Lower Limb Movement Research Articles

The effects of core muscle fatigue on lower limbs and trunk during single-leg drop landing: A comparison between recreational runners with and without dynamic knee valgus

BackgroundA deficit in neuromuscular trunk control can impact the lower limb motion, predisposing runners to injuries. This deficit may show a greater impact on runners with dynamic knee valgus. This study aimed to compare the effect of core fatigue on kinetic, kinematic, and electromyographic parameters of the trunk and lower limbs during single-leg drop landing between runners with and without dynamic knee valgus. MethodsTwenty-seven recreational runners were allocated to the valgus (n = 14) and non-valgus groups (n = 13). They performed the test before and after a fatigue protocol, taking a step forward and landing on the force platform while maintaining balance. The fatigue protocol included isometric and dynamic exercises performed consecutively until voluntary exhaustion. The vertical ground reaction force, the sagittal and frontal plane angles, and the electromyographic activity were evaluated. The integral of electromyographic activity was calculated into three movement phases. ANOVA with repeated measures was used to verify the group, time, and interaction effects. ResultsAfter fatigue, both groups showed a significant reduction in the minimum (p = 0.01) and maximum (p = 0.02) knee angles in the frontal plane (more dynamic knee valgus) and greater gluteus medius activity (p = 0.05) from the peak of knee flexion to the end of the movement. The valgus group had a greater hip excursion (p = 0.01) and vertical linear shoulder displacement (p = 0.02) than the non-valgus. ConclusionOur results suggest that core fatigue can impact the local muscle and the distal joint and that the groups presented different strategies to deal with the demand during landing.

Effects of Progressive and Velocity-Based Autoregulatory Resistance Training on Lower-Limb Movement Ability in Taekwondo Athletes.

Both autoregulatory progressive resistance exercise (APRE) and velocity-based resistance training (VBRT) utilize real-time monitoring of athlete physical performance to adjust training loads to provide appropriate training stimuli. However, the monitoring and adjustment approaches differ between both methods. This study aimed to compare the effects of APRE and VBRT on the muscle strength, power, and agility of college taekwondo athletes. Eight weeks of APRE and VBRT will promote similar results to strength gains in regards maximal strength, but VBRT will be superior to APRE in explosive power and agility. Clinical trial. Level 3. Thirty taekwondo athletes were divided randomly into 2 groups (VBRT/APRE), and all participants completed an 8-week APRE/VBRT intervention. Maximum strength, explosive power, and agility performance were assessed during the squat 1-repetition maximum (1RM), countermovement jump (CMJ), drop jump (DJ), kicking strength test (KST), taekwondo-specific agility test (TSAT), and hexagon test (HT). Highly significant time effects (P < 0.01) were observed for squat 1RM, CMJ, and TSAT in both the APRE and VBRT groups. However, there were no significant group-by-time differences for any of the measured outcomes to intergroup (P > 0.05), but APRE had a small effect size (ES) over VBRT for CMJ (ES = 0.48, = 0.06), TSAT (ES = 0.26, = 0.02), and HT (ES = 0.42, = 0.05). An 8-week autoregulatory APRE and VBRT can both effectively improve both the maximal strength, explosive power, and agility performance of taekwondo athletes, with APRE exhibiting potential advantages in improving CMJ, TSAT, and HT. These results provide important insights into the selection of suitable resistance training programs by professional coaches, taking into account athlete needs, training efficiency, and safety considerations.

The influence of balance support base manipulation on the kinematics of lower limbs during single-legged squats in people with patellofemoral pain

BackgroundGiven that people with patellofemoral pain (PFP) exhibit deficits in postural control, certain postural reactions may be associated with movement alterations in this population. Therefore, the objective of the present study was to investigate whether manipulation of the support base for balance maintenance could lead to different patterns of lower limb kinematics in people with PFP during single-legged squats. MethodsFourteen participants with PFP and 14 asymptomatic controls were first assessed performing single-legged squats freely, and then while holding a stick to provide stabilization during the task. Center of pressure (CoP) behavior and movements of the hip, knee, ankle in the sagittal, frontal, and transverse planes were evaluated. ResultsFor the participants with PFP, the use of support led to a reduction in the magnitude of CoP oscillation compared to free squatting, with effect sizes ranging from small to large, but no significant differences were found for the kinematic variables. No significant differences were observed for CoP or kinematic variables in the comparisons between squat conditions in asymptomatic controls. ConclusionIn summary, performing single-legged squats in a more stabilized condition did not influence lower limb movements in people with PFP.

Functional magnetic resonance imaging of the lumbosacral cord during a lower extremity motor task

Abstract Blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) can be used to map neuronal function in the cervical cord, yet conclusive evidence supporting its applicability in the lumbosacral cord is still lacking. This study aimed to (i) demonstrate the feasibility of BOLD fMRI for indirectly mapping neural activity in the lumbosacral cord during a unilateral lower extremity motor task and (ii) investigate the impact of echo time (TE) on the BOLD effect size. Twelve healthy volunteers underwent BOLD fMRI using four reduced field-of-view single-shot gradient-echo echo planar imaging sequences, all with the same geometry but different TE values ranging from 20 to 42 ms. Each sequence was employed to acquire a single 6-min rest run and two 10-min task runs, which included alternating 15-s blocks of rest and unilateral ankle dorsi- and plantar flexion. We detected lateralized task-related BOLD activity at neurological levels L3-S2, centered at the ipsilateral (right) ventral spinal cord but also extending into the ipsilateral dorsal spinal cord. This pattern of activation is consistent with our current understanding of spinal cord organization, wherein lower motor neurons are located in the ventral gray matter horn, while interneurons neurons of the proprioceptive pathway, activated during the movement, are located in the dorsal horns and the intermediate gray matter. At the subject level, BOLD activity showed considerable variability but was lateralized in all participants. The highest BOLD effect size within the ipsilateral ventral spinal cord, as well as the highest split-half reliability, was observed at a TE of 42 ms. Sequences with a shorter TE (20 and 28 ms) also detected activity in the medioventral part of the spinal cord, likely representing large vein effects. In summary, our results demonstrate the feasibility of detecting task-related BOLD activity in the lumbosacral cord induced by voluntary lower limb movements. BOLD fMRI in the lumbosacral cord has significant implications for assessing motor function and its alterations in disease or after spinal cord injury.

Effect of orthopedic insoles on lower limb motion kinematics and kinetics in adults with flat foot: a systematic review.

Flatfoot is characterized by the collapse of the medial longitudinal arch, eversion of the rearfoot and abduction of the loaded forefoot. Orthopedic insoles are the frequently recommended treatment to support the arch of the foot, adjust the structure of the foot, reduce pain, improve stability and new techniques have been applied to the design of orthopedic insoles in recent years. However, the effectiveness of orthopedic insoles in different motions is still debated from the perspective of biomechanics. Therefore, this study aimed to explore the impact of orthopedic insoles on the kinematics and kinetics of lower limb motion, and to verify effectiveness and propose possible future research directions. We conducted a literature search across three databases employing Boolean operations and filtered results based on eligibility criteria. A total of 671 relevant literature were searched in this review, and 19 literature meeting the requirements were finally included. The results showed that: 1) orthopedic insoles were effective when patients walk, run and jump from the perspective of biomechanics; 2) orthopedic insoles had different result on the change of ankle sagittal angle, moment and peak pressure in the metatarsal region; 3) Whether the effect of insoles, which uses new techniques such as different 3D printed technologies and adds various accessories, can be further improved remains to be further studied; 4) Follow-up studies can pay more attention to the differences between diverse populations, increase the breadth of running and jumping and other movements research and long-term intervention.

Numerical simulation of response behavior and damage regularity of human lower limbs under axial impact load

Abstract Axial impacts to the lower extremities of personnel in events such as explosions and falls on the underside of vehicles, which are extremely hazardous to personnel, may result in serious injuries. Most of the current studies on human lower limb injuries from axial loading have not considered the restraining effect of the knee joint. In this paper, based on the THUMS human finite element model, the failure parameters of the tibia, calcaneus, and talus of the lower limb are added and verified. On this basis, the response behavior of the lower limbs of personnel under different axial loads is investigated, and the damage law is further analyzed and studied. It is found that the motion of human lower limbs under axial impact is divided into two phases: the axial motion phase and the rotation phase around the knee joint, and the lower limbs are mainly subjected to compression and bending loads, respectively. The duration of the axial motion phase is related to the impact velocity and the rate of change of velocity and affects the magnitude of tibial force.

The Effectiveness of Strengthening Exercise on Improving Physical Function in Chronic Dialysis with Comorbidity: A Case Study

BACKGROUND: Individuals living with End stage renal disease (ESRD) on long term hemodialysis (HD) generally has a sedentary life style. This leads to reduction of physical function and poor quality of life. Exercise intervention improves muscular strength, physical fitness and Quality of life (QOL) in maintained hemodialysis Individuals. CASE SCENARIO: A 67-year-old female presented with chronic hemodialysis period was carried on wheelchair with the help of relative as she was referred to physiotherapy department with chief complain of weakness in both lower limb and difficulty in walking for 1 year. In this case along with chronic dialysis related dysfunction, patient had atherosclerosis had an acute coronary event and she was on AKT since last one year as she was having pott’s spine. METHODOLOGY: In our evaluation, she had full range of motion of lower limb with muscle weakness by manual muscle testing (MMT=3-4/5), Reduced balance and physical performance by short physical performance battery (SPPB=4/12), and partially dependent for functional activity by functional independent measure (FIM= 81/126). In Physiotherapy intervention: Exercise program started with active exercise, cycling, balance and gait training. Progressively in active exercise increased weight with weight cuff, increase cycling time and task specific balance activities with independent walking each week. RESULT: After four week of intervention improvement in muscle strength (MMT=4-5/5), balance (SPPB=7/12), minimal assistance in functional activities (FIM=109/126). CONCLUSION: Individualized strengthening exercise program improve physical function and muscle strength in chronic dialysis patient. Keywords: Hemodialysis, physical function, muscle strength.

Features of the development of coordination abilities in young schoolchildren

Background and Study Aim. The development of coordination abilities in young schoolchildren is crucial for their physical and psychological health, as well as academic success. In the contemporary educational environment, there is insufficient attention to the systematic and targeted development of these abilities through the integration of physical activity into the learning process. The purpose of this study is to develop and test a comprehensive program aimed at developing the coordination abilities of young schoolchildren through the use of rhythmic and choreographic means. Materials and Methods. The study involved fourth-grade students (n=40), including 20 girls and 20 boys. All participants were divided into two groups: a control group (CG, n=20) and an experimental group (EG, n=20). Both groups attended two choreography lessons and one physical education lesson weekly. The study lasted 10 weeks. The experiment was conducted in the city of Zmiiev (Kharkiv region, Ukraine), located in a war zone since February 2022. The requirements of the military administration for ensuring the safety of the experiment participants were observed. Results. Data analysis revealed significant statistical differences between the control and experimental groups across all applied tests (p&lt;0.05). In the experimental group of girls, there was a significant improvement in the "Rhythmic Movements of Upper and Lower Limbs" test (p&lt;0.01). These results were consistent with improvements in other coordination ability tests in the experimental group (p&lt;0.05). Improvements in strength ability indicators were observed in both groups. However, no statistically significant differences between the CG and EG were recorded. Conclusions. The study confirmed that a specially designed program with elements of dance and choreography significantly positively affects the development of coordination abilities in young schoolchildren. Such a program contributes to the physical development of children, improves their emotional state, stimulates activity, and develops a sense of responsibility.

Residual deficits of knee and hip joint coordination and clinical performance after return to sports in athletes with anterior cruciate ligament reconstruction

BackgroundBiomechanical changes and neuromuscular adaptations have been suggested as risk factors of secondary injury in individuals after anterior cruciate ligament reconstruction (ACLr). To achieve a better understanding of preventive mechanisms, movement quality is an important factor of consideration. Few studies have explored time-series analysis during landing alongside clinical performance in injured and non-injured individuals. The purpose of the study was to investigate the biomechanical risks of recurrent injury by comparing clinical and jump-landing performance assessments between athletes with ACLr and healthy controls.MethodThis study was observational study. Sixteen athletes with and without ACLr voluntarily participated in clinical and laboratory measurements. Single-leg hop distance, isokinetic tests, landing error score, and limb symmetry index (LSI) were included in clinical report. Lower limb movements were recorded to measure joint biomechanics during multi-directional landings in motion analysis laboratory. Hip-knee angle and angular velocity were explored using discrete time-point analysis, and a two-way mixed analysis of variance (2 × 4, group × jump-landing direction) was used for statistical analysis. Time series and hip-knee coordination analyses were performed using statistical parametric mapping and descriptive techniques.ResultsSignificantly lower single-leg hop distance was noted in ACLr group (158.10 cm) compared to control group (178.38 cm). Although the hip and knee moments showed significant differences between four directions (p < 0.01), no group effect was observed (p > 0.05). Statistical parametric mapping showed significant differences (p ≤ 0.05) between groups for hip abduction and coordinate plot of hip and knee joints. Athletes with ACLr demonstrated a higher velocity of hip adduction. Time-series analysis revealed differences in coordination between groups for frontal hip and knee motion.ConclusionsAthletes with ACLr landed with poor hip adduction control and stiffer knee on the involved side. Multi-directions landing should be considered over the entire time series, which may facilitate improved movement quality and return to sports in athletes with ACLr.

Exploration of deep learning-driven multimodal information fusion frameworks and their application in lower limb motion recognition

Research on Lower Limb Motion Recognition (LLMR) based on various wearable sensors has been widely applied in exoskeleton robots, exercise rehabilitation, etc. Typically, employing multimodal information tends to yield higher accuracy and stronger robustness compared to using unimodal information. Due to the inevitable reliance on feature engineering in shallow machine learning-based LLMR methods, this study leverages the powerful non-linear feature mapping capability of deep learning (DL) to construct several end-to-end LLMR frameworks, including: Convolutional Neural Networks (CNNs), CNN-Recurrent Neural Networks (RNNs) and CNN-Graph Neural Networks (GNNs). The effectiveness of the proposed frameworks is verified in distinct tasks, including the recognition of seven types of lower limb motions in healthy subjects and three types of motions in patients with stroke, as well as the phase recognition task during the sit-to-stand (SitTS) process in patients with stroke, achieving the highest mean accuracy of 95.198 %, 99.784 %, and 99.845 %, respectively. Further research and integration of two transfer learning techniques, adaptive Batch Normalization (BN) and model fine-tuning, significantly enhance the applicability of the proposed frameworks in inter-subject prediction. Additionally, systematic analyses are conducted to assess the strengths and weaknesses of different models in terms of recognition performance, complexity, and adaptability to variations in the number of modalities and sensor channels. Experimental results indicate that the proposed frameworks hold promise in providing potential support for the development of human-robot collaborative lower limb exoskeletons or rehabilitation robots.

An Experiment Using Functional Near-Infrared Spectroscopy and Robot-Assisted Multi-Joint Pointing Movements of the Lower Limb.

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.

Intentionally Lengthening Nonparetic Step Length Inhibits the Paretic-Side Swing-Phase Ankle Motion More than Knee Motion

Gait training to intentionally lengthen the nonparetic step length can increase the propulsive force of the paretic leg but may also induce overactivity of the knee extensor muscles that might limit knee flexion during the swing phase. Herein, we investigated the effects of lengthening the nonparetic step length during gait on the joint motion and muscle activity of the paretic lower limb. Fifteen chronic stroke patients (stroke group) and 15 healthy participants (control group) were evaluated for lower limb joint movements, electromyography, and spatiotemporal gait parameters during walking. Walking conditions were Normal (comfortable walking) and NP-Long/Contralateral-Long (walking with a lengthened step length of the nonmeasured limb). The trailing limb angle, a surrogate for propulsive forces, was increased in both groups by changing the step length, with no significant change in the peak knee flexion angle during the swing phase. However, the stroke group did not increase ankle plantar flexor activity in the stance phase or ankle dorsiflexion angle in the swing phase. Intentionally lengthening the nonparetic step length did not limit knee flexion. However, the effect of increased propulsive force during the stance phase was insufficient, with the possibility of decreased foot clearance.

The relationship of peak ankle dorsiflexion angle with lower extremity biomechanics during walking.

Abnormal lower limb movement patterns have been observed during walking in individuals with limited ankle dorsiflexion. The purpose of this study was to investigate the relationships of peak ankle dorsiflexion angle during the stance phase of walking with the lower extremity biomechanics at the corresponding moment and to determine a cutoff value of functional limited ankle dorsiflexion during walking. Kinematic and kinetic data of 70 healthy participants were measured during walking. Spearman's correlation coefficients were calculated to establish the association between peak ankle dorsiflexion and angle and moment of ankle, knee, and hip, ground reaction force, and pelvic movement at peak ankle dorsiflexion. All variables significantly related to peak ankle dorsiflexion were extracted as a common factor by factor analysis. Maximally selected Wilcoxon statistic was used to perform a cutoff value analysis. Peak ankle dorsiflexion positively correlated with ankle plantar flexion moment (r=0.432; p=0.001), ankle external rotation moment (r=0.251; p=0.036), hip extension angle (r=0.281; p=0.018), hip flexion moment (r=0.341; p=0.004), pelvic ipsilateral rotation angle (r=0.284; p=0.017), and medial, anterior, and vertical ground reaction force (r=0.324; p=0.006, r=0.543; p=0.001, r=0.322; p=0.007), negatively correlated with knee external rotation angle (r=-0.394; p=0.001) and hip adduction angle (r=-0.256; p=0.032). The cutoff baseline value for all 70 participants was 9.03°. There is a correlation between the peak ankle dorsiflexion angle and the lower extremity biomechanics during walking. If the peak ankle dorsiflexion angle is less than 9.03°, the lower limb movement pattern will change significantly.

Prediction and Mechanisms of Spontaneous Resorption in Lumbar Disc Herniation: Narrative Review.

The major symptoms of lumbar disc herniation (LDH) are low back pain, radiative lower extremity pain, and lower limb movement disorder. Patients with LDH suffer from great distress in their daily life accompanied by severe economic hardship and difficulty in self-care, with an increasing tendency in the aging population. PubMed and the Cochrane Central Register of Controlled Trials were searched for relevant studies of spontaneous resorption or regression in LDH after conservative treatment and for other potential studies, which included those from inception to June 30, 2023. The objective of this narrative review is to summarize previous literatures about spontaneous resorption in LDH and to discuss the mechanisms and influencing factors in order to assess the probability of spontaneous resorption by conservative treatment. Spontaneous resorption without surgical treatment is influenced by the types and sizes of the LDH, inflammatory responses, and therapeutic factors. If the lumbar disc herniated tissue comprises a higher percentage of cartilage or modic changes have been shown on magnetic resonance imaging (MRI), resorption in LDH is prevented. The bull's eye sign on enhanced MRI, which is a ring enhancement around a protruding disc, is a vital indicator for easy reabsorption. In addition, the type of extrusion and sequestration in LDH could forecast the higher feasibility of natural reabsorption. Moreover, the higher the proportion of protrusion on the intervertebral disc tissue within the spinal canal, the greater the likelihood of reabsorption. Therefore, which illustrates the feasibility of conservative treatments for LDH. Nonsurgical management of LDH with clinical symptoms is recommended by the authors.

#2072 Impact of the GoodRENal platform on lower-limbs muscle strength in a Spanish sample

Abstract Background and Aims People with chronic kidney disease on hemodialysis have low levels of physical activity and low lower-limbs muscle strength, partly due to the sedentary lifestyle, and a big number of hours sitting or in a recumbent position. The GoodRENal project aimed at creating an intradialysis health platform to improve health-related quality of life. The present study focused on the impact of the GoodRENal intradialysis platform on lower-limbs muscle strength. Method People in hemodialysis treatment from Spain were included. Participants were randomized into two groups, the GoodRENal or the usual care group. The participants used the GoodRENal platform for 12 weeks, 3 times a week. Games using non-immersive virtual reality were created aiming at educating on nutritional habits, increasing physical activity during the HD session, improving cognitive skills and increasing psychological well-being. All of them included dual tasks, so that the movement of the legs was used in every game. An Azure Kinect camera was used to capture the movement and all activities were dual, so that movement of lower limbs was promoted in every game. A handheld dynamometer was used to assess hip flexors and abductors muscle strength during the hemodialysis session. This procedure has proven to be reliable and save. An ANOVA mixed model (group and time factors) was used to analyze the results. Results 19 participants were included (Control n = 9; GoodRENal n = 10). Participants’ mean age was 73.4 years for the control and 68.3 years for the GoodRENal group, with a hemodialysis vintage, median 34 months (minimum 3- maximum 277) and 25 months (minimum 5- maximum 48) for the control and GoodRENal groups. Right hip flexor muscles changed in the control group over time: Baseline 124.7 (23.2) N; 4 weeks 121.3 (20.3) N; 12 weeks 119.0 (21.1) N. In the GoodRENal group, the data were: Baseline 116.7 (34.7) N; 4 weeks 124.7 (36.7) N; 12 weeks 142.7 (44.7) N. The ANOVA showed a significant time × group interaction (F = 11.347 p &amp;lt; 0.001) with a significant improvement in the GoodRENal group. Left hip abductor muscles changed in the control group over time: Baseline 124.5 (24.0) N; 4 weeks 123.0 (26.1) N; 12 weeks 122.0 (24.7) N. In the GoodRENal group, the data were: Baseline 111.1 (30.4) N; 4 weeks 119.2 (33.0) N; 12 weeks 138.5 (36.3) N. The ANOVA showed a significant time × group interaction (F = 15.218 p &amp;lt; 0.001) with a significant improvement in the GoodRENal group. Both left hip flexors (F = 19.055 p &amp;lt; 0.001) and abductors (F = 15.036 p &amp;lt; 0.001) showed a significant time per group interaction, with an improvement in the GoodRENal group. Conclusion The GoodRENal platform is a feasible strategy to increase the muscle strength of the hip flexors and abductors muscles. Future studies with bigger samples should confirm these results.

#747 The digital intradialytic health intervention GoodRENal: feasibility and participants’ opinion

Abstract Background and Aims People with chronic kidney disease on hemodialysis present many comorbidities, including malnutrition and frailty. These factors contribute to a sedentary lifestyle, cognitive impairment, and decreased emotional well-being. Intradialytic exercise with non-immersive virtual reality may improve health-related quality of life and functional capacity in these individuals. The GoodRENal project was developed to create a digital intradialytic health platform to improve health-related quality of life. This study aimed to test the feasibility of the GoodRENal intradialytic platform and to identify participants’ opinions about the use of the platform. Method People on hemodialysis treatment from Spain, Greece and Sweden were included. Non-immersive virtual reality games were created to educate on food intake aiming to better control potassium, phosphate, sodium and liquids. It also aimed at increasing physical activity during HD sessions, improving cognitive skills and enhancing psychological well-being. An Azure Kinect camera was used to capture the movement and all activities were designed as dual-tasks, so the movement of lower limbs was promoted in every game. During a trial session, patients were asked about their perception of the platform through a questionnaire designed to evaluate their opinion. It consisted of 10 general questions, 6 questions for the Physical Activity games, 4 for the Nutrition games, 6 for the Cognition games and 7 for the Psychology games. Every question was rated with a Likert scale. Answers are presented in three categories ‘agree’ (4 or 5 out of 5), ‘neither agree nor disagree’ (3 out of 5), and ‘disagree’ (1 or 2 out of 5). Results 27 participants were included in this study (Spain n = 9; Greece n = 10; Sweden n = 8). Participants’ mean age was 64.6 years, 9 women, with a hemodialysis vintage, median 27 months (minimum 4- maximum 240). The questions with a higher degree of agreement or disagreement are summarized. In terms of general feedback on the GoodRENal platform, more than 90% of respondents found the instructions easy to follow and that playing the games was a pleasant break during the hemodialysis session. Furthermore, they disagreed with the statement that the back was tiring. The questions related to the physical activity games with the highest rate of agreement related to the ideas that the program provides a good workout (80% agreement), the possibility to have more exercises (70% agreement) and that it was fun (60% agreement). Regarding the nutrition games, more than 70% agreed that they had gained new knowledge about what to eat and about 60% felt motivated to modify what they ate. For the cognition games, more than 80% maintained attention during the games, but only 35% felt motivated to engage in cognitively stimulating activities. Finally, regarding the games aimed at emotional well-being, 30% of the patients indicated that they felt good about the exercises. Conclusion The GoodRENal platform is a feasible strategy to increase physical activity during hemodialysis treatment, as well as to improve nutritional information and cognitive status of patients. As a general impression the platform was easy to follow and it was a nice break. Future studies should take into account participants’ opinion to improve the content of a digital intradialytic health platform.

Efficacy of neuromuscular exercises to promote movement quality and reduce musculoskeletal injury during initial military training in Royal Navy recruits

IntroductionMusculoskeletal injuries (MSKIs) are a significant problem in the Royal Navy, contributing to 48% of all medical discharges from service between 2019 and 2020. The objective of the study was...

Lower Limb Motion Recognition with Improved SVM Based on Surface Electromyography.

During robot-assisted rehabilitation, failure to recognize lower limb movement may efficiently limit the development of exoskeleton robots, especially for individuals with knee pathology. A major challenge encountered with surface electromyography (sEMG) signals generated by lower limb movements is variability between subjects, such as motion patterns and muscle structure. To this end, this paper proposes an sEMG-based lower limb motion recognition using an improved support vector machine (SVM). Firstly, non-negative matrix factorization (NMF) is leveraged to analyze muscle synergy for multi-channel sEMG signals. Secondly, the multi-nonlinear sEMG features are extracted, which reflect the complexity of muscle status change during various lower limb movements. The Fisher discriminant function method is utilized to perform feature selection and reduce feature dimension. Then, a hybrid genetic algorithm-particle swarm optimization (GA-PSO) method is leveraged to determine the best parameters for SVM. Finally, the experiments are carried out to distinguish 11 healthy and 11 knee pathological subjects by performing three different lower limb movements. Results demonstrate the effectiveness and feasibility of the proposed approach in three different lower limb movements with an average accuracy of 96.03% in healthy subjects and 93.65% in knee pathological subjects, respectively.

Children With Cerebral Palsy's Experiences With Adaptive Climbing: A Qualitative Study on Parents' Perspectives.

Interest in adaptive sports for children with cerebral palsy (CP) is growing, but current evidence on the benefits and indications for one sport, adaptive climbing, is limited. We sought to describe perceived changes observed by parents of children with CP who participated in adaptive climbing. Parents whose children with CP participated in 5 or more adaptive climbing sessions were eligible to participate and were emailed a recruitment letter and flyer. Data were collected through semi-structured interviews, using a moderator guide. Interviews were transcribed and content analyzed, with data grouped into concepts, categories, and themes until data saturation. Ten parents (9 mothers, 1 father) of 10 children with CP (5 girls, 5 boys; ages 7 to 19 years) were interviewed for 15 to 45 minutes each, yielding 4 themes. First, parents perceived that adaptive climbing challenged the children physically (in reach, balance, strength, and head/neck and lower limb motion); second, that it sharpened children's cognitive skills (in focus, problem-solving, and strategic thinking); third, that it raised children's confidence (socially, physically, and emotionally); and fourth, that it expanded children's sense of what they could do (in mastering a challenge, claiming an athletic identity, and participating in a sport like their peers). In this qualitative study, parents described physical, cognitive, and psychosocial benefits of adaptive climbing for their children with CP. These descriptions can be used to inform future studies of children with CP who participate in adaptive climbing.

Lower Limb Motion Intent Recognition Based on Sensor Fusion and Fuzzy Multitask Learning

Lower Limb Motion Intent Recognition Based on Sensor Fusion and Fuzzy Multitask Learning