Stroke affects approximately 800,000 individuals each year, with 65% having residual impairments.... more Stroke affects approximately 800,000 individuals each year, with 65% having residual impairments. Studies have demonstrated that mass practice leads to regaining motor function in affected extremities; however, traditional therapy does not include the repetitions needed for this recovery. Videogames have been shown to be good motivators to complete repetitions. Advances in technology and low-cost hardware bring new opportunities to use computer games during stroke therapy. This study examined the use of the Microsoft (Redmond, WA) Kinectâ„¢ and Flexible Action and Articulated Skeleton Toolkit (FAAST) software as a therapy tool to play existing free computer games on the Internet. Three participants attended a 1-hour session where they played two games with upper extremity movements as game controls. Video was taken for analysis of movement repetitions, and questions were answered about participant history and their perceptions of the games. Participants remained engaged through both g...
Stroke survivor gait adaptation and performance after training on a Powered Ankle Foot Orthosis
2010 IEEE International Conference on Robotics and Automation, 2010
Abstract—With over 600 thousand people each year sur-viving a stroke, it has become the leading c... more Abstract—With over 600 thousand people each year sur-viving a stroke, it has become the leading cause of serious long-term disability in the United States [1], [2]. The ad-verse financial and social conditions attributed to stroke have prompted researchers and entrepreneurs to explore ...
Can the use of a terminal device augment plantar pressure reduction with a total contact cast?
Foot & Ankle International
HYPOTHESES/PURPOSE: Total contact casting (TCC) has been shown to promote the healing of plantar ... more HYPOTHESES/PURPOSE: Total contact casting (TCC) has been shown to promote the healing of plantar neurotrophic ulcers by reducing plantar pressures and has become the established treatment standard by which all others are measured. The purpose of this study was to determine if terminal cast devices (cast shoes and heels) significantly affect the amount of plantar pressure reduction when used with a total contact cast. Plantar pressures were measured in the right feet of 28 healthy adult volunteers using the Novel EMED PEDAR system (Novel GmbH, Munich, Germany) for six conditions: athletic shoe (i.e., control), TCC alone, TCC with a conventional cast shoe (EBI, Parsipanny, NJ), TCC with a custom rigid rocker cast shoe (NPS, St. Louis, MO), TCC with a rubber rocker heel (Cast Walker, DM Systems Inc., Evanston, IL), and TCC with a traditional flat rubber heel (Zimmer, Warsaw, IN). Peak plantar pressures were recorded from the forefoot, midfoot, and hindfoot. Analysis of variance (ANOVA) was used to determine statistical significance. The greatest reductions in forefoot plantar pressures compared to the athletic shoe control were seen in the TCC with the conventional cast shoe and the TCC with the rigid rocker shoe; a mean plantar pressure reduction of 30% was observed for both conditions (p < .001). Significant midfoot plantar pressure reductions (p < .001) were achieved with the TCC alone, TCC with the conventional cast shoe, TCC with the rigid rocker heel, TCC with the flat rubber heel, and TCC with the rubber rocker heel. Mean reductions were 42%, 51%, 47%, 40%, and 46%, respectively. While athletic shoe peak hindfoot pressures were only reduced by 15% by TCC alone, the addition of the rubber rocker heel to TCC reduced athletic shoe pressures by 32% and the addition of the flat rubber heel to TCC reduced athletic shoe pressures by 29%. The reductions with TCC and the heels were both significant when using the athletic shoe as the control (p < .001) and the TCC alone as the control (p < .05). Plantar pressure reduction with TCC can be augmented with the addition of a terminal cast device and the effects shown in this study are significantly different than previously reported. These results suggest that terminal cast devices should be chosen according to location of the neuropathic ulcer. In this study, forefoot pressures were reduced the most with TCC and either the conventional cast shoe or the rigid rocker shoe. The authors therefore recommend these combinations for forefoot ulcers. TCC alone or combined with any of the terminal devices proved equally effective for midfoot plantar pressure reduction. Hindfoot ulcers should be treated with TCC and the rubber rocker heel or the flat rubber heel as these provided the best hindfoot pressure reductions.
The purpose of this investigation was to compare weight distributions of a relatively large numbe... more The purpose of this investigation was to compare weight distributions of a relatively large number of below-knee (BK) amputee and able-bodied children during two different standing positions. Twenty-one BK amputees and 200 able-bodied children volunteered as subjects for this investigation. Each child stood on a pressure plate and three sets of trial data were collected. One set of trial data was collected with both feet together on the pressure plate and two were collected with feet placed 20cm apart. The total force applied by each foot to the pressure plate was normalised by dividing by subject weight to yield foot force to body weight ratios. Data were separated into forefoot and rearfoot areas, force for the forefoot area was then calculated and normalised by dividing by total foot force to yield forefoot to whole-foot force ratios. Ratios for the two foot placement conditions and for non-prosthetic, prosthetic, dominant, and nondominant feet were compared using paired ttests (p<0.05). Results indicated that: 1) BK amputee children placed more weight on their non-prosthetic limb than their prosthetic limb, yet this was not different from able-bodied children in respect of weight distribution between dominant and non-dominant limbs; 2) approximately 90% of the load on the prosthetic foot was placed on the forefoot; and 3) the load on the non-prosthetic foot was evenly distributed between the forefoot and rearfoot like that of able-bodied children. It was concluded that except for substantially more weight on the forefoot of the prosthetic leg BK amputee children stood in the same way as able-bodied children.
Center of mass location and segment angular orientation of below-knee-amputee and able-bodied children during walking
Archives of Physical Medicine and Rehabilitation
This investigation compared the center of mass (COM) locations and segment angular orientations o... more This investigation compared the center of mass (COM) locations and segment angular orientations of the gait of below-knee-amputee (BKA) children to those of able-bodied (AB) children. Eleven AB children (mean age, 8.4 years) and three BKA children (mean age, 7.5 years) volunteered to participate as subjects. Film data (100 frames per second) of a typical walking stride, were collected for the children during four experimental sessions held at six-month intervals. Two 16mm cameras were used to obtain frontal and lateral views of the subjects. The same approximate rate of walking (1.2m/s +/- 10%) was enforced for all testing sessions and at least three trials of data were collected for each subject during each session. Segmental endpoints of each subject from the film of each camera were digitized and the direct linear transformation (DLT) method was used to obtain three-dimensional segmental location-time data for a complete stride. These data were then used to determine whole body COM locations and angular orientations for the segments. Discrete values describing normalized locations at touchdown, midsupport, and takeoff were determined for whole body COM and the angular orientation of the trunk, thighs, and legs. In the sagittal plane the COM was lower and more anterior for the BKA children when compared to that of the AB children. This was primarily due to the greater forward flexion of the trunk.(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of this investigation was to develop normative ground reaction force data for able-bo... more The purpose of this investigation was to develop normative ground reaction force data for able-bodied (AB) and trans-tibial amputee (TTA) children during running. Two hundred AB (mean age 9.4 years, range 7-12) and 21 TTA (mean age 11.1 years, range 5-17) children ran (2.2 m/s±10%) over a force platform. Ground reaction force data were normalized, averaged within groups and plotted to produce force-time curves characterizing the different leg types (i.e. able-bodied, nonprosthetic and prosthetic). In addition, discrete variables characterizing the leg type differences were determined.
The purpose of this investigation was to compare intersegmental knee and hip forces for below-kne... more The purpose of this investigation was to compare intersegmental knee and hip forces for below-knee amputee (BKA) and able-bodied children during standing. Three unilateral BKA children and 10 able-bodied children (7-9 years) were tested on four separate occasions at six month intervals. Three trials of external force and spatial data during standing were collected from each subject for each session. These data were utilised to determine the intersegmental forces at the knees and hips of the children using a static force analysis. Results indicated that in some instances the intersegmental forces for the BKA children were significantly greater than those of the able-bodied children and in other instances significantly lower (p<0.05). In all cases, however, the values were substantially less than corresponding values for walking and running. The effects of the forces upon spatial orientations indicated significant differences between the two groups of children. The frontal plane prosthetic knee angle, the sagittal plane prosthetic and non-prosthetic knee angles, and the sagittal plane trunk angle were all greater for the BKA children when compared to ablebodied children. These differences may be the result of the anatomical structure of the amputee and/or the construction of the prosthesis.
In the United States alone, more than five million people are living with long term motor impairm... more In the United States alone, more than five million people are living with long term motor impairments caused by a stroke. Video game-based therapies show promise in helping people recover lost range of motion and motor control. While researchers have demonstrated the potential utility of game-based rehabilitation through controlled studies, relatively little work has explored longer-term home-based use of therapeutic games. We conducted a six-week home study with a 62 year old woman who was seventeen years post-stroke. She played therapeutic games for approximately one hour a day, five days a week. Over the six weeks, she recovered significant motor abilities, which is unexpected given the time since her stroke. Through observations and interviews, we present lessons learned about the barriers and opportunities that arise from long-term home-based use of therapeutic games.
The purpose of this pilot investigation was to develop a method to test the influence of specific... more The purpose of this pilot investigation was to develop a method to test the influence of specific prosthetic features in preventing trans-tibial amputees from walking like able-bodied subjects. An able-bodied subject was fitted with a patellar-tendon-bearing orthosis incorporating several features of an amputee's prosthesis. Kinetic, kinematic and metabolic data were collected as features were systematically removed from the orthosis. While wearing the orthosis the gait of the able-bodied subject closely simulated trans-tibial amputee gait kinematically, kinetically and metabolically. Although it was obvious that the various prosthetic features influenced the kinetics and kinematics of gait, they were difficult to quantify with only a single subject. However, the two features which appeared to have the largest influence in preventing trans-tibial amputees from walking like able-bodied subjects were patellar tendon loading and a solid ankle.
Two Methods for Modeling Aberrant Kinematics in Upper Extremity Nerve Compression Syndromes
Upper extremity nerve compression (UENC) syndromes share the hallmark features of pain and reduce... more Upper extremity nerve compression (UENC) syndromes share the hallmark features of pain and reduced function (1-2). Carpal tunnel syndrome (CTS) alone accounts for more days of lost work in the U.S. than any other condition (3-4). Work-related upper extremity disorders (WRUED) as a whole account for 1/3 of workers compensation costs in US private industry (5). Pathological kinematics, including cervicothoracic and scapular alterations, contribute to the development of WRUEDs, including subacromial conflict, glenohumeral instability and neurovascular impingement (6-10). These same postures have been associated with a number of nerve compression entities, including thoracic outlet syndrome (11-13) and CTS (14-15). The relationship between kinematics and neuropathy has been studied more extensively in the lower extremity. Aberrant posture and compensatory proximal muscle activity in lower extremity neuropathy patients have been attributed to decreased afferent input to the spinal cord (...
American journal of orthopedics (Belle Mead, N.J.)
Malunion after tibia fracture can have a negative effect on a patient's gait, joint kinematic... more Malunion after tibia fracture can have a negative effect on a patient's gait, joint kinematics, and functional outcome. We conducted a study to determine whether surgical correction of malunited tibias improves gait, joint kinematics, and patients' perception of their health and overall well-being. Eleven patients with tibial malunions were treated with osteotomy, deformity correction, and open reduction and internal fixation (ORIF). Minimum follow-up was 7 months (mean, 11 months; range, 7-17 months). In all cases, the osteotomy eventually healed. Two patients needed revision surgery: One had late collapse of the regenerate bone and underwent revision ORIF away from the site of deformity correction; the other required exchange intramedullary nailing. Surgical correction of malunited tibia fractures resulted in significant improvement toward the normative in lower extremity joint kinematic values and patients' perceptions of their health and overall well-being. Surprisin...
Objective: Stroke is one of the leading causes of serious long-term disability. However, home exe... more Objective: Stroke is one of the leading causes of serious long-term disability. However, home exercise programs given at rehabilitation often lack in motivational aspects. The purposes of this pilot study were (1) create individualized virtual reality (VR) games and (2) determine the effectiveness of VR games for improving movement in upper extremities in a 6-week home therapy intervention for persons with stroke. Subjects and Methods: Participants were two individuals with upper extremity hemiparesis following a stroke. VR games were created using the Looking Glass programming language and modified based on personal interests, goals, and abilities. Participants were asked to play 1 hour each day for 6 weeks. Assessments measured upper extremity movement (range of motion and Action Research Arm Test [ARAT]) and performance in functional skills (Canadian Occupational Performance Measure [COPM] and Motor Activity Log [MAL]). Results: Three VR games were created by a supervised occupational therapist student. The participants played approximately four to six times a week and performed over 100 repetitions of movements each day. Participants showed improvement in upper extremity movement and participation in functional tasks based on results from the COPM, ARAT, and MAL. Conclusions: Further development in the programming environment is needed to be plausible in a rehabilitation setting. Suggestions include graded-level support and continuation of creating a natural programming language, which will increase the ability to use the program in a rehabilitation setting. However, the VR games were shown to be effective as a home therapy intervention for persons with stroke. VR has the potential to advance therapy services by creating a more motivating home-based therapy service.
Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse,... more Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse, providing inconsistent results. The current gold standard (bone pins) is prohibitively invasive. The purposes of the current study are to describe a virtual projection alternative to surface markers for video motion capture (VMC) of the scapula and to compare the results of the projection and surface marker methods to the results of similar existing methods. Ten participants were evaluated using VMC. Surface markers were applied to the trunk and arm in accordance with existing guidelines. Three markers were affixed to plastic base on the skin over the acromion process. Other scapular landmarks were digitized in a neutral position. These landmarks' locations were defined in reference to the acromion cluster and used to generate the projection. Humerothoracic, glenohumeral, and scapulothoracic kinematics were evaluated during shoulder abduction, flexion, and scaption. Joint angles pro...
IEEE ... International Conference on Rehabilitation Robotics : [proceedings], 2011
The purpose of the study described here was to develop and feasibility test the Rutgers Ankle CP,... more The purpose of the study described here was to develop and feasibility test the Rutgers Ankle CP, aimed at ankle strengthening and improved control for children with cerebral palsy (CP). The system was an upgrade in hardware (new foot attachment, new robot controller) and software (new games and programming language) of the earlier Rutgers Ankle in order to permit training of children with CP. The new Rutgers Ankle CP was used to train ankle strength and motor control in a 7 year old boy with CP during 36 rehabilitation sessions (12 weeks, 3 times/week). Assessments for impairment, function and quality of life were taken before and after training. Results indicated improvements in both strength and motor control. Gait function improved substantially in ankle kinematics, speed and endurance. Overall function (GMFM) indicated improvements that were typical of other ankle strength training programs. Quality of life increased beyond what would be considered a minimal clinical important ...
This investigation determined relationships between coronal vertical alignment (CVA) and sagittal... more This investigation determined relationships between coronal vertical alignment (CVA) and sagittal vertical alignment (SVA) variables calculated from radiographs and surface markers representing bony landmarks. Biplanar radiographs were taken on 28 subjects (standing) after 2 metallic surface markers were placed on the skin superficial to C7 and S2. The CVA-R and SVA-R were measured on the radiographs. Similar variables were calculated from the surface markers (CVA-P-R, SVA-P-R). Correlation between CVA-R and CVA-P-R was 0.894 (p<0.000), and between SVA-R and SVA-P-R was 0.946 (p<0.000). Results lead to three recommendations: (1) obtain surface marker data when radiographs are taken to establish relationships between the two sets of data, (2) take care in providing instructions to the subjects if measures are to be taken at different times, and (3) observe caution in interpreting results when simultaneous x-ray and surface marker data were not recorded.
Comparison of three heel cord surgeries in children with cerebral palsy
Journal of applied biomechanics, 2005
This nonrandomized prospective descriptive study compared outcomes of three isolated heel cord su... more This nonrandomized prospective descriptive study compared outcomes of three isolated heel cord surgeries in children with spastic diplegia cerebral palsy (CP): (1) heel cord advancement (HCA), (2) heel cord lengthening according to Vulpius (HCL-V), and (3) heel cord lengthening according to White (HCL-W). Thirty-two children were tested prior to and approximately 1 year after undergoing one of the three surgeries. Objective measures were collected for ankle passive and active range of motion, gross motor function measure (GMFM), and gait. All surgeries indicated significant improvements in end range passive and active ankle dorsiflexion, GMFM, and dorsiflexion during gait. Gait speed was significantly improved for the HCA group, but appeared to be the result of maturity. Gait speed for the HCL-V and HCL-W groups was unchanged. The study was the first to directly compare three heel-cord-lengthening surgeries.
Stroke affects approximately 800,000 individuals each year, with 65% having residual impairments.... more Stroke affects approximately 800,000 individuals each year, with 65% having residual impairments. Studies have demonstrated that mass practice leads to regaining motor function in affected extremities; however, traditional therapy does not include the repetitions needed for this recovery. Videogames have been shown to be good motivators to complete repetitions. Advances in technology and low-cost hardware bring new opportunities to use computer games during stroke therapy. This study examined the use of the Microsoft (Redmond, WA) Kinectâ„¢ and Flexible Action and Articulated Skeleton Toolkit (FAAST) software as a therapy tool to play existing free computer games on the Internet. Three participants attended a 1-hour session where they played two games with upper extremity movements as game controls. Video was taken for analysis of movement repetitions, and questions were answered about participant history and their perceptions of the games. Participants remained engaged through both g...
Stroke survivor gait adaptation and performance after training on a Powered Ankle Foot Orthosis
2010 IEEE International Conference on Robotics and Automation, 2010
Abstract—With over 600 thousand people each year sur-viving a stroke, it has become the leading c... more Abstract—With over 600 thousand people each year sur-viving a stroke, it has become the leading cause of serious long-term disability in the United States [1], [2]. The ad-verse financial and social conditions attributed to stroke have prompted researchers and entrepreneurs to explore ...
Can the use of a terminal device augment plantar pressure reduction with a total contact cast?
Foot & Ankle International
HYPOTHESES/PURPOSE: Total contact casting (TCC) has been shown to promote the healing of plantar ... more HYPOTHESES/PURPOSE: Total contact casting (TCC) has been shown to promote the healing of plantar neurotrophic ulcers by reducing plantar pressures and has become the established treatment standard by which all others are measured. The purpose of this study was to determine if terminal cast devices (cast shoes and heels) significantly affect the amount of plantar pressure reduction when used with a total contact cast. Plantar pressures were measured in the right feet of 28 healthy adult volunteers using the Novel EMED PEDAR system (Novel GmbH, Munich, Germany) for six conditions: athletic shoe (i.e., control), TCC alone, TCC with a conventional cast shoe (EBI, Parsipanny, NJ), TCC with a custom rigid rocker cast shoe (NPS, St. Louis, MO), TCC with a rubber rocker heel (Cast Walker, DM Systems Inc., Evanston, IL), and TCC with a traditional flat rubber heel (Zimmer, Warsaw, IN). Peak plantar pressures were recorded from the forefoot, midfoot, and hindfoot. Analysis of variance (ANOVA) was used to determine statistical significance. The greatest reductions in forefoot plantar pressures compared to the athletic shoe control were seen in the TCC with the conventional cast shoe and the TCC with the rigid rocker shoe; a mean plantar pressure reduction of 30% was observed for both conditions (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Significant midfoot plantar pressure reductions (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) were achieved with the TCC alone, TCC with the conventional cast shoe, TCC with the rigid rocker heel, TCC with the flat rubber heel, and TCC with the rubber rocker heel. Mean reductions were 42%, 51%, 47%, 40%, and 46%, respectively. While athletic shoe peak hindfoot pressures were only reduced by 15% by TCC alone, the addition of the rubber rocker heel to TCC reduced athletic shoe pressures by 32% and the addition of the flat rubber heel to TCC reduced athletic shoe pressures by 29%. The reductions with TCC and the heels were both significant when using the athletic shoe as the control (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and the TCC alone as the control (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Plantar pressure reduction with TCC can be augmented with the addition of a terminal cast device and the effects shown in this study are significantly different than previously reported. These results suggest that terminal cast devices should be chosen according to location of the neuropathic ulcer. In this study, forefoot pressures were reduced the most with TCC and either the conventional cast shoe or the rigid rocker shoe. The authors therefore recommend these combinations for forefoot ulcers. TCC alone or combined with any of the terminal devices proved equally effective for midfoot plantar pressure reduction. Hindfoot ulcers should be treated with TCC and the rubber rocker heel or the flat rubber heel as these provided the best hindfoot pressure reductions.
The purpose of this investigation was to compare weight distributions of a relatively large numbe... more The purpose of this investigation was to compare weight distributions of a relatively large number of below-knee (BK) amputee and able-bodied children during two different standing positions. Twenty-one BK amputees and 200 able-bodied children volunteered as subjects for this investigation. Each child stood on a pressure plate and three sets of trial data were collected. One set of trial data was collected with both feet together on the pressure plate and two were collected with feet placed 20cm apart. The total force applied by each foot to the pressure plate was normalised by dividing by subject weight to yield foot force to body weight ratios. Data were separated into forefoot and rearfoot areas, force for the forefoot area was then calculated and normalised by dividing by total foot force to yield forefoot to whole-foot force ratios. Ratios for the two foot placement conditions and for non-prosthetic, prosthetic, dominant, and nondominant feet were compared using paired ttests (p<0.05). Results indicated that: 1) BK amputee children placed more weight on their non-prosthetic limb than their prosthetic limb, yet this was not different from able-bodied children in respect of weight distribution between dominant and non-dominant limbs; 2) approximately 90% of the load on the prosthetic foot was placed on the forefoot; and 3) the load on the non-prosthetic foot was evenly distributed between the forefoot and rearfoot like that of able-bodied children. It was concluded that except for substantially more weight on the forefoot of the prosthetic leg BK amputee children stood in the same way as able-bodied children.
Center of mass location and segment angular orientation of below-knee-amputee and able-bodied children during walking
Archives of Physical Medicine and Rehabilitation
This investigation compared the center of mass (COM) locations and segment angular orientations o... more This investigation compared the center of mass (COM) locations and segment angular orientations of the gait of below-knee-amputee (BKA) children to those of able-bodied (AB) children. Eleven AB children (mean age, 8.4 years) and three BKA children (mean age, 7.5 years) volunteered to participate as subjects. Film data (100 frames per second) of a typical walking stride, were collected for the children during four experimental sessions held at six-month intervals. Two 16mm cameras were used to obtain frontal and lateral views of the subjects. The same approximate rate of walking (1.2m/s +/- 10%) was enforced for all testing sessions and at least three trials of data were collected for each subject during each session. Segmental endpoints of each subject from the film of each camera were digitized and the direct linear transformation (DLT) method was used to obtain three-dimensional segmental location-time data for a complete stride. These data were then used to determine whole body COM locations and angular orientations for the segments. Discrete values describing normalized locations at touchdown, midsupport, and takeoff were determined for whole body COM and the angular orientation of the trunk, thighs, and legs. In the sagittal plane the COM was lower and more anterior for the BKA children when compared to that of the AB children. This was primarily due to the greater forward flexion of the trunk.(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of this investigation was to develop normative ground reaction force data for able-bo... more The purpose of this investigation was to develop normative ground reaction force data for able-bodied (AB) and trans-tibial amputee (TTA) children during running. Two hundred AB (mean age 9.4 years, range 7-12) and 21 TTA (mean age 11.1 years, range 5-17) children ran (2.2 m/s±10%) over a force platform. Ground reaction force data were normalized, averaged within groups and plotted to produce force-time curves characterizing the different leg types (i.e. able-bodied, nonprosthetic and prosthetic). In addition, discrete variables characterizing the leg type differences were determined.
The purpose of this investigation was to compare intersegmental knee and hip forces for below-kne... more The purpose of this investigation was to compare intersegmental knee and hip forces for below-knee amputee (BKA) and able-bodied children during standing. Three unilateral BKA children and 10 able-bodied children (7-9 years) were tested on four separate occasions at six month intervals. Three trials of external force and spatial data during standing were collected from each subject for each session. These data were utilised to determine the intersegmental forces at the knees and hips of the children using a static force analysis. Results indicated that in some instances the intersegmental forces for the BKA children were significantly greater than those of the able-bodied children and in other instances significantly lower (p<0.05). In all cases, however, the values were substantially less than corresponding values for walking and running. The effects of the forces upon spatial orientations indicated significant differences between the two groups of children. The frontal plane prosthetic knee angle, the sagittal plane prosthetic and non-prosthetic knee angles, and the sagittal plane trunk angle were all greater for the BKA children when compared to ablebodied children. These differences may be the result of the anatomical structure of the amputee and/or the construction of the prosthesis.
In the United States alone, more than five million people are living with long term motor impairm... more In the United States alone, more than five million people are living with long term motor impairments caused by a stroke. Video game-based therapies show promise in helping people recover lost range of motion and motor control. While researchers have demonstrated the potential utility of game-based rehabilitation through controlled studies, relatively little work has explored longer-term home-based use of therapeutic games. We conducted a six-week home study with a 62 year old woman who was seventeen years post-stroke. She played therapeutic games for approximately one hour a day, five days a week. Over the six weeks, she recovered significant motor abilities, which is unexpected given the time since her stroke. Through observations and interviews, we present lessons learned about the barriers and opportunities that arise from long-term home-based use of therapeutic games.
The purpose of this pilot investigation was to develop a method to test the influence of specific... more The purpose of this pilot investigation was to develop a method to test the influence of specific prosthetic features in preventing trans-tibial amputees from walking like able-bodied subjects. An able-bodied subject was fitted with a patellar-tendon-bearing orthosis incorporating several features of an amputee's prosthesis. Kinetic, kinematic and metabolic data were collected as features were systematically removed from the orthosis. While wearing the orthosis the gait of the able-bodied subject closely simulated trans-tibial amputee gait kinematically, kinetically and metabolically. Although it was obvious that the various prosthetic features influenced the kinetics and kinematics of gait, they were difficult to quantify with only a single subject. However, the two features which appeared to have the largest influence in preventing trans-tibial amputees from walking like able-bodied subjects were patellar tendon loading and a solid ankle.
Two Methods for Modeling Aberrant Kinematics in Upper Extremity Nerve Compression Syndromes
Upper extremity nerve compression (UENC) syndromes share the hallmark features of pain and reduce... more Upper extremity nerve compression (UENC) syndromes share the hallmark features of pain and reduced function (1-2). Carpal tunnel syndrome (CTS) alone accounts for more days of lost work in the U.S. than any other condition (3-4). Work-related upper extremity disorders (WRUED) as a whole account for 1/3 of workers compensation costs in US private industry (5). Pathological kinematics, including cervicothoracic and scapular alterations, contribute to the development of WRUEDs, including subacromial conflict, glenohumeral instability and neurovascular impingement (6-10). These same postures have been associated with a number of nerve compression entities, including thoracic outlet syndrome (11-13) and CTS (14-15). The relationship between kinematics and neuropathy has been studied more extensively in the lower extremity. Aberrant posture and compensatory proximal muscle activity in lower extremity neuropathy patients have been attributed to decreased afferent input to the spinal cord (...
American journal of orthopedics (Belle Mead, N.J.)
Malunion after tibia fracture can have a negative effect on a patient's gait, joint kinematic... more Malunion after tibia fracture can have a negative effect on a patient's gait, joint kinematics, and functional outcome. We conducted a study to determine whether surgical correction of malunited tibias improves gait, joint kinematics, and patients' perception of their health and overall well-being. Eleven patients with tibial malunions were treated with osteotomy, deformity correction, and open reduction and internal fixation (ORIF). Minimum follow-up was 7 months (mean, 11 months; range, 7-17 months). In all cases, the osteotomy eventually healed. Two patients needed revision surgery: One had late collapse of the regenerate bone and underwent revision ORIF away from the site of deformity correction; the other required exchange intramedullary nailing. Surgical correction of malunited tibia fractures resulted in significant improvement toward the normative in lower extremity joint kinematic values and patients' perceptions of their health and overall well-being. Surprisin...
Objective: Stroke is one of the leading causes of serious long-term disability. However, home exe... more Objective: Stroke is one of the leading causes of serious long-term disability. However, home exercise programs given at rehabilitation often lack in motivational aspects. The purposes of this pilot study were (1) create individualized virtual reality (VR) games and (2) determine the effectiveness of VR games for improving movement in upper extremities in a 6-week home therapy intervention for persons with stroke. Subjects and Methods: Participants were two individuals with upper extremity hemiparesis following a stroke. VR games were created using the Looking Glass programming language and modified based on personal interests, goals, and abilities. Participants were asked to play 1 hour each day for 6 weeks. Assessments measured upper extremity movement (range of motion and Action Research Arm Test [ARAT]) and performance in functional skills (Canadian Occupational Performance Measure [COPM] and Motor Activity Log [MAL]). Results: Three VR games were created by a supervised occupational therapist student. The participants played approximately four to six times a week and performed over 100 repetitions of movements each day. Participants showed improvement in upper extremity movement and participation in functional tasks based on results from the COPM, ARAT, and MAL. Conclusions: Further development in the programming environment is needed to be plausible in a rehabilitation setting. Suggestions include graded-level support and continuation of creating a natural programming language, which will increase the ability to use the program in a rehabilitation setting. However, the VR games were shown to be effective as a home therapy intervention for persons with stroke. VR has the potential to advance therapy services by creating a more motivating home-based therapy service.
Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse,... more Scapula mobility complicates upper extremity kinematics assessment. Existing methods are diverse, providing inconsistent results. The current gold standard (bone pins) is prohibitively invasive. The purposes of the current study are to describe a virtual projection alternative to surface markers for video motion capture (VMC) of the scapula and to compare the results of the projection and surface marker methods to the results of similar existing methods. Ten participants were evaluated using VMC. Surface markers were applied to the trunk and arm in accordance with existing guidelines. Three markers were affixed to plastic base on the skin over the acromion process. Other scapular landmarks were digitized in a neutral position. These landmarks' locations were defined in reference to the acromion cluster and used to generate the projection. Humerothoracic, glenohumeral, and scapulothoracic kinematics were evaluated during shoulder abduction, flexion, and scaption. Joint angles pro...
IEEE ... International Conference on Rehabilitation Robotics : [proceedings], 2011
The purpose of the study described here was to develop and feasibility test the Rutgers Ankle CP,... more The purpose of the study described here was to develop and feasibility test the Rutgers Ankle CP, aimed at ankle strengthening and improved control for children with cerebral palsy (CP). The system was an upgrade in hardware (new foot attachment, new robot controller) and software (new games and programming language) of the earlier Rutgers Ankle in order to permit training of children with CP. The new Rutgers Ankle CP was used to train ankle strength and motor control in a 7 year old boy with CP during 36 rehabilitation sessions (12 weeks, 3 times/week). Assessments for impairment, function and quality of life were taken before and after training. Results indicated improvements in both strength and motor control. Gait function improved substantially in ankle kinematics, speed and endurance. Overall function (GMFM) indicated improvements that were typical of other ankle strength training programs. Quality of life increased beyond what would be considered a minimal clinical important ...
This investigation determined relationships between coronal vertical alignment (CVA) and sagittal... more This investigation determined relationships between coronal vertical alignment (CVA) and sagittal vertical alignment (SVA) variables calculated from radiographs and surface markers representing bony landmarks. Biplanar radiographs were taken on 28 subjects (standing) after 2 metallic surface markers were placed on the skin superficial to C7 and S2. The CVA-R and SVA-R were measured on the radiographs. Similar variables were calculated from the surface markers (CVA-P-R, SVA-P-R). Correlation between CVA-R and CVA-P-R was 0.894 (p<0.000), and between SVA-R and SVA-P-R was 0.946 (p<0.000). Results lead to three recommendations: (1) obtain surface marker data when radiographs are taken to establish relationships between the two sets of data, (2) take care in providing instructions to the subjects if measures are to be taken at different times, and (3) observe caution in interpreting results when simultaneous x-ray and surface marker data were not recorded.
Comparison of three heel cord surgeries in children with cerebral palsy
Journal of applied biomechanics, 2005
This nonrandomized prospective descriptive study compared outcomes of three isolated heel cord su... more This nonrandomized prospective descriptive study compared outcomes of three isolated heel cord surgeries in children with spastic diplegia cerebral palsy (CP): (1) heel cord advancement (HCA), (2) heel cord lengthening according to Vulpius (HCL-V), and (3) heel cord lengthening according to White (HCL-W). Thirty-two children were tested prior to and approximately 1 year after undergoing one of the three surgeries. Objective measures were collected for ankle passive and active range of motion, gross motor function measure (GMFM), and gait. All surgeries indicated significant improvements in end range passive and active ankle dorsiflexion, GMFM, and dorsiflexion during gait. Gait speed was significantly improved for the HCA group, but appeared to be the result of maturity. Gait speed for the HCL-V and HCL-W groups was unchanged. The study was the first to directly compare three heel-cord-lengthening surgeries.
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Papers by Jack Engsberg