Non-oncological outcomes following limb salvage surgery in patients with knee sarcoma: a scoping review.

PURPOSE: Limb salvage surgery is a surgical procedure for tumour resection in bone and soft-tissue cancers. Guidelines aim to preserve as much function and tissue of the limb as possible. Surgical outcome data is routinely available as part of surgical reporting processes. What is less known are important non-oncological outcomes throughout recovery from both clinical and patient perspectives. The objective of this review was to explore non-oncological outcomes in patients diagnosed with sarcoma around the knee following limb salvage surgery. MATERIALS AND METHODS: A scoping review methodology was used, and results analysed using CASP checklists. RESULTS: Thirteen studies were included and following appraisal and synthesis, three themes emerged as providing important measures intrinsic to successful patient recovery: (1) physical function, (2) quality of life and, (3) gait and knee goniometry. Specifically, patients develop range of motion complications that alter gait patterns and patients often limit their post-operative participation in sport and leisure activities. CONCLUSIONS: This study has shown the importance of exploring confounding factors, adopting a holistic view of patient recovery beyond surgical outcomes, proposing evidence-based guidance to support and inform healthcare providers with clinical decision-making. This review highlights the paucity and lack of quality of research available, emphasising how under-represented this population is in the research literature.IMPLICATIONS FOR REHABILITATIONPatients having undergone LSS often have limited participation in sport and leisure activities.Patients can develop range of motion complications, such as flexion contracture or extension lag, which may affect the pattern of gait.Clinical consideration should be given to walking ability and gait patterns during the rehabilitation phase to prevent poor functional outcomes during recovery.Variation of treatment protocols, outcome measurement and rehabilitative care has been identified as important in predicting the outcomes in recovery from LSS procedures.

A review of innovation strategies and processes to improve access to AT: Looking ahead to open innovation ecosystems.

It is essential to understand the strategies and processes which are deployed currently across the Assistive Technology (AT) space toward measuring innovation. The main aim of this paper is to identify functional innovation strategies and processes which are being or can be deployed in the AT space to increase access to AT globally. We conducted a scoping review of innovation strategies and processes in peer-reviewed literature databases and complemented this by identifying case studies demonstrating innovation strategies. The review includes WHO world region, publication year, AT type and a sector analysis against the Systems-Market for Assistive and Related Technologies Framework. We analyzed the case studies and interviews using thematic analysis. We included 91 papers out of 3,127 after review along with 72 case studies. Our results showed that product innovations were more prevalent than provision or supply innovations across papers and case studies. Case studies yielded two themes: open innovation (OI); radical and disruptive innovation. Financial instruments which encourage OI are needed and we recommend pursuing OI for AT innovation. Embedding AT within larger societal missions will be key to success governments and investors need to understand what AT is and their translational socioeconomic value.

Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation.

PURPOSE: To characterise the global functioning post-stroke in patients with normal knee posture (NKP) and abnormal knee posture (AKP) during loading-response. METHODS: 35 people, 6 months post-stroke. with NKP and AKP were identified and assessed using clinical measures classified into the corresponding International Classification of Functioning, Disability and Health (ICF) domains: weight function (body mass index); muscle power (knee isometric strength); muscle tone (Modified Ashworth Scale); voluntary motor control (Leg sub-score of Fugl-Meyer scale); walking short distances (5-meter walk test; Timed-Up and Go test); walking on different surfaces (Functional Ambulation Categories); moving around (Falls Efficacy Scale); moving using equipment (walking aids) and global assessment of function (WHODAS II). Age, gender, marital status, current occupation and caregivers support characterised personal factors. RESULTS: Patients with AKP had significantly lower knee flexor strength, higher knee flexor and extensor spasticity, more difficulty in maintaining a standing position, walking short and long distances, used walking aids more often and needed more caregiver support. Restriction in activities and participation were correlated with knee flexor strength for AKP and with knee spasticity for NKP group. CONCLUSIONS: AKP restricts functioning and participation.

Fast gait speed and self-perceived balance as valid predictors and discriminators of independent community walking at 6 months post-stroke--a preliminary study.

PURPOSE: To determine the validity of walking speed, muscle strength, function of the hemiparetic lower limb and self-perceived balance to predict and discriminate independent community walkers (ICW) within the first 6 months post-stroke. METHODS: Inpatients with a first ischemic stroke (<3 months), able to walk, were evaluated (T0) and re-evaluated after 6 months post-stroke (T1). Comfortable, fast speed and the difference between fast and comfortable speed, muscle strength of knee flexors and extensors, sensory-motor function of the hemiparetic lower limb and self-perceived balance were assessed at T0 and T1. At T1, a self-reported question was used to discriminate ICW versus Dependent Community Walkers (DCW). ROC curve analysis was used to determine valid predictive (T0) and discriminative (T1) cut-offs of ICW. RESULTS: Only 25.7% of the 35 participants were ICW at T1. Valid predictive cut-offs at T0 were found for fast speed (≥0.42 m/s) and Falls Efficacy Scale (<57). Valid discriminators were found at T1 for fast speed (>0.84 m/s) and FES (<18.50). CONCLUSION: Fast speed and self-perceived balance appear to be important characteristics of ICW at 6 months and may be useful early predictors of the potential for patients to achieve this. Further research is needed to ensure the precision of these functional cut-offs.

A systematic review of the key factors affecting tissue viability and rehabilitation outcomes of the residual limb in lower extremity traumatic amputees.

Most traumatic lower limb amputees ambulate using a prosthetic limb. Comfort, appearance of the missing limb and function are confirmed as being important during rehabilitation post-amputation. Emerging evidence suggests that impaired tissue viability of the stump affects rehabilitation and thus clinical ability to provide optimum care. The primary objective of this systematic review was to identify key factors relating to tissue viability of the residual limb in lower extremity traumatic amputees. A secondary objective was to identify factors that affect rehabilitation post-amputation. In total, 218 studies were assessed; 37 met pre-determined criteria. Studies were classified according to the WHO ICF framework and the NHMRC level of evidence. Five key themes emerged; Prosthetic Fit; The Residuum; Quality of Life; Amputee Care and Prosthetic Use. The evidence indicates that high frequencies of skin problems affecting tissue viability within this population are inherently linked to intolerance of the prosthesis. Stump integrity, amputee care regimen and pain were also identified as impacting on quality of life, affecting rehabilitation and the ability to become independently mobile. Levels of evidence within all studies were low and indicative of the majority being non-randomised cohort studies or case-control studies. As there are a limited number of interventional studies, further development of robust outcome measures, clinical trials and prospective studies are of utmost importance to unravel the links between tissue viability and the other key factors. This will inform clinical management strategies and help develop targeted therapies and care pathways.

Complex hand dexterity: a review of biomechanical methods for measuring musical performance.

Complex hand dexterity is fundamental to our interactions with the physical, social, and cultural environment. Dexterity can be an expression of creativity and precision in a range of activities, including musical performance. Little is understood about complex hand dexterity or how virtuoso expertise is acquired, due to the versatility of movement combinations available to complete any given task. This has historically limited progress of the field because of difficulties in measuring movements of the hand. Recent developments in methods of motion capture and analysis mean it is now possible to explore the intricate movements of the hand and fingers. These methods allow us insights into the neurophysiological mechanisms underpinning complex hand dexterity and motor learning. They also allow investigation into the key factors that contribute to injury, recovery and functional compensation. The application of such analytical techniques within musical performance provides a multidisciplinary framework for purposeful investigation into the process of learning and skill acquisition in instrumental performance. These highly skilled manual and cognitive tasks present the ultimate achievement in complex hand dexterity. This paper will review methods of assessing instrumental performance in music, focusing specifically on biomechanical measurement and the associated technical challenges faced when measuring highly dexterous activities.

Lower limb co-contraction during walking in subjects with stroke: A systematic review.

PURPOSE: The aim of this paper was to identify and synthesise existing evidence on lower limb muscle co-contraction (MCo) during walking in subjects with stroke. METHODS: An electronic literature search on Web of Science, PubMed and B-on was conducted. Studies from 1999 to 2012 which analysed lower limb MCo during walking in subjects with stroke, were included. RESULTS: Eight articles met the inclusion criteria: 3 studied MCo in acute stage of stroke, 3 in the chronic stage and 2 at both stages. Seven were observational and 1 had a pretest-posttest interventional design. The methodological quality was "fair to good" to "high" quality (only 1 study). Different methodologies to assess walking and quantify MCo were used. There is some controversy in MCo results, however subjects with stroke tended towards longer MCo in both lower limbs in both the acute and chronic stages, when compared with healthy controls. A higher level of post-stroke walking ability (speed; level of independence) was correlated with longer thigh MCo in the non-affected limb. One study demonstrated significant improvements in walking ability over time without significant changes in MCo patterns. CONCLUSIONS: Subjects with stroke commonly present longer MCo during walking, probably in an attempt to improve walking ability. However, to ensure recommendations for clinical practice, further research with standardized methodologies is needed.

Methodologies to assess muscle co-contraction during gait in people with neurological impairment - a systematic literature review.

PURPOSE: To review the methodologies used to assess muscle co-contraction (MCo) with surface electromyography (sEMG) during gait in people with neurological impairment. METHODS: The Scopus (1995-2013), Web of Science (1970-2013), PubMed (1948-2013) and B-on (1999-2013) databases were searched. Articles were included when sEMG was used to assess MCo during gait in people with impairment due to central nervous system disorders (CNS). RESULTS: Nineteen articles met the inclusion criteria and most studied people with cerebral palsy and stroke. No consensus was identified for gait assessment protocols (surfaces, speed, distance), sEMG acquisition (electrodes position), analysis of sEMG data (filters, normalisation techniques) and quantification of MCo (agonist-antagonist linear envelopes overlapping or agonist-antagonist overlapping periods of muscles activity, onset delimited). CONCLUSION: Given the wide range of methodologies employed, it is not possible to recommend the most appropriate for assessing MCo. Researchers should adopt recognized standards in future work. This is needed before consensus about the role that MCo plays in gait impairment in neurological diseases and its potential as a target for gait rehabilitation can be determined.

Markerless motion capture and measurement of hand kinematics: validation and application to home-based upper limb rehabilitation.

Dynamic movements of the hand, fingers, and thumb are difficult to measure due to the versatility and complexity of movement inherent in function. An innovative approach to measuring hand kinematics is proposed and validated. The proposed system utilizes the Microsoft Kinect and goes beyond gesture recognition to develop a validated measurement technique of finger kinematics. The proposed system adopted landmark definition (validated through ground truth estimation against assessors) and grip classification algorithms, including kinematic definitions (validated against a laboratory-based motion capture system). The results of the validation show 78% accuracy when identifying specific markerless landmarks. In addition, comparative data with a previously validated kinematic measurement technique show accuracy of MCP ± 10° (average absolute error (AAE) = 2.4°), PIP ± 12° (AAE = 4.8°), and DIP ± 11° (AAE = 4.8°). These results are notably better than clinically based alternative manual measurement techniques. The ability to measure hand movements, and therefore functional dexterity, without interfering with underlying composite movements, is the paramount objective to any bespoke measurement system. The proposed system is the first validated markerless measurement system using the Microsoft Kinect that is capable of measuring finger joint kinematics. It is suitable for home-based motion capture for the hand and, therefore, achieves this objective.

A narrative review on haptic devices: relating the physiology and psychophysical properties of the hand to devices for rehabilitation in central nervous system disorders.

PURPOSE: This article provides rehabilitation professionals and engineers with a theoretical and pragmatic rationale for the inclusion of haptic feedback in the rehabilitation of central nervous system disorders affecting the hand. METHOD: A narrative review of haptic devices used in sensorimotor hand rehabilitation was undertaken. Presented papers were selected to outline and clarify the underlying somatosensory mechanisms underpinning these technologies and provide exemplars of the evidence to date. RESULTS: Haptic devices provide kinaesthetic and/or tactile stimulation. Kinaesthetic haptics are beginning to be incorporated in central nervous system rehabilitation; however, there has been limited development of tactile haptics. Clinical research in haptic rehabilitation of the hand is embryonic but initial findings indicate potential clinical benefit. CONCLUSIONS: Haptic rehabilitation offers the potential to advance sensorimotor hand rehabilitation but both scientific and pragmatic developments are needed to ensure that its potential is realized.

Modified kinematic technique for measuring pathological hyperextension and hypermobility of the interphalangeal joints.

Dynamic finger joint motion is difficult to measure using optical motion analysis techniques due to the limited surface area allowed for adequate marker placement. This paper describes an extension of a previously validated kinematic measurement technique using a reduced surface marker set and outlines the required calculations based on a specific surface marker placement to calculate flexion/extension and hyperextension of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints. The modified technique has been assessed for accuracy using a series of static reference frames (absolute residual error = ±3.7°, cross correlation between new method and reference frames; r=0.99). The method was then applied to a small group of participants with rheumatoid arthritis (seven females, one male; mean age = 62.8 years ± 12.04) and illustrated congruent strategies of movement for a participant and a large range of finger joint movement over the sample (5.8-71.1°, smallest to largest active range of motion). This method used alongside the previous paper provides a comprehensive, validated method for calculating 3-D wrist, hand, fingers, and thumb kinematics to date and provides a valuable measurement tool for clinical research.

Validation and application of a computational model for wrist and hand movements using surface markers.

A kinematic model is presented based on surface marker placement generating wrist, metacarpal arch, fingers and thumb movements. Standard calculations are used throughout the model and then applied to the specified marker placement. A static trial involving eight unimpaired participants was carried out to assess inter-rater reliability. The standard deviations across the data were comparable to manual goniometers. In addition, a test-retest trial of ten unimpaired participants is also reported to illustrate the variability of movement at the wrist joint, metacarpal arch, and index finger as an example of model output when repeating the same task many times. Light and heavyweight versions of the tasks are assessed and characteristics of individual movement strategies presented. The participant trial showed moderate correlation in radial/ulnar deviation of the wrist (r = 0.65), and strong correlation in both metacarpal arch joints (r = 0.75 and r = 0.85), the MCP (r = 0.79), and PIP (r = 0.87) joints of the index finger. The results indicate that individuals use repeated strategies of movement when lifting light and heavyweight versions of the same object, but showed no obvious repeated pattern of movement across the population.