analysis and decomposition of accelerometric signals of trunk and thigh obtained during the sit-to-stand movement

Piezoresistive accelerometer signals fre frequently used in movement analysis. However, their use and interpretation are complicated by the fact that the signal is composed of different acceleration components. The aim of the study was to obtain insight into the components of accelerometer signals from the trunk and thigh segments during four different sit-to-stand (STS) movements (self-selected, slow, fast and fullflexion). Nine subjects performed at least six trials of each type of STS movement. Accelerometer signals from the trunk and thigh in the sagittal direction were decomposed using kinematic data obtained from an opto-electronic device. Each acceleration signal was decomposed into gravitational and inertial components, and the inertial component of the trunk was subsequently decomposed into rotational and translational components. The accelerometer signals could be reliably reconstructed: mean normalised root mean square (RMS) trunk: 6.5% (range 3–12%), mean RMS thigh: 3% (range 2–5%). The accelerometric signals were highly characteristic and repeatable. The influence of the inertial component was significant, especially on the timing of the specific event of maximum trunk flexion in the accelerometer signal. The effect of inertia was larger in the trunk signal than in the thigh signal and increased with higher speeds. The study provides insight into the acceleration signal, its components and the influence of the type of STS movement and supports its use in STS movement analysis.

Dynamometry of intrinsic hand muscles in patients with Charcot-Marie-Tooth disease

Background: Several problems are associated with manual muscle testing and dynamometry in the hands of patients with Charcot–Marie–Tooth (CMT) disease. Objective: To evaluate the efficacy of the Rotterdam Intrinsic Hand Myometer (RIHM) to directly measure intrinsic hand muscle strength in CMT disease. Methods: We measured hand muscle strength and hand function in 41 patients with CMT disease. Results: RIHM measurement of intrinsic strength had excellent reliability. We found overlapping RIHM strength values in Medical Research Council grades 3 to 5. High grip and pinch strength could be found in patients with severe intrinsic muscle weakness. RIHM measurements were more strongly correlated with fine motor skills of the hand than grip and pinch strength. Conclusions: The Rotterdam Intrinsic Hand Myometer is a reliable instrument to measure intrinsic hand muscles strength in patients with Charcot–Marie–Tooth disease, providing more detailed information than manual muscle testing and a more direct assessment of intrinsic muscle loss than grip and pinch dynamometers.

Recovery of the Sit-to-Stand Movement After Stroke: A Longitudinal Cohort Study

Background and Objective . To present quantitative data on sit-to-stand (STS)-related functioning and recovery during the first year after stroke. STS-related functioning was used to evaluate independent STS movement, rising speed, and actual STS performance during normal daily life. Methods. This was a prospective cohort study of 50 patients poststroke. Assessments were made at 0, 3, 6, 9, 12, 24, and 48 weeks poststroke. Actual STS performance was assessed at 0, 12, and 48 weeks. The main outcome measures were the following: ability to rise independently, rising speed (power chair stand up), number of STS movements, percentage of time walking and standing during daily life (using an activity monitor), and clinical outcomes, measured among others by the Barthel index (BI). Results. During year 1, the percentage of patients able to rise increased from 54% to 83%. Most improvements occurred during weeks 0 to 12, whereas no significant changes were observed during weeks 12 to 24. Rising speed similarly increased from 0.15 to 0.26 s− 1 during weeks 0 to 12 and to 0.30 s−1 at week 48. Gait speed and BI also significantly increased. The number of STS movements increased significantly during weeks 0 to 12 (from 10.6 to 17.7) but not during weeks 12 to 48. Conclusions. STS-related functioning improved significantly in the first year after stroke, with the most improvement occurring during the first 12 weeks. After 12 weeks, rising speed, gait speed, and BI continue to improve.

Sensory Evaluation of the Hands in Patients with Charcot-Marie-Tooth Disease Using Semmes-Weinstein Monofilaments

In this study, the intra- and interobserver reliability of the Semmes-Weinstein monofilaments (SWMFs) was determined in the hands of 15 patients with Charcot-Marie-Tooth disease. In addition, the amount and distribution of sensory loss in the hand, and the relation between sensory loss, intrinsic muscle strength, and hand dexterity was explored in 45 patients. SWMF testing had good intra- and interobserver reliability with intraclass correlation coefficients of 0.91 and 0.86, respectively. The SWMF testing revealed normal sensory function in 43% of all six locations. The average loss of the intrinsic hand muscle strength was 57%. Poor strength was found in patients with both poor and with good sensory function. The correlation between the measurements of intrinsic muscle strength and the Sollerman test for dexterity was 0.70.

Opinions of Youngsters with Congenital Below-Elbow Deficiency, and Those of Their Parents and Professionals Concerning Prosthetic Use and Rehabilitation Treatment

Background Youngsters with unilateral congenital below-elbow deficiency (UCBED) seem to function well with or without a prosthesis. Reasons for rejecting prostheses have been reported earlier, but unfortunately not those of the children themselves. Furthermore, reasons for acceptance are underexplored in the literature. Objectives To investigate opinions of children and early and late adolescents with UCBED, and those of their parents and healthcare professionals, concerning (1) reasons to wear or not to wear prostheses and (2) about rehabilitation care. Methods During one week of online focus group interviews, 42 children of 8–12 y/o, early and late adolescents of 13–16 and 17–20 y/o, 17 parents, and 19 healthcare professionals provided their opinions on various topics. This study addresses prosthetic use or non-use of prosthetics and rehabilitation care. Data were analyzed using the framework approach. Results Cosmesis was considered to be the prime factor for choosing and wearing a prosthesis, since this was deemed especially useful in avoiding stares from others. Although participants functioned well without prostheses, they agreed that it was an adjuvant in daily-life activities and sports. Weight and limited functionality constituted rejection reasons for a prosthesis. Children and adolescents who had accepted that they were different no longer needed the prosthesis to avoid being stared at. The majority of participants highly valued the peer-to-peer contact provided by the healthcare professionals. Conclusions For children and adolescents with UCBED, prostheses appeared particularly important for social integration, but much less so for functionality. Peer-to-peer contact seemed to provide support during the process of achieving social integration and should be embedded in the healthcare process.

Hand Function and Activity Performance of Children with Longitudinal Radial Deficiency

BACKGROUND The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two. METHODS We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined. RESULTS The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance. CONCLUSIONS Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function.