Reliability and comparison of trunk and pelvis angles, arm distance and center of pressure in the seated functional reach test with and without foot support in children.

This study determined test-retest reliability of trunk and pelvis joint angles, arm distance and center of pressure (COP) excursion for the seated functional reach test (FRT) and compared these variables during the seated FRT with and without foot support. Fifteen typically developing children (age 9.3±4.1years) participated. Trunk and pelvis joint angles, arm distance, and COP excursion were collected on two days using three-dimensional motion analysis and a force plate while subjects reached maximally with and without foot support in the anterior, anterior/lateral, lateral, posterior/lateral directions. Age, weight, height, trunk and arm lengths were correlated (p<0.01) with maximum arm distance reached. Maximum arm distance, trunk and pelvis joint angles, and COP with and without foot support were not significant (p<0.05) for the two test periods. Excellent reliability (ICCs>0.75) was found for maximum arm distance reached in all four directions in the seated FRT with and without foot support. Most trunk and pelvis joint angles and COP excursions during maximum reach in all four directions showed excellent to fair reliability (ICCs>0.40-0.75). Reaching with foot support in all directions was significantly greater (p<0.05) than without foot support; however, most COP excursions and trunk and pelvic angles were not significantly different. Findings support the addition of anterior/lateral and posterior/lateral reaching directions in the seated FRT. Trunk and pelvis movement analysis is important to examine in the seated FRT to determine the specific movement strategies needed for maximum reaching without loss of balance.

Feasibility of Computer-Based Videogame Therapy for Children with Cerebral Palsy.

OBJECTIVES: Standing and gait balance problems are common in children with cerebral palsy (CP), resulting in falls and injuries. Task-oriented exercises to strengthen and stretch muscles that shift the center of mass and change the base of support are effective in improving balance. Gaming environments can be challenging and fun, encouraging children to engage in exercises at home. The aims of this project were to demonstrate the technical feasibility, ease of use, appeal, and safety of a computer-based videogame program designed to improve balance in children with CP. MATERIALS AND METHODS: This study represents a close collaboration between computer design and clinical team members. The first two phases were performed in the laboratory, and the final phase was done in subjects' homes. The prototype balance game was developed using computer-based real-time three-dimensional programming that enabled the team to capture engineering data necessary to tune the system. Videogame modifications, including identifying compensatory movements, were made in an iterative fashion based on feedback from subjects and observations of clinical and software team members. RESULTS: Subjects (n=14) scored the game 21.5 out of 30 for ease of use and appeal, 4.0 out of 5 for enjoyment, and 3.5 on comprehension. There were no safety issues, and the games performed without technical flaws in final testing. CONCLUSIONS: A computer-based videogame incorporating therapeutic movements to improve gait and balance in children with CP was appealing and feasible for home use. A follow-up study examining its effectiveness in improving balance in children with CP is recommended.

Development and validation of the Function In Sitting Test in adults with acute stroke.

BACKGROUND AND PURPOSE: Research studies indicate that sitting balance ability is a substantial predictor of functional recovery after stroke. There are no gold standards for sitting balance assessment, and commonly used balance measures do not isolate sitting balance abilities. This study was designed to develop, pilot test, and analyze reliability and validity of a short test of functional sitting balance in patients following acute stroke. METHODS: The Function In Sitting Test (FIST) was constructed after reviewing balance measures and interviewing 15 physical therapists. A written survey regarding the FIST items and scoring scales was designed, pilot tested, and sent to 12 additional physical therapists with expertise in measurement construction, balance assessment, and/or research. Thirty-one adults who were within 3 months following stroke participated in this study. RESULTS: The expert panel survey was returned by 83.3% of the participants. Survey feedback and weighted rank analysis reduced the number of FIST items from 26 to 17. After subject testing, Item Response Theory analysis eliminated 3 additional items. The person separation index was 0.978 and the coefficient alpha was 0.98, indicating high internal consistency of the FIST. The Item Response Theory analysis confirmed content and construct validity. Concurrent validity was supported by high correlations to the modified Rankin Scale, static balance indices, and dynamic balance grades. DISCUSSION AND CONCLUSIONS: The 14-item FIST is reliable and valid in adults following acute stroke. Studies of intra- or intertester reliability and evaluative validity studies including applications to other patient populations with sitting balance dysfunction are now necessary.

Amplitude threshold criteria improve surface electrode specificity during walking and functional movements.

Contamination of electromyographic (EMG) data due to crosstalk in recordings from surface electrodes can lead to misinterpretation of results. The purpose of this study was to determine if removing a portion of the EMG signal normalized to a maximum voluntary contraction (MVC) would improve the specificity of surface electrode recordings. We hypothesized that setting an amplitude threshold to define when a muscle was active would remove that part of the myoelectric signal most likely to include crosstalk, without affecting the intensity or the onset and cessation times. Surface and intramuscular electrodes recorded signals from the same muscles of adults performing cyclic ankle movements and walking at self-selected speeds. Signals identified as crosstalk were eliminated when 15% and 18% of the amplitude of the normalized signal was removed and muscle timing or intensity was not significantly changed in most cases.

The kinematic and kinetic effects of solid, hinged, and no ankle-foot orthoses on stair locomotion in healthy adults.

This study compared the effects of a unilateral solid ankle-foot orthosis (AFO), hinged AFO and no AFO (shoe) worn by healthy adults on pelvic angles, lower extremity joint angles, moments and powers, and temporal-spatial gait characteristics during stair locomotion. A convenience sample of 19 healthy adults participated in this repeated measures design with subjects serving as their own controls. Subjects ambulated on stairs wearing a left shoe and either a right solid AFO, hinged AFO or shoe. Kinematic and kinetic data were collected with motion analysis equipment and a force plate for the three conditions. Pelvic angles and right hip, knee and ankle angles, moments and powers during stance were compared to determine differences among the conditions. Subjects wearing either orthosis walked slower during stair locomotion and with a shorter right single limb support time during descent. Sagittal knee and ankle angles, moments and powers were similar in individuals wearing a hinged AFO or shoe during pull-up (PU) in ascent and controlled lowering (CL) in descent. Decreased ankle dorsiflexion angle, plantar flexion power, knee flexion angle and extensor moment were seen in subjects wearing a solid AFO as compared to a hinged AFO during PU in ascent and CL in descent. Findings contributed to understanding how biomechanical changes imposed at the ankle by a unilateral solid AFO resulted in more kinetic and kinematic compensations than the hinged AFO in healthy adults without the confounding effects of neuromuscular impairments.

A comparison of gait with solid and hinged ankle-foot orthoses in children with spastic diplegic cerebral palsy.

This study compared the effects of solid and hinged ankle-foot orthoses (AFOs) on the gait of children with spastic diplegic cerebral palsy (CP) who ambulate with excessive ankle plantar flexion during stance. Twelve children with spastic diplegic CP wore no AFOs for an initial 2-week period, solid AFOs for 1 month, no AFOs for 2 weeks, and hinged AFOs for 1 month. Lower extremity muscle timing, knee and ankle joint motions, moments and powers, and temporal-distance characteristics were measured during ambulation for an initial barefoot baseline test, and with solid and hinged AFOs for the other two tests. Both orthoses increased stride length, reduced abnormal ankle plantar flexion during initial contact, midstance and terminal stance (TST), and increased ankle plantar flexor moments closer to normal during TST. Hinged AFOs increased ankle dorsiflexion at TST and increased ankle power generation during preswing (PSW) as compared to solid AFOs, and increased ankle dorsiflexion at loading compared to no AFOs. No other significant differences were found for the gait variables when comparing these orthoses. Either AFO could be used to reduce the excessive ankle plantar flexion without affecting the knee position during stance. The hinged AFO would be recommended to produce more normal dorsiflexion during TST and increased ankle power generation during PSW in children with spastic diplegic CP.