Combat-related foot injuries: impact on gait and functional outcome

2018 ◽  
Vol 164 (5) ◽  
pp. 322-327 ◽  
Author(s):  
Loes G M de Kruijff ◽  
M Prins ◽  
A van der Krans ◽  
R Hoencamp ◽  
P van der Wurff
Keyword(s):  
The Netherlands ◽  
Ankle Joint ◽  
Peak Power ◽  
Walking Speed ◽  
Service Members ◽  
Step Width ◽  
Foot Injuries ◽  
Stride Duration ◽  
High Level ◽  
Böhler’S Angle

IntroductionPrior to deployment of the Netherlands Army Task Force Urozgan in Afghanistan, the Dutch Military and civilian healthcare systems had limited experience in treating blast injuries and their long-term consequences. This meant that guidelines for treatment and rehabilitation were lacking. The aim of this cohort study was to quantify kinematic and kinetic abnormalities in service members with foot injuries in relation to functional outcome using gait analysis.MethodIn nine service members with combat-related talus, calcaneus and/or navicular bone (TCN) fractures and nine controls, gait parameters were measured using Gait Real-Time Analysis Interactive Lab system. High-level mobility was evaluated by the Comprehensive High-Level Activity Mobility Predictor (CHAMP), and functional ability was assessed by Lower Extremity Functional Scale (LEFS) questionnaire.ResultsSignificant differences were found for LEFS and CHAMP scores (P<0.01), comfortable walking speed and ankle joint range of motion (ROM) (P<0.05), all lower in the group with TCN fractures. For this group, a trend (0.1>P>0.05) for higher step width and lower stride duration and peak power was found. A strong correlation (0.6>r>0.79) is shown between LEFS and comfortable walking speed and CHAMP and ankle joint ROM. The correlations between LEFS and stride duration, step width, ankle joint ROM and peak power, and between CHAMP and comfortable walking speed and stride duration, were moderate (0.4>r>0.59).ConclusionsThis study demonstrated that service members with TCN fractures, compared with healthy controls, have altered gait characteristics, specifically lower walking speed and ankle joint ROM, both related to lower physical functioning. Patients with bilateral depressed Böhler’s angle had the worse functional performance, and further research is recommended to evaluate the relationship between Böhler’s angle and physical performance.Clinical TrialThe Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).

INFLUENCE OF FOOT INSOLE ON THE GAIT PERFORMANCE IN SUBJECTS WITH FLAT FOOT DISORDER

2019 ◽  
Vol 19 (06) ◽  
pp. 1950050
Author(s):  
M. T. KARIMI ◽  
R. B. TAHMASEBI ◽  
B. SATVATI ◽  
F. FATOYE
Keyword(s):  
Range Of Motion ◽  
Ankle Joint ◽  
Lower Limb ◽  
Walking Speed ◽  
Force Plate ◽  
Flat Foot ◽  
Gait Performance ◽  
Positive Effects ◽  
Significant Difference ◽  
Foot Disorder

Flat foot is the most common foot disorder that influences the alignment of the lower limb structure. It is controversial whether the use of foot insole influences kinetic and kinematic of the leg or not. Therefore, this study investigated the influence of foot insole on the gait performance in subjects with flat foot disorder. A group of flat foot subject was recruited into this study (the number of subjects was 15). The motion of the leg joints was determined using the Qualysis motion analysis system. Moreover, the force applied on the lower limb was recorded by a Kistler force plate. The range of motion of the lower limb joints, the moments applied on the lower limb joints and force transmitted through the leg were the parameters used in this study. The difference between these parameters during walking with and without insole was evaluated using the paired [Formula: see text]-test. Significant value was set at [Formula: see text]. There was no significant difference between the range of motion of ankle joint while walking with and without insole. However, the medial directed force applied on the leg decreased significantly [Formula: see text]. The use of foot insole did not influence the moments transmitted through the hip and knee joints. The walking speed of the subjects improved while walking with foot insole. Use of foot insole influenced the magnitude of the force applied on the leg and the adductor moment of ankle joint due to its influence on foot alignment. As the walking speed of the improved subjects follows the use of insole, it can be concluded that it may have a positive effects on the performance of flat foot subjects.

Effects of walking speed on the step-by-step control of step width

2018 ◽  
Vol 68 ◽  
pp. 78-83 ◽  
Author(s):  
Katy H. Stimpson ◽  
Lauren N. Heitkamp ◽  
Joscelyn S. Horne ◽  
Jesse C. Dean
Keyword(s):  
Walking Speed ◽  
Step Width ◽  
Step Control

A Dutchman in London: reflections of a hospital chief executive from the Netherlands in the NHS

BMJ Leader ◽  
2021 ◽  
pp. leader-2021-000509
Author(s):  
Marcel Levi
Keyword(s):  
Health Care ◽  
The Netherlands ◽  
Health Care Professionals ◽  
Chief Executive ◽  
Point Of View ◽  
British Society ◽  
The Public ◽  
Interesting Insight ◽  
Clinical Point ◽  
High Level

BackgroundThe NHS is a fascinating health care system and is enjoying a lot of support from all layers of British society. However, it is clear that the system has excellent features but also areas that can be improved.Story of selfA number of years as a chief executive in one of London’s largest hospital has brought me a wealth of impressions, experiences, and understanding about working in the NHS. Contrasting those to my previous experience as chief executive in Amsterdam (The Netherlands) provides an interesting insight.ObservationsVery strong features of the NHS are the high level of health care professionals, the focus on quality and safety, and involvement of patients and the public. However, the NHS can significantly improve by addressing the lack of clinical professionals in the lead, curtailing ever increasing bureaucracy, and reducing its peculiar preference for outsourcing even the most crucial activities to private parties. The frequent inability to swiftly and successfully complete goal-directed negotiations as well as the large but from a clinical point of view irrelevant private sector are areas of sustained bewilderment. Lastly, the drive for innovation and transformation as well as the level of biomedical research in the NHS and supported by the British universities is fascinating and outstanding.

The Portable Warrior Test of Tactical Agility: A Novel Functional Assessment That Discriminates Service Members Diagnosed With Concussion From Controls

2021 ◽  
Author(s):  
Amy Seal Cecchini ◽  
Julianna Prim ◽  
Wanqing Zhang ◽  
Courtney H Harrison ◽  
Karen L McCulloch
Keyword(s):  
Construct Validity ◽  
Functional Assessment ◽  
Motor Task ◽  
Service Members ◽  
Control Group ◽  
Readiness Assessment ◽  
Mobility Assessment ◽  
Healthy Control ◽  
High Level ◽  
Return To Duty

ABSTRACT Introduction Return-to-duty (RTD) readiness assessment for service members (SM) following concussion requires complex clinical considerations. The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a functional assessment which improves on previous laboratory-based RTD assessments. Methods Sixty-four SM diagnosed with concussion and 60 healthy control (HC) SM participated in this study. Group differences were analyzed to validate the POWAR-TOTAL. The High-level Mobility Assessment Test (HiMAT) was used to examine concurrent construct validity. An exploratory logistic regression analysis examined predictive validity. Results The groups were demographically well-matched except for educational level. POWAR-TOTAL measures were statistically significantly different between the groups with moderate to large effect sizes. Concussed participants were less likely to be able to complete all trials of the POWAR-TOTAL. Motor scores correlated highly with HiMAT scores. POWAR-TOTAL motor task performance and membership in the control group was significantly associated with self-reported physical readiness to deploy. Conclusion The POWAR-TOTAL is a clinically feasible, military relevant assessment that is sensitive to differences between concussed and HC SM. This analysis supports the discriminant and construct validity of the POWAR-TOTAL, and may be useful for medical providers evaluating RTD readiness for SM who have sustained a concussion.

scholarly journals Dual tasking to optimize performance for the tactical athlete

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S21.2-S21
Author(s):  
Selena Bobula ◽  
Jami Skarda-Craft ◽  
Alina Souvignier
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
High Performance ◽  
Task Demands ◽  
Interdisciplinary Treatment ◽  
Service Members ◽  
Interdisciplinary Management ◽  
Language Fluency ◽  
Dual Tasking ◽  
High Level

This session with cover aspects of the DoD's Intrepid Spirit (IS) model for caring for service members with symptoms of traumatic brain injury (TBI) and comorbidities and taking care further with interdisciplinary management of the high-level functioning tactical athlete. Traumatic brain injury and concussion are common injuries among service members and athletes. As more research is completed on concussion, consequences of this injury have become better understood, but much is still left unknown, to include proper treatment for high performance tactical athletes and service members. This lecture will discuss interdisciplinary treatment for high-level performance needs with emphasis on utilization of dual tasking. This session will describe the IS mission and programs available through the Warrior Recovery Center at Fort Carson then further expand upon specialized co-treatments between Speech-Language Pathology (SLP) and Physical Therapy (PT) to push high-level patients to a higher standard. These interventions include aggressive dual-task demands with balance, exertional, and endurance tasks combined with challenges of working memory, delayed recall, visual tracking, language fluency, visual reasoning, and executive functions in English and the service member's secondary language. A case report will be provided to offer example interventions as well as improvements throughout treatment for service members who participated in this advanced intervention.

scholarly journals A Model to Predict the Effect of Ankle Joint Misalignment on Calf Band Movement in Ankle-Foot Orthoses

2007 ◽  
Vol 31 (1) ◽  
pp. 76-87 ◽  
Author(s):  
Stefania Fatone ◽  
Andrew H. Hansen
Keyword(s):  
Ankle Joint ◽  
Walking Speed ◽  
Sagittal Plane ◽  
Plantar Flexion ◽  
Dimensional Model ◽  
Ankle Foot Orthosis ◽  
Ankle Joints ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis ◽  
Anterior Posterior

Accurate alignment of anatomical and mechanical joint axes is one of the major biomechanical principles pertaining to articulated orthoses, yet knowledge of the potential effects of axis misalignment is limited. The purpose of this project was to model the effects of systematic linear (proximal-distal and anterior-posterior) misalignments of single axis mechanical ankle joints in an ankle-foot orthosis (AFO) in order to determine the degree and direction of calf band travel that would occur over a functional range of motion. Sagittal plane misalignments of the ankle joint centres of an AFO were simulated using a simple two-dimensional model for both a range of ankle angles and a typical able-bodied ankle kinematic curve for self-selected normal walking speed. The model assumed that no movement occurred between the foot and the foot-plate of the AFO. The model predicted that for anterior (positive horizontal) misalignments, dorsiflexion movements would cause the calf band to travel proximally (i.e., up the leg) and plantar flexion movements would cause the calf band to travel distally (i.e., down the leg). The opposite was predicted for posterior (negative horizontal) misalignments. Proximal (positive vertical) misalignments would cause only distal movements of the calf band while distal (negative vertical) misalignments would cause only proximal movements of the calf band. Anterior-posterior misalignments were found to have a much larger effect on the amount of calf band travel than proximal-distal misalignments.

scholarly journals The home food environment of overweight gatekeepers in the Netherlands

2014 ◽  
Vol 18 (10) ◽  
pp. 1815-1823 ◽  
Author(s):  
Maartje P Poelman ◽  
Emely de Vet ◽  
Elizabeth Velema ◽  
Jacob C Seidell ◽  
Ingrid HM Steenhuis
Keyword(s):  
The Netherlands ◽  
Living Room ◽  
Snack Food ◽  
Food Environments ◽  
Cross Sectional ◽  
Level Of Education ◽  
Snack Foods ◽  
Food Items ◽  
Home Food ◽  
High Level

AbstractObjectiveThe aim of the present study was to gain insight into (i) processed snack-food availability, (ii) processed snack-food salience and (iii) the size of dinnerware among households with overweight gatekeepers. Moreover, associations between gatekeepers’ characteristics and in-home observations were determined.DesignA cross-sectional observation of home food environments was conducted as part of a baseline measurement of a larger study.SettingHome food environments of overweight and obese gatekeepers in the Netherlands.SubjectsHousehold gatekeepers (n278). Mean household size of the gatekeepers was 3·0 (sd1·3) persons. Mean age of the gatekeepers was 45·7 (sd9·2) years, 34·9 % were overweight and 65·1 % were obese. Of the gatekeepers, 20·9 % had a low level of education and 42·7 % had a high level of education.ResultsIn 70 % of the households, eight or more packages of processed snack foods were present. In 54 % of the households, processed snack foods were stored close to non-processed food items and in 78 % of households close to non-food items. In 33 % of the households, processed snack foods were visible in the kitchen and in 15 % of the households processed snack foods were visible in the living room. Of the dinnerware items, 14 % (plates), 57 % (glasses), 78 % (dessert bowls), 67 % (soup bowls) and 58 % (mugs) were larger than the reference norms of the Netherlands Nutrition Centre Foundation. Older gatekeepers used significantly smaller dinnerware than younger gatekeepers.ConclusionsEnvironmental factors endorsing overconsumption are commonly present in the home environments of overweight people and could lead to unplanned eating or passive overconsumption.

scholarly journals Stabilization Strategies for Fast Walking in Challenging Environments With Incomplete Spinal Cord Injury

2021 ◽  
Vol 2 ◽  
Author(s):  
Tara Cornwell ◽  
Jane Woodward ◽  
Wendy Ochs ◽  
Keith E. Gordon
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Walking Speed ◽  
Center Of Mass ◽  
Lateral Stability ◽  
Step Width ◽  
Incomplete Spinal Cord Injury ◽  
Foot Placement ◽  
Fast Speed ◽  
Cord Injury

Gait rehabilitation following incomplete spinal cord injury (iSCI) often aims to enhance speed and stability. Concurrently increasing both may be difficult though as certain stabilization strategies will be compromised at faster speeds. To evaluate the interaction between speed and lateral stability, we examined individuals with (n = 12) and without (n = 12) iSCI as they performed straight walking and lateral maneuvers at Preferred and Fast treadmill speeds. To better detect the effects of speed on stability, we challenged lateral stability with a movement amplification force field. The Amplification field, created by a cable-driven robot, applied lateral forces to the pelvis that were proportional to the real-time lateral center of mass (COM) velocity. While we expected individuals to maintain stability during straight walking at the Fast speed in normal conditions, we hypothesized that both groups would be less stable in the Amplification field at the Fast speed compared to the Preferred. However, we found no effects of speed or the interaction between speed and field on straight-walking stability [Lyapunov exponent or lateral margin of stability (MOS)]. Across all trials at the Fast speed compared to the Preferred, there was greater step width variability (p = 0.031) and a stronger correlation between lateral COM state at midstance and the subsequent lateral foot placement. These observations suggest that increased stepping variability at faster speeds may be beneficial for COM control. We hypothesized that during lateral maneuvers in the Amplification field, MOS on the Initiation and Termination steps would be smaller at the Fast speed than at the Preferred. We found no effect of speed on the Initiation step MOS within either field (p &gt; 0.350) or group (p &gt; 0.200). The Termination step MOS decreased at the Fast speed within the group without iSCI (p &lt; 0.001), indicating a trade-off between lateral stability and forward walking speed. Unexpectedly, participants took more steps and time to complete maneuvers at the Fast treadmill speed in the Amplification field. This strategy prioritizing stability over speed was especially evident in the group with iSCI. Overall, individuals with iSCI were able to maintain lateral stability when walking fast in balance-challenging conditions but may have employed more cautious maneuver strategies.

scholarly journals Asymptomatic Genu Recurvatum Reshapes Lower Limb Sagittal Joint and Elevation Angles During Gait at Different Speeds

2020 ◽  
Author(s):  
Frederic Dierick ◽  
Celine Schreiber ◽  
Pauline Lavalee ◽  
Fabien Buisseret
Keyword(s):  
Knee Joint ◽  
Lower Limb ◽  
Gait Cycle ◽  
Walking Speed ◽  
Elevation Angle ◽  
Step Width ◽  
Genu Recurvatum ◽  
Secondary Objective ◽  
Lower Maximum ◽  
Spatio Temporal

Purpose: The main objective of this study is to characterize the lower limb sagittal joint and elevation angles during walking in participants with asymptomatic genu recurvatum and compare it with control participants without knee deformation. The secondary objective is to study the influence of walking speed on these kinematic variables. Methods: The spatio-temporal parameters and kinematics of the lower limb were recorded using an optoelectronic motion capture system in 26 participants (n = 13 with genu recurvatum and n = 13 controls). The participants walked on an instrumented treadmill during five minutes at three different speeds: slow, medium and fast. Results: Participants with genu recurvatum showed several significant differences with controls: a narrower step width, a greater maximum hip joint extension angle, a greater knee joint extension angle at mid stance, a lower maximum knee joint extension angle during the swing phase, and a greater ankle joint extension angle at the end of the gait cycle. Participants with genu recurvatum had a greater minimum thigh elevation angle, a greater maximum foot elevation angle, and a change in the orientation of the covariance plane. Walking speed had a significant effect on nearly all lower limb joint, elevation angle, and covariance plane parameters. Conclusion: Our findings show that genu recurvatum reshapes lower limb sagittal joint and elevation angles during walking at different speeds but preserves the covariation of elevation angles along a plane during both stance and swing phases and the rotation of this plane with increasing speed.

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