Functional movement screen test: A reliable screening test for young elite ice hockey players

ObjectivesTo determine inter-rater and intra-rater reliability of the Functional Movement Screen (FMS) test among young elite hockey players.DesignReliability study.SettingInter-rater reliability was evaluated by two raters in the field. All performances were videotaped. Two other raters evaluated the videos once and then again 6 weeks later to determine intra-rater reliability. A weighted kappa statistic was used to analyze intra-rater and inter-rater reliability of each FMS sub-test, while an intra-class correlation coefficient (ICC) was calculated for the total score.ParticipantsTwenty-eight male hockey players aged 13–16.Main OutcomeFMS total and sub-tests scores.ResultsThe video raters demonstrated excellent intra-rater reliability for the total score, with an ICC of 0.96 (95% CI; 0.92–0.98) and 0.96 (95% CI; 0.91–0.98). The field raters achieved excellent inter-rater reliability for the total score, with an ICC of 0.96 (95% CI; 0.92–0.98). Sub-test analysis showed good agreement among all four raters for five of the seven main sub-tests.ConclusionFMS is a reliable test for young elite hockey players. Further research should be done to assess the predictive validity of the FMS test within this population so that physiotherapists may eventually use it as an injury prevention tool.     

Intra-rater reliability,inter-rater reliability and minimal detectable change of the posterior shoulder endurance test in elite athletes

ObjectiveInvestigate intra-rater and inter-rater reliability of the posterior shoulder endurance test (PSET) and calculate minimal detectable change (MDC) to establish measurement properties and inform use of the PSET in practice.Study designTest-retest reliability. Setting: British Canoe Slalom National Training Centre.ParticipantsTwelve participants (7 male, 5 female; 22.5 ± 4.48 years; 73.4 ± 6.36 kg) were investigated by two physiotherapists with >10 years’ experience.Main outcome measureIntraclass correlation coefficients (ICC) were calculated for intra-rater reliability (ICC 3,1) and inter-rater reliability (ICC 2,1) and used to calculate MDC.ResultsIntra-rater reliability scores were 0.84 and 0.85 for rater A and B, respectively, with 95% confidence interval (CI) crossing moderate to excellent reliability for both raters (0.5–0.75 and > 0.9). Inter-rater reliability scores were 0.74 and 0.63 at baseline and follow-up, respectively, with 95% CI crossing poor to good reliability in both time points (<0.5 and >0.75). MDC95% for intra-rater scores was 6 repetitions, MDC95% for inter-rater scores was 8 repetitions at baseline and 9 repetitions at follow-up.ConclusionThe PSET has acceptable intra-rater reliability but further work is needed to narrow the CI to an appropriate level for inter-rater reliability. The MDC calculated helps clinicians interpret changes in tests scores.     

The TiltMeter app is a novel and accurate measurement tool for the weight bearing lunge test

ObjectivesThe weight bearing lunge test is increasing being used by health care clinicians who treat lower limb and foot pathology. This measure is commonly established accurately and reliably with the use of expensive equipment. This study aims to compare the digital inclinometer with a free app, TiltMeter on an Apple iPhone.DesignThis was an intra-rater and inter-rater reliability study. Two raters (novice and experienced) conducted the measurements in both a bent knee and straight leg position to determine the intra-rater and inter-rater reliability. Concurrent validity was also established.MethodsAllied health practitioners were recruited as participants from the workplace. A preconditioning stretch was conducted and the ankle range of motion was established with the weight bearing lunge test position with firstly the leg straight and secondly with the knee bent. The measurement device and each participant were randomised during measurement.ResultsThe intra-rater reliability and inter-rater reliability for the devices and in both positions were all over ICC 0.8 except for one intra-rater measure (Digital inclinometer, novice, ICC 0.65). The inter-rater reliability between the digital inclinometer and the tilmeter was near perfect, ICC 0.96 (CI: 0.898–0.983); Concurrent validity ICC between the two devices was 0.83 (CI: ?0.740 to 0.445).ConclusionsThe use of the Tiltmeter app on the iPhone is a reliable and inexpensive tool to measure the available ankle range of motion. Health practitioners should use caution in applying these findings to other smart phone equipment if surface areas are not comparable.     

Inter- and intra-rater reliability of the GAITRite system among individuals with sub-acute stroke

Technology-based assessment tools with semi-automated processing, such as pressure-sensitive mats used for gait assessment, may be considered to be objective; therefore it may be assumed that rater reliability is not a concern. However, user input is often required and rater reliability must be determined. The purpose of this study was to assess the inter- and intra-rater reliability of spatial and temporal characteristics of gait in stroke patients using the GAITRite system. Forty-six individuals with stroke attending in-patient rehabilitation walked across the pressure-sensitive mat 2–4 times at preferred walking speeds, with or without a gait aid. Five raters independently processed gait data. Three raters re-processed the data after a delay of at least one month. The intraclass correlation coefficients (ICC) and 95% confidence intervals of the ICC were determined for velocity, step time, step length, and step width. Inter-rater reliability for velocity, step time, and step length were high (ICC > 0.90). Intra-rater reliability was generally greater than inter-rater reliability (from 0.81 to >0.99 for inter-rater versus 0.77 to >0.99 for intra-rater reliability). Overall, this study suggests that GAITRite is a reliable assessment tool; however, there still remains subjectivity in processing the data, resulting in no patients with perfect agreement between raters. Additional logic checking within the processing software or standardization of training could help to reduce potential errors in processing.     

Increasing the number of gait trial recordings maximises intra-rater reliability of the CODA motion analysis system

OBJECTIVE: This study investigates the optimum number of gait trial recordings to maximise intra-rater reliability with the CODA motion analysis system in a normal population. Potential sources of variability in test-retest experimental procedures will be discussed. BACKGROUND: The most recent study by [Maynard V, Bakheit AMO, Oldham J, Freeman J. Intra-rater and inter-rater reliability of gait measurements with CODA mpx30 motion analysis system. Gait Posture 2003;17:59-67] that evaluated the Cartesian Optoelectronic Dynamic Anthropometer (CODA) motion analysis system exhibited poor correlation for intra-rater reliability of kinematic and kinetic parameters. It is unknown what the optimum number of gait trials is required during testing to represent an individuals gait pattern during normal walking. DESIGN: Ten healthy subjects (mean 28.5 years) were tested on two occasions by an experienced well trained rater during normal walking to establish intra-rater reliability using 1-2, 1-4, 1-6, 1-8, and 1-10 gait trial recordings to represent the mean. The 3D kinematic, kinetic parameters of hip, knee and ankle joints and spatio-temporal parameters were recorded during normal walking. Intra-class correlation coefficient and Bland and Altman limits of agreement were chosen to analyse the results. RESULTS: Spatio-temporal parameters exhibited least test-retest variability, as measurement of only two gait trials to represent the mean produced similar variability in test-retest as when higher numbers of trials were measured. Kinematic parameters were more variable than kinetic while for both variability decreased with increasing numbers of trials measured and would advocate measuring 10 gait trials for future analysis when measuring these parameters. CONCLUSIONS: Generally intra-rater reliability improves when larger number of gait trial recordings represent a subject's gait.     

Is markerless,smart phone recorded two-dimensional video a clinically useful measure of relevant lower limb kinematics in runners with patellofemoral pain? A validity and reliability study

ObjectivesInvestigate the validity and reliability of markerless, smart phone collected, two-dimensional (2D) video, analysed using the ‘Hudl technique’ application, compared to three-dimensional (3D) kinematics during running, in participants with patellofemoral pain (PFP).DesignValidity/reliability study.SettingBiomechanics laboratory.ParticipantsMales/females with PFP (n = 21, 10 males, 11 females, age 32.1 months [±12.9]).Main outcome measuresManually synchronised 2D and 3D measurement of peak hip adduction (HADD) and peak knee flexion (KFLEX) during running.Results2D and 3D measures of peak KFLEX (p = 0.02, d = 1.13), but not peak HADD (p = 0.25, d = −0.27), differed significantly. Poor validity was identified for 2D measurement of peak HADD (ICC 0.06, 95% CI -0.35, 0.47) and peak KFLEX ICC 0.42, 95% CI (−0.10, 0.75). Moderate intra-rater reliability was identified for both variables (ICC 0.61–65), alongside moderate inter-rater reliability for peak KFLEX (ICC 0.71) and poor inter-rater reliability for peak HADD (ICC 0.31).ConclusionsMeasurement of peak HADD and KFLEX in runners with PFP using markerless, smart phone collected 2D video, analysed using the Hudl technique Application is invalid, with poor to moderate reliability. Investigation of alternate 2D video approaches to increase precision is warranted. At present, 2D video analysis of running using Hudl Technique cannot be advocated.     

Intra-rater and inter-rater reliability,minimal detectable change,and construct validity of the Edinburgh Visual Gait Score in children with cerebral palsy

BackgroundThe Edinburgh Visual Gait Score (EVGS) has been used for observational gait assessment in children with cerebral palsy (CP). However, the measurement error of the EVGS and its detailed relationship with gross motor function remain unclear.Research questionsThis study aimed to confirm the intra-rater and inter-rater reliability as well as the minimal detectable change (MDC) values for the EVGS with the use of the video analysis software and examine the relationship between the EVGS and the Gross Motor Function Measure 66 (GMFM-66) with regard to construct validity.MethodsThis cross-sectional study was conducted for 62 children (mean age 11.3 ± 3.9 years) with spastic CP at Gross Motor Function Classification System (GMFCS) level I (32 children), II (25 children) or III (5 children). Three raters independently scored the EVGS using Kinovea video analysis software. The intra-rater and inter-rater reliability were calculated using intra-class correlation coefficients (ICC_2,1), and the MDC₉₀ was calculated using standard error of measurement. The construct validity was examined by correlating the EVGS with the GMFM-66.ResultsThe EVGS showed good or excellent reliability within each rater (ICC_2,1 = 0.90–0.97) and between raters (ICC_2,1 = 0.91). The MDC₉₀ of the EVGS ranged from 3.6 to 6.0. There was a significant correlation between the EVGS and the GMFM-66 (r = − 0.69 to − 0.73, p < 0.001).SignificanceThe intra-rater and inter-rater reliability of the EVGS is sufficient for observational gait assessment. The high correlation between the EVGS and the GMFM-66 supports its construct validity. The authors propose an MDC of 6.0 for the EVGS. These results can help in the application of EVGS to children with CP at GMFCS level I-II with mild to moderate gait pathology, as there were few children with CP at GMFCS level III.     

Validity and reliability of the Dynamic Gait Index in children with hemiplegic cerebral palsy

BackgroundDynamic Gait Index (DGI) is a performance-based tool can be applied in a short time and evaluates dynamic balance and gait ability.Research questionIs the DGI valid and reliable for assessing gait and balance disorders in children with hemiplegic cerebral palsy (CP)?MethodsSixteen children with hemiplegic CP (5 females, 11 males; mean age 10y 3mo, SD 2y 7mo; range 6–14y; Gross Motor Function Classification System (GMFCS) levels I [n = 9], II [n = 7]) and 16 age-matched typically developing (TD) (8 females, 8 males; mean age 9y 9mo, SD 2y 6mo; range 6–14y) participated. The relationship between the DGI, Four-Square Step Test (FSST), Timed Up and Go Test (TUG) and Pediatric Berg Balance Scale (PBS) was analyzed. To determine the test-retest reliability, the DGI was performed twice and; for the inter-rater reliability, only DGI was reapplied by a different rater on the same day. Internal consistency was obtained by Cronbach-α value. Validity was tested by Spearman correlation coefficient and reliability was calculated by Intraclass correlation coefficient (ICC).ResultsThere was a significant difference between hemiplegic CP and TD and between the children with GMFCS level I and II in the comparison of results of the DGI and other tests. All items on the DGI had appropriate internal consistency (Cronbach-α = 0.969). The test-retest (ICC = 0.970 CI(0.915- 0.990)) and inter-rater (ICC = 0.983 CI(0.882- 0.998)) reliabilities were found to be excellent. A negative, moderate correlation between FSST and DGI (rs = −0.673, p = 0.004); a positive, high correlation between PBS (rs = 0.724, p = 0.002) and DGI and a negative, high correlation between TUG and DGI (rs = −0.828, p < 0.001) was detected.SignificanceDGI with features such as its feasibility in a short time, being simple but distinctive and not requiring heavy equipment is a valid and reliable method in children with hemiplegic CP.     

Is it safe for extended-role radiographers to measure migration percentage in children with cerebral palsy?

IntroductionIn the surveillance of children with cerebral palsy, the measurement of migration percentage is used to identify children at risk of hip dislocation. Early identification of children at risk facilitates early intervention with less invasive surgical procedures to prevent further deterioration.The aim of this study is to evaluate the safety of the measurements of migration percentage for surveillance in cerebral palsy by extended-role radiographers by evaluating the reliability and validity of measurements performed by these professionals.MethodsA sample of thirty pelvic x-rays were selected from the local cerebral palsy database. A range of hip displacement was selected including some challenging borderline x-rays. All ten extended-role radiographers completed measurements using TraumaCAD which were repeated at a minimum of 4 weeks.Inter-rater and intra-rater reliability was calculated using intraclass correlation coefficients. The accuracy and safety of the system was evaluated by converting measurements into referral categories (red, amber or green) and cohen's kappa was calculated when categories were compared to measurements to orthopaedic surgeonResultsThe inter-rater reliability between radiographers was 0.938 (95% CI 0.914–0.991). The intra-rater reliability was 0.941 (95% CI 0.931–0.949).The percentage agreement was 94.8% for green, 93.8% for amber and 98.2% for red hips. The weighted kappa value was 0.923 (95% CI 0.889–0.957).ConclusionThe reliability and accuracy of radiographer measurement of migration percentage is excellent. It is safe for radiographers to calculate the migration percentage using semi-automated software for the surveillance of children with cerebral palsy.Implications for practiceWe recommend the measurement of migration percentage may be performed by extended-role radiographers to deliver accurate and reliable measurements for use in cerebral palsy surveillance.     

Reliability of the Thomas test for assessing range of motion about the hip

ObjectivesRehabilitative protocols and research are significantly influenced by the ability to perform reliable measures of specific physical attributes or functions. The hypothesis was that the Thomas test for evaluating range of motion about the hip joint is a reliable clinical assessment tool.SubjectsParticipants (n=54) were between the ages of 18 and 45, and had no history of trauma.MethodsThree Board-Certified Athletic Therapists assessed hip range of motion using pass/fail and goniometer scoring systems. A re-test session was completed seven to ten days later.ResultsStatistically, Kappa values for pass/fail scoring (intra-rater ℜ=0.47, inter-rater ℜ=0.39) and ICC values (intra-rater ℜ=0.52, inter-rater ℜ=0.60) for goniometer data both indicated that the Thomas test demonstrated poor intra and inter-rater reliability. However, measurement error values (SEM=1°, ME=2°, and CV=15%) and Bland and Altman plots demonstrated that there was only a small degree of intra-rater variance for each examiner when executing the Thomas test in a clinical setting.ConclusionsResults call into question the statistical reliability of the Thomas test, but provide clinicians with important information regarding the reliability limits of the Thomas test when used to clinically evaluate hip range of motion and ilio-psoas muscle flexibility in a physically active population. More research is required in order to determine the variables that may confound statistical reliability of this orthopaedic technique that is commonly used in a clinical setting to assess hip function.     

Patient perception of dizziness and imbalance does not correlate with gait measures in adolescent athletes post-concussion

BackgroundDizziness and gait impairments are commonly observed following a concussion, and both are associated with prolonged concussion recovery.Research questionIs there a correlation between combined self-reported dizziness and balance impairment severity with objective gait impairments after concussion?MethodsParticipants (n = 51; 15.4 ± 1.6 years; 51 % female; 7.3 ± 3.2 days post-injury) age 12–18 years self-reported ratings of dizziness and balance impairment using the Post-Concussion Symptom Inventory (PCSI) within 14 days of injury. Individual ratings of dizziness, balance impairment, and moving clumsily on the PCSI were combined to create a comprehensive dizziness and imbalance score. Participants also completed a smartphone-based gait evaluation under single-task and dual-task conditions. Correlation coefficients (Pearson r for normally distributed and Spearman rho for non-normally distributed variables) were calculated between self-reported symptoms and single and dual-task spatiotemporal gait parameters, specifically step velocity, step time, and step length.ResultsCorrelation coefficients indicated that there was low to no correlation between self-reported dizziness and imbalance impairment severity and smartphone-obtained gait parameters under single- or dual-task conditions, including step velocity (single-task: r=-0.22, p = 0.13; dual-task: r=-0.05, p = 0.72), step time (single-task: rho = 0.16, p = 0.27; dual-task: rho = 0.14, p = 0.33), and step length (single-task: r=-0.15, p = 0.30; dual-task: r = 0.03, p = 0.84).SignificanceSelf-reported dizziness and balance impairment severity within the first two weeks of concussion may not reflect objectively measured gait performance, given the lack of association between subjective symptom ratings and functional measures. Further, smartphone collected gait parameters may not provide the necessary sensitivity to detect an association with dizziness. The lack of significant correlation between self-reported symptoms and objective gait performance highlights the importance of using both objective and subjective measures to obtain a more complete picture of concussion deficits.     

Intra- and interrater reliability of the ‘lumbar-locked thoracic rotation test’ in competitive swimmers ages 10 through 18 years

ObjectivesMeasuring thoracic spine mobility can be of interest to competitive swimmers as it has been associated with shoulder girdle function and scapular position in subjects with and without shoulder pain. At present, no reliability data of thoracic spine mobility measurements are available in the swimming population. This study aims to evaluate the within-session intra- and interrater reliability of the “lumbar-locked rotation test” for thoracic spine rotation in competitive swimmers aged 10 to 18 years. This reliability study is part of a larger prospective cohort study investigating potential risk factors for the development of shoulder pain in competitive swimmers.DesignWithin-session, intra- and inter-rater reliability.SettingCompetitive swimming clubs in Belgium.Participants21 competitive swimmers.Main outcome measuresIntra- and inter-rater reliability of the lumbar-locked thoracic rotation test.ResultsIntraclass correlation coefficients (ICCs) ranged from 0.91 (95% CI 0.78 to 0.96) to 0.96 (0.89–0.98) for intra-rater reliability. Results for inter-rater reliability ranged from 0.89 (0.72–0.95) to 0.86 (0.65–0.94) respectively for right and left thoracic rotation.ConclusionResults suggest good to excellent reliability of the lumbar-locked thoracic rotation test, indicating this test can be used reliably in clinical practice.     

Reliability of a field-based drop vertical jump screening test for ACL injury risk assessment

Objectives: There is an epidemic of anterior cruciate ligament (ACL) injuries in youth athletes. Poor neuromuscular control is an easily modifiable risk factor for ACL injury, and can be screened for by observing dynamic knee valgus on landing in a drop vertical jump test. This study aims to validate a simple, clinically useful population-based screening test to identify at-risk athletes prior to participation in organized sports. We hypothesized that both physicians and allied health professionals would be accurate in subjectively assessing injury risk in real-time field and office conditions without motion analysis data and would be in agreement with each other. Methods: We evaluated the inter-rater reliability of risk assessment by various observer groups, including physicians and allied health professionals, commonly involved in the care of youth athletes. Fifteen athletes age 11–17 were filmed performing a drop vertical jump test. These videos were viewed by 242 observers including orthopaedic surgeons, orthopaedic residents/fellows, coaches, athletic trainers (ATCs), and physical therapists (PTs), with the observer asked to subjectively estimate the risk level of each jumper. Objective injury risk was calculated using normalized knee separation distance (measured using Dartfish, Alpharetta, GA), based on previously published studies. Risk assessments by observers were compared to each other to determine inter-rater reliability, and to the objectively calculated risk level to determine sensitivity and specificity. Seventy one observers repeated the test at a minimum of 6 weeks later to determine intra-rater reliability. Results: Between groups, the inter-rater reliability was high, κ = 0.92 (95% CI 0.829–0.969, p < 0.05), indicating that no single group gave better (or worse) assessments, including comparisons between physicians and allied health professionals. With a screening cutoff isolated to subjects identified by observers as “high risk”, the sensitivity was 63.06% and specificity 82.81%. Reducing the screening cutoff to also include jumpers identified as “medium risk” increased sensitivity to 95.04% and decreased the specificity to 46.07%. Intra-rater reliability was moderate, κ = 0.55 (95% CI 0.49–0.61, p < 0.05), indicating that individual observers made reproducible risk assessments. Conclusions: This study supports the use of a simple, field-based observational drop vertical jump screening test to identify athletes at risk for ACL injury. Our study shows good inter- and intra-rater reliability and high sensitivity and suggests that screening can be performed without significant training by physicians as well as allied health professionals, including: coaches, athletic trainers and physical therapists. Identification of these high-risk athletes may play a role in enrollment in appropriate preventative neuromuscular training programs, which have been shown to decrease the incidence of ACL injuries in this population.     

The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: A systematic review and meta-analysis

ObjectivesThe purpose of this systematic review was to determine the viability of the dual-task paradigm in the evaluation of a sports-related concussion.DesignSystematic review and meta-analysis.MethodsEight electronic databases were searched from their inception until the 11^th of April 2011. Studies were grouped according to their reported gait performance variables and their time(s) of assessment(s). Raw mean differences (MD) and 95% confidence intervals (CI) were calculated based on raw means and standard deviations for gait performance measures in both single- and dual-task conditions. Dual-task deficits were pooled using a random effects model and heterogeneity (I²) between studies was assessed.ResultsTen studies representing a total sample of 168 concussed and 167 matched (age and gender) non-concussed participants met the inclusion criteria. Meta-analysis demonstrated that dual-task performance deficits were detected (p < 0.05) in the concussed group for gait velocity (GV) (MD = ?0.133; 95% CI ?0.197, ?0.069) and range of motion of the centre of mass in the coronal plane (ML-ROM) (MD = 0.007; 95% CI 0.002, 0.011), but not in the non-concussed group; GV (MD = ?0.048; 95% CI ?0.101, 0.006), ML-ROM (MD = 0.002; 95% CI ?0.001, 0.005).ConclusionsThe results of this study indicate that GV and ML-ROM are sensitive measures of dual-task related changes in concussed patients and should be considered as part of a comprehensive assessment for a sports-related concussion.     

Diagnostic value of a vision-based intelligent gait analyzer in screening for gait abnormalities

BackgroundEarly detection of gait abnormalities is critical for preventing severe injuries in future falls. The timed up and go (TUG) test is a commonly used clinical gait screening test; however, the interpretation of its results is limited to the TUG total time.Research questionWhat is diagnostic accuracy of the low-cost, markerless, automated gait analyzer, with the aid of vision-based artificial intelligence technology, which extract gait spatiotemporal features and screen for abnormal walking patterns through video recordings of the TUG test?MethodsOur dataset contained retrospective data from outpatients from the Department of Neurology or Rehabilitation of two tertiary hospitals in Shanghai. A panel of three expert neurologists specialized in movement disorders reviewed the gait performance in each TUG video, and labeled them separately, with the most commonly assigned label being used as the reference standard. The gait analyzer performed the AlphaPose algorithm to track the human joint position and calculated the spatiotemporal parameters by filtering and double-threshold signal detection. Gait spatiotemporal features and expert labels were input into machine learning models, and the accuracy of each model was tested with leave-one-out cross-validation (LOOCV).ResultsA total of 284 participants were recruited. Among these, 100 were labeled as having abnormal gait performance by experts. The Naive Bayes classifier achieved the best performance with a full-data accuracy of 90.14% and a LOOCV accuracy of 89.08% for screening abnormal gait performance.SignificanceThis study is the first to investigate the accuracy of a vision-based intelligent gait analyzer for screening abnormal clinical gait performance. By virtue of a pose estimation algorithm and machine learning models, our intelligent gait analyzer can detect abnormal walking patterns approximate to judgements made by experienced neurologists, which is expected to be a supplementary gait assessment protocol for basic-level doctors in the future.     

User-driven treadmill walking promotes healthy step width after stroke

BackgroundWalking with user-driven treadmill control is believed to be more like overground walking than fixed-speed treadmill walking. Walking speed and ground reaction forces differ between overground and fixed-speed treadmill walking, but not between overground and user-driven treadmill walking in healthy and post-stroke subjects. However, studies assessing spatiotemporal gait parameters during user-driven treadmill walking are limited. This information may help confirm that user-driven treadmill walking is more like overground walking than fixed-speed treadmill walking, as well as inform the development of post-stroke gait rehabilitation programs.Research questionHow do spatiotemporal gait parameters for individuals post-stroke differ between fixed-speed and user-driven treadmill walking?MethodsEighteen subjects (10 M, 8 F; 62 ± 12 years; 1.73 ± 0.12 m; 84.9 ± 12.9 kg; 40 ± 30 months post-stroke) with chronic post-stroke hemiparesis participated in this study. Participants walked on an instrumented treadmill in its fixed-speed and user-driven modes at their self-selected and fastest comfortable walking speeds. Subjects wore retroreflective markers for motion capture. Shapiro-Wilk tests were used to assess for normality and one-way repeated measures ANOVAs were used to compare between conditions with α = 0.05. Bonferroni corrections were used for multiple comparisons.ResultsStep width was significantly smaller with user-driven control (13.7 cm, 95 % CI: [0.131, 0.145]) than fixed-speed control (16.8 cm, 95 % CI:[0.160, 0.174]), while step length and step time did not differ across treadmill conditions. Step length and step time differed between self-selected and fast walking speeds, but not treadmill control conditions.SignificanceThe results of this study show that user-driven treadmill control encourages healthy gait biomechanics and a greater sense of stability in post-stroke subjects. Individuals post-stroke walked with smaller step width with user-driven treadmill control, which has been associated with increased balance. Post-stroke gait rehabilitation may benefit from programs with user-driven treadmill training paradigms to improve mobility following stroke.     

Prognosis for Persistent Post Concussion Symptoms using a Multifaceted Objective Gait and Balance Assessment Approach

BackgroundConcussion prognosis is a challenging clinical task. Identification of measures useful for persistent symptom risk can help optimize treatment pathways and allow clinicians to offer appropriate anticipatory guidance.Research QuestionCan a multifaceted single/dual-task postural control assessment within one week of a diagnosed concussion identify the odds of developing persistent post-concussion symptoms (PPCS; symptoms that persist for more than 28 days post-concussion)?MethodsWe conducted a prospective cohort study of youth and young adult athletes who were evaluated within 7 days of injury, and followed until they no longer reported concussion symptoms. Participants were grouped into those who developed PPCS and those who did not. During the initial evaluation, participants completed a postural control evaluation in single/dual-task conditions. We calculated six gait performance variables (in single/dual-task conditions), nine quiet stance performance variables, and three cognitive task performance (standing and walking) variables. We conducted between-group comparisons to identify candidate PPCS prognostic variables, and multivariable models to adjust for covariates (age, post-injury evaluation time, history of concussion, and BMI).ResultsSixty-six participants completed the study: 24% reported PPCS (mean age = 16.9 ± 3.5 years; 50% female; evaluated 4.2 ± 1.9 days post-injury) and 74% (mean age = 18.3 ± 3.0 years; 52% female; evaluated 3.5 ± 1.6 days post-injury) did not. Between-group comparisons indicated greater dual-task transverse plane center-of-mass (COM) range of motion (ROM) (13.1 ± 4.3 vs. 9.9 ± 2.5 degrees; p = 0.013) and lateral step variability (5.1 ± 1.4 vs. 4.0 ± 1.2 cm; p = 0.003) for the PPCS group relative to the no PPCS group. After multivariable modeling, dual-task transverse plane COM ROM (adjusted odds ratio = 1.34, 95% CI = 1.07, 1.68) and lateral step variability (adjusted odds ratio = 1.85, 95% CI = 1.13, 3.05) were significantly associated with PPCS.SignificanceDual-task transverse plane movement and lateral step variability demonstrate viable prognostic ability for PPCS among youth and young adult athletes and, along with other established factors, may add incremental value to PPCS prognosis models.     

Reliability and minimal detectable change of gait variables in community-dwelling and hospitalized older fallers

PurposeGait variables may constitute surrogate outcomes for fall risk. Their reliability in a specific population of older fallers has not been fully established, which limits their research and clinical applications. This study aimed to determine test–retest reliability and minimal detectable change (MDC) values for selected fall-related gait variables in older adults with a recent fall history.MethodsCommunity-dwelling (n = 30) and hospitalized (n = 30) fallers aged ≥ 65 years were assessed twice using an instrumented pressure-sensitive walkway, under single- and dual-task gait conditions. Intraclass correlation coefficient (ICC_(2,1)), standard error of measurement (SEM; SEM%) and MDC at 95% confidence level (MDC₉₅; MDC₉₅%), were used as reliability estimates.ResultsThe ICC_(2,1) for gait velocity was greater than 0.84 across all gait conditions and groups; SEM% and MDC₉₅% did not exceed 6.5% and 18.1%, respectively. Gait variability measures returned lower ICC_(2,1) (range 0.18–0.79), and markedly higher SEM% (16.3–31.9%) and MDC₉₅% (45.3–88.3%). Overall, hospitalized fallers exhibited larger SEM and MDC₉₅ values for variability measures compared to community-dwellers in all gait conditions, while larger values were found for all variables while dual-tasking compared to single-tasking in both groups.ConclusionsGait velocity was found to be highly reliable and likely to be sensitive to change over repeated sessions in community-dwelling and hospitalized older fallers, both under single- and dual-task conditions. Gait variability measures showed lower reliability, irrespective of gait condition or group, displaying consistently larger measurement error, particularly under dual-task conditions. Clinicians should consider MDC₉₅ values before using gait variability variables as evaluative outcome measures at patient level.     

An ankle joint model-based image-matching motion analysis technique

This study presented a model-based image-matching (MBIM) motion analysis technique for ankle joint kinematic measurement. Five cadaveric below-hip specimens were manipulated through a full range of ankle joint motions in bare-foot and shoed conditions. The ankle motions were analyzed by bone-pin marker-based motion analysis and MBIM motion analysis techniques respectively. The root mean square errors of all angles of motion were less than 3°. The average Intraclass Correlation Coefficients (ICCs) for the intra-rater reliability were greater than 0.928 and the average ICCs for the inter-rater reliability were greater than 0.948 for all angles of motion. Excellent validity, intra-rater reliability and inter-rater reliability were achieved for the MBIM technique in both bare-foot and shoed conditions. The MBIM technique can therefore provide good estimates of ankle joint kinematics.     

Activity trackers are not valid for step count registration when walking with crutches

BackgroundThe use of activity trackers has been proposed in rehabilitation where resuming physical activity is deemed crucial, e.g. after total knee arthroplasty (TKA). As patients initially often walk with crutches, it is of importance that clinicians can rely on the information provided by activity trackers.Research questionTo determine concurrent validity of 2 activity trackers for step count, positioned on different locations on the body during gait with crutches.MethodsThirty healthy participants performed normal gait and gait with one crutch and two crutches over a distance of 400 m while wearing a Garmin Vivofit 3 and Nokia Go on both wrists and both sides at the waist (only Nokia Go). The gold standard was manual step count. Inter-device reliability (within brand) was assessed by calculating Intraclass Correlation Coëfficients (ICC) and concurrent validity was determined by performing paired sample t-tests, ICC and Bland-Altman Plots with % bias and 95% CI Limits of Agreement (LoA).ResultsDuring normal gait, both the Nokia and Garmin showed good to excellent inter-device reliability (ICC > 0.75). Both devices showed concurrent validity compared to manual step count, with slightly better results for the Garmin compared to the Nokia at the wrist (% bias = respectively 0.0% and -1.4% with 95% CI LoA: respectively -1.7%;1.7% and -8.6%;5.8%; ICC: respectively 0.995 and 0.859). During gait with crutches, however, overall 95% CI of LoA were beyond clinically acceptable differences and ICC values with the gold standard were poor. Therefore, notwithstanding a sometimes reported small average % bias, validity of the activity trackers for step count during gait with crutches was not established, independent of tracker position.SignificanceActivity trackers showed no concurrent validity when monitoring step count during gait with crutches. This should be taken into account when implementing this technology in e.g. post-operative goal setting in patients with TKA.