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Johansson, G. M. & Häger, C. K. (2019). A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke. Journal of NeuroEngineering and Rehabilitation, 16(1), Article ID 8.
Open this publication in new window or tab >>A modified standardized nine hole peg test for valid and reliable kinematic assessment of dexterity post-stroke
2019 (English)In: Journal of NeuroEngineering and Rehabilitation, ISSN 1743-0003, E-ISSN 1743-0003, Vol. 16, no 1, article id 8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Impairments in dexterity after stroke are commonly assessed by the Nine Hole Peg Test (NHPT), where the only outcome variable is the time taken to complete the test. We aimed to kinematically quantify and to compare the motor performance of the NHPT in persons post-stroke and controls (discriminant validity), to compare kinematics to clinical assessments of upper extremity function (convergent validity), and to establish the within-session reliability.

METHODS: The NHPT was modified and standardized (S-NHPT) by 1) replacing the original peg container with an additional identical nine hole pegboard, 2) adding a specific order of which peg to pick, and 3) specifying to insert the peg taken from the original pegboard into the corresponding hole of the target pegboard. Eight optical cameras registered upper body kinematics of 30 persons post-stroke and 41 controls during the S-NHPT. Four sequential phases of the task were identified and analyzed for kinematic group differences. Clinical assessments were performed.

RESULTS: The stroke group performed the S-NHPT slower (total movement time; mean diff 9.8 s, SE diff 1.4), less smoothly (number of movement units; mean diff 0.4, SE diff 0.1) and less efficiently (path ratio; mean diff 0.05, SE diff 0.02), and used increased scapular/trunk movements (acromion displacement; mean diff 15.7 mm, SE diff 3.5) than controls (P < 0.000, r ≥ 0.32), indicating discriminant validity. The stroke group also spent a significantly longer time grasping and releasing pegs relative to the transfer phases of the task compared to controls. Within the stroke group, kinematics correlated with time to complete the S-NHPT and the Fugl-Meyer Assessment (rs 0.38-0.70), suggesting convergent validity. Within-session reliability for the S-NHPT was generally high to very high for both groups (ICCs 0.71-0.94).

CONCLUSIONS: The S-NHPT shows adequate discriminant validity, convergent validity and within-session reliability. Standardization of the test facilitates kinematic analysis of movement performance, which in turn enables identification of differences in movement control between persons post-stroke and controls that may otherwise not be captured through the traditional time-based NHPT. Future research should ascertain further psychometric properties, e.g. sensitivity, of the S-NHPT.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Clinical laboratory techniques, Outcome assessment, Stroke, Upper extremity
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-155494 (URN)10.1186/s12984-019-0479-y (DOI)30642350 (PubMedID)
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-01-18Bibliographically approved
Markström, J. L., Tengman, E. & Häger, C. (2018). ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury. Knee Surgery, Sports Traumatology, Arthroscopy, 26(2), 358-367
Open this publication in new window or tab >>ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury
2018 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 2, p. 358-367Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACLR), solely physiotherapy (ACLPT), and controls (CTRL). Between-leg kinematic differences within groups were also investigated.

METHODS: Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACLR, 34 ACLPT) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics.

RESULTS: Significant group effects during both Take-off and Landing were found, with ACLPT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACLR and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACLR also presented different kinematics to ACLPT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL.

CONCLUSION: Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury.

LEVEL OF EVIDENCE: Prospective cohort study, Level II.

Keywords
Anterior cruciate ligament, Long-term, Movement strategy, One-leg vertical hop, Treatment
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-144713 (URN)10.1007/s00167-017-4528-4 (DOI)000424056400002 ()28337590 (PubMedID)
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-06-09Bibliographically approved
Hébert-Losier, K., Schelin, L., Tengman, E., Strong, A. & Häger, C. (2018). Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture. Knee (Oxford), 25(2), 226-239
Open this publication in new window or tab >>Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture
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2018 (English)In: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 25, no 2, p. 226-239Article in journal (Refereed) Published
Abstract [en]

Background: Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop–jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts.

Methods: Subjects with unilateral ACL ruptures treated more than two decades ago (17–28 years) conservatively with physiotherapy (ACLPT, n = 26) or in combination with reconstructive surgery (ACLR, n = 28) and healthy-knee controls (n = 25) performed 40-cm drop–jumps. Three-dimensional knee, hip, and trunk kinematics were analyzed during Rebound, Flight, and Landing phases. Curves were time-normalized and compared between groups (injured and non-injured legs of ACLPT and ACLR vs. non-dominant and dominant legs of controls) and within groups (between legs) using functional analysis of variance methods.

Results: Compared to controls, ACL groups exhibited less knee and hip flexion on both legs during Rebound and greater knee external rotation on their injured leg at the start of Rebound and Landing. ACLR also showed less trunk flexion during Rebound. Between-leg differences were observed in ACLR only, with the injured leg more internally rotated at the hip. Overall, kinematic curves were similar between ACLR and ACLPT. However, compared to controls, deviations spanned a greater proportion of the drop–jump movement at the hip in ACLR and at the knee in ACLPT.

Conclusions: Trunk and bilateral leg kinematics during double-leg drop–jumps are still compromised long after ACL-rupture care, independent of treatment. Curve analyses indicate the presence of distinct compensatory mechanisms in ACLPT and ACLR compared to controls.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
ACL, Biomechanics, Functional data analysis, Interval testing procedure, Lower extremity, Rehabilitation
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-145719 (URN)10.1016/j.knee.2017.12.005 (DOI)000430519800004 ()29525548 (PubMedID)2-s2.0-85042919592 (Scopus ID)
Available from: 2018-03-15 Created: 2018-03-15 Last updated: 2018-09-19Bibliographically approved
Markström, J., Tengman, E. & Häger, C. (2018). Different dynamic knee stability and frontal plane kinematics and kinetics between landings in common one-leg hops for ACL-reconstructed women and knee-healthy controls. In: 8th World Congress of Biomechanics, Dublin, July 8-12, 2018: . Paper presented at 8th World Congress of Biomechanics, Dublin, July 8-12, 2018.
Open this publication in new window or tab >>Different dynamic knee stability and frontal plane kinematics and kinetics between landings in common one-leg hops for ACL-reconstructed women and knee-healthy controls
2018 (English)In: 8th World Congress of Biomechanics, Dublin, July 8-12, 2018, 2018Conference paper, Poster (with or without abstract) (Refereed)
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-150559 (URN)
Conference
8th World Congress of Biomechanics, Dublin, July 8-12, 2018
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-08-21
Stenlund, T., Öhberg, F., Lundström, R., Lindroos, O., Häger, C., Neely, G. & Rehn, B. (2018). Double-sided Mechanical Shocks Provoke Larger Seated Postural Reactions Compared to Single-Sided Mechanical Shocks. Spine, 43(8), E482-E487
Open this publication in new window or tab >>Double-sided Mechanical Shocks Provoke Larger Seated Postural Reactions Compared to Single-Sided Mechanical Shocks
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2018 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 43, no 8, p. E482-E487Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: Human volunteers were exposed experimentally to single-sided mechanical shocks (SSMS) and double-sided mechanical shocks (DSMS) while seated.

OBJECTIVE: To describe and contrast seated postural reactions due to SSMS or DSMS in healthy male adults.

SUMMARY OF BACKGROUND DATA: Mechanical shocks to the body, caused when driving on irregular terrain, are suggested to be hazardous to the spine and may be associated with the reported musculoskeletal pain of the back and neck among professional drivers. However, very little is known about the characteristics of seated postural reactions and the biomechanical effects caused by mechanical shocks.

METHODS: Twenty healthy male subjects (18-43 years old) were exposed while seated to 5 SSMS and 15 DSMS in lateral directions. The second acceleration in the DSMS was in the opposite direction to the first acceleration and was either fast, medium or slow depending on the speed of direction change. Surface electromyography (EMG) was recorded in muscles of the upper neck, trapezius, erector spinae and external oblique while kinematics were recorded with inertial sensors placed at the neck, trunk and pelvis. Muscle activity was normalized to maximum voluntary contractions (MVC).

RESULTS: The EMG amplitudes were significantly higher (0.6-1%; p < 0.001) for the fast DSMS compared to all other shocks. Range of motion (ROM) of the neck and trunk was greater during the DSMS compared to the SSMS. Evoked muscle activity was less than 2% MVC in the trapezius, less than 10% MVC in the erector spinae and upper neck while the activity exceeded 10% MVC in the external oblique muscles.

CONCLUSION: Fast DSMS in lateral directions appear more demanding compared to SSMS, demonstrating augmented seated postural reactions. However, the present mechanical shocks employed did not seem to induce postural reactions with regard to ROM or muscle activity of a magnitude likely to cause musculoskeletal overload.

LEVEL OF EVIDENCE: 4.

National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-144712 (URN)10.1097/BRS.0000000000002396 (DOI)000440520600008 ()28858181 (PubMedID)
Funder
AFA Insurance
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-09-13Bibliographically approved
Markström, J., Grip, H., Schelin, L. & Häger, C. (2018). Elite women athletes with superior knee function present similar dynamic knee stability, although different movement strategies, when compared to controls. In: 23rd annual Congress of the European College of Sport Science: Sport Science at the cutting edge, Dublin, July 4-7, 2018: . Paper presented at 23rd Annual Congress of the European College of Sport Science, Dublin, July 4-7, 2018.
Open this publication in new window or tab >>Elite women athletes with superior knee function present similar dynamic knee stability, although different movement strategies, when compared to controls
2018 (English)In: 23rd annual Congress of the European College of Sport Science: Sport Science at the cutting edge, Dublin, July 4-7, 2018, 2018Conference paper, Oral presentation with published abstract (Refereed)
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-150557 (URN)
Conference
23rd Annual Congress of the European College of Sport Science, Dublin, July 4-7, 2018
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-08-21
Svedmark, Å., Björklund, M., Häger, C. K., Nilsson Sommar, J. & Wahlström, J. (2018). Impact of workplace exposure and stress on neck pain and disabilities in women: a longitudinal follow-up after a rehabilitation intervention. Annals of Work exposure and Health, 62(5), 591-603
Open this publication in new window or tab >>Impact of workplace exposure and stress on neck pain and disabilities in women: a longitudinal follow-up after a rehabilitation intervention
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2018 (English)In: Annals of Work exposure and Health, ISSN 2398-7308, Vol. 62, no 5, p. 591-603Article in journal (Refereed) Published
Abstract [en]

Introduction: The aim was to evaluate if pain, disability, and work productivity are influenced by physical and psychosocial work exposures as well as by stress, up to 1 year after a randomized controlled trial treatment intervention, and to determine whether any such association differed between treatment and control groups.

Methods: Ninety-seven working women suffering non-specific neck pain (n = 67 treatment group, n = 30 control group) were followed from end of treatment intervention and at 9- and 15-month follow-ups, respectively. Physical and psychosocial exposures, as well as perceived stress, were assessed after the treatment intervention. Pain, neck disability, and work productivity were assessed at baseline, after intervention 3 months later and at 9- and 15-month follow-ups. Longitudinal assessment was conducted using the exposure level at 3 months as predictor of pain, disability, and work productivity at 3, 9, and 15 months, respectively. Mixed models were used to estimate longitudinal associations, accounting for within-individual correlation of repeated outcome measures by incorporation of a random intercept. Age and duration of neck pain were adjusted for in all models. To evaluate group differences, interactions between exposures and treatment groups were estimated.

Results: High perceived stress was associated with more neck pain, more neck disability, and decreased work productivity in both cross-sectional and longitudinal analyses. High ‘control of decision’ was associated with less neck pain, less neck disability, and higher work productivity in cross-sectional analyses but only to less disability and higher productivity in longitudinal analyses. Shoulder/arm load was the only physical exposure variable that was significantly associated with work productivity in the univariate analyses. Only small differences were observed between treatment and control groups.

Conclusion: High perceived stress and low ‘control of decision’ were associated with more neck pain, increased neck disability, and decreased work productivity. Treatment interventions for individuals with neck pain should take into account psychosocial workplace exposures and stress to improve intermediate and long-term results.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
non-specific neck pain, physiotherapy, shoulder pain, work productivity
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-139392 (URN)10.1093/annweh/wxy018 (DOI)000449420200007 ()29562318 (PubMedID)2-s2.0-85050676120 (Scopus ID)
Funder
AFA Insurance, 090288Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-1403
Available from: 2017-09-11 Created: 2017-09-11 Last updated: 2018-11-26Bibliographically approved
Srinivasan, D., Tengman, E. & Häger, C. K. (2018). Increased movement variability in one-leg hops about 20 years after treatment of anterior cruciate ligament injury. Clinical Biomechanics, 53, 37-45
Open this publication in new window or tab >>Increased movement variability in one-leg hops about 20 years after treatment of anterior cruciate ligament injury
2018 (English)In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 53, p. 37-45Article in journal (Refereed) Published
Abstract [en]

Background: Recent studies highlight the need for understanding movement control of adjacent joints when evaluating knee function following anterior cruciate ligament (ACL) injury. However, while short-term adaptations to lower-extremity joint coupling have been studied, little is known about any potential long-term adaptations in neuromuscular control displayed by ACL-injured individuals. The aim of our study was to determine whether coordination variability of the hip-knee joint couplings during the one-leg hop is altered about 20 years after injury in two ACL-injured groups compared to healthy knee controls.

Methods: Seventy persons performed one leg hops ~23 years after ACL injury and following different treatments: 33 participants treated with physiotherapy in combination with ACL-reconstruction (ACLR); 37 participants with physiotherapy alone (ACLPT). They were compared to 33 matched controls. A vector coding procedure was used to create joint couplings for knee and hip angles on all the cardinal planes for the Take-off and Landing phases. The standard deviation of each coupling was computed as a measure of coordination variability.

Findings: Both the ACL groups differed significantly from controls on their injured side with ~50% higher knee abduction-adduction/hip internal-external rotation variability during the Take-off phase; ~33% higher knee abduction-adduction/knee flexion-extension variability and greater knee abduction-adduction/hip flexion-extension variability (ACLR 50%; ACLPT 80%) during the Landing phase. There were no major differences between injured and non-injured sides in any group.

Interpretation: Increased variability in lower-extremity joint couplings has emerged as a conspicuous feature of ACL injured persons in the very long term compared to non-injured controls, independent of treatment. Further research of the processes leading to alterations in movement variability using longitudinal studies would facilitate better understanding of the functional adaptations leading to knee dysfunction in the short- and long-term after ACL injury.

Keywords
vector coding, movement variability, kinematics, ACL reconstruction, physiotherapy
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-144718 (URN)10.1016/j.clinbiomech.2018.02.003 (DOI)29433043 (PubMedID)
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-06-09Bibliographically approved
Arumugam, A., Markström, J. L. & Häger, C. K. (2018). Introducing a novel test with unanticipated medial/lateral diagonal hops that reliably captures hip and knee kinematics in healthy women. Journal of Biomechanics
Open this publication in new window or tab >>Introducing a novel test with unanticipated medial/lateral diagonal hops that reliably captures hip and knee kinematics in healthy women
2018 (English)In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380Article in journal (Refereed) In press
Abstract [en]

Despite a vast literature on one-leg hops and cutting maneuvers assessing knee control pre/post-injury of the anterior cruciate ligament (ACL), comprehensive and reliable tests performed under unpredictable conditions are lacking. This study aimed to: (1) assess the feasibility of an innovative, knee-challenging, one-leg double-hop test consisting of a forward hop followed by a diagonal hop (45°) performed medially (UMDH) or laterally (ULDH) in an unanticipated manner; and (2) determine within- and between-session reliability for 3-dimensional hip and knee kinematics and kinetics of these tests. Twenty-two healthy women (22.3 ± 3.3 years) performed three successful UMDH and ULDH, twice 1–4 weeks apart. Hop success rate was 69–84%. Peak hip and knee angles demonstrated moderate to excellent within-session reliability (intraclass correlation coefficient [ICC] 95% confidence interval [CI]: 0.67–0.99, standard error of measurement [SEM] ≤  3°) and poor to excellent between-session reliability (ICC CI: 0.22–0.94, SEM ≤ 3°) for UMDH and ULDH. The smallest real difference (SRD) was low (≤ 5°) for nearly all peak angles. Peak hip and knee moments demonstrated poor to excellent reliability (ICC CI: 0–0.97) and, in general, moments were more reliable within-session (SEM ≤ 0.14 N.m/kg.m, both directions) than between-session (SRD ≤ 0.43 N.m/kg.m). Our novel test was feasible and, in most but not all cases, provided reliable angle estimates (within-session > between-session, both directions) albeit less reliable moments (within-session > between-session, both directions). The relatively large hip and knee movements in the frontal and transverse planes during the unanticipated hops suggest substantial challenge of dynamic knee control. Thus, the test seems appropriate for evaluating knee function during ACL injury rehabilitation.

Keywords
Motion analysis, Biomechanics, Anterior cruciate ligament, Sports, Rehabilitation
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-152959 (URN)10.1016/j.jbiomech.2018.10.015 (DOI)
Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2018-11-20
Abramowicz, K., Häger, C., Pini, A., Schelin, L., Sjöstedt de Luna, S. & Vantini, S. (2018). Nonparametric inference for functional-on-scalar linear models applied to knee kinematic hop data after injury of the anterior cruciate ligament. Scandinavian Journal of Statistics, 45(4), 1036-1061
Open this publication in new window or tab >>Nonparametric inference for functional-on-scalar linear models applied to knee kinematic hop data after injury of the anterior cruciate ligament
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2018 (English)In: Scandinavian Journal of Statistics, Vol. 45, no 4, p. 1036-1061Article in journal (Refereed) Published
Abstract [en]

Motivated by the analysis of the dependence of knee movement patterns during functional tasks on subject-specific covariates, we introduce a distribution-free procedure for testing a functional-on-scalar linear model with fixed effects. The procedure does not only test the global hypothesis on the entire domain but also selects the intervals where statistically significant effects are detected. We prove that the proposed tests are provided with an asymptotic control of the intervalwise error rate, that is, the probability of falsely rejecting any interval of true null hypotheses. The procedure is applied to one-leg hop data from a study on anterior cruciate ligament injury. We compare knee kinematics of three groups of individuals (two injured groups with different treatments and one group of healthy controls), taking individual-specific covariates into account.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
analysis of covariance, functional data, human movement, intervalwise testing, permutation test
National Category
Probability Theory and Statistics
Identifiers
urn:nbn:se:umu:diva-150935 (URN)10.1111/sjos.12333 (DOI)000450039100010 ()
Funder
Swedish Research Council, K2014-99X-21876-04-4Swedish Research Council, 340-2013-5203Swedish Research Council, 2016-02763Västerbotten County Council, ALF VLL548501Västerbotten County Council, VLL-358901Västerbotten County Council, 7002795
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-01-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0366-4609

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