Effect of brace design on patients with ACL-ruptures.

Different designs of functional knee braces for ACL-injury rehabilitation exist. In addition to the mechanical stabilization provided by rigid shell braces, sleeve braces also address proprioceptive mechanisms, but little is known if this leads to benefits for ACL-deficient subjects. Therefore the aim of this study was to investigate the effect of 2 different functional brace designs (shell and sleeve brace) on functional achievements in ACL-deficient patients. 28 subjects with ACL-ruptured knees performed tests for knee joint laxity, joint position sense, static and dynamic balance and isometric and dynamic lower limb extension strength in non-braced, sleeve braced and shell braced condition. The results showed a significant decrease in knee joint laxity for sleeve (33%; p<0.001) and rigid shell bracing (14%, p=0.039). The sleeve brace revealed a significant increase in dynamic balance after perturbation (20%; p=0.024) and a significant increase in dynamic lower limb peak rate of force development (17%; p=0.015) compared to the non-braced condition. The effects might be caused by the flexible area of support and the incorporated mechanisms to address proprioceptive aspects. Braces might not be needed in simple daily life tasks, but could provide beneficial support in more dynamic settings when patients return to sporting activities after an ACL-injury.

[A biomechanical analysis of cyclical hand motor function: a pilot study in different Parkinsonian syndromes]. / Biomechanische Analyse zyklischer Handfunktionen : Eine Pilotstudie bei unterschiedlichen Parkinson-Syndromen.

INTRODUCTION: Clinical assessment of hand bradykinesia in Parkinson's disease (PD) focuses mainly on the frequency, amplitude and rhythm of movements, thereby subjectively evaluating the correct performance of hand movements. The aim of the study was to quantify hand bradykinesia with kinematic data in different Parkinsonian syndromes. PATIENTS AND METHODS: This retrospective study compared patients with idiopathic PD (IPD, n = 18), atypical Parkinson's syndrome (APS, n = 17), secondary Parkinson's syndrome (SPS, n = 18) and healthy controls (C, n = 18). All patients were receiving the best medical treatment. Hand movements were recorded using an ultrasound-system (Zebris®, Isny, Germany). Subjects were asked to perform pronation/supination of the forearm (diadochokinesis), flexion/extension of the hand (hand tapping) and tapping of the index finger. Mean amplitude, mean frequency and mean variability of movements were determined. RESULTS: APS patients had significant complex hand movement disability with reduced amplitude and frequency in combination with increased motion variability in all movement tasks. The key disturbance in the IPD group concerned the rhythm in hand tapping and index finger tapping in combination with moderately reduced velocity and range of motion in all conditions. The cyclical hand movement characteristics in SPS patients showed movement slowness with normal amplitude and variability in all motor conditions. CONCLUSION: Our results suggest that computerized quantitative analysis of cyclical hand movements can characterize and identify different representations of hand bradykinesia in different Parkinsonian disorders and hence may help clinicians to accurately assess therapeutic targets and outcome of interventions.

[Static posturography in selected Parkinson syndromes: quantitative analysis of postural control]. / Statische Posturographie bei ausgewählten Parkinson-Syndromen : Quantitative Beurteilung der posturalen Kontrolle.

OBJECTIVES: Idiopathic Parkinson's disease (IPD) is associated with postural disturbances and falls. The assessment of postural instability by the pull test may lead to inconclusive results. Static posturography measurements may give more reliable information regarding the differential diagnosis of Parkinson syndromes. PATIENTS AND METHODS: We compared results of the pull test and static posturography (sway area in eyes-open/eyes-closed conditions) in healthy controls (C) and patients with akinetic-rigid IPD (n=18), atypical Parkinson syndromes (APS; n=18) and secondary Parkinson syndromes (SPS; n=17). RESULTS: Static posturography and the pull test results did not differ significantly between controls and patients with akinetic-rigid IPD. APS patients had significantly greater postural sway areas when tested with eyes open compared to controls (APS: 16.89 vs C: 6.89 mm, p≤0.001) and IPD patients (APS: 16.89 vs IPD: 9.55 mm, p=0.005). The correlation in the APS group between the pull test and sway area in the eyes-open condition was significant (r=0.526, p=0.025). With eyes closed, postural instability in APS patients was not significantly increased (+2%, p=.847). SPS patients were more unstable under the eyes-closed condition compared to controls (sway area SPS: 26.29 vs C: 8.79 mm, p≤0.001), IPD patients (sway area SPS: 26.29 vs IPD: 11.06 mm, p≤0.001) and APS patients (sway area SPS: 26.29 vs APS: 17.28 mm, p=0.027), without a significant correlation to the pull test. The sway area in the SPS patients increased significantly by 67% (p=0.001) under the eyes-closed condition. CONCLUSION: Static posturography may be a helpful tool for the differentiation of Parkinson syndromes.

Effects of obesity on the biomechanics of stair-walking in children.

Anthropometric characteristics, particularly body mass, are important factors in the development and progression of varus/valgus angular deformities of the knee and have long-term implications including increased risk of osteoarthritis. However, information on how excessive body weight affects the biomechanics of dynamic activities in children is limited. The purpose of this study was to test the hypothesis that during stair-walking lower extremity joint moments normalized to body mass in obese children are greater than those in normal-weight children. Eighteen obese children (10.5±1.5 years, 148±10cm, 56.6±8.4kg) and 17 normal-weight children (10.4±1.3 years, 143±9cm, 36.7±7.5kg) were recruited. A Vicon system and two AMTI force plates were used to record and analyze the kinematics and kinetics of ascending and descending stairs. Significant differences in spatio-temporal, kinematic and kinetic parameters during ascending and descending stairs between obese and normal-weight children were detected. For stair ascent, greater hip abduction moments (+23%; p=0.001) and greater knee extension moments (+20%; p=0.008) were observed. For stair descent, smaller hip extension moment (-52%; p=0.031), and greater hip flexion moments (+25%; p=0.016) and knee extension moments (+15%, p=0.008) were observed for obese subjects. To date, it is unclear if and how the body may adapt to greater joint moments in obese children. Nevertheless, these differences in joint moments may contribute to a cumulative overloading of the joint through adolescence into adulthood, and potentially result in a greater risk of developing knee and hip osteoarthritis.

Impact of skier actions on the gliding times in alpine skiing.

Alpine ski races are typically won by fractions of a second. It is therefore essential for ski racers to minimize air drag as well as ski-snow friction. In contrast to air drag, ski-snow friction during actual skiing has rarely been investigated so far. Two tasks, forward/backward leaning and edging of the skis, were selected, which (a) were expected to have an impact on ski-snow friction, and (b) could be executed while gliding in tucked position. Two hypotheses were tested: (H1) Run times are affected by forward or backward leaning. (H2) Run times are affected by edging of the skis. Four professional ski testers were recruited, who conducted a total of 68 runs of straight gliding. Execution of the tasks was documented by video recordings and by measuring the force application point on the skis of one tester. The findings of this study support (H2) but not (H1). There are indications that the increased run times for edging are caused by increased ski-snow friction. From a performance point of view, it seems beneficial for ski racers to minimize edging in the gliding sections of a race.

Specific fitness training and testing in competitive sports.

Improvements of athletic capacity in high-performance sport are mainly achieved through an increase of the quality of training. In physical preparation, the quality of training can be improved by developing highly specific means of training. The aim of this paper is to present three examples of how highly specific means of fitness training of world class athletes can be developed. The first example presents a test profile of specific motor abilities of top class tennis players, the second one deals with the improvement of specific strength training methods for ski jumpers, and the third deals with the development of specific training devices of Alpine ski racers.

Knee joint forces during downhill walking with hiking poles.

The aim of this study was to determine external and internal loads on the knee joint during downhill walking with and without hiking poles. Kinematic, kinetic and electromyographic data were collected from eight males during downhill walking on a ramp declined at 25 degrees. Planar knee joint moments and forces were calculated using a quasi-static knee model. The results were analysed for an entire pole-cycle as well as differentiated between single and double support phases and between each step of a pole-cycle. Significant differences between downhill walking with and without hiking poles were observed for peak and average magnitudes of ground reaction force, knee joint moment, and tibiofemoral compressive and shear forces (12-25%). Similar reductions were found in patellofemoral compressive force, the quadriceps tendon force and the activity of the vastus lateralis; however, because of a high variability, these differences were not significant. The reductions seen during downhill walking with hiking poles compared with unsupported downhill walking were caused primarily by the forces applied to the hiking poles and by a change in posture to a more forward leaning position of the upper body, with the effect of reducing the knee moment arm.

Comparisons of the ski turn techniques of experienced and intermediate skiers.

We compared selected kinematic variables for four different ski turn techniques performed by five experienced and five intermediate male skiers. The four ski turn techniques were the upstem turn, the downstem turn, the parallel turn and the parallel step turn. Each turn was divided into the initiation phase and the first and second steering phases. Most of the statistically significant differences (P < 0.05) between the two groups were found for the initiation phases of the four turns. Both the hip axis-hand axis angle and the edging angle of the uphill ski were significantly different between the two groups for the upstem turn at the beginning of the initiation phase. For the downstem turn, significant differences between the groups were found at the start of the initiation phase for the hip axis-hand axis angle, the shoulder axis-fall line angle, and the edging angle of the uphill ski. The standard deviation of the distance between the tips of the two skis over the second steering phase also differed significantly between the two groups. For the parallel step turn, significant differences were found at the start of the initiation phase for the edging angle of the downhill ski and the downhill ski to movement direction angle. Significant differences were also found for the edging angle of the downhill ski in the middle of the second steering phase and the shoulder axis to movement direction angle at the end of this phase. For the initiation phase of the parallel turn, significant differences were found for the timing of setting the ski pole, the uphill knee angle at the start of this phase and the range of the knee angle of the uphill leg from the start to the end of this phase. For this turn, significant differences between the two groups were also found for the edging angle of the downhill ski in the middle of the second steering phase and the shoulder axis to movement direction angle at the end of this phase. One of the reasons it was possible to identify a few significant differences only for the turns analysed, was the variability within the intermediate group: for most of the variables analysed, the standard deviation was much higher for the intermediate than for the experienced group.