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BACKGROUND: A peroneus longus to brevis tendon transfer is recommended for a severely torn peroneus tendon, but there is little research on the outcome. We conducted a prospective cohort study to examine patient-reported outcomes after this procedure.

METHODS: Thirty-two patients underwent a peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction, 11 had an additional calcaneal osteotomy. The Foot and Ankle Outcome Score (FAOS) and Short Form-36 (SF-36) were assessed preoperatively, six and 12 months after surgery.

RESULTS: Preoperative mean FAOS was 51.7 (SD 17.8) compared with 72.7 (SD 21.2) at 12 months, an improvement of 21 (95 % CI 12.7-28.0) (p < 0.0001). SF-36 improved significantly in the three domains involving physical function and bodily pain (p < 0.007).

CONCLUSION: Patient-reported outcomes improved significantly through peroneus longus to brevis tendon transfer. This procedure is worth considering for patients with a severely damaged peroneus tendon.

LEVEL OF EVIDENCE: Level II: Prospective cohort study.

There is a call to action for physiotherapists worldwide to contribute to the transition towards ‘sustainable health’. In this paper, we build upon the current definition of ‘sustainable health’ and also on ‘sustainable physical activity’ to introduce and theoretically substantiate the concept of sustainable human movements, and suggest a definition thereof. Sustainable human movements will be described as a threshold concept with three aligned critical concepts; (i) movement control, including forces as causes of emerging movements, (ii) movement quality, referring to how movements are performed in terms of optimisation, and (iii) physical literacy, including motivation, confidence and physical competence. A deep understanding of these concepts, combined with a collaboration and learning approach applied together with the patient, is proposed to enable a sustainable human movement approach to permeate physiotherapy theory and practice. To facilitate this, a generic and easily accessible tool has recently been developed. It combines support for structured observational movement analysis and pedagogical support for creating a mutual and extended understanding of a patient’s lived experience. This encourages the patient to become actively involved and take responsibility for promoting his/her ‘sustainable health’. The aims of this paper are to a) suggest a theoretical framework for and definition of the concept sustainable human movements, and b) introduce a clinical tool that ultimately aims at promoting sustainable movements and health.

 Background:  Pilocytic astrocytoma is the most common brain tumour type in childhood located in the posterior fossa, and treated mainly with surgery. These tumours have low mortality, but knowledge concerning its long-term outcome is sparse.

 Aims:  The aim was to investigate if patients treated for pilocytic astrocytoma in the posterior fossa had motor complications, including balance, motor and process skills.

 Methods and results:  This descriptive single-centre study includes eight children and 12 adults, treated for pilocytic astrocytoma as children. Motor performance was investigated with Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, and dynamic balance with the mini-balance evaluation systems test. Physiological cost index, six-minute walk test, hand grip strength and assessment of motor and process skills were also evaluated. Ten patients reported motor difficulties, mainly from the upper limbs. The motor performance test showed results within normal limits except for manual dexterity, which was significantly below mean (p = .008). In the dynamic balance test patients had significantly lower results compared with controls (p = .036). Physiological cost index, six-minute walk tests and hand grip strength showed results within normal limits. In the Assessment of Motor and Process Skills, patients over 16 years had significantly lower results compared with test norms for motor activities of daily living (ADL) and 30% of all patients scored below the cut-off level for difficulties with motor skills.

 Conclusions:  Motor performance for patients treated for pilocytic astrocytoma in the posterior fossa in childhood is satisfactory but some patients display difficulties with balance, manual dexterity and ADL motor skills. Thus, it is important to identify those in need of motor follow-up and training.

Background Kinematic analysis of the 3D reach-to-grasp drinking task is recommended in stroke rehabilitation research. The number of trials required to reach performance stability, as an important aspect of reliability, has not been investigated for this task. Thus, the aims of this study were to determine the number of trials needed for the drinking task to reach within-session performance stability and to investigate trends in performance over a set of trials in non-disabled people and in a sample of individuals with chronic stroke. In addition, the between-sessions test-retest reliability in persons with stroke was established.

Methods The drinking task was performed at least 10 times, following a standardized protocol, in 44 non-disabled and 8 post-stroke individuals. A marker-based motion capture system registered arm and trunk movements during 5 pre-defined phases of the drinking task. Intra class correlation statistics were used to determine the number of trials needed to reach performance stability as well as to establish test-retest reliability. Systematic within-session trends over multiple trials were analyzed with a paired t-test.

Results For most of the kinematic variables 2 to 3 trials were needed to reach good performance stability in both investigated groups. More trials were needed for movement times in reaching and returning phase, movement smoothness, time to peak velocity and inter-joint-coordination. A small but significant trend of improvement in movement time over multiple trials was demonstrated in the non-disabled group, but not in the stroke group. A mean of 3 trials was sufficient to reach good to excellent test-retest reliability for most of the kinematic variables in the stroke sample.

Conclusions This is the first study that determines the number of trials needed for good performance stability (non-disabled and stroke) and test-retest reliability (stroke) for temporal, endpoint and angular metrics of the drinking task. For most kinematic variables, 3-5 trials are sufficient to reach good reliability. This knowledge can be used to guide future kinematic studies.

Background: Whole-body movement adjustments during gait are common post-stroke, but comprehensive ways of quantifying and evaluating gait from a whole-body perspective are lacking.

Research question: Can novel kinematic variables related to Center of Mass (CoM) position discriminate side asymmetries as well as coordination between the upper and lower body during gait within persons post-stroke and compared to non-disabled controls?

Methods: Thirty-one persons post-stroke and 41 age-matched non-disabled controls walking at their self-selected speed were recorded by 3D motion capture. The Ankle-CoM Inclination Angle (A-CoMIA) and the Head-CoM Inclination Angle (H-CoMIA) defined the angle between the CoM and the ankle and the head, respectively, in the frontal plane. These angles and their angular velocities were compared between groups, and with regard to motor impairment severity during all phases of the gait cycle (GC) using a functional interval-wise testing analysis suitable for curve data. Upper and lower body coordination was assessed using crosscorrelation.

Results: The A-CoMIA was symmetrical between body sides in persons post-stroke but larger compared to controls. The angular velocity of A-CoMIA also differed when compared to controls. The H-CoMIA was consistently asymmetrical in persons post-stroke and larger than in controls throughout the stance phase. There were only minor group differences in the angular velocity of H-CoMIA, with some side asymmetry in persons post-stroke. The A-CoMIA of the non-affected side, and the HCoMIA, discriminated between persons with more severe impairments compared to those with milder impairments post-stroke. The variables showed strong cross correlations in both groups.

Significance: The A-CoMIA and Head-CoMIA discriminated post-stroke gait from non-disabled, as well as motor impairment severity. These variables with the advantageous curve analysis during the entire GC add valuable whole-body information to existing parameters of post-stroke gait analysis through assessment of symmetry and upper and lower body coordination.

Purpose: The aim of this study was to investigate how health-related quality of life (HRQoL) and functional shoulder range of motion are affected among patients with diabetes with shoulder problems, treated with a specific physiotherapy programme. A further aim was to investigate how health-related quality of life, functional shoulder range of motion, pain intensity, and shoulder function correlate within the group of patients after the treatment period.

Method: A pre–post treatment design was applied for a study group of ten patients with type 1 diabetes and shoulder problems. The physiotherapy treatment consisted of exercises promoting enhanced microcirculation in the shoulder tissues, optimal shoulder co-ordination,  and muscle relaxation. The Short Form-36 (SF-36), shoulder range of motion measures, the Shoulder Rating Scale – Swedish version, and pain intensity measures were used. The results regarding SF-36 were compared with the results of a control group of patients having either type 1 or type 2 diabetes and shoulder problems that did not receive any specific physiotherapy treatment.

Results: As a potential result of physiotherapy training, a significant change towards higher scores was observed in the physical component summary (PCS) measure of SF-36. There was a significant improvement regarding PCS in the study group as compared with the control group. There were negative correlations between the four aspects of pain intensity and PCS and Shoulder Rating Scale – Swedish version, respectively, but a positive correlation between PCS and Shoulder Rating Scale – Swedish version. “Handraising” and “hand-behind-back” were significantly improved, and proved to be positively correlated with Shoulder Rating Scale – Swedish version.

Conclusions: The results of this study indicate that patients with type 1 diabetes and shoulder problems,treated with a specific physiotherapy programme, may improve with respect to physical aspects of healthrelated quality of life, and partially regain their range of motion in the shoulder joint. Based on these results, the associated treatment protocol may be recommended for physiotherapy treatment in such patients.

We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait.

Le contrôle nerveux et la biomécanique de la marche chez le sujet sain et le sujet hémiplégique ainsi que les stratégies de rééducation au regard de la physiopathologie de la marche après accident vasculaire cérébral (AVC) ont été passés en revue. Chez le sujet sain ou hémiplégique, un contrôle moteur de type modulaire tâche-dépendant assure simultanément le support antigravitaire, le contrôle de l’équilibre et la déambulation au cours de la marche. L’hémiparésie après AVC est due à une interruption de voies nerveuses descendantes habituellement sans lésion directe des structures du tronc cérébral et du cervelet impliqués dans le contrôle moteur automatique. Après AVC, la récupération d’une station debout et de la marche se fait habituellement avec un comportement postural impliquant davantage le côté non atteint dans le contrôle du support et de l’équilibre, probablement suite à la faiblesse musculaire initiale du côté atteint. Divers types de rééducation sont pratiqués, visant directement le comportement musculaire ou des tâches posturales ou de locomotion en utilisant un équipement plus ou moins sophistiqué. Bien que la faible vitesse de marche s’améliore souvent avec le temps ou après diverses rééducations, le comportement postural asymétrique est souvent renforcé, maintenu ou seulement réduit transitoirement. Ce comportement postural asymétrique apparaît robuste, avec utilisation prédominante du côté non atteint pour assurer les tâches posturales antigravitaires. Ainsi chez les patients post-AVC, il est suggéré que la rééducation, incluant des renforcements et étirements des muscles parétiques, associe aussi divers exercices impliquant une utilisation posturale automatique des muscles parétiques pour corriger le comportement postural asymétrique et en tirer un bénéfice secondaire sur la marche.

Background:

Sit-to-stand (STS) is a crucial transfer influencing a person's independence in daily activities, as well as safety and quality of life, and is thus vital to evaluate in research and in practice. Clinical STS tests provide single values in seconds or numbers of STS. There is, however, increasing numbers of research papers reporting spatial and temporal kinematic and kinetic process STS data.

Objectives:

To provide an overview of research findings from laboratory-based movement analyses regarding phases and determinants of typical STS, characteristics of successful versus failed STS transfers, and finally STS performance in some neurological conditions.

Major Findings:

The STS transfer, previously regarded as mainly requiring lower limb muscle strength, is increasingly recognized as a complex transfer skill. Muscle strength, balance, foot position, chair height and the movement strategy are major determinants influencing STS performance. Scaling and timing of momentum generation throughout STS seems critical for success or failure. Sit-to-stand in stroke and Parkinson's disease (PD) is characterized by asymmetry in force generation and difficulties in switching movement direction, respectively. In-depth, knowledge regarding mechanisms of momentum control during STS sub-phases, STS failures, as well as exploration of variability in normal and atypical STS is still lacking.

Conclusions:

Recent research based on instrumented movement analyses has generated better understanding of movement control during STS, but the specifics are not yet reflected in clinical assessments. There seems to be a call for clinical tools capturing determinants and process characteristics of the STS transfer for a more comprehensive evaluation in rehabilitation.

Objective. The NeuroFlexor is a novel method incorporating a biomechanical model for the measurement of neural and nonneural contributions to resistance induced by passive stretch. In this study, we used the NeuroFlexor method to explore components of passive movement resistance in the wrist and finger muscles in subjects with Parkinson's disease (PD).

Methods. A cross-sectional comparison was performed in twenty-five subjects with PD with clinically identified rigidity and 14 controls. Neural (NC), elastic (EC), and viscous (VC) components of the resistance to passive extension of the wrist were calculated using the NeuroFlexor. Measurements were repeated during a contralateral activation maneuver.

Results. PD subjects showed greater total resistance (P < 0.001) and NC (P = 0.002) compared to controls. EC and VC did not differ significantly between groups. Contralateral activation maneuver resulted in increased NC in the PD group but this increase was due to increased resting tension. Total resistance and NC correlated with clinical ratings of rigidity and with bradykinesia.

Conclusions. The findings suggest that stretch induced reflex activity, but not nonneural resistance, is the major contributor to rigidity in wrist muscles in PD. The NeuroFlexor is a potentially valuable clinical and research tool for quantification of rigidity.

Knowledge regarding neuroplasticity post-stroke is increasingly expanding. In spite of this, only a few physiotherapy interventions have been able to demonstrate effectiveness in achieving recovery of lost sensorimotor control. The aims of this review article are to highlight and discuss challenges for physiotherapists working with patients post-stroke, to question some current assessment methods and treatment approaches, and to pose critical questions indicating a possible new direction for physiotherapists in stroke rehabilitation. Differentiation between recovery and compensation post-stroke is increasingly being emphasized. Implementation of this goal in the clinic is insufficient, with a lack of assessment tools with potential to discriminate between the concepts. Large-scale reviews are performed without considering whether functional gains are achieved through “more effective” compensatory strategies or through recovery. Cortical plasticity in neurorehabilitation research and voluntary control in contemporary treatment methods are in focus. Challenges for physiotherapists in stroke rehabilitation consist of rethinking, including looking upon the body under the influence of gravity, focusing on implicit factors that impact movement control and developing new assessment tools. The introduction of a new assessment and treatment concept aiming at expanding the boundaries of center of mass movements towards the paretic side is proposed. In conclusion, we need to assume our responsibilities and step forward as the experts in movement science that we have the potential to be.