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STUDY DESIGN: Cross-sectional study (ALLRISC) OBJECTIVE: To compare experienced sitting-related health and stability problems between persons with paraplegia (PP) and tetraplegia (TP) and to investigate associations with personal, lesion and wheelchair characteristics as well as satisfaction with seating posture. SETTING: Dutch multicenter cohort study. SUBJECTS: Wheelchair-users with Spinal Cord Injury (SCI) living in the community for ≥10 years after SCI (N=264). METHODS: A self-report questionnaire on seating was developed. Sitting-related problems and satisfaction with sitting posture were compared between participants with PP and TP using Chi-square, t-tests and logistic regression analyses. RESULTS: Thirty-three percent reported sitting to be tiring (regularly to always), 28% reported sitting to be painful, 29% pressure ulcers and 8% instability in sitting and 33% during reaching. Except for instability during reaching, no differences in occurrence of sitting-problems were found between the TP and PP-group. Among all characteristics, ‘lack of support in the wheelchair’ associated with all sitting-problems within PP. Persons with TP appeared more dissatisfied with their sitting posture than PP: 51% vs 36% (p=0.022) and respectively 51% and 47% thought sitting posture could be improved (p=0.670). Pain and instability were associated with dissatisfaction. CONCLUSIONS: Sitting-related pain, fatigue, pressure ulcers and instability during reaching as well as dissatisfaction with sitting posture were frequently reported by persons with chronic SCI. Especially in persons with PP, sitting problems appeared to associate with experienced lack of support in the wheelchair and seating. Therefore, an accurate hands on assessment -wheelchair/seating-user-fitting and stability check may contribute to prevention of sitting related-problems.

PURPOSE: Assessment of ventilatory threshold (VT) in people after stroke could provide valuable information for daily life participation, since VT identifies the workload below which activities can be sustained for a long period of time. This study aimed to give insight in the VT of people after stroke. The purpose was twofold: 1) to assess the inter- and intra-rater reliability of VT assessment by experienced assessors, 2) to report on VT values of sub-acute stroke patients in rehabilitation. METHODS: 59 cardiopulmonary exercise tests (CPET) from sub-acute stroke patients (14F/44M, 59±11 years, 16±56 weeks since stroke) were selected from the Heliomare database. Tests were presented in a random order to two experienced sports-physicians, who independently determined VT by a combination of the V-slope method1 and the ventilatory equivalents method, to assess inter-rater reliability. One physician repeated this sequence one week later to assess intra-rater reliability. Intra-class correlation coefficients (ICC) type 2,1 and standard error of measurement (SEM) were calculated to establish reliability for oxygen uptake values at VT (VO2-VT). If a good reliability (ICC>0.8) was established, the average values of the experienced rater were presented to describe VO2-VT in this cohort. RESULTS: VT was determined by both raters in 55/59 tests. Inter- and intra-rater reliability of VO2-VT determination were good (ICC 0.88 and 0.98, SEM 1.15 and 0.47 ml/kg/min resp.). Average VO2-VT values were 9.4±2.5 ml/kg/min, corresponding to 43.1±8.5% of peak oxygen uptake. CONCLUSION: The VT can be determined reliably for people after stroke from CPET data, by experienced raters. Relative VO2-VT values in this cohort are comparable to those reported in other cohorts of people after stroke. However, both relative and absolute VO2-VT are (very) low in comparison to the healthy population. This low VT could be limiting daily life functioning for people after stroke2.

PURPOSE: To investigate the Roll-Over Shape (RoS) of foot and ankle while walking with and without Ankle-Foot Orthoses (AFOs) with different degrees of stiffness in children with Cerebral Palsy (CP) walking with excessive knee flexion. METHODS: 15 children with CP walking with excessive knee flexion were prescribed a ventral shell AFO with a rigid footplate and integrated ankle hinge of which stiffness could be varied. All participants walked barefoot (BF), with shoes only (Sh) and with AFO in a rigid (rAFO), stiff (sAFO) and flexible (fAFO) setting. Centre of pressure (CoP) and shank kinematics of 3 steps of the most affected leg were collected. RoS was determined during single support, based on a circular fit of CoP data in the local reference frame of the shank. The radius (R) and arc length (Alength) were calculated and normalized for shank length. RESULTS: Circular RoS fitting was possible for all subjects in BF, while in the other conditions some data could not be fitted, especially for sAFO (n=7) and rAFO (n=9). Compared to BF and Sh, mean(SD) R and Alength increased significantly with an AFO (R: BF=0.32(0.18); Sh=0.31(0.19); fAFO=0.51(0.31); sAFO=0.46(0.15); rAFO=0.41(0.32), Alength: BF=0.22(0.10); Sh=0.21(0.07); fAFO=0.24(0.08); sAFO=0.26(0.06); rAFO=0.31(0.06)). RoS was translated backward in all conditions relative to the barefoot condition. CONCLUSIONS: The backward shift of the RoS and increased R and Alength while walking with AFOs is related to a decreased inclination of the shank. A larger R could thus indicate better shank alignment during walking. However, RoS could not be fitted in all cases, suggesting an absence of a circular RoS. As a result of the rigid footplate and restricted ankle range of motion, the second rocker motion and roll-over of the foot is lost in some cases with an AFO. Our data thus suggests that RoS analysis could be informative of AFO behaviour and alignment in children with CP.

Study Design Cross-sectional study.Objectives To describe experienced sitting-related health and stability problems among persons with paraplegia (PP) or tetraplegia (TP) and to investigate associations with personal, lesion and wheelchair characteristics as well as satisfaction with sitting posture.Setting Dutch community.Methods A self-report questionnaire on seating was developed and completed by wheelchair-users living with Spinal Cord Injury (SCI) for >= 10 years (N= 264). Sitting-related problems and satisfaction with sitting posture were compared between participants with PP and TP using Chi-square and t-tests. Logistic regression analyses were performed to investigate associated characteristics.Results Reported sitting-related problems comprised: sitting to be tiring (regularly to always) (33%), sitting to be painful (28%), pressure ulcers in the last three months (29%), instability while sitting (8%) and instability during reaching (33%). Except for instability during reaching, no differences in occurrence of sitting-problems were found between lesion-group. Persons with TP were more dissatisfied with their sitting posture than persons with PP: 51% vs 36% (p = 0.022) and 51% and 47% respectively thought their sitting posture could be improved (p = 0 .670) . 'Experienced lack of support in the wheelchair' was associated with most sitting-problems. Pain and instability were associated with dissatisfaction with sitting posture.Conclusion Sitting-related problems and dissatisfaction with sitting posture were frequently reported by persons with long-standing SCI. Sitting problems appeared to associate with lacking support in the wheelchair/seating. A comprehensive feedback from the wheelchair user and a stability check (reach task), as part of the wheelchair/seating-user fitting, may contribute to prevention of sitting-related problems.