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Purpose: To evaluate fatigue and cognitive functioning in patients with low-grade glioma and to assess whether cognitive functioning and employment status differ between patients with severe and non-severe mental fatigue. Methods: Cross-sectional study. Fatigue was measured with the multidimensional fatigue inventory, objective cognitive functioning with a neuropsychological test battery, and mood with the Center for Epidemiological Studies Depression Scale. Results: Thirty-one patients, mean age 44 ± 11, mean time post-diagnosis 2.5 ± 1.4 years, participated. Severe mental fatigue was present in 55% and depression in 36% of the patients. Attention deficits were observed in 75% (Stroop’s test), memory deficits in 36% (Rey Auditory Verbal Learning Test), and executive functioning deficits in 42% (Stroop’s test). Severe mental fatigue patients demonstrated significantly worse scores on Stroop’s test-Card-II (p = 0.043), Trail Making Test-B (p = 0.014), Trail Making Test-B/A (p = 0.014), and Digit-Span (p = 0.046), compared to non-severe mental fatigue patients. Severe mental fatigue patients worked significantly less hours per week (p = 0.013) and had more changes in their employment status (p = 0.009) after diagnosis. Conclusions: Patients with low grade glioma show high rates of fatigue, especially in the mental domain, which might be associated with deficits in cognitive functioning and changes in employment status.Implications for rehabilitation The majority of patients with low grade glioma suffers from severe mental fatigue and has deficits in cognitive functioning, which may affect employment status. Patients with low grade glioma should be screened for fatigue with the multidimensional fatigue inventory, to differentiate between mental and physical fatigue. Patients with low grade glioma with severe mental fatigue should be screened for problems in cognitive functioning with an objective neuropsychological test battery. Cognitive and vocational rehabilitation programs should aim at coping with severe mental fatigue and attention deficits in patients with low grade glioma.

Background: Especially in younger knee osteoarthritis patients, the ability to perform physical activity (PA) after knee arthroplasty (KA) is of paramount importance, given many patients’ wish to return to work and perform demanding leisure time activities. Goal Attainment Scaling (GAS) rehabilitation after KA may improve PA because it uses individualized activity goals. Therefore, our aim was to objectively quantify PA changes after KA and to compare GAS-based rehabilitation to standard rehabilitation. Methods: Data were obtained from the randomized controlled ACTION trial, which compares standard rehabilitation with GAS-based rehabilitation after total and unicompartmental KA in patients

Purpose: The aim of this study was to assess the criterion validity of the Activ8 to detect "active wheelchair use" and to distinguish 6 types of wheelchair activities using video recordings as a gold standard. Methods: Ten participants who use a manual wheelchair were participants in this study. Data of 2 participants were used for adapting the algorithm and data of 7 participants were used for assessing the criterion validity. Results: Criterion validity for detecting "active wheelchair use" had a relative time difference of 7.4%, agreement of 96%, sensitivity of 98.3%, and positive predictive value of 90%. Results for distinguishing 6 types of wheelchair activities had an agreement of 73%, sensitivity of 67.1%, and positive predictive value of 65.5%. Conclusions: The Activ8 is able to detect "active wheelchair use" in youth using a manual wheelchair. Further development of the algorithm is necessary to distinguish between different types of wheelchair activities.

Objective: To investigate employment status and return to work in relation to fatigue in patients with World Health Organization (WHO) grade II glioma. Design: Exploratory cross-sectional study. Subjects: Patients with grade II glioma, who underwent surgery between 2005 and 2016. Methods: A postal survey was sent in 2019, which included the Short Form-Health and Labour Questionnaire and the Multi-dimensional Fatigue Index. Outcomes of fatigue in subgroups of (not-) return to work were compared using independent t-tests and χ2 tests. The association between fatigue and return to work was analysed using multivariable logistic regression. Results: In total, 73 patients were included in the study (age at diagnosis 41.0 years (standard deviation (SD) 9.2 years), time post-diagnosis 8.0 years (interquartile range (IQR) 6–11 years). At diagnosis, 61 patients were employed and 32 returned to work during follow-up. The return to work group was significantly younger than the not-return to work group (p=0.007). The proportion of patients who indicated that the consequences of glioma had affected return to work, in terms of demotion or reduced working hours, was 68.7%. The not-return to work group reported significantly more fatigue in all domains than the return to work group (p

Objectives: Physical activity is promoted in patients with hip or knee osteoarthritis (OA), yet little is known about its relationship with symptoms, functional limitations and Quality of Life (QoL). We investigated if OA-associated pain, functional limitations and QoL are associated with objectively measured physical activity in patients with end-stage hip/knee OA.Methods: Cross-sectional study including patients scheduled for primary total hip/knee arthroplasty. Patients wore an accelerometer (Activ8) with physical activity assessed over waking hours, and expressed as number of activity daily counts (ADC) per hour, %time spent on physical activity i.e. walking, cycling or running (%PA), and %time spent sedentary (%SB). Pain, functional limitations and joint-specific and general QoL were assessed with the Hip disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) and the Short Form (SF)-12. Multivariate linear regression models with the three to Z-scores transformed parameters of physical activity as dependent variables and adjusted for confounding, were conducted. Results: 49 hip and 48 knee OA patients were included. In hip and knee OA patients the mean number of ADC, %PA and %SB were 18.79 +/- 7.25 and 21.19 +/- 6.16, 14 +/- 6.4 and 15 +/- 5.0, and 66 +/- 10.5 and 68 +/- 8.7, respectively. In hip OA, better joint-specific and general QoL were associated with more ADC, (13 0.028; 95%CI:0.007-0.048, 130.041; 95%CI:0.010- 0.071). Also, better general QoL was associated with the %PA (13 0.040, 95%CI:0.007- 0.073). No other associations were found.Conclusion: Whereas QoL was associated with physical activity in hip OA, pain and functional limitations were not related to objectively measured physical activity in patients with end-stage hip or knee OA.(c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background Several device-based instruments have been validated in the pediatric population, but none of these are clinically applicable and provide real-time feedback on actual physical activity in terms of postures and movements. A new device (Activ8) is promising for that purpose. Objective The objective was to investigate the criterion validity of the Activ8 for measuring static (sitting, standing) and dynamic (walking, bicycling, running) activities, and for separating postures and movements within basic and complex activities in children and adolescents (youths) with typical development (TD) and peers with motor disability (not typical development [NTD]). Design This was a criterion validation study. Methods Ten participants with TD (mean age [standard deviation] = 14 [2.5] years) and 10 participants with NTD (mean age = 12.9 [2.1] years) performed a standardized series of basic and daily life (complex) activities. The Activ8 measured postures and movements, while camera recording served as a reference. The outcome measures were the mean time differences between the Activ8 output and video data for the merged categories “static” and “dynamic” and for the separate postures and movements. Results For the merged categories static and dynamic, the criterion validity was found to be excellent both in participants with TD and participants with NTD within basic activities, and was found to be good to excellent in participants with TD and moderate to good in participants with NTD within complex activities. The detection of separate postures and movements was found to be poor to excellent in both groups within complex activities. Limitations The sample of youths with NTD was small and limited to youths who could be considered to be at least ambulatory within a household. Conclusions Activ8 is a valid tool when the merged categories static and dynamic are used to interpret physical activity in daily life in both youths with TD and youths with NTD and mild motor impairment. To optimize the quantification of separate postures and movements, adjustment of the existing algorithm is required.

Introduction: To set up and guide interventions with the aim to increase physical activity and lower sedentary behavior valid monitoring of physical behavior is essential. The aim of this study was to evaluate the validity of the single-unit Activ8 activity monitor to classify several body postures and movements.Methods: Twelve healthy adults performed a series of activities, representative for everyday life, according to a standard protocol. Activ8 was both worn in the trouser pocket (prescribed location) and fixated to the front of the thigh. Activities were video recorded and analyzed thereafter. Postures and movements that were analyzed were lying/sitting, standing, walking, cycling, and running.Results: The agreement between Activ8 output and video analysis was 89.7% (inter-subject range: 66.0 to 96.6%) for the pocket location and 91.9% (range 85.5 to 95.1%) for the thigh location. Sensitivity and positive predictive value scores for both locations were all above 80%, except for standing (69% or higher). Differences in classified duration of separate postures and movements were within 20% for walking, sitting and running.Conclusion: The Activ8 is a valid instrument to quantify a defined set of body postures and movements. Because of the smaller time difference, the thigh location is preferred for research purposes.

To objectively measure changes in both moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) during and after standard cardiac rehabilitation (CR).Prospective cohort study.Outpatient CR center.Patients (N=135) with acute coronary syndrome (ACS) who completed CR.Multidisciplinary CR according to current guidelines.The proportion of time spent in MVPA and SB was objectively measured with an accelerometer. The distribution of time in MVPA and SB was also determined (eg, average length of time periods spent in MVPA and SB). All measurements were obtained before CR, after CR, and at 1-year follow-up.Patients' time in MVPA during waking hours increased by .65% (≈5min) during CR (P=.002) and remained increased at 1-year follow-up (P=.037). The MVPA distribution did not change. During CR, time spent in SB decreased by 2.49% (≈22min; P.001), and SB time became more fragmented with more breaks and shorter SB periods (P.001). These SB improvements were maintained at 1-year follow-up (P.001).Patients with ACS achieved a small improvement in MVPA time during CR, but MVPA distribution remained unchanged. More substantial improvements occurred for SB time and distribution. However, by the end of CR, patients still spent relatively little time in MVPA and a long time in SB, which is known to be detrimental to cardiovascular health. Although CR programs have the potential to improve physical behavior, our findings highlight the need to develop adjusted CR targets that address the amount and distribution of MVPA and SB.

Objective: Botulinum toxin (BoNT-A) is widely used in combined treatment for spastic cerebral palsy, but its added value preceding comprehensive rehabilitation for motor impairments, gait, and goal attainment has not been studied. Design: A comparative multi-centre trial, in which two groups underwent comprehensive rehabilitation (i.e. high-intensive functional physiotherapy, and indicated casting/orthoses). One group received intramuscular BoNT-A prior to rehabilitation, and the other group did not receive BoNT-A. Subjects/patients: Children with spastic cerebral palsy, Gross Motor Function Classification System (GMFCS) levels I–III, age range 4–12 years, indicated for BoNT-A treatment regarding mobility problems. Methods: Sixty-five children participated (37 boys), mean age 7.3 years (standard deviation (SD) 2.3, range 4–12 years), equally distributed across GMFCS levels. Forty-one children received BoNT-A+ comprehensive rehabilitation and 24 received comprehensive rehabilitation only. Functional leg muscle strength, passive range of motion, angle of catch, cerebral palsy-related pain, walking speed, kinematic gait parameters, goal attainment, and proxy-reported general functioning were assessed at baseline, primary end-point (12 weeks) and 24-week follow-up. Statistical analyses were performed with linear mixed models. Results: At the primary end-point there were no statistically significant differences in treatment effects between the groups, except for the angle-of-catch of the rectus femoris, which was in favour of comprehensive rehabilitation without BoNT-A (12° difference, 95% confidence interval (95% CI) 2:23, p = 0.025). Results at follow-up were similar. Conclusion: At the group level, treating with BoNT-A prior to comprehensive rehabilitation did not add to the clinical effectiveness of rehabilitation. Thus, BoNT-A prescription and use should be critically reconsidered in this cerebral palsy age- and GMFCS-subgroup.

The results of conservative treatment of knee osteoarthritis (OA) are generally evaluated in epidemiological studies with clinical outcome measures as primary outcomes. Biomechanical evaluation of orthoses shows that there are potentially beneficial biomechanical changes to joint loading; however, evaluation in relation to clinical outcome measures in longitudinal studies is needed. We asked (1) is there an immediate effect on gait in patients using a laterally wedged insole or valgus knee brace; (2) is there a late (6 weeks) effect; and (3) is there a difference between subgroups within each group with respect to patient compliance, body mass index, and OA status? This was a secondary analysis of data from a previous randomized controlled trial of patients with early medial knee OA. A total of 91 patients were enrolled in that trial, and 73 (80%) completed it after 6 months. Of the enrolled patients, 80 (88%) met prespecified inclusion criteria for analysis in the present study. The patients were randomized to an insole or brace. Gait was analyzed with and without wearing the orthosis (insole or brace) at baseline and after 6 weeks. Measurements were taken of the knee adduction moment, ground reaction force, moment arm, walking speed, and toe-out angle. Data were analyzed with regression analyses based on an intention-to-treat principle. A mean reduction of 4% (+/- A 10) (95% confidence interval [CI], -0.147 to -0.03, p = 0.003) of the peak knee adduction moment and 4% (+/- A 13) (95% CI, -0.009 to -0.001, p = 0.01) of the moment arm at baseline was observed in the insole group when walking with an insole was compared with walking without an insole. A mean reduction of 1% (+/- A 10) (95% CI, -0.002 to -0.001, p = 0.001) of the peak knee adduction moment and no reduction of the moment arm were measured after 6 weeks. No reduction of knee adduction moment, moment arm, or ground reaction force was seen in the brace group at baseline and after 6 weeks. Subgroup analysis showed no differences in biomechanical effect for obesity, stage of OA, and whether patients showed a clinical response to the treatment. Laterally wedged insoles unload the medial compartment only at baseline in patients with varus alignment and by an amount that might not be clinically important. No biomechanical alteration was seen after 6 weeks of wearing the insole. Valgus brace therapy did not result in any biomechanical alteration. Taken together, this study does not show a clinically relevant biomechanical effect of insole and brace therapy in patients with varus medial knee OA. Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Objectives Anterior Cruciate Ligament (ACL) deficiency may result in abnormal lower limb loading with increased foot pronation. This study evaluated spatiotemporal parameters and plantar pressure distribution during walking in participants with and without an ACL rupture. Design Cross-sectional. Methods Plantar pressure was measured in 42 unilateral ACL deficient (ACLD) participants and 32 healthy controls while walking barefoot. Spatiotemporal parameters, pressure distribution and center of pressure (CoP) during foot roll off were determined. Differences in spatiotemporal parameters and pressure distribution were analyzed using a Linear Mixed Model. CoP position was analyzed with one-way ANOVA. Results ACLD participants had a longer contact time and earlier forefoot contact compared to controls. The ACLD side showed a shorter contact time and a faster roll off toward the forefoot compared to the ACL intact side. Compared to controls, ACLD participants had increased pressure under the medioproximal side of the midfoot. Within ACLD participants, the ACLD side had decreased pressure under the heel and increased pressure under the forefoot. Foot pronation was not different between groups or within ACLD participants. CoP of the ACLD participants was significantly more toward the toes during initial contact and toward the heel during foot flat. Conclusions Changes in lower limb loading during barefoot walking in ACLD participants are due to changes in roll off pattern, most likely in order to reduce anterior shear forces on the knee. Dynamic plantar pressure measurements may assist in evaluating and guiding interventions aimed at normalizing lower limb and knee biomechanics in ACL deficiency.

Bagheri, J, van den Berg-Emons, RJ, Pel, JJ, Horemans, HL, and Stam, HJ. Acute effects of whole-body vibration on jump force and jump rate of force development: A comparative study of different devices. J Strength Cond Res 26(3): 691-696, 2012-The goal of this study was to compare the acute effects of whole-body vibration (WBV) delivered by 3 devices with different mechanical behavior on jump force (JF) and jump rate of force development (JRFD). Twelve healthy persons (4 women and 8 men; age 30.5 +/- 8.8 years; height 178.6 +/- 7.3 cm; body mass 74.8 +/- 9.7 kg) were exposed to WBV for 15 and 40 seconds using 2 professional devices (power plate [PP; vertical vibration] and Galileo 2000 [GA; oscillatory motion around the horizontal axis in addition to vertical vibration]) and a home-use device [Power Maxx, PM; horizontal vibration]). The JF and JRFD were evaluated before, immediately after, and 5 minutes after WBV. The JF measured immediately after 40 seconds of vibration by the GA device was reduced (3%, p = 0.05), and JRFD measured after 5 minutes of rest after 40 seconds of vibration by the PM device was reduced (12%, p < 0.05) compared with the baseline value. The acute effects of WBV (15 or 40 seconds) on JF and JRFD were not significantly different among the 3 devices. In conclusion, our hypothesis that WBV devices with different mechanical behaviors would result in different acute effects on muscle performance was not confirmed.

Background: Spasticity is often clinically assessed with the Tardieu Scale, using goniometry to measure the range of motion and angle of catch. However, the test-retest and inter-rater reliability of these measurements have been questioned. Inertial sensors (IS) have been developed to measure orientation in space and are suggested to be a more appropriate tool than goniometry to measure angles in Tardieu Scale measurements. Objective: To compare the test-retest and inter-rater reliability of Tardieu Scale scores measured with IS and goniometry. Methods: Two physiotherapists performed Tardieu Scale measurements in two sessions, using both goniometry and IS, to quantify spasticity in elbow flexors of 13 stroke patients. Results: For goniometry, test-retest and inter-rater reliability proved to be excellent (ICC 0.86) and fair to good (ICC 0.66), respectively. For IS, both test-retest (ICC 0.76) and inter-rater reliability (ICC 0.84) were excellent. Conclusions: Inertial sensors are reliable and accurate to use in Tardieu Scale measurements to quantify spasticity in the elbow flexors of hemiplegic stroke patients. (C) 2010 Elsevier B.V. All rights reserved.

Introduction/Background Regaining and optimizing walking function for mobility and daily physical activity purposes is one of the most important goals during inpatient rehabilitation for many people with incomplete spinal cord injury (iSCI). In clinical practice, walking function is almost exclusively objectified with measures of capacity, such as distance, speed, or ability to perform a task. However, it is unclear to what extent walking capacity relates to actual walking behavior in people with a recent iSCI. Therefore, the aim of this study was to assess the association between walking speed and walking behavior in ambulatory people with a recent iSCI. Material and method People with iSCI who were expected to become at least household walkers were tested before discharge from inpatient rehabilitation. Walking capacity was determined by walking speed measured with a standardized 10 meter walking test. Walking behavior was measured objectively, during one week, with a validated accelerometry based activity monitor attached to the front of the thigh. Results Forty-six people with iSCI participated in this study. Their mean (SD) walking speed was 0.79 (0.41) m/s. The walking time averaged per day varied between 2.1 and 142.6 minutes; the group median (IQR) was 52.7 (15.2–87.8) minutes. A two-tailed spearman's ranked correlation analyses revealed a positive association between walking speed and daily walking time (rs = 0.734, P Conclusion We found a significant association between walking speed and walking behavior, suggesting that people who walk faster are likely to walk more during daily life.

Physical whole-body vibration (WBV) exercises become available at various levels of intensity. In a first series of measurements, we investigated 3-dimensional platform accelerations of three different WBV devices without and with three volunteers of different weight (62, 81 and 100 kg) in squat position (150 degrees knee flexion). The devices tested were two professional devices, the PowerPlate and the Galileo-Fitness, and one home-use device, the PowerMaxx. In a second series of measurements, the transmission of vertical platform accelerations of each device to the lower limbs was tested in eight healthy volunteers in squat position (100 degrees knee flexion). The first series showed that the platforms of two professional devices vibrated in an almost perfect vertical sine wave at frequencies between 25-50 and 5-40 Hz, respectively. The platform accelerations were slightly influenced by body weight. The PowerMaxx platform mainly vibrated in the horizontal plane at frequencies between 22 and 32 Hz, with minimal accelerations in the vertical direction. The weight of the volunteers reduced the platform accelerations in the horizontal plane but amplified those in the vertical direction about eight times. The vertical accelerations were highest in the Galileo (approximately 15 units of g) and the PowerPlate (approximately 8 units of g) and lowest in the PowerMaxx (approximately 2 units of g). The second series showed that the transmission of vertical accelerations at a common preset vibration frequency of 25 Hz were largest in the ankle and that transmission of acceleration reduced approximately 10 times at the knee and hip. We conclude that large variation in 3-dimensional accelerations exist in commercially available devices. The results suggest that these differences in mechanical behaviour induce variations in transmissibility of vertical vibrations to the (lower) body.

Objective: To study physical behavior in detail in fatigued persons with multiple sclerosis (MS). Design: Case-control explorative study. Setting: Outpatient rehabilitation department and participants' daily environment. Participants: Fatigued persons with MS (n = 23) were selected from a randomized controlled trial. Cases were matched by age and sex to healthy, nonfatigued controls (n = 23). Eligible persons with MS were severely fatigued (Checklist Individual Strength fatigue domain mean score, 43.2 +/- 6.6) and ambulatory (Expanded Disability Status Scale mean score, 2.5 +/- 1.5). Interventions: Not applicable. Main Outcome Measures: Measurements were performed using an accelerometer over 7 days. Outcomes included the following: amount of physical activity expressed in counts per day, counts per minute (CPM), and counts per day period (morning, afternoon, evening); duration of activity intensity categories (sedentary, light physical activity, moderate-to-vigorous physical activity [MVPA]); and distribution of MVPA and sedentary periods over the day. Results: Persons with MS had fewer counts per day (mean difference, -156 x 10(3); 95% confidence interval [CI], -273 x 10(3) to -39 x 103; P = .010), had fewer CPM (mean difference, -135; 95% CI, -256 to -14; P = .030), and were less physically active in the morning (mean difference, -200; 95% CI, -389 to -11; P = .039) and evening (mean difference, -175; 95% CI, -336 to -14; P = .034) than controls. Persons with MS spent a higher percentage of their time sedentary (mean difference, 5.6; 95% CI,.1-11.1; P = .045) and spent less time at the higher MVPA intensity (mean difference, -2.4; 95% CI, -4.7 to -0.09; P = .042). They had fewer MVPA periods (mean difference, 29; 95% CI, -56.2 to -2.6; P = .032) and a different distribution of sedentary (mean difference,.033; 95% CI,.002 to.064; P = .039) and MVPA periods (mean difference,-.08; 95% CI,-.15 to -.01; P = .023). Conclusions: Detailed analyses of physical behavior showed that ambulatory fatigued persons with MS do differ from healthy controls not only in physical activity level, but also in other physical behavior dimensions (eg, day patterns, intensity, distribution). (C) 2015 by the American Congress of Rehabilitation Medicine

Background and purpose To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch. Methods During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement ≥75%. Results The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example ‘spasticity’ or ‘hypertonia’. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyperreflexia and non-velocity dependent involuntary background activation. The term ‘spasticity’ should only be used next to stretch hyperreflexia, and ‘stiffness’ next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed. Conclusions A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena. This is the pre-peer reviewed version of the following article: [European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch], which has been published in final form at [http://onlinelibrary.wiley.com/doi/10.1111/ene.13322/abstract]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

This study assessed whether self-propelled wheelchair driving can be validly detected by a new method using a set of two commonly used accelerometers.In a rehabilitation centre, 10 wheelchair-bound persons with spinal cord injury (SCI) (aged 29-63 years) performed a series of representative daily activities according to a protocol including self-propelled wheelchair driving and other activities. Two ActiGraph GT3X+ accelerometers were used; one was attached at the wrist, the other to the spokes of the wheelchair wheel. Based on the movement intensity of the two accelerometers, a custom-made algorithm in MatLab differentiated between self-propelled wheelchair driving and other activities (e.g. being pushed or arm movements not related to wheelchair driving). Video recordings were used for reference. Validity scores between the accelerometer output and the video analyses were expressed in terms of agreement, sensitivity and specificity scores.Overall agreement for the detection of self-propelled wheelchair driving was 85%; sensitivity was 88% and specificity 83%. Disagreement between accelerometer output and video analysis was largest for wheelchair driving at very low speed on a treadmill, wheelchair driving on a slope on a treadmill, and being pushed in the wheelchair whilst making excessive arm movements.Valid detection of self-propelled wheelchair driving is provided by two accelerometers and a simple algorithm. Disagreement with the video analysis was largest during three atypical daily activities.

Accelerometry has the potential to measure balance, defined as high-frequency body sway, ambulatorily in a simple and inexpensive way. The aim of this study was to determine and compare the sensitivity of accelerometric balance parameters during the sit-to-stand (STS) movement. Eleven healthy subjects (four males, 28.2 plusmn7.9 years) and 31 patients with stroke (21 males; 63.3plusmn12.8 years) were included. The healthy subjects performed STS movements in four conditions with different levels of difficulty. Data of the patients were compared 1) with healthy subjects, 2) between patient subgroups, and 3) between different phases of recovery to assess the sensitivity of accelerometry for differences in balance control. Accelerometers were attached to the trunk, and force plate measurements were simultaneously done in the healthy subjects. Main outcome measures were root mean square (rms) and area under the curve (AUC) derived from the high-frequency component of the transversal acceleration signal of the trunk. In all comparisons there was a significant difference in AUC data (p < 0.05), and AUC appeared to be more sensitive than rms. Variability in AUC was not completely or mainly the result of changes and differences in the duration of the STS movement. As a conclusion, accelerometry is a potentially valuable technique to measure balance during the STS movement.

Accelerometry is frequently used in movement analysis to assess body postures and motions. Here, we assessed the validity of ambulatory accelerometric measurement of the sit-to-stand (STS) movement duration. We compared accelerometric and opto-electronic assessment of the STS movement duration under four conditions (comfortable, slow, fast movement and exaggerated trunk flexion) with six healthy subjects and six subjects with stroke who performed movements six times under each condition. Accelerometric and opto-electronic data of STS movement duration were strongly related (r = 0.98). Accelerometry showed a fixed bias of 0.07 s (95% CI 0.008, 0.141) in healthy subjects and 0.32 s (95% CI 0.223, 0.422) in stroke subjects. In healthy subjects, a significant negative proportional bias of 0.1 was detected (95% CI -0.160, -0.032). Accelerometry showed discriminative validity in comparing stroke subjects to healthy subjects, and in comparing speed conditions. Our results indicate that accelerometry can provide valid data on the STS movement duration, furthermore during its use additional information on the STS movement, such as balance control, can be recorded.

Objective measurement of weight bearing during a long-term period can give insight into the postoperative loading of the lower extremity of orthopedic patients to avoid complications. This study investigated the validity of vertical ground reaction force measurements during a long-term period using the Pedar Mobile insole pressure system, by comparing it with a Kistler force platform. In addition, the validity of a new sensor drift correction algorithm to correct for offset drift in the Pedar signal was evaluated. Ground reaction force data were collected during dynamic and static conditions from five healthy subjects every hour for 7 h. A mean offset drift of 14.6% was found after 7 h. After applying the drift correction algorithm the Pedar system showed a high accuracy for the second peak in the ground reaction force-time curve (1.1 to 3.4% difference, p0.05) and step duration (-2.0 to 4.4% difference, p0.05). Less accuracy was found for the first peak in the ground reaction force-time curve (5.2 to 12.0% difference; p0.05 for the first 3 h, p0.05 for the last 4 h) and, consequently, in the vertical force impulse (5.5 to 11.0% difference, p0.05). The Pedar Mobile system appeared to be a valid instrument to measure the vertical force during a long-term period when using the drift correction program described in this study.

The prosthetic activity monitor (PAM) is an instrument to assess over the long-term the duration and spatio-temporal characteristics of walking of amputees, during normal daily life. In this study, the validity of PAM-derived measurements was investigated. Twelve transtibial amputees performed an activity protocol, consisting of stationary and walking activities, and activities associated with nonlocomotor movements. The protocol also included potential sources of error and activities assumed to be prone to misdetection. Measurements consisted of the PAM and video recordings. Agreement between video analysis and PAM output was the main outcome measure. The PAM generally correctly classified stationary activities (100% inactive, 0% active, 0% locomotion), nonlocomotor activities (45% inactive, 55% active, 0% locomotion) and walking activities (0% inactive, 1.8% active, 98.2% locomotion). When walking, the number of strides taken was slightly underestimated (-1.0%). The underestimation of distance travelled (-6.2%) and walking speed (-5.8%) was greater. The agreement with video output decreased when the PAM was misaligned, when persons walked at a speed below the defined minimum speed, and when persons walked with crutches. The PAM provides valid data on activity classes and number of strides. Although the majority of the distance data was satisfactory, in some cases considerable differences were found between the PAM and the video data. The impact of alignment, walking speed, and use of assistive devices on the PAM's operation should be considered.