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The creation of a single-bone-forearm is a salvage procedure to stabilize the forearm. The purpose of this study was to investigate clinical outcomes and how these patients compensate for the lack of forearm rotation. We evaluated four patients (three children, one adult) who had undergone single-bone-forearm surgery. Patients were examined clinically and with three-dimensional motion analysis. We found these patients are generally capable to perform important activities of daily living (e.g. glass jug pouring), which would normally need forearm rotation. Motion analysis revealed remarkable compensatory motion at other joints during these activities. We conclude that patients with a single-bone-forearm can maintain a certain level of daily activities by using compensatory motions at other joints, although the time needed to complete the tasks may be longer. Level of evidence: IV

BACKGROUND: In recent years, the reliability of inverse (IK) and direct kinematic (DK) models in gait analysis have been assessed intensively, but mainly for lean populations. However, obesity is a growing issue. So far, the sparse results available for the reliability of clinical gait analysis in obese populations are limited to direct kinematic models. Reliability error-margins for inverse kinematic models in obese populations have not been reported yet. RESEARCH QUESTIONS: Is there a difference in the reliability of IK models compared with a DK model in obese children? Are there any differences in the joint kinematic output between IK and DK models? METHODS: A test-retest study was conducted using three-dimensional gait analysis data from two obese female and eight obese male participants from an earlier study. Data were analyzed using a DK model and two OpenSim-based IK models. Test-retest reliability was compared by calculating the Standard Error of Measurement (SEM) along with similar absolute reliability measures. A Friedman Test was used to assess whether there were any significant differences in the reliability between the models. Kinematic output of the models was compared by using Statistical Parametric Mapping (SPM). RESULTS: No significant differences were found in the reliability between the DK and IK models. The SPM analysis indicated several significant differences between both IK models and the DK approach. Most of these differences were continuous offsets. SIGNIFICANCE: Reliability values showed clinically acceptable error-margins and were comparable between all models. Therefore, our results support the careful use of IK models in overweight or obese populations, e.g. for musculoskeletal modelling studies. The inconsistent kinematic output can mainly be explained by different model conventions and anatomical segment coordinate frame definitions. ispartof: GAIT & POSTURE vol:66 pages:201-207 ispartof: location:England status: published

Introduction Three-dimensional gait analysis (3DGA) in obese populations is a difficult task due to a great amount of subcutaneous fat. This makes it more challenging to identify anatomical landmarks, thus leading to inconsistent marker placement. Therefore, the purpose of this study was to investigate the test-retest reliability for kinematic measurements of obese children and adolescents. Methods Nine males and two females with an age-based BMI above the 97th percentile (age: 14.6 ± 2.6 years, BMI: 33.4 ± 4.4 kg/m 2 ) were administered to two 3DGA sessions. To quantify reliability of discrete parameters the intraclass correlation coefficient (ICC 2,k ), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. To quantify waveform similarity, the coefficient of multiple correlation (CMC) and the linear fit method (LFM) were used. Results From 28 kinematic parameters, 23 showed acceptable ICCs (≥0.70) and the remaining parameters demonstrated moderate values. These were peak hip extension during stance (0.58), mean pelvis rotation (0.60), mean anterior pelvic tilt (0.64), peak knee flexion during swing (0.67) and peak hip abduction during swing (0.69). The SEM was below 5° for all parameters. The MDC for the sagittal, frontal, and transversal plane were on average 7.5° ± 2.2, 4.6° ± 1.3 and 6.0° ± 0.9 respectively. Both the LFM and CMC showed, in general, moderate to good reliability except for pelvis tilt and hip rotation. Conclusion Data demonstrated acceptable error margins especially for the sagittal and frontal plane. Low reliability for the pelvis tilt indicates that great effort is necessary to position the pelvic markers consistently during repeated sessions.

Background Childhood obesity is one of the most critical and accelerating health challenges throughout the world. It is a major risk factor for developing varus/valgus misalignments of the knee joint. The combination of misalignment at the knee and excess body mass may result in increased joint stresses and damage to articular cartilage. A training programme, which aims at developing a more neutral alignment of the trunk and lower limbs during movement tasks may be able to reduce knee loading during locomotion. Despite the large number of guidelines for muscle strength training and neuromuscular exercises that exist, most are not specifically designed to target the obese children and adolescent demographic. Therefore, the aim of this study is to evaluate a training programme which combines strength and neuromuscular exercises specifically designed to the needs and limitations of obese children and adolescents and analyse the effects of the training programme from a biomechanical and clinical point of view. Methods/Design A single assessor-blinded, pre-test and post-test randomised controlled trial, with one control and one intervention group will be conducted with 48 boys and girls aged between 10 and 18 years. Intervention group participants will receive a 12-week neuromuscular and quadriceps/hip strength training programme. Three-dimensional (3D) gait analyses during level walking and stair climbing will be performed at baseline and follow-up sessions. The primary outcome parameters for this study will be the overall peak external frontal knee moment and impulse during walking. Secondary outcomes include the subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS), frontal and sagittal kinematics and kinetics for the lower extremities during walking and stair climbing, ratings of change in knee-related well-being, pain and function and adherence to the training programme. In addition, the training programme will be evaulated from a clinical and health status perspective by including the following analyses: cardiopulmonary testing to quantify aerobic fitness effects, anthropometric measures, nutritional status and psychological status to characterise the study sample. Discussion The findings will help to determine whether a neuromuscular and strength training exercise programme for the obese children population can reduce joint loading during locomotion, and thereby decrease the possible risk of developing degenerative joint diseases later in adulthood. Trial registration ClinicalTrials NCT02545764, Date of registration: 24 September 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1091-5) contains supplementary material, which is available to authorized users.