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Publications (10 of 35) Show all publications
Rusaw, D. (2019). Adaptations from the prosthetic and intact limb during standing on a sway referenced support surface for transtibial prosthesis users. Disability and Rehabilitation: Assistive Technology, 14(7), 682-691
Open this publication in new window or tab >>Adaptations from the prosthetic and intact limb during standing on a sway referenced support surface for transtibial prosthesis users
2019 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 14, no 7, p. 682-691Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate the bilateral postural adaptations as a result of standing on an increasingly unstable sway-referenced support surface with both the intact and prosthetic limb for transtibial prosthesis users (TPUs).

Method: TPUs (n = 14) and matched controls (n = 14) stood quietly in multiple foot placement conditions (intact foot, prosthetic foot and both feet) on a sway-referenced support surface which matched surface rotation to the movement of the centre of pressure (CoP). Force and motion data were collected and used to analyse CoP mean position, displacement integral and force components under intact and prosthetic limbs.

Results: Significant differences were found between prosthesis users and controls in CoP mean position in anteroposterior (1.5 (95% CI, 1.2–1.8) cm) and mediolateral directions (3.1 (95% CI, 0.5–5.7) cm. CoP displacement integrals were significantly different greater for prosthesis user group in the anteroposterior direction. Force components differences were found in all planes (anteroposterior: 0.6 (95% CI, 0.4–0.8 N); mediolateral: 0.1 (95% CI, 0.0–0.2 N & 0.3 (95% CI, 0.2–0.4) N, inferosuperior: 2.2 (95% CI, 1.4–3.0) N).

Conclusions: TPUs have bilateral static and dynamic postural adaptations when standing on a sway-referenced support surface that is different to controls, and between prosthetic and intact sides. Results further support evidence highlighting importance of the intact limb in maintenance of postural control in prosthesis users. Differences indicate clinical treatment should be directed towards improving outcomes on the intact side.

Implications for rehabilitation:

  • Prosthesis users have bilateral adaptations when standing on a sway referenced support surface

  • These adaptations are different to controls, and between prosthetic and intact sides.

  • The intact limb is the major contributor to maintenance of postural control in prosthesis users.

  • Clinical treatment should account for this when interventions are designed.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Balance, postural control, transtibial, amputee, prosthesis
National Category
Orthopaedics
Identifiers
urn:nbn:se:hj:diva-41126 (URN)10.1080/17483107.2018.1498925 (DOI)000480276700005 ()30409065 (PubMedID)2-s2.0-85057569055 (Scopus ID)HOA HHJ 2019 (Local ID)HOA HHJ 2019 (Archive number)HOA HHJ 2019 (OAI)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-08-30Bibliographically approved
Möller, S., Ramstrand, N., Hagberg, K. & Rusaw, D. (2019). Can Microprocessor-Controlled Prosthetic Knees Reduce Attentional Demand during Singleand Dual-task Walking?. In: : . Paper presented at ISPO’s 17th World Congress (International Society for Prosthetics and Orthotics), 5-8 October 2019, Kobe, Japan.
Open this publication in new window or tab >>Can Microprocessor-Controlled Prosthetic Knees Reduce Attentional Demand during Singleand Dual-task Walking?
2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

BACKGROUND

Walking with a lower-limb prosthesis while performing a secondary task (dual-tasking) has been suggested to increase demand on attentional resources, negatively affecting balance and gait performance.[1, 2] Brain imaging research has suggested that microprocessor-controlled prosthetic knees (MPKs) reduce attentional demands during single-task walking.[3] To date the effects of MPK on brain activity during dual-task walking has not been investigated.

AIM

To evaluate effects of single- and dual-task walking on cortical brain activity in individuals using a non-MPK or MPK and controls and compare differences between the 3 groups.

METHOD

A cross-sectional study was performed involving twenty-nine individuals with a transfemoral amputation or knee disarticulation who were provided with either a non-MPK or an MPK, and 16 controls. Functional near-infrared spectroscopy was used to evaluate cortical brain activity (oxygenated haemoglobin (oxyHb) concentration level changes) while participants walked on a stable level surface and simultanously performed 2 dual-task activities; 1) walking while sorting through keys; and, 2) walking in sequence around randomly number cones. Temporospatial variables was recorded for each activity.

RESULTS

Increased brain activity (oxyHb concentration level changes) were observed when a secondary task was added in the MPK-group (p=.000) and in the control group (p=.007). No significant differences were observed between single- and dual-task walking in the non-MPK group (p>.05). Significantly increased brain activity (oxyHb concentrations level changes) was observed during single-task walking in the non-MPK group when compared to the MPK-group and controls. Significantly different results in temporospatial parameters were also observed.

DISCUSSION AND CONCLUSION

Results suggest that dual-task walking increases cognitive demand in individuals fitted with MPKs and controls. The lack of difference with the non-MPK group may suggests that their maximum capacity was already reached during single-task walking.

REFERENCES

[1] Morgan, Prosthet Orthot Int 2016. [2] Nagamatsu, Psychol Aging 2011. [3] Möller, Prosthet Orthot Int 2018.

ACKNOWLEDGEMENTS

Thanks to Jette Schack, Evin Güler, Vera Kooiman, Lamija Pasalic, Promobilia Foundation, ALF/LUA Research Grants, Össur and Team Olmed.

National Category
Physiotherapy
Identifiers
urn:nbn:se:hj:diva-46966 (URN)
Conference
ISPO’s 17th World Congress (International Society for Prosthetics and Orthotics), 5-8 October 2019, Kobe, Japan
Available from: 2019-12-04 Created: 2019-12-04 Last updated: 2019-12-04Bibliographically approved
Hill, S., Rusaw, D., Goihl, T., Hjerman, A. K., Reed Schwannborg, L. & Bauger, K. (2019). Developing National Curriculum Guidelines: An Appropriateness-Based Approach. In: : . Paper presented at ISPO’s 17th World Congress (International Society for Prosthetics and Orthotics), 5-8 October 2019, Kobe, Japan.
Open this publication in new window or tab >>Developing National Curriculum Guidelines: An Appropriateness-Based Approach
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

BACKGROUND

In 2017, the Norwegian Ministry of Education and Research began work on a project to develop national curriculum guidelines for all health and social care education programmes at Bachelor level and above. The guidelines will consist of a statement of purpose, learning outcomes and guidance on the structure of the programme. Whilst curriculum guidance exists for many professions and disciplines, there is little written about its development.

AIM

To develop national guidelines for prosthetics and orthotics education using an appropriateness-based approach.

METHOD

A modified RAND/UCLA method was used to gather information and rank appropriateness of developed learning outcomes. Collaboration with stakeholders was important and information was gathered from various professional and user organisations. Programme outlines (if available in English) from ISPO category 1 accredited programmes, together with those from northern European countries were also gathered.

RESULTS

A total of 23 programmes were invited to provide their programme documents or were accessible online. 11 programme documents were obtained and - without programme level outcomes - were excluded (n=4). Information was obtained via email, online discussion and focus groups from various organisations. The data were collated and organised into different competency areas. From this data 126 learning outcomes were developed and organised into an online questionnaire. All participants who had attended the focus groups and development group members rated the appropriateness of the learning outcome and its competence area. A further focus group and development meeting was held where results were discussed, and the learning outcomes reduced to 51. After drafting of the remaining sections, the document was sent out for consultation. Feedback from the consultation was collated and the guidelines adjusted as necessary.

DISCUSSION AND CONCLUSION

In comparison to existing programme learning outcomes from the documents obtained, there is a considerable difference in the number of learning outcomes. There are country specific differences that need to be accounted for when developing national guidelines. However, the development of national curriculum guidelines using an appropriateness-based approach ensured both a national and international focus.

National Category
Pedagogy
Identifiers
urn:nbn:se:hj:diva-46967 (URN)
Conference
ISPO’s 17th World Congress (International Society for Prosthetics and Orthotics), 5-8 October 2019, Kobe, Japan
Available from: 2019-12-04 Created: 2019-12-04 Last updated: 2019-12-04Bibliographically approved
Ramstrand, N., Gjøvaag, T., Starholm, I. M. & Rusaw, D. (2019). Effects of knee orthoses on kinesthetic awareness and balance in healthy individuals. Journal of Rehabilitation and Assistive Technologies Engineering, 6
Open this publication in new window or tab >>Effects of knee orthoses on kinesthetic awareness and balance in healthy individuals
2019 (English)In: Journal of Rehabilitation and Assistive Technologies Engineering, ISSN 2055-6683, Vol. 6Article in journal (Refereed) Published
Abstract [en]

Introduction: Conflicting evidence exists regarding the effects of knee orthoses on proprioception. One belief is that pressure applied by orthoses heightens kinesthetic awareness and that this affects balance. This study aimed to investigate effects of two different orthosis designs on kinesthetic awareness and balance in healthy individuals.

Methods: Twenty individuals (13 women) participated in this case series study. Each were tested wearing 1/no orthosis, 2/soft elastic orthosis and 3/non-elastic jointed orthosis. Pressure under orthoses was recorded. Kinesthetic awareness was investigated by testing Joint Position Sense (JPS) and Threshold to Detection of Passive Motion (TDPM). Balance was tested using a Modified Sensory Organization Test (mSOT).

Results: Non-elastic jointed orthoses applied the greatest pressure to the knee. With non-elastic jointed orthoses, TDPM was significantly poorer for pooled results (p= 0.02) and when the start position of the knee was 70 degrees (mean threshold = 0.6 º, 0.6 º, 0.7º for no-orthosis, elastic and jointed-orthoses; p= 0.03). No major differences were observed in JPS or balance and correlation between proprioception and balance was poor.

Conclusions: There may be a limit to the amount of pressure that should be applied to the knee joint by an orthosis. Exceeding this limit may compromise kinesthetic awareness.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Orthotics, joint position sense, detection of passive motion, proprioception, knee brace
National Category
Orthopaedics
Identifiers
urn:nbn:se:hj:diva-43599 (URN)10.1177/2055668319852537 (DOI)000478868500001 ()31428444 (PubMedID)GOA HHJ 2019;HHJCHILDIS,HHJADULTIS (Local ID)GOA HHJ 2019;HHJCHILDIS,HHJADULTIS (Archive number)GOA HHJ 2019;HHJCHILDIS,HHJADULTIS (OAI)
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-08-28Bibliographically approved
Jarl, G., Hellstrand Tang, U., Nordén, E., Johannesson, A. & Rusaw, D. (2019). Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument. Prosthetics and orthotics international, 43(5), 556-563
Open this publication in new window or tab >>Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument
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2019 (English)In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 5, p. 556-563Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality.

OBJECTIVES: The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries.

STUDY DESIGN: Systematic review.

METHODS: Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall's W) were calculated.

RESULTS: Domain scores indicate that many guidelines have not sufficiently addressed stakeholder involvement (average score: 55%), applicability (20%) and editorial independence (33%) in the development process. Inter-rater agreement for assessors indicated 'good' agreement for clinical practice guidelines from Finland, Norway and Sweden (W = 0.653, p < 0.001; W = 0.512, p = 0.003 and W = 0.532, p = 0.002, respectively) and 'strong' agreement for the clinical practice guideline from Denmark (W = 0.800, p < 0.001).

CONCLUSION: Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation.

CLINICAL RELEVANCE: The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Orthotic device; braces; orthosis; practice guidelines
National Category
Orthopaedics
Identifiers
urn:nbn:se:hj:diva-43774 (URN)10.1177/0309364619857854 (DOI)000490795700010 ()31256710 (PubMedID)2-s2.0-85068589958 (Scopus ID)
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2019-11-19Bibliographically approved
Rusaw, D., Ramstrand, N. & Nylander, E. (2019). Optimizing strategies for literature searching in Prosthetics & Orthotics. In: : . Paper presented at ISPO’s 17th World Congress (International Society for Prosthetics & Orthotics), 5-8 October 2019, Kobe, Japan.
Open this publication in new window or tab >>Optimizing strategies for literature searching in Prosthetics & Orthotics
2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

This instructional course is intended for graduate and post-graduate students, as well as those actively involved in research within the Prosthetics and Orthotics field.

Literature searches are a necessary component of effective research. To identify and access suitable literature, researchers need to understand which databases are most appropriate, how they differ in terms of content and search structure, and how to develop a search strategy which optimizes the proportion of relevant literature sources. Additionally, scholarly journals are increasingly requiring authors to publish utilized search strings to allow duplication of results.

The choice of terms and syntax used to construct searches within literature databases have a major influence on the outcomes of a literature search. If this process is not conducted correctly, it can result in unnecessary identification of inappropriate sources or unintended omission of appropriate literature. This instructional course will be led by academic P&Os and librarians and will equip participants with the tools to develop an advanced search strategy for a prosthetics and orthotics related topic. In addition, the concept of validated search filters, also known as search hedges, will be introduced. These can be used to efficiently and accurately filter the evergrowing volume of literature. During the course, participants will be provided with a validated search hedge which has been developed by the instructional team to be utilized when conducting a systematic search for literature within the area of limb prosthetics.

Statement of the objective / learning objectives. Upon completion, the student will:

Understand the concept of a search hedge

Make informed decisions about the selection and use of literature databases

Independently develop a search strategy for a prosthetics and orthotics related topic

National Category
Information Studies Computer and Information Sciences Learning
Identifiers
urn:nbn:se:hj:diva-46968 (URN)
Conference
ISPO’s 17th World Congress (International Society for Prosthetics & Orthotics), 5-8 October 2019, Kobe, Japan
Available from: 2019-12-04 Created: 2019-12-04 Last updated: 2019-12-05Bibliographically approved
Möller, S., Rusaw, D., Hagberg, K. & Ramstrand, N. (2019). Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking. Prosthetics and orthotics international, 43(3), 257-265
Open this publication in new window or tab >>Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking
2019 (English)In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, no 3, p. 257-265Article in journal (Refereed) Published
Abstract [en]

Background: Individuals using a lower-limb prosthesis indicate that they need to concentrate on every step they take. Despite self-reports of increased cognitive demand, there is limited understanding of the link between cognitive processes and walking when using a lower-limb prosthesis.

Objective: The objective was to assess cortical brain activity during level walking in individuals using different prosthetic knee components and compare them to healthy controls. It was hypothesized that the least activity would be observed in the healthy control group, followed by individuals using a microprocessor-controlled prosthetic knee and finally individuals using a non-microprocessor-controlled prosthetic knee.

Study Design: Cross-sectional study.

Methods:: An optical brain imaging system was used to measure relative changes in concentration of oxygenated and de-oxygenated haemoglobin in the frontal and motor cortices during level walking. The number of steps and time to walk 10 m was also recorded. The 6-min walk test was assessed as a measure of functional capacity.

Results: Individuals with a transfemoral or knee-disarticulation amputation, using non-microprocessor-controlled prosthetic knee ( n = 14) or microprocessor-controlled prosthetic knee ( n = 15) joints and healthy controls ( n = 16) participated in the study. A significant increase was observed in cortical brain activity of individuals walking with a non-microprocessor-controlled prosthetic knee when compared to healthy controls ( p < 0.05) and individuals walking with an microprocessor-controlled prosthetic knee joint ( p < 0.05).

Conclusion: Individuals walking with a non-microprocessor-controlled prosthetic knee demonstrated an increase in cortical brain activity compared to healthy individuals. Use of a microprocessor-controlled prosthetic knee was associated with less cortical brain activity than use of a non-microprocessor-controlled prosthetic knee.

Clinical Relevance: Increased understanding of cognitive processes underlying walking when using different types of prosthetic knees can help to optimize selection of prosthetic components and provide an opportunity to enhance functioning with a prosthesis.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Attention, artificial limb, brain, gait, neuroimaging
National Category
Orthopaedics
Identifiers
urn:nbn:se:hj:diva-42040 (URN)10.1177/0309364618805260 (DOI)000473489500003 ()30375285 (PubMedID)2-s2.0-85059453859 (Scopus ID)
Available from: 2018-11-15 Created: 2018-11-15 Last updated: 2019-08-08Bibliographically approved
Rusaw, D. (2018). An Iterative Feedback Procedure for Course Evaluation and Structure. In: : . Paper presented at ISPO Global Educators Meeting 2018, Göttingen, Germany, 18-20 September 2018.
Open this publication in new window or tab >>An Iterative Feedback Procedure for Course Evaluation and Structure
2018 (English)Conference paper, Oral presentation only (Refereed)
National Category
Educational Sciences
Identifiers
urn:nbn:se:hj:diva-41671 (URN)
Conference
ISPO Global Educators Meeting 2018, Göttingen, Germany, 18-20 September 2018
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-02Bibliographically approved
Rusaw, D. (2018). Biomechanical Models of Standing in Prosthetic Users. In: : . Paper presented at 11. Nordiske Bandagist Kongres, 6-8 September, 2018, Copenhagen, Denmark.
Open this publication in new window or tab >>Biomechanical Models of Standing in Prosthetic Users
2018 (English)Conference paper, Oral presentation only (Other academic)
National Category
Orthopaedics
Identifiers
urn:nbn:se:hj:diva-41672 (URN)
Conference
11. Nordiske Bandagist Kongres, 6-8 September, 2018, Copenhagen, Denmark
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-02Bibliographically approved
Rusaw, D., Hellstrand Tang, U., Nordén, E., Johannesson, A. & Jarl, G. (2018). Clinical guidelines for orthotic treatment of osteoarthritis of the knee: a review with a nordic perspective. In: : . Paper presented at 11. Nordiske Bandagist Kongres, 6-8 September, 2018, Copenhagen, Denmark.
Open this publication in new window or tab >>Clinical guidelines for orthotic treatment of osteoarthritis of the knee: a review with a nordic perspective
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2018 (English)Conference paper, Oral presentation only (Other academic)
National Category
Orthopaedics
Identifiers
urn:nbn:se:hj:diva-41674 (URN)
Conference
11. Nordiske Bandagist Kongres, 6-8 September, 2018, Copenhagen, Denmark
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0220-6278

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