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1.
  • Strandberg, Johan, 1981- (författare)
  • Non-parametric methods for functional data
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • In this thesis we develop and study non-parametric methods within three major areas of functional data analysis: testing, clustering and prediction. The thesis consists of an introduction to the field, a presentation and discussion of the three areas, and six papers.In Paper I, we develop a procedure for testing for group differences in functional data. In case of significant group differences, the test procedure identifies which of the groups that significantly differ, and also the parts of the domain they do so, while controlling the type I error of falsely rejecting the null hypothesis. In Paper II, the methodology introduced in Paper I is applied to knee kinematic curves from a one-leg hop for distance to test for differences within and between three groups of individuals (with and without knee deficits). It was found that two of the groups differed in their knee kinematics. We also found that the individual kinematic patterns differed between the two legs in one of the groups. In Paper III, we test for group differences in three groups with respect to joint kinematics from a vertical one-leg hop using a novel method that allows accounting for multiple joints at the same time. The aim of Paper III, as one of few within the field of biomechanics, is to illustrate how different choices prior to the analysis can result in different contrasting conclusions. Specifically, we show how the conclusions depend on the choice of type of movement curve, the choice of leg for between-group comparisons and the included joints.In Paper IV, we present a new non-parametric clustering method for dependent functional data, the double clustering bagging Voronoi method. The objective of the method is to identify latent group structures that slowly vary over domain and give rise to different frequency patterns of functional data object types. The method uses a bagging strategy based on random Voronoi tessellations in which local representatives are formed and clustered. Combined with the clustering method, we also propose a multiresolution approach which allows identification of latent structures at different scales. A simulated dataset is used to illustrate the method's potential in finding stable clusters at different scales. The method is also applied to varved lake sediment data with the aim of reconstructing the climate over the past 6000 years, at different resolutions. In Paper V, we expand and modify the bagging strategy used in Paper IV, by considering different methods of generating the tessellations and clustering the local representatives of the tessellations. We propose new methods for clustering dependent categorical data (e.g., labelled functional data) along a one-dimensional domain, which we also compare in a simulation study. In Paper VI, two kriging approaches to predict spatial functional processes are compared, namely functional kriging and spatio-temporal kriging. A simulation study is conducted to compare their prediction performance and computational times. The overall results show that prediction performance is about the same for stationary spatio-temporal processes while functional kriging works better for non-stationary spatio-temporal processes. Furthermore, the computational time for (ordinary) kriging for functional data, was considerably lower than spatio-temporal kriging. Conditions are also formulated under which it is proved that the two functional kriging methods: ordinary kriging for functional data and pointwise functional kriging coincide.
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2.
  • Grinberg, Adam, 1980- (författare)
  • Sensorimotor function following anterior cruciate ligament injury : movement control, proprioception and neuropsychological perspectives
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: The high incidence of anterior cruciate ligament (ACL) injuries in sports suggests an involvement of both biomechanical and neurocognitive risk factors. Athletes are constantly exposed to challenging sports scenarios, which are often characterised by high-intensity movements combined with a multi-stimuli environment and continuous psychological pressure. Post-injury loss of knee proprioception and long-term injury-associated neuroplasticity arguably place an athlete in a disadvantage when coping with such situations when returning to sports (RTS). This is postulated to contribute to a high rate of re-injuries, seen despite achieving RTS eligibility. Psychological factors such as re-injury fears and anxieties are also suggested to influence central sensorimotor processing and to therefore play a role in the generation and control of functional movements. Their assessment is however based on suboptimal tools, particularly when administered to the athletic population. In general, current clinical assessments focus primarily on coarse outcome measures while disregarding aspects such as multi-joint control and the influence of psychological aspects on motor performance. This thesis focuses on the role of proprioception and re-injury anxiety on functional movement control following ACL injury and reconstruction (ACLR), with implications for risks of re-injury.Methods: This thesis is comprised of four cross-sectional studies (Papers I-IV), that stem from two data collections performed in a motion analysis laboratory. Paper I introduces a novel obstacle clearance test aimed to functionally assess proprioception and sensorimotor control. The goal of the test was to cross an obstacle, downward vision occluded, aiming for minimal foot clearance. Individuals following ACLR and rehabilitation were compared to both mildly active uninjured persons (CTRL) and elite athletes (ATH). A kinematic analysis, using 3D motion capture, included estimates of lower limb movement accuracy, variability and symmetry. Paper II evaluates knee proprioception among the same individuals using a weight-bearing knee joint position sense (JPS) test, and outcomes were compared with associated outcomes from the obstacle clearance test. Paper III explores whether self-reported fear of re-injury is manifested in the biomechanics (kinematics and electromyography) of a standardised rebound side-hop test (SRSH). An ACLR group was stratified into high-fear and low-fear subgroups based on one discriminating question, and compared also to uninjured controls. In Paper IV, a threat-conditioning test paradigm is introduced, aiming to invoke and measure a neurophysiological arousal response to movement-related fear, among uninjured individuals. Conditioned auditory stimuli were occasionally followed by unexpected perturbations of the base of support, and compared with neutral stimuli. Electroencephalography was continuously registered and event-related potentials were explored as potential anxiety biomarkers.Results: Kinematic asymmetry was observed for the ACLR group during obstacle crossing, both for individual joints and for multi-joint movement and velocity curves. In addition, trailing leg trajectory variability during higher obstacle crossings was lower for ACLR compared to both control groups. The less physically-active CTRL group demonstrated less crossing accuracy (larger obstacle distances and JPS errors) compared to both ACLR and ATH. Moderate positive correlations were observed between knee JPS absolute errors and obstacle distances, for the injured leg of the ACLR group only. Individuals with ACLR, classified as having high fear, demonstrated higher biceps femoris amplitudes and anterior-posterior co-contraction index during landing. Side-hop performance was also distinguishable for ACLR (regardless of fear allocation) with greater hip and knee flexion, while high-fear individuals also had more trunk flexion. Perturbation-related fearful response was reflected as a high-amplitude contingent negative variation (CNV) wave in response to conditioned compared to neutral stimuli. The CNV wave was observed over all electrode cites but most significantly over frontal and central cortical areas.Conclusions: Even following rehabilitation, individuals with ACLR showed unique sensorimotor function, characterised by less trajectory variability and greater multi-joint asymmetry when proprioception was challenged (i.e., downward vision occluded). However, knee JPS did not seem to be deficient among these individuals, but instead more related to physical activity, than to the ACLR history. Correlations to JPS errors, seen exclusively for the ACLR leg might suggest a tendency to focus attention more internally when crossing an obstacle (generally an external focus task), though this should be investigated further. Higher levels of self-reported fear of re-injury were manifested in the biomechanics of side hops, with seemingly stiffer landings and protective neuromuscular strategy. This has potential implications for joint degeneration hastening as well as reduced motor adaptability, implying a risk for re-injury. Finally, the balance-perturbation test paradigm seemed to provoke threat-associated arousal in the form of a CNV wave among uninjured individuals. The CNV wave should further be explored as a potential biomarker for re-injury anxiety. Future research should implement this paradigm on individuals with different levels of self-reported movement-related fears and anxieties, striving for a more holistic approach in rehabilitation following ACLR.
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3.
  • Strong, Andrew, 1983- (författare)
  • Knee function, knee proprioception and related brain activity following anterior cruciate ligament injury
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Injury of the anterior cruciate ligament (ACL) may have negative effects on the short- and long-term function and proprioception of the knee joint. However, existing tests of knee function are often sports-related and less relevant for assessment in the very long term and there remains no ‘gold standard’ test of knee proprioception. A growing body of research also suggests neuroplasticity post-ACL injury, but brain response to lower limb proprioception tasks is not established and nor is the potentially related impact of ACL injury. Developing standardised, reliable and valid tests of knee function and proprioception including brain imaging may target rehabilitation interventions more efficiently.Methods: Paper I assesses knee function ~23 years after ACL injury. One ACL-injured group treated with physiotherapy only (ACLD) and one with additional reconstruction (ACLR) were compared to asymptomatic controls for performance and knee kinematics of the One-leg rise (OLR) test. Paper II is a published protocol for Paper III, which is a systematic review and meta-analysis of the psychometric properties (PMPs) of knee joint position sense (JPS) tests among individuals with ACL injury. Paper IV describes the development of one weight-bearing (WB) and one non-weight-bearing (NWB) knee JPS test using motion capture. Test-retest reliability is assessed and errors are compared between an active ACLR group (~23 months after reconstruction) and two asymptomatic groups of different activity levels. Paper V characterises brain response to a knee JPS test using simultaneous functional magnetic resonance imaging and motion capture among individuals ~2 years after ACL reconstruction and controls.Results: ACLD performed significantly fewer repetitions of the OLR with both legs compared to controls and displayed significantly greater knee abduction than ACLR and controls. Meta-analyses found sufficient validity for existing knee JPS tests, particularly those of passive movements, by showing that ACL-injured knees produce significantly greater absolute errors than contralateral asymptomatic knees and those of controls. However, the tests were found not to be responsiveness to intervention and the remaining PMPs, such as reliability, require more evidence to better determine their quality. The novel knee JPS tests of paper IV showed mixed reliability but were better for the WB compared to the NWB test and when absolute rather than variable error was the outcome measure. Post-hoc comparisons revealed significantly greater errors for less-active controls compared to the ACLR group. For Paper V, the knee JPS test recruited brain regions such as the parietal cortex, precentral gyrus and insula. Greater knee JPS errors were correlated with greater activation in the insula, as well as the anterior and middle cingula. The ACLR group showed significantly greater response compared to controls for mainly the precuneus, but only at the uncorrected level.Conclusions: Knee function may be negatively affected more than two decades after ACL injury based on performance and knee kinematics of the OLR test, which offers a clinician-friendly assessment tool of lower limb function but requires further investigation. Existing knee JPS tests seem to discriminate ACL-injured from asymptomatic knees. Passive tests produce greater differences, but current methods are diverse and often poorly reported, complicating recommendation of specific tests for research or clinics. The novel WB and NWB knee JPS tests should be developed for improved reliability, but their outcomes demonstrate the importance of considering activity level when comparing knee JPS between groups, which is rarely done. Brain regions recruited during our knee JPS test have previously been associated with, e.g. sensorimotor processes, interoception and body schema, confirming proprioceptive demands of the task. Correlations between knee JPS errors and response in the insula and cingula suggest they have an important role during such tasks. Subtle differences in brain response between ACLR and CTRL warrant further investigation.
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4.
  • Markström, Jonas L., 1985- (författare)
  • Movement strategies and dynamic knee control after anterior cruciate ligament injury : a three-dimensional biomechanical analysis
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Rupture of the anterior cruciate ligament (ACL) is common and mainly occurs in non-contact situations in sports, often due to momentarily poor movement control. Assessment of movement quality during sport-like tasks iscrucial to understand how to decrease the high risk of reinjury for ACL-injured persons, but also how to prevent primary injury. This thesis addresses movement quality after ACL injury and includes development and evaluation of a novel standardized rebound side hop test (SRSH) for reliability and agreement of landing mechanics, and compares these outcomes between asymptomatic persons with different athletic levels, and between different hop tests.Methods: This thesis involves five papers based on two separate data collections performed in a motion analysis laboratory. Paper I is a long-term follow up of ACL-injured persons treated with or without ACL reconstruction (ACLR) compared to asymptomatic persons (total N = 99, age 35-63), while papers II-V included ACLR persons, and asymptomatic elite athletes and non-athletes (total N = 79, age 17-34). A motion capture system synchronized with force plates and surface electromyography (EMG) registered trunk, hip and knee angles and moments and knee muscle activity during the hop for distance, vertical hop, and SRSH. Novel measures of dynamic knee robustness were also evaluated using finite helical axis inclination angles extracted from knee rotation intervals of 10˚.Results: On average 23 years after injury, ACL injured persons performed the vertical hop with diverse angles compared to controls and their non-injured leg.The younger groups of ACLR persons and controls generally displayed excellent reliability and agreement for SRSH landing mechanics. These outcomes differed between the groups, and between legs for ACLR persons, despite similar dynamic knee robustness and acceptable knee function outcomes. Curve analyses further displayed differences between athletes and non-athletes, mainly with greater hip moments for athletes, although with similar values for dynamic knee robustness. Finally, greater knee angles and moments considered strenuous for the ACL were evident during the first rebound landing in SRSH compared to the other landings.Conclusions: Persons who have suffered an ACL injury, regardless of whether treated with ACLR or not, appear to use task-coping strategies in preparation for and during landings to decrease knee joint loading, probably to preserve dynamic knee robustness. More attention should be given to the trunk and hip in clinics when evaluating movement quality after ACL injury to reduce the risk of future injuries due to movement compensation. High-level athletic training may also improve the ability to maintain dynamic knee robustness whilst performing a sport-like side-to-side task more efficiently through increased engagement of the hip. Finally, side hop landings should be assessed when evaluating and correcting for erroneous landing mechanics to improve knee landing control.
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5.
  • Nedergård, Heidi, 1978- (författare)
  • “Taking the next step” : whole-body biomechanical gait analysis, and user-perspectives on robotic-assisted gait training post-stroke
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Stroke, and its subsequent motor function impairments may result in limited gait ability characterised by compensatory movement patterns that include deviations and asymmetries. How these movement patterns should be evaluated and quantified in order to be monitored and treated in the long term is not yet standardised. Limitations in walking quality and quantity negatively affect quality of life and lead to great costs for society if independence is lost. Improved walking ability is hence highly prioritised in stroke rehabilitation. Gait-assisting robots have been developed to enable favourable controlled, high-intensive and task-specific training. Studies evaluating the effects of robotic-assisted gait training (RAGT) have, however, shown inconsistent results. Identifying responders to treatment may facilitate further development of RAGT to improve outcomes. This requires in-depth knowledge of how specific gait movement patterns should best be identified, quantified and treated in rehabilitation. There is also a need for greater insight into how individuals experience gait training in general, and RAGT in particular, as this will likely affect the performance and outcomes of training.Aim: This thesis aims to contribute to the discussion on how to quantify gait movement patterns post-stroke from a whole-body perspective. It will also evaluate the effects of RAGT on biomechanical measures of gait and explore the experience of high-intensive and robotic-assisted gait training in persons with impaired walking ability due to stroke.Methods: A systematic review and meta-analysis consolidated the evidence for the effects of RAGT on biomechanical measures of gait in persons post-stroke. Two descriptive, cross-sectional studies based on kinematic gait data (31 persons post-stroke and 41 non-disabled controls) investigated potential variables to quantify post-stroke gait. The size and angular velocity of the inclination angles between the Centre of Mass (CoM) and the ankle or head, respectively, was investigated with curve analyses covering the entire gait cycle. Furthermore, misclassification rates were calculated based on leave-one-out cross-validation and logistic regression to address the combinations of kinematic variables that most correctly classify a person post-stroke when compared to controls. Finally, individual interviews were performed and analysed using qualitative content analysis to explore the experiences of high-intensive gait training, including RAGT, among persons post-stroke.Results: The systematic review included 13 studies with a total of 412 individuals. The meta-analyses did generally not reveal significant differences between RAGT and comparator groups for biomechanical parameters. Risk of bias assessments raised concerns for several of the studies and the general quality of evidence for these outcomes was very low. An important finding was an inconsistency of biomechanical outcome measures. Data from the primary cross-sectional studies included in this thesis indicated a bilateral lower body adaptation likely to increase the base of support and an upper body leaning towards the affected side during walking in persons post-stroke. Furthermore, core sets of 2-3 kinematic gait variables were identified from both the upper and lower body that, when combined, were most likely to differentiate post-stroke gait from gait in non-disabled controls. Finally, qualitative analysis of participants’ perspectives on high-intensive gait training including RAGT revealed four categories which described: 1) A generally positive mindset when starting the gait training intervention; 2) That engaging in a high-intensive gait training programme was appreciated although experienced as mentally and physically exhausting. The role of the physiotherapist was perceived as crucial; 3) Potential barriers during RAGT, such as discomfort and lost control during walking with the robot, but also facilitators like concrete feedback and the possibility to walk longer distances, and; 4) The participants’ feelings of confidence or concern for the future.      Conclusions: The systematic review demonstrated a very low certainty in current evidence for employing RAGT instead of non-robotic gait training to improve gait biomechanics post-stroke. In addition, it emphasized the lack of standardised guidelines as to which outcome measures most sufficiently quantify gait post-stroke. The cross-sectional studies included in this thesis, presenting upper and lower body kinematic variables to differentiate gait patterns between individuals with stroke and those without, highlight the advantages of adopting a whole-body perspective when evaluating gait post-stroke. Finally, interviews identified valuable aspects from the user’s perspective that should be considered during further development of RAGT devices and the design of high-intensive gait rehabilitation programmes post-stroke. 
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6.
  • Thurston, Charlotte, et al. (författare)
  • Mobile health to promote physical activity in people post stroke or transient ischemic attack : study protocol for a feasibility randomised controlled trial
  • 2023
  • Ingår i: BMC Neurology. - : BioMed Central (BMC). - 1471-2377. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND– Let’s get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden.Methods: One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments.Discussion: We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA.
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7.
  • Arumugam, Ashokan, et al. (författare)
  • Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury : A systematic review and GRADE evidence synthesis
  • 2021
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:5
  • Forskningsöversikt (refereegranskat)abstract
    • Objective: To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury.Design: Systematic Review.Data sources: PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020.Eligibility criteria: Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included.Data extraction and synthesis: Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.Results: Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by ≤2°, TTDPM by ≤1.5° and QFC by ≤6 Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low.Conclusions: The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS/TTDPM/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking.PROSPERO registration number CRD42018107349.
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9.
  • Arumugam, Ashokan, et al. (författare)
  • Sedentary and physical activity time differs between self-reported ATLS-2 physical activity questionnaire and accelerometer measurements in adolescents and young adults in the United Arab Emirates
  • 2023
  • Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Most young adults and adolescents in the United Arab Emirates (UAE) do not meet the established internationally recommended physical activity levels per day. The Arab Teen Lifestyle Study (ATLS) physical activity questionnaire has been recommended for measuring self-reported physical activity of Arab adolescents and young adults (aged 14 years to mid-twenties). The first version of the ATLS has been validated with accelerometers and pedometers (r ≤ 0.30). The revised version of the questionnaire (ATLS-2, 2021) needs further validation. The aim of this study was to validate the self-reported subjective sedentary and physical activity time of the ATLS-2 (revised version) physical activity questionnaire with that of Fibion accelerometer-measured data.METHODS: In this cross-sectional study, 131 healthy adolescents and young adults (aged 20.47 ± 2.16 [mean ± SD] years (range 14-25 years), body mass index 23.09 ± 4.45 (kg/m2) completed the ATLS-2 and wore the Fibion accelerometer for a maximum of 7 days. Participants (n = 131; 81% non-UAE Arabs (n = 106), 13% Asians (n = 17) and 6% Emiratis (n = 8)) with valid ATLS-2 data without missing scores and Fibion data of minimum 10 h/day for at least 3 weekdays and 1 weekend day were analyzed. Concurrent validity between the two methods was assessed by the Spearman rho correlation and Bland-Altman plots.RESULTS: The questionnaire underestimated sedentary and physical activity time compared to the accelerometer data. Only negligible to weak correlations (r ≤ 0.12; p > 0.05) were found for sitting, walking, cycling, moderate intensity activity, high intensity activity and total activity time. In addition, a proportional/systematic bias was evident in the plots for all but two (walking and moderate intensity activity time) of the outcome measures of interest.CONCLUSIONS: Overall, self-reported ATLS-2 sedentary and physical activity time had low correlation and agreement with objective Fibion accelerometer measurements in adolescents and young adults in the UAE. Therefore, sedentary and physical activity assessment for these groups should not be limited to self-reported measures.
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10.
  • Arumugam, Ashokan, 1981-, et al. (författare)
  • Thigh muscle co-contraction patterns in individuals with anterior cruciate ligament reconstruction, athletes and controls during a novel double-hop test
  • 2022
  • Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Efficient neuromuscular coordination of the thigh muscles is crucial in maintaining dynamic knee stability and thus reducing anterior cruciate ligament (ACL) injury/re-injury risk. This cross-sectional study measured electromyographic (EMG) thigh muscle co-contraction patterns during a novel one-leg double-hop test among individuals with ACL reconstruction (ACLR; n = 34), elite athletes (n = 22) and controls (n = 24). Participants performed a forward hop followed by a 45° unanticipated diagonal hop either in a medial (UMDH) or lateral direction (ULDH). Medial and lateral quadriceps and hamstrings EMG were recorded for one leg (injured/non-dominant). Quadriceps-to-Hamstring (Q:H) ratio, lateral and medial Q:H co-contraction indices (CCIs), and medial-to-lateral Q:H co-contraction ratio (CCR; a ratio of CCIs) were calculated for three phases (100 ms prior to landing, initial contact [IC] and deceleration phases) of landing. We found greater activity of the quadriceps than the hamstrings during the IC and deceleration phases of UMDH/ULDH across groups. However, higher co-contraction of medial rather than lateral thigh muscles during the deceleration phase of landing was found; if such co-contraction patterns cause knee adduction, a putative mechanism to decrease ACL injury risk, during the deceleration phase of landing across groups warrants further investigation.
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11.
  • Cronström, Anna, et al. (författare)
  • Are demographics, physical function and psychological response associated with return to sport at one year following ACL-reconstruction?
  • 2024
  • Ingår i: Physical Therapy in Sport. - : Elsevier. - 1466-853X .- 1873-1600. ; 68, s. 22-30
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To determine the relative contribution of each of the following aspects: demographics, physical function, and patient-reported outcome measures (PROMs), including both physical and psychological constructs, to return to sport (RTS) (any level) one-year post anterior cruciate ligament reconstruction (ACLR). Design: Cross-sectional cohort study.Methods: We included data for 143 participants (73 women, mean (SD) age 24 (5.8) years) ∼ one-year post-ACLR. Data comprised demographics, physical function (hop performance, hip and knee peak torque) and PROMs (Knee Osteoarthritis Outcome Score subscales, perceived stress, and ACL Return to Sport after Injury scale (ACL-RSI)). We then used a Z-normalized multivariable logistic regression model to establish the relative contribution of factors associated with RTS.Results: Sixty-four (45%) of the participants had returned to sport at one year post-ACLR. In the regression model, greater hip abduction peak torque (OR = 1.70, 95% CI; 1.01 to 2.84) and greater psychological readiness to RTS (OR = 2.32, 95% CI; 1.30 to 4.12) were the only variables associated with RTS (R2 = 0.352).Conclusions: The significant contribution of hip abduction strength and psychological readiness to RTS was still relatively small, suggesting other potential factors explaining RTS which may not be captured by common RTS criteria.
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12.
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13.
  • Cronström, Anna, et al. (författare)
  • Does sensorimotor function predict graft rupture, contra-lateral injury or failure to return to sports after ACL reconstruction? A protocol for the STOP Graft Rupture study
  • 2021
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 11:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction People with anterior cruciate ligament (ACL) reconstruction (ACLR) are at high risk of sustaining a graft rupture and/or contra-lateral ACL injury. The main factors that may predispose individuals for subsequent ACL injuries are, however, not established. To reduce the risk of reinjuries, it is of particular interest to identify modifiable risk-factors, for instance, those related to sensorimotor control which are responsive to training. The aim of the current study protocol is to present the design of our prospective cohort study STOP Graft Rupture investigating sensorimotor function as predictors for graft rupture, contra-lateral ACL injury and/or failure to return to sport (RTS) within 3 years following ACLR. Methods and analysis We aim to recruit 200 individuals (15-35 years, ∼50% women) with ACLR from Norrland University Hospital, Umeå and Lund University Hospital, Lund, Sweden. Participants will be assessed with a comprehensive test battery for sensorimotor muscle function, including hop performance, muscle strength, muscle activation, hip and ankle range of motion and postural orientation as well as patient-reported function 1 year after ACLR (baseline). For a subgroup of individuals (Umeå cohort), 3D kinematics and joint position sense will also be evaluated. At follow-up (≥3 years post-ACLR), the participants will be asked to answer questions related to new ACL injuries to either knee and about RTS. Separate logistic regression models, adjusting for possible confounders, will be used to evaluate the influence of the different sensorimotor predictors on the prospective outcomes (graft rupture, contra-lateral ACL injury, RTS). Ethics and dissemination This study was approved by the Swedish Ethical Review Board (Dnr 2016/319 and Dnr 2019-04037). The results will be published in international peer-reviewed scientific journals and presented at clinical and scientific congresses. Trial registration number NCT04162613.
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14.
  • Cronström, Anna, et al. (författare)
  • Factors associated with sports function and psychological readiness to return to sports at 12 months after anterior cruciate ligament reconstruction : a cross-sectional study
  • 2023
  • Ingår i: American Journal of Sports Medicine. - : Sage Publications. - 0363-5465 .- 1552-3365. ; 51:12, s. 3112-3120
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Sports function and psychological readiness to return to sports (RTS) are important outcomes when evaluating rehabilitation after anterior cruciate ligament reconstruction (ACLR). It is, however, unclear which specific factors contribute most to these outcomes.Purpose: To determine associations between demographic characteristics, objective measurements of physical function, patient-reported outcome measure scores, sports-related function assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale, and psychological readiness to RTS assessed with the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale at 1 year after ACLR.Study Design: Cross-sectional study; Level of evidence, 3. Methods: At a mean of 12.5 ± 2.0 months after ACLR, 143 participants (50.3% female), with a mean age of 25.0 ± 5.7 years, were assessed for demographic characteristics, physical factors (hop performance, muscle strength, ankle and hip range of motion), and psychological factors (KOOS Pain and Symptoms subscales, Perceived Stress Scale, fear of reinjury) as well as the KOOS Sport and Recreation subscale and ACL-RSI scale. Backward linear regression models were used to evaluate factors associated with sports function and psychological readiness to RTS.Results: Lower isokinetic knee extension peak torque (limb symmetry index) (B = 18.38 [95% CI, 3.01-33.75]), lower preinjury activity level (B = 2.00 [95% CI, 0.87-3.14]), greater knee pain (B = 0.90 [95% CI, 0.70-1.10]), shorter time between injury and reconstruction (B = 0.16 [95% CI, 0.05-0.26]), and greater fear of reinjury (B = 0.11 [95% CI, 0.01-0.20]) were associated with a worse KOOS Sport and Recreation subscore (R2 = 0.683). A shorter hop distance (B = 0.15 [95% CI, 0.00-0.29]) was associated with a lower ACL-RSI score (R2 = 0.245).Conclusion: A combination of knee muscle strength, activity level, knee pain, timing of surgery, and fear of reinjury accounted for approximately 70% of the variation in sports function at 1 year after ACLR. In contrast, there was only 1 weak association between physical function and psychological readiness to RTS at this time point. Thus, factors associated with current sports function are much better known than features related to psychological readiness to RTS.
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17.
  • Cronström, Anna, et al. (författare)
  • Return to sports : a risky business? a systematic review with meta-analysis of risk factors for graft rupture following acl reconstruction
  • 2023
  • Ingår i: Sports Medicine. - : Springer. - 0112-1642 .- 1179-2035. ; 53:1, s. 91-110
  • Forskningsöversikt (refereegranskat)abstract
    • Background: The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified.Objective: The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR.Methods: A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality.Results: Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69–9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26–3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32–3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58–2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21–2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34–2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39–0.59), female sex (OR 0.88, 95% CI 0.79–0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69–0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62–0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture.Conclusion: Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.
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18.
  • Cronström, Anna, et al. (författare)
  • Risk Factors for Contra-Lateral Secondary Anterior Cruciate Ligament Injury : A Systematic Review with Meta-Analysis
  • 2021
  • Ingår i: Sports Medicine. - : Springer. - 0112-1642 .- 1179-2035. ; 51:7, s. 1419-1438
  • Forskningsöversikt (refereegranskat)abstract
    • Background: The risk of sustaining a contra-lateral anterior cruciate ligament (C-ACL) injury after primary unilateral ACL injury is high. C-ACL injury often contributes to a further decline in function and quality of life, including failure to return to sport. There is, however, very limited knowledge about which risk factors that contribute to C-ACL injury.Objective: To systematically review instrinsic risk factors for sustaining a C-ACL injury.Methods: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Inclusion criteria were prospective or retrospective studies investigating any intrinsic risk factor for future C-ACL injury. Meta-analysis was performed and expressed as odds ratios (OR) if two or more articles assessed the same risk factor.Results: 44 moderate-to-high quality studies were eventually included in this review, whereof 35 studies were eligible for meta-analysis, including up to 59 000 individuals. We identified seven factors independently increasing the odds of sustaining a C-ACL injury (in order of highest to lowest OR): (1) returning to a high activity level (OR 3.26, 95% CI 2.10–5.06); (2) Body Mass Index < 25 (OR 2.73, 95% CI 1.73–4.36); (3) age ≤ 18 years (OR 2.42, 95% CI 1.51–3.88); (4) family history of ACL injury (OR 2.07, 95% CI 1.54–2.80); (5) primary ACL reconstruction performed ≤ 3 months post injury (OR 1.65, 95% CI: 1.32–2.06); (6) female sex (OR 1.35, 95% CI 1.14–1.61); and (7) concomitant meniscal injury (OR 1.21, 95% CI 1.03–1.42). The following two factors were associated with decreased odds of a subsequent C-ACL injury: 1) decreased intercondylar notch width/width of the distal femur ratio (OR 0.43, 95% CI 0.25–0.69) and 2) concomitant cartilage injury (OR 0.83, 95% CI 0.69–1.00). There were no associations between the odds of sustaining a C-ACL injury and smoking status, pre-injury activity level, playing soccer compared to other sports or timing of return to sport. No studies of neuromuscular function in relation to risk of C-ACL injury were eligible for meta-analysis according to our criteria.Conclusion: his review provides evidence that demographic factors such as female sex, young age (≤ 18 years) and family history of ACL injury, as well as early reconstruction and returning to a high activity level increase the risk of C-ACL injury. Given the lack of studies related to neuromuscular factors that may be modifiable by training, future studies are warranted that investigate the possible role of factors such as dynamic knee stability and alignment, muscle activation and/or strength and proprioception as well as sport-specific training prior to return-to-sport for C-ACL injuries.
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19.
  • Cronström, Anna, et al. (författare)
  • Risk factors for contra-lateral secondary anterior cruciate ligament injury : a systematic review with meta-analysis
  • 2021
  • Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 55:Suppl 1, s. A75-A76
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: There is limited knowledge about which risk factors that contribute to the high numbers of contra-lateral anterior cruciate ligament (C-ACL) injury after primary ACL injury.Objective:  To systematically review intrinsic risk factors for sustaining a C-ACL injury.Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses were performed and expressed as odds ratios (OR).Setting: The included studies describe a variety of sport settings and activity levels.Participants: The review comprises studies including males and/or females of any age with ACL injury.Assessment of Risk Factors: The review comprises longitudinal studies investigating any intrinsic risk factor for future C-ACL injury.Main Outcome Measurements: C-ACL injuryResults: Thirty-five moderate-to-high quality studies were eligible for meta-analysis, including up to ~59 000 individuals. The following factors all independently increased the odds of sustaining a C-ACL: Returning to a high activity level (OR: 3.26, 95% CI: 2.10–5.06), BMI < 25 (OR: 2.73, 95% CI: 1.73–4.36), Age ≤ 18 years (OR: 2.42, 95% CI: 1.51–3.88), Family history of ACL injury (OR: 2.07, 95% CI: 1.54–2.80), Primary ACL reconstruction performed ≤ 3 months post injury (OR: 1.65, 95% CI: 1.32–2.06), Female sex (OR: 1.35, 95% CI: 1.14–1.61) and Concomitant meniscal injury (OR 1.21, 95% CI: 1.03–1.42). There were no associations between the odds of sustaining a C-ACL injury and Smoking status, Pre-injury activity level, Playing soccer compared to other sports or Timing of return to sport.Conclusions: Demographic factors such as female sex, young age and family history of ACL injury, as well as early reconstruction and returning to a high activity level all contribute to the risk of sustaining a C-ACL injury. Studies on modifiable sensorimotor risk factors are warranted.
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20.
  • Cronström, Anna, et al. (författare)
  • Risk factors for graft rupture after anterior cruciate ligament reconstruction : a systematic review with meta-analysis
  • 2021
  • Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 55:Suppl 1, s. A76-A76
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Underlying factors contributing to increased risk of graft rupture after anterior cruciate ligament reconstruction (ACLR) are not well described.Objective: To systematically review intrinsic risk factors for sustaining a graft rupture.Design: A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MEDLINE, CINAHL, EMBASE, Sport Discus) were searched from inception to January 2020. Meta-analyses (random effect model) were performed and expressed as odds ratios (OR).Setting: The included studies describe a variety of sport settings and activity levels.Participants: The review comprises studies including males and/or females of any age who have had ACLR.Assessment of Risk Factors: All longitudinal studies investigating any intrinsic risk factor for future graft rupture were included.Main Outcome Measurements: Graft rupture.Results: Seventy-seven studies were eligible for meta-analysis. The following factors all independently increased the odds of sustaining a graft rupture after ACLR: Age ≤ 18 years (OR: 3.87, 95% CI: 2.32–6.46), higher pre-primary injury activity level (OR: 2.43, 95% CI: 1.56–3.82), family history of ACL injury (OR: 1.98, 95% CI: 1.50–2.62), returning to a high activity level (OR: 1.87, 95% CI: 1.11–3.15), and increased lateral tibial slope (OR: 1.64, 95% CI: 1.13–2,38). None of the following factors were found to be associated with future graft rupture; sex, smoking status, generalized joint laxity, timing of surgery or return to sport (RTS), playing soccer compared to other sports, hop performance at time of RTS or concomitant meniscal or collateral ligament injuries.Conclusions: Young age, family history of ACL injury, high tibial slope and previous and current high activity level should be considered when screening for increased risk of graft rupture following ACLR. Future studies on the possible role of sensorimotor factors, e.g., muscle activation and/or strength and proprioception for future graft ruptures are warranted.
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21.
  • Feldmann, Daneil C., et al. (författare)
  • Investigation of multiple populations highlight VEGFA polymorphisms to modulate anterior cruciate ligament injury
  • 2022
  • Ingår i: Journal of Orthopaedic Research. - : John Wiley & Sons. - 0736-0266 .- 1554-527X. ; 40:7, s. 1604-1612
  • Tidskriftsartikel (refereegranskat)abstract
    • Polymorphisms in VEGFA and KDR encoding proteins have been associated with anterior cruciate ligament (ACL) injury risk. We leveraged a collective sample from Sweden, Poland, and Australia to investigate the association of functional polymorphisms in VEGFA and KDR with susceptibility to ACL injury risk. Using a case–control genetic association approach, polymorphisms in VEGFA and KDR were genotyped and haplotypes inferred from 765 controls, and 912 cases clinically diagnosed with ACL rupture. For VEGFA, there was a significant overrepresentation of the rs2010963 CC genotype (p = 0.0001, false discovery rate [FDR]: p = 0.001, odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.47–3.19) in the combined ACL group (18%) compared to the combined control group (11%). The VEGFA (rs699947 C/A, rs1570360 G/A, rs2010963 G/C) A-A-G haplotype was significantly (p = 0.010, OR: 0.85, 95% CI: 0.69–1.05) underrepresented in the combined ACL group (23%) compared to the combined control group (28%). In addition, the A-G-G construct was significantly (p = 0.036, OR: 0.81, 95% CI: 0.64–1.02) underrepresented in the combined ACL group (12%) compared to the combined CON group (16%). Our findings support the association of the VEGFA rs2010963 CC genotype with increased risk and (ii) the VEGFA A-A-G haplotype with a reduced risk, and are in alignment with the a priori hypothesis. Collectively identifying a genetic interval within VEGFA to be implicated in ACL risk modulation and highlight further the importance of vascular regulation in ligament biology.
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22.
  • Fjellman-Wiklund, Anncristine, et al. (författare)
  • Retrospective experiences of individuals two decades after anterior cruciate ligament injury : a process of re-orientation towards acceptance
  • 2022
  • Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165. ; 44:21, s. 6267-6276
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury.Methods: Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer 20–29 years ago.Results: A theoretical model was developed with the core category Re-orientation towards acceptance, overarching three categories illustrating the long-term process post-injury. Initially the persons felt like disaster had struck; their main recall was strong pain followed by reduced physical ability and fear of movement and re-injury. In the aftermaths of injury, no participant reached the pre-injury level of physical activity. Over the years, they struggled with difficult decisions, such as whether to partake or refrain from different physical activities, often ending-up being less physically active and thereby gaining body weight. Fear of pain and re-injury was however perceived mainly as psychological rather than resulting from physical limitations. Despite negative consequences and adjustments over the years, participants still found their present life situation manageable or even satisfying.Conclusion: ACL injury rehabilitation should support coping strategies e.g., also related to fear of re-injury and desirable physical activity levels, also with increasing age.IMPLICATIONS FOR REHABILITATIONMore than 20 years after the ACL injury, the individuals despite re-orientation towards acceptance and a settlement with their life situation, still had fear of both pain and re-injury of the knee, with concerns about physical activity and gaining of body weight. Patients with ACL injury may need better individual guidance and health advice on how to remain physically active, to find suitable exercises and to maintain a healthy body weight. Education related to pain, treatment choices, physical activity, injury mechanisms in participatory discussions with the patient about the ACL injury may be beneficial early in the rehabilitation process to avoid catastrophizing and avoidance behaviour. ACL injury rehabilitation needs to address coping strategies incorporating the psychological aspects of suffering an ACL injury, including fear of movement/secondary injury, in order to support return-to-sport and/or re-orientation over time.
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23.
  • Glavare, Maria, et al. (författare)
  • Virtual reality exercises in an interdisciplinary rehabilitation programme for persons with chronic neck pain: A feasibility study
  • 2021
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 2003-0711. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To investigate the feasibility of a virtual reality exercise intervention within an interdisciplinary rehabilitation programme for persons with chronic neck pain. The effects of the intervention on symptom severity, variables related to chronic neck pain, and patients' experience of exercises were assessed.Methods: Nine women and 3 men participated in a 6-week virtual reality exercise intervention during an interdisciplinary rehabilitation programme. Symptom severity was rated before and after each session of virtual reality exercise, using questionnaires before and after the interdisciplinary rehabilitation programme, and questions about participants' experiences.Results: Neck pain symptoms increased temporarily during the exercises, but no lasting deterioration was found after the interdisciplinary rehabilitation programme. Depression, pain interference, pain control, sleep and kinesiophobia improved significantly after the programme. Participants experienced that the virtual reality exercises increased motivation to exercise and provided a focus other than pain. However, the equipment was heavy; and exercising was tiring and reminded them of their challenges.Conclusion: This study indicates that virtual reality exercises as part of an interdisciplinary rehabilitation programme are feasible and safe for patients with chronic neck pain. Pain symptoms may increase temporarily during the exercises. Virtual reality exercises may support participants by increasing motivation to exercise and providing helpful feedback. Further research into the added value of virtual reality exercises in an interdisciplinary rehabilitation programme for patients with chronic neck pain is warranted.
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24.
  • Grinberg, Adam, 1980-, et al. (författare)
  • An electroencephalography-based approach to evaluate movement-related anxiety in physically active adults and following anterior cruciate ligament injury
  • 2022
  • Konferensbidrag (refereegranskat)abstract
    • Background: Psychophysiological consequences often persist following musculoskeletal trauma and can result in vastly decreased quality of life. Re-injury anxiety is particularly common among individuals following anterior cruciate ligament (ACL) injury. Existing assessments of re-injury anxiety are, however, restricted to subjective suboptimal questionnaires, which may result in under-reporting and thus poorer injury management. We propose a novel approach to objectively quantify arousal response to movement-related anxiety. A new experimental paradigm was implemented to induce and record a conditioned electrophysiological response to a sudden perturbation, experienced to be potentially injurious.Objective: To explore the feasibility of detecting anxiety-associated electrocortical response and to evaluate its discriminative ability between asymptomatic individuals and those who had experienced an ACL injury.Methods: Physically-active asymptomatic persons and individuals post-ACL reconstruction stood blindfolded on a perturbation platform capable of generating high-acceleration translations (1.5 m/s2). Auditory stimuli were repeatedly presented in four-second intervals, as either low- or high-frequency tones. Half of the high-frequency tones were followed 1.5 seconds later by a destabilizing perturbation in one of eight randomized directions. The two tone conditions were thus termed ‘Neutral’ and ‘Anxiety’, as the high-frequency tone was intended to invoke an arousal response in anticipation of a potential perturbation. Event-related potentials (ERP) were computed for nine electrodes by averaging 100 Neutral and 100 Anxiety trials. Significant ERP components were identified using functional data analysis. Paired difference-waves’ amplitudes (Neutral - Anxiety) were compared between groups.Results: ERP correlates of anxiety were detected for both groups in frontal and central midline locations, with an observable contingent negative variation (CNV) from 500 ms post-stimulus in Anxiety compared with Neutral trials. This ERP component is reflective of a threat-induced arousal response, associated with attention and expectancy of an anxiety-relevant event. Preliminary data indicate no group differences in CNV amplitudes.Conclusions: Objective evaluation of an arousal response to movement-related anxiety was found to be feasible, resulting in a threat-induced CNV. Further investigation will elucidate the discriminative power of such an approach to differentiate between individuals with high and low re-injury anxiety, as well as potential associations with existing patient-reported outcome measures.
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25.
  • Grinberg, Adam, 1980-, et al. (författare)
  • An electroencephalography-based approach to evaluate movement-related anxiety in physically-active persons
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Psychological consequences often persist following musculoskeletal trauma and can result in vastly decreased quality of life. Re-injury anxiety is reported to hinder return to sports and can itself be a precursor for secondary injuries. Existing assessments of re-injury anxiety are restricted to subjective questionnaires, which may result in under-reporting and thus poorer injury management. In the current study, we introduced an experimental approach to objectively quantify movement-related anxiety using a threat-conditioning paradigm. We aimed to explore the feasibility of such an approach among non-injured persons.Ten physically-active individuals stood blindfolded on a platform capable of generating high-acceleration translations in eight different directions. Consecutive auditory stimuli were presented (four-second intervals), as either high- (conditioned stimulus; CS+) or low- (neutral stimulus; CS–) tones. Half of the CS+ trials were followed by a perturbation in a pseudo-random order. Event-related potentials were computed for nine electrodes by averaging 100 X CS– and 100 X CS+ trials. Significant latencies for CS– – CS+ comparisons were identified using interval-wise testing. Mean-amplitudes for significant intervals were used to detect a channel effect.Large negative CS+ waveforms were observed from 302-627ms post-stimulus and continuing until the end of the trials, most prominently over frontal and central midline locations (p ≤ 0.025). This effect, inferred as a contingent negative variation wave (CNV), may be reflective of threat-induced arousal response.Our test paradigm was found to be feasible, with a CNV suggested as a potential biomarker for re-injury anxiety. Further validation is needed, as well as exploring the discriminative power of such an approach between individuals with and without previous injury.
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26.
  • Grinberg, Adam, et al. (författare)
  • An obstacle clearance test for evaluating sensorimotor control after anterior cruciate ligament injury : A kinematic analysis
  • 2022
  • Ingår i: Journal of Orthopaedic Research. - : John Wiley & Sons. - 0736-0266 .- 1554-527X. ; 40:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Sensorimotor deficits, particularly proprioceptive, are often reported following rupture of the anterior cruciate ligament (ACL). High secondary injury rates and long-term negative consequences suggest that these deficits are not properly identified using current assessment methods. We explored a novel obstacle clearance test to evaluate sensorimotor control in individuals following ACL reconstruction (ACLR) and rehabilitation. Thirty-seven post-ACLR individuals, 23 nonathletic asymptomatic controls (CTRL), and 18 elite athletes stepped over a hurdle-shaped obstacle, downward vision occluded, aiming for minimal clearance. Kinematic outcomes (3D motion capture) for the leading and trailing legs, for two unpredictably presented obstacle heights, were categorized into Accuracy: vertical foot clearance and minimal distance from the obstacle; Variability: end-point and hip/knee trajectory; and Symmetry: trunk/hip/knee crossing angles, hip–knee–ankle movement, and velocity curves. Accuracy was worse for CTRL compared with both other groups. ACLR had less leading and trailing vertical foot clearance with their injured compared with their noninjured leg. ACLR and athletes had less crossing knee flexion in their injured/nondominant legs compared with their contralateral leg, both leading and trailing. ACLR showed greater trunk flexion when crossing with their injured leg, both leading and trailing. For the leading leg, ACLR showed greater asymmetry for the hip–knee–ankle velocity curve compared with elite athletes. Trailing leg trajectory variability was lower for ACLR compared with CTRL and athletes for higher obstacles. Clinical significance: Sensorimotor deficits in individuals post-ACLR were reflected by greater asymmetry and less variable (more stereotypical) trajectories rather than limb positioning ability. This consideration should be addressed in clinical evaluations.
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27.
  • Grinberg, Adam, et al. (författare)
  • Does a knee joint position sense test make functional sense? : Comparison to an obstacle clearance test following anterior cruciate ligament injury
  • 2022
  • Ingår i: Physical Therapy in Sport. - : Churchill Livingstone. - 1466-853X .- 1873-1600. ; 55, s. 256-263
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To evaluate knee joint position sense (JPS) among individuals with anterior cruciate ligament reconstruction (ACLR), cleared for return to sport, and investigate whether JPS errors are associated with outcomes of a functional obstacle clearance test (OC; downward vision occluded).Design: Cross-sectional.Setting: Controlled laboratory.Participants: Thirty-four individuals following ACLR, 23 non-athletic asymptomatic controls (CTRL), 18 athletes (ATH).Main outcome measures: absolute error (AE) and variable error (VE) for weight-bearing knee JPS (target angles: 40°, 65°); minimal distances of the lower extremity from the obstacle (at any time and vertical clearance; two obstacle heights).Results: Larger AE (P = 0.023) and VE (P = 0.010) were observed for CTRL compared with ACLR. CTRL also had larger OC distances for the trailing leg compared with ATH (P ≤ 0.046) and greater variability compared to both other groups (P ≤ 0.033). Moderate positive correlations (Rs ≥ 0.408, P ≤ 0.029) were observed between AE for the 40° angle and low-obstacle distances, for the injured ACLR leg.Conclusions: Knee JPS was worse in less-active individuals rather than following ACLR. Functional assessments like our OC test should complement isolated JPS tests, as they emphasize whole-body coordination and thus constitute more relevant estimations of proprioception.
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31.
  • Häger, Charlotte, Professor, 1962-, et al. (författare)
  • Svenskt nationellt nätverk för forskning om främre korsbandsskador
  • 2023
  • Ingår i: Idrottsmedicin. - Järna : Svensk förening för fysisk aktivitet och idrottsmedicin. - 1103-7652. ; :4, s. 36-43
  • Tidskriftsartikel (populärvet., debatt m.m.)abstract
    • Det har nyligen bildats ett svenskt nationellt och tvärprofessionellt nätverk för forskningom främre korsbandsskada med fokus på hur och varför man får skadan, vilkakonsekvenserna blir och hur personer med främre korsbandsskada ska behandlas. Enmålsättning är att diskutera och nå en gemensam syn i Sverige om viktiga nyckelfrågorsom exempelvis hur man med bästa evidens dels bör utvärdera funktion efter skada påett tillförlitligt och adekvat sätt och vilka tester som ska användas både i forskning ochklinik, samt vilka rekommendationer som ska ges för behandling/träning. Vi ger här enövergripande presentation av nätverket och dess verksamhet och vilken betydelse detkan ha.
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32.
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33.
  • Häger Ross, Charlotte, 1962- (författare)
  • To grip and not to slip : sensorimotor mechanisms in reactive control of grasp stability
  • 1995
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The reactive control of fingertip forces maintaining grasp stability was examined in man during a prehensile task. Blindfolded subjects used the precision grip between the tips of index finger and thumb to restrain an object that was subjected to unpredictable load forces. These were delivered tangential to the parallel grip surfaces of the object. Load forces, grip forces (perpendicular to the grip surfaces) and position of the object were recorded.Subjects automatically adjusted the grip forces to loads of various amplitudes and rates. Thereby they maintained a reliable safety margin against frictional slips without using excessive grip forces. A rapid rise in grip force lasting about 0.2 s was triggered after a short delay following the onset of a sustained ramp load increase. This 'catch-up' response caused a quick restoration of an adequate grip:load force ratio that prevented frictional slips. If the ramp load continued to increase after the catchup response, the grip force also increased in parallel with the load change in a 'tracking' manner. Consequently, during the hold phases of 'ramp-and-hold' loads, the employed grip forces were approximately proportional to the load amplitude. Sensory information about the rate of change of the load force parametrically scaled the 'catchup' and 'tracking' responses.Following anesthetic block of sensory input from the digits, the grip responses were both delayed and attenuated or even abolished. To compensate for these impairments, subjects had to voluntarily maintain exceedingly high grip forces to prevent the object from slipping. The grip control improved slightly during hand and forearm support conditions that allowed marked wrist movements to occur in response to the loading. This indicates that signals from receptors in muscles, joints or skin areas proximal to the digits can to some extent be used to adjust grip forces during impaired digital sensibility. In contrast, these signals had only minor influence on the control during normal digital sensibility.Grip responses to loads delivered in various directions revealed that the load direction, in relation to gravity and to the hand's geometry, represents intrinsic task variables in the automatic processes that maintain a stable grasp. The load direction influenced both the response latencies and the magnitudes of the grip responses. The response latencies were shortest for loads in directions that were the most critical with regard to the consequences of frictional slippage, i.e., loads directed away from the palm or in the direction of gravity. Recordings of signals in cutaneous afferents innervating the finger tips demonstrated that these effects on the response latencies depended on differences in the time needed by the central nervous system to implement the motor responses. The short latencies in the most ‘criticar load directions may reflect the preparation of a default response, while additional central processing would be needed to execute the response to loads in other directions. Adjustments to local frictional anisotropies at the digit-object interface largely explained the magnitude effects.In conclusion, grip responses are automatically adjusted to the current loading condition during unpredictable loading of a hand held object. Subjects call up a previously acquired sensorimotor transform that supports grasp stability by preventing both object slippage and excessive grip forces. Cutaneous sensory information about tangential forces and frictional conditions at the digit-object interface is used to initiate and scale the grip responses to the current loading conditions, largely in a predictive manner.
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34.
  • Johansson, Anna-Maria, 1981-, et al. (författare)
  • Influence of visual feedback, hand dominance and sex on individuated finger movements
  • 2021
  • Ingår i: Experimental Brain Research. - : Springer. - 0014-4819 .- 1432-1106. ; 239:6, s. 1911-1928
  • Tidskriftsartikel (refereegranskat)abstract
    • The ability to perform individual finger movements, highly important in daily activities, involves visual monitoring and proprioception. We investigated the influence of vision on the spatial and temporal control of independent finger movements, for the dominant and non-dominant hand and in relation to sex. Twenty-six healthy middle-aged to old adults (M age = 61 years; range 46–79 years; females n = 13) participated. Participants performed cyclic flexion–extension movements at the metacarpophalangeal joint of one finger at a time while keeping the other fingers as still as possible. Movements were recorded using 3D optoelectronic motion technique (120 Hz). The movement trajectory distance; speed peaks (movement smoothness); Individuation Index (II; the degree a finger can move in isolation from the other fingers) and Stationarity Index (SI; how still a finger remains while the other fingers move) were extracted. The main findings were: (1) vision only improved the II and SI marginally; (2) longer trajectories were evident in the no-vision condition for the fingers of the dominant hand in the female group; (3) longer trajectories were specifically evident for the middle and ring fingers within the female group; (4) females had marginally higher II and SI compared with males; and (5) females had fewer speed peaks than males, particularly for the ring finger. Our results suggest that visual monitoring of finger movements marginally improves performance of our non-manipulative finger movement task. A consistent finding was that females showed greater independent finger control compared with males.
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35.
  • Liebermann, Dario G., et al. (författare)
  • Spatiotemporal lower-limb asymmetries during stair descent in athletes following anterior cruciate ligament reconstruction
  • 2024
  • Ingår i: Journal of Electromyography & Kinesiology. - : Elsevier. - 1050-6411 .- 1873-5711. ; 75
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: This study evaluated motor control recovery at different times following anterior cruciate ligament reconstruction (ACLR) by investigating lower-limb spatiotemporal symmetry during stair descent performances.Methods: We used a cross-sectional design to compare asymptomatic athletes (Controls, n = 18) with a group of people with ACLR (n = 49) divided into three time-from-ACLR subgroups (Early: <6 months, n = 17; Mid: 6–18 months, n = 16; Late: ≥18 months, n = 16). We evaluated: “temporal symmetry” during the stance subphases (single-support, first and second double-support) and “spatial symmetry” for hip-knee-ankle intra-joint angular displacements during the stance phase using a dissimilarity index applied on superimposed 3D phase plots.Results: We found significant between-group differences in temporal variables (p ≤ 0.001). Compared to Controls, both Early and Mid (p ≤ 0.05) showed asymmetry in the first double-support time (longer for their injured vs. non-injured leg), while Early generally also showed longer durations in all other phases, regardless of stepping leg. No statistically significant differences were found for spatial intra-joint symmetry between groups.Conclusion: Temporal but not spatial asymmetry in stair descent is often present early after ACLR; it may remain for up to 18 months and may underlie subtle intra- and inter-joint compensations. Spatial asymmetry may need further exploration.
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36.
  • Markström, Jonas, 1985-, et al. (författare)
  • A minority of athletes pass symmetry criteria in a series of hop and strength tests irrespective of having an ACL reconstructed knee or being noninjured
  • 2023
  • Ingår i: Sports Health. - : Sage Publications. - 1941-7381 .- 1941-0921. ; 15:1, s. 45-51
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Between-leg symmetry in 1-leg hop and knee strength performances is considered important after anterior cruciate ligament reconstruction (ACLR) to facilitate a safer return to sport. While few athletes with ACLR demonstrate symmetry in test batteries, reference data for noninjured athletes are lacking, thus questioning how ACLR-specific poor symmetry is.Hypothesis: Athletes with ACLR (hamstring autograft) show lower symmetry and have a lower proportion of symmetric individuals than noninjured athletes for knee flexion strength but not for hop for distance, vertical hop, and knee extension strength.Study design: Cross-sectional.Level of Evidence: Level 3.Methods: A total of 47 athletes with ACLR (median 13.0 months post-ACLR) who had returned to their sport, and 46 noninjured athletes participated. Symmetry was calculated between the worse and better legs for each test and combinations of them using the limb symmetry index (LSIWORSE-BETTER, ranging from 0% to 100%). The 2 groups were compared for these values and the proportions of individuals classified as symmetric (LSIWORSE-BETTER ≥90%) using independent t-tests and Fisher’s exact tests, respectively.Results: Athletes with ACLR were less symmetric than noninjured athletes for knee flexion strength with a lower LSIWORSE-BETTER (83% vs 91%, P < 0.01) and a lower proportion of symmetric individuals (39% vs 63%, P = 0.04). No differences between groups were revealed for the hop tests, knee extension strength, or combinations of tests (P > 0.05). Only 17% of the athletes with ACLR and 24% of the noninjured athletes demonstrated symmetric performances for all 4 tests.Conclusion: Athletes with ACLR (hamstring autograft) showed poorer symmetry in knee flexion strength than noninjured athletes, although both groups had few individuals who passed the test battery’s symmetry criteria.Clinical relevance: Symmetry is uncommon among athletes irrespective of ACLR and should be considered regarding expected rehabilitation outcomes and return-to-sport decisions post-ACLR.
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37.
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38.
  • Markström, Jonas, 1985-, et al. (författare)
  • Atypical lower limb mechanics during weight acceptance of stair descent at different time frames after anterior cruciate ligament reconstruction
  • 2022
  • Ingår i: American Journal of Sports Medicine. - : Sage Publications. - 0363-5465 .- 1552-3365. ; 50:8, s. 2125-2133
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: An anterior cruciate ligament (ACL) rupture may result in poor sensorimotor knee control and, consequentially, adapted movement strategies to help maintain knee stability. Whether patients display atypical lower limb mechanics during weight acceptance of stair descent at different time frames after ACL reconstruction (ACLR) is unknown.Purpose:To compare the presence of atypical lower limb mechanics during the weight acceptance phase of stair descent among athletes at early, middle, and late time frames after unilateral ACLR.Study Design:Controlled laboratory study.Methods:A total of 49 athletes with ACLR were classified into 3 groups according to time after ACLR—early (<6 months; n = 17), middle (6-18 months; n = 16), and late (>18 months; n = 16)—and compared with asymptomatic athletes (control; n = 18). Sagittal plane hip, knee, and ankle angles; angular velocities; moments; and powers were compared between the ACLR groups’ injured and noninjured legs and the control group as well as between legs within groups using functional data analysis methods.Results:All 3 ACLR groups showed greater knee flexion angles and moments than the control group for injured and noninjured legs. For the other outcomes, the early group had, compared with the control group, less hip power absorption, more knee power absorption, lower ankle plantarflexion angle, lower ankle dorsiflexion moment, and less ankle power absorption for the injured leg and more knee power absorption and higher vertical ground reaction force for the noninjured leg. In addition, the late group showed differences from the control group for the injured leg revealing more knee power absorption and lower ankle plantarflexion angle. Only the early group took a longer time than the control group to complete weight acceptance and demonstrated asymmetry for multiple outcomes.Conclusion:Athletes with different time frames after ACLR revealed atypically large knee angles and moments during weight acceptance of stair descent for both the injured and the noninjured legs. These findings may express a chronically adapted strategy to increase knee control. In contrast, atypical hip and ankle mechanics seem restricted to an early time frame after ACLR.Clinical Relevance:Rehabilitation after ACLR should include early training in controlling weight acceptance. Including a control group is essential when evaluating movement patterns after ACLR because both legs may be affected.
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39.
  • Markström, Jonas, 1985-, et al. (författare)
  • Strategies for knee stabilising and pivot-shift avoidance in a step-down and cross-over task observed sub-acutely after anterior cruciate ligament reconstruction
  • 2024
  • Ingår i: Clinical Biomechanics. - : Elsevier. - 0268-0033 .- 1879-1271. ; 115
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Individuals with a recent anterior cruciate ligament reconstruction may demonstrate an altered movement strategy for protecting the knee and maintaining stability. Altered knee movement might lead to abnormal intra-articular load, potentially contributing to early knee osteoarthritis onset. A protective strategy may be particularly evident during active tasks that induce a pivot-shift manoeuvre, such as a step-down and cross-over task. In this study, we investigated whether knee joint mechanics and muscle activity differed between participants early (∼3 months) following reconstruction (n = 35) to uninjured controls (n = 35) during a step-down and cross-over task with a 45° change-of-direction.Methods: We used motion capture, force plates and surface electromyography to compare time-normalised curves of sagittal and transverse-plane knee mechanics and muscle activity during the cross-over phase between groups using functional t-tests. We also compared knee mechanics between sides within the injured group and compared discrete outcomes describing the cross-over phase between groups.Findings: Compared to controls, the injured participants had greater knee flexion angle and moment, lower internal rotation moment, more preparatory foot rotation of the pivoting leg, a smaller cross-over angle, and a longer cross-over phase for both the injured and uninjured sides. The injured leg also had greater biceps femoris and vastus medialis muscle activity compared to controls and different knee mechanics than the uninjured leg.Interpretation: Individuals with anterior cruciate ligament reconstruction showed a knee-stabilising and pivot-shift avoidance strategy for both legs early in rehabilitation. These results may reflect an altered motor representation and motivate considerations early in rehabilitation.
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40.
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41.
  • Naili, Josefine E., et al. (författare)
  • A longitudinal case-control study of a female athlete preinjury and after ACL reconstruction : hop performance, knee muscle strength, and knee landing mechanics
  • 2023
  • Ingår i: Sports Health. - : Sage Publications. - 1941-7381 .- 1941-0921. ; 15:3, s. 357-360
  • Tidskriftsartikel (refereegranskat)abstract
    • Athletes with an anterior cruciate ligament (ACL) injury followed by ACL reconstruction (ACLR) often perform various testing to guide return to sport, but preinjury data are rarely available for comparison. This longitudinal case-control study reports absolute value and between-leg symmetry data on maximal performances for single-leg hop height and distance, muscle strength, and side hop landing mechanics of an 18-year-old female soccer athlete collected 5 months before sustaining an ACL injury and again at 10, 13, and 29 months post-ACLR. Her data were compared across test sessions and to cross-sectional data of 15 asymptomatic female athletes.
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42.
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43.
  • Nedergård, Heidi, et al. (författare)
  • Core Sets of Kinematic Variables to Consider for Evaluation of Gait Post-stroke
  • 2022
  • Ingår i: Frontiers in Human Neuroscience. - : Frontiers Media S.A.. - 1662-5161. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Instrumented gait analysis post-stroke is becoming increasingly more common in research and clinics. Although overall standardized procedures are proposed, an almost infinite number of potential variables for kinematic analysis is generated and there remains a lack of consensus regarding which are the most important for sufficient evaluation. The current aim was to identify a discriminative core set of kinematic variables for gait post-stroke.Methods: We applied a three-step process of statistical analysis on commonly used kinematic gait variables comprising the whole body, derived from 3D motion data on 31 persons post-stroke and 41 non-disabled controls. The process of identifying relevant core sets involved: (1) exclusion of variables for which there were no significant group differences; (2) systematic investigation of one, or combinations of either two, three, or four significant variables whereby each core set was evaluated using a leave-one-out cross-validation combined with logistic regression to estimate a misclassification rate (MR).Results: The best MR for one single variable was shown for the Duration of single-support (MR 0.10) or Duration of 2nd double-support (MR 0.11) phase, corresponding to an 89–90% probability of correctly classifying a person as post-stroke/control. Adding Pelvis sagittal ROM to either of the variables Self-selected gait speed or Stride length, alternatively adding Ankle sagittal ROM to the Duration of single-stance phase, increased the probability of correctly classifying individuals to 93–94% (MR 0.06). Combining three variables decreased the MR further to 0.04, suggesting a probability of 96% for correct classification. These core sets contained: (1) a spatial (Stride/Step length) or a temporal variable (Self-selected gait speed/Stance time/Swing time or Duration of 2nd double-support), (2) Pelvis sagittal ROM or Ankle plantarflexion during push-off, and (3) Arm Posture Score or Cadence or a knee/shoulder joint angle variable. Adding a fourth variable did not further improve the MR.Conclusion: A core set combining a few crucial kinematic variables may sufficiently evaluate post-stroke gait and should receive more attention in rehabilitation. Our results may contribute toward a consensus on gait evaluation post-stroke, which could substantially facilitate future diagnosis and monitoring of rehabilitation progress.
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44.
  • Nedergård, Heidi, et al. (författare)
  • Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke : a systematic review and meta-analysis
  • 2021
  • Ingår i: Journal of NeuroEngineering and Rehabilitation. - : BioMed Central (BMC). - 1743-0003. ; 18:1
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-stroke when compared with non-robotic gait training alone.Methods: Nine databases were searched using database-specific search terms from their inception until January 2021. We included randomized controlled trials investigating the effects of RAGT (e.g., using exoskeletons or end-effectors) on spatiotemporal, kinematic and kinetic parameters among adults suffering from any stage of stroke. Screening, data extraction and judgement of risk of bias (using the Cochrane Risk of bias 2 tool) were performed by 2–3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the biomechanical gait measures of interest.Results: Thirteen studies including a total of 412 individuals (mean age: 52–69 years; 264 males) met eligibility criteria and were included. RAGT was employed either as monotherapy or in combination with other therapies in a subacute or chronic phase post-stroke. The included studies showed a high risk of bias (n = 6), some concerns (n = 6) or a low risk of bias (n = 1). Meta-analyses using a random-effects model for gait speed, cadence, step length (non-affected side) and spatial asymmetry revealed no significant differences between the RAGT and comparator groups, while stride length (mean difference [MD] 2.86 cm), step length (affected side; MD 2.67 cm) and temporal asymmetry calculated in ratio-values (MD 0.09) improved slightly more in the RAGT groups. There were serious weaknesses with almost all GRADE domains (risk of bias, consistency, directness, or precision of the findings) for the included outcome measures (spatiotemporal and kinematic gait parameters). Kinetic parameters were not reported at all.Conclusion: There were few relevant studies and the review synthesis revealed a very low certainty in current evidence for employing RAGT to improve gait biomechanics post-stroke. Further high-quality, robust clinical trials on RAGT that complement clinical data with biomechanical data are thus warranted to disentangle the potential effects of such interventions on gait biomechanics post-stroke.
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45.
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46.
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47.
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48.
  • Nedergård, Heidi, et al. (författare)
  • Users’ experiences of intensive robotic-assisted gait training post-stroke : “a push forward or feeling pushed around?”
  • 2022
  • Ingår i: Disability and Rehabilitation. - : Taylor & Francis. - 0963-8288 .- 1464-5165.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke.Materials and methods: Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis.Results: Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended.Conclusions: The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments.
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49.
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50.
  • Palmcrantz, S., et al. (författare)
  • Impact of Intensive Gait Training With and Without Electromechanical Assistance in the Chronic Phase After Stroke-A Multi-Arm Randomized Controlled Trial With a 6 and 12 Months Follow Up
  • 2021
  • Ingår i: Frontiers in Neuroscience. - : Frontiers Media SA. - 1662-453X .- 1662-4548. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Movement related impairments and limitations in walking are common long-term after stroke. This multi-arm randomized controlled trial explored the impact of training with an electromechanically assisted gait training (EAGT) system, i.e., the Hybrid Assistive Limb(R) (HAL), when integrated with conventional rehabilitation focused on gait and mobility. Material and Methods: Participants, aged 18-70 years with lower extremity paresis but able to walk with manual support or supervision 1-10 years after stroke, were randomized to (A) HAL-training on a treadmill, combined with conventional rehabilitation interventions (HAL-group), or (B) conventional rehabilitation interventions only (Conventional group), 3 days/week for 6 weeks, or (C) no intervention (Control group). Participants in the Control group were interviewed weekly regarding their scheduled training. Primary outcome was endurance in walking quantified by the 6 Minute Walk Test (6MWT). A rater blinded to treatment allocation performed assessments pre- and post-intervention and at follow-ups at 6 and 12 months. Baseline assessment included the National Institute of Health Stroke Scale (NIHSS) and the Modified Ranking Scale (MRS). Secondary outcomes included the Fugl Meyer Assessment- Lower Extremity, 10 Meter Walk Test, Berg Balance Scale (BBS), Barthel Index (BI) and perceived mobility with the Stroke Impact Scale. Results: A total of 48 participants completed the intervention period. The HAL-group walked twice as far as the Conventional group during the intervention. Post-intervention, both groups exhibited improved 6 MWT results, while the Control group had declined. A significant improvement was only found in the Conventional group and when compared to the Control group (Tukey HSD p = 0.022), and not between the HAL group and Conventional group (Tukey HSD p = 0.258) or the HAL- group and the Control group (Tukey HSD p = 0.447). There was also a significant decline in the Conventional group from post-intervention to 6 months follow up (p = 0.043). The best fitting model to predict outcome included initial balance (BBS), followed by stroke severity (NIHSS), and dependence in activity and participation (BI and MRS). Conclusion: Intensive conventional gait training induced significant improvements long-term after stroke while integrating treadmill based EAGT had no additional value in this study sample. The results may support cost effective evidence-based interventions for gait training long-term after stroke and further development of EAGT.
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