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  • 1. Barnett, C. T.
    et al.
    Vanicek, N.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    A longitudinal analysis of the relationships between postural control, falls efficacy and falling in unilateral transtibial prosthesis users2017Konferensbidrag (Refereegranskat)
  • 2.
    Barnett, Cleveland T.
    et al.
    Nottingham Trent University, Nottingham, U.K. .
    Vanicek, Natalie
    University of Hull, Hull, U.K. .
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Do predictive relationships exist between postural control and falls efficacy in unilateral transtibial prosthesis users?2018Ingår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 99, nr 11, s. 2271-2278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    To assess whether variables from a postural control test relate to and predict falls efficacy in prosthesis users.

    Design

    Twelve-month within and between subjects repeated measures design. Participants performed the Limits of Stability (LOS) test protocol at study baseline and at 6-month follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I) questionnaire, reflecting the fear of falling, and reported the number of falls monthly between study baseline and 6-month follow-up, and additionally at 9- and 12-month follow-ups.

    Setting

    University biomechanics laboratories.

    Participants

    A group of active unilateral transtibial prosthesis users of primarily traumatic etiology (PROS) (n=12) with at least one year of prosthetic experience and age and gender matched control participants (CON) (n=12).

    Interventions

    Not applicable.

    Main Outcome Measure(s)

    Postural control variables derived from centre of pressure data obtained during the LOS test, which was performed on and reported by the Neurocom Pro Balance Master, namely; reaction time (RT), movement velocity (MVL), endpoint (EPE) and maximum (MXE) excursion and directional control (DCL). Number of falls and total FES-I scores.

    Results

    During the study period, the PROS group had higher FES-I scores (U = 33.5, p =0.02), but experienced a similar number of falls, compared to the CON group. Increased FES-I score were associated with decreased EPE (R=-0.73, p=0.02), MXE (R=-0.83, p<0.01) and MVL (R=-0.7, p=0.03) in the PROS group, and DCL (R=-0.82, p<0.01) in the CON group, all in the backwards direction.

    Conclusions

    Study baseline measures of postural control, in the backwards direction only, are related to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile and experienced prosthesis users.

  • 3.
    Barnett, Cleveland T.
    et al.
    Nottingham Trent University, Nottingham, UK.
    Vanicek, Natalie
    University of Hull, Hull, UK.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Does postural control predict falling and the fear of falling in lower limb amputees?2015Ingår i: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 39, nr 1 (suppl.), artikel-id 313Artikel i tidskrift (Refereegranskat)
  • 4.
    Jarl, Gustav
    et al.
    Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hellstrand Tang, Ulla
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nordén, Erika
    Ottobock, Medical Care Sweden, Stockholm, Sweden.
    Johannesson, Anton
    Össur Clinics Scandinavia, Stockholm, Sweden.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument2019Ingår i: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 5.
    Möller, Saffran
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Hagberg, Kerstin
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Cortical brain activity of transfemoral or knee-disarticulation prosthesis users performing single and dual-task walking activitiesManuskript (preprint) (Övrigt vetenskapligt)
  • 6.
    Möller, Saffran
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Hagberg, Kerstin
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Differences in mobility for individuals using a non-microprocessor-controlled versus a microprocessor-controlled prosthetic kneeManuskript (preprint) (Övrigt vetenskapligt)
  • 7.
    Möller, Saffran
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för omvårdnad. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Hagberg, Kerstin
    Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Sweden.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Reduced cortical brain activity with the use of microprocessor-controlled prosthetic knees during walking2019Ingår i: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 43, nr 3, s. 257-265Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Ramstrand, Nerrolyn
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Andersson, Christina Björk
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Effects of an unstable shoe construction on standing balance in children with developmental disabilities: a pilot study2008Ingår i: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 32, nr 4, s. 422-433Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aimed to investigate if prolonged use of shoes incorporating an unstable sole construction could facilitate improvements of balance in a sample of developmentally disabled children. Ten children (six male and four female) aged between 10 and 17 years participated in the study. Children were fitted with shoes incorporating an unstable sole (Masai Barefoot Technology) and instructed to wear them for a minimum of two hours per day for eight weeks. A within subjects repeated measures design was used. Children were tested prior to receiving the shoes, four weeks after receiving the shoes and eight weeks after receiving the shoes. A force plate capable of rotating about a single axis (NeuroCom International Inc, Oregon) was used to test static balance, reactive balance and directional control. Static balance was not found to be influenced by prolonged use of the footwear; however, significant improvements were noted in children's reactive balance both with the shoes and barefoot. Results suggest that reactive balance can be improved by prolonged and regular use of shoes incorporating an unstable sole construction.

  • 9.
    Ramstrand, Nerrolyn
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Gjøvaag, T.
    Starholmen, I.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Effects of knee orthosis design on proprioception and balance2017Konferensbidrag (Refereegranskat)
  • 10.
    Ramstrand, Nerrolyn
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD.
    Gjøvaag, Terje
    Oslo Metropolitan University, Norway.
    Starholm, Inger Marie
    Oslo Metropolitan University, Norway.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Effects of knee orthoses on kinesthetic awareness and balance in healthy individuals2019Ingår i: Journal of Rehabilitation and Assistive Technologies Engineering, ISSN 2055-6683, Vol. 6Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Ramstrand, Nerrolyn
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Thuesen, Anna Helena
    Nielsen, Dennis Brandborg
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Effects of an unstable shoe construction on balance in women aged over 50 years.2010Ingår i: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 25, nr 5, s. 455-460Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Shoes with an unstable sole construction are commonly used as a therapeutic tool by physiotherapists and are widely available from shoe and sporting goods retailers. The aim of this study was to investigate the effects of using an unstable shoe (Masai Barefoot Technology) on standing balance, reactive balance and stability limits. METHODS: Thirty-one subjects agreed to participate in the study and underwent balance tests on three different occasions. After test occasion one (baseline) 20 subjects received Masai Barefoot Technology shoes and were requested to wear them as much as possible for the remaining eight weeks of the study. Three specific balance tests were administered on each test occasion using a Pro Balance Master (NeuroCom International Inc., Oregon, USA). Tests included; a modified sensory organization test, reactive balance test and limits of stability test. FINDINGS: Subjects in the intervention group significantly improved their performance on elements of all three tests however results on these variables were not demonstrated to be significantly better than the control group. No significant differences were observed across testing occasions in the control group. INTERPRETATION: Results from the present study suggest that, for this group of individuals, use of unstable footwear may improve certain aspects of balance.

  • 12.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Adaptations from the prosthetic and intact limb during standing on a sway referenced support surface for transtibial prosthesis users2019Ingår i: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 14, nr 7, s. 682-691Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    An Iterative Feedback Procedure for Course Evaluation and Structure2018Konferensbidrag (Refereegranskat)
  • 14.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Biomechanical Models of Standing in Prosthetic Users2018Konferensbidrag (Övrigt vetenskapligt)
  • 15.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Instrumented motion analysis and trans-tibial prosthetics: a systematic review2009Konferensbidrag (Övrigt vetenskapligt)
  • 16.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Instrumented motion analysis of trans-tibial prosthesis users: a systematic review of data capture and analysis techniques2010Ingår i: 13th ISPO World Congress: Abstracts, 2010, s. 969-970Konferensbidrag (Refereegranskat)
  • 17.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Limb prostheses and postural control: evaluation, interaction and functional consequence2015Konferensbidrag (Övrigt vetenskapligt)
  • 18.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Observational gait analysis: The prosthetic challenges2004Konferensbidrag (Övrigt vetenskapligt)
  • 19.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Sagittal plane position of the functional joint centre of prosthetic foot-ankle mechanisms2010Ingår i: 13th ISPO World Congress: Abstracts, 2010, s. 1257-1258Konferensbidrag (Refereegranskat)
  • 20.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    The effects of liner thickness and suspension technique on knee joint proprioception in trans-tibial amputees2007Konferensbidrag (Refereegranskat)
  • 21.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    The prosthesis and weight-bearing contributions on EMG response latency subsequent to rapid platform perturbation in transtibial prosthesis users2013Konferensbidrag (Refereegranskat)
  • 22.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    The use of vibratory feedback to improve postural stability of individuals with transtibial amputation2013Konferensbidrag (Refereegranskat)
  • 23.
    Rusaw, David
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    The validity of forceplate data as a measure of rapid and targeted volitional movements of the center of mass in transtibial prosthesis users2017Ingår i: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 12, nr 7, s. 686-693Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To validate outcome variables from the Limits of Stability protocol that are derived from the center of pressure with those same variables derived from the center of mass during rapid, volitional responses in transtibial prosthesis users.

    Method: Prosthesis users (n=21) and matched controls (n=21) executed movements while force and motion data were collected.  Correlation coefficients were used to investigate relationships between center of pressure and center of mass for: x/y coordinates positions, Limits of Stability outcome variables and muscular reaction times. 

    Results: Significant differences were seen in correlation between x/y coordinate positions toward the intact limb (mean effect size of differences: r = 0.38).  Limits of Stability variables were positively correlated (reaction time and maximum excursion range rs: 0.585 – 0.846; directional control and mean velocity range rs: 0.307 – 0.472).  Muscular reaction times correlated weakly with those from center of pressure (mean rs prosthesis users – 0.186 and controls –  0.101). 

    Conclusions: Forceplate measures are valid in describing rapid, volitional movements in unilateral transtibial prosthesis users.  Limits of Stability outcomes extracted from center of pressure and center of mass are highly correlated but can be sensitive to direction.  Muscular reaction time correlates very little with reaction times extracted from the other variables.

  • 24.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Hagberg, Kerstin
    University of Gothenburg.
    Nolan, Lee
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Karolinska Institutet and GIH, Stockholm.
    Bilateral electromyogram response latency following platform perturbation in unilateral transtibial prosthesis users: Influence of weight distribution and limb position2013Ingår i: Journal of rehabilitation research and development, ISSN 0748-7711, E-ISSN 1938-1352, Vol. 50, nr 4, s. 531-544Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Appropriate muscular response following an external perturbation is essential inpreventing falls. Transtibial prosthesis users lack a foot-ankle complex and associatedsensorimotor structures on the side with a prosthesis. Its effect on rapid responses ofthe lower-extremity to external surface perturbations is unknown. The aim of thepresent study was to compare electromyographic (EMG) response latencies of otherwisehealthy unilateral transtibial prosthesis users (n=23, mean age 48 years [standarddeviation 14]) and a matched control group (n=23, mean age 48 years [standard deviation13]) following sudden support surface rotations in the pitch plane (toes-up and toesdown).Perturbations were elicited in various weight-bearing and limb-perturbedconditions. The results indicated that transtibial prosthesis users have delayed responsesof multiple muscles of the lower-extremity following perturbation, both in the intact limband the residual limb. Weight-bearing had no influence on the response latency in theresidual limb, but did on the intact limb. Which limb received the perturbation wasfound to influence the muscular response, with the intact limb showing a significantlydelayed response when the perturbation was received only on the side with a prosthesis.These delayed responses may represent an increased risk of falling for individuals thatuse a transtibial prosthesis.

  • 25.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Hagberg, Kerstin
    Institute for Clinical Sciences, Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nolan, Lee
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Can vibratory feedback be used to improve postural stability in persons with transtibial limb loss?2012Ingår i: Journal of rehabilitation research and development, ISSN 0748-7711, E-ISSN 1938-1352, Vol. 49, nr 8, s. 1239-1254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The use of vibration as a feedback modality to convey motion of the body has been shown to improve measures of postural stability in some groups of patients. Because individuals using transtibial prostheses lack sensation distal to the amputation, vibratory feedback could possibly be used to improve their postural stability. The current investigation provided transtibial prosthesis users (n = 24, mean age 48 yr) with vibratory feedback proportional to the signal received from force transducers located under the prosthetic foot. Postural stability was evaluated by measuring center of pressure (CoP) movement, limits of stability, and rhythmic weight shift while participants stood on a force platform capable of rotations in the pitch plane (toes up/toes down). The results showed that the vibratory feedback increased the mediolateral displacement amplitude of CoP in standing balance and reduced the response time to rapid voluntary movements of the center of gravity. The results suggest that the use of vibratory feedback in an experimental setting leads to improvements in fast open-loop mechanisms of postural control in transtibial prosthesis users.

  • 26.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Hellstrand Tang, Ulla
    Nordén, Erika
    Johannesson, Anton
    Jarl, Gustav
    Clinical guidelines for orthotic treatment of osteoarthritis of the knee: a review with a nordic perspective2018Konferensbidrag (Övrigt vetenskapligt)
  • 27.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Institute for Clinical Sciences, Department of Orthopaedics, University of Gothenburg, Sweden.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Motion-analysis studies of transtibial prosthesis users: a systematic review2011Ingår i: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 35, nr 1, s. 8-19Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Three-dimensional motion analysis has been used since the beginning of the 1980s to evaluate many aspects of physical function of transtibial amputees. Despite its common use for clinical research, there is large variability in methods of capturing three-dimensional data, description of these methods, reporting of joint kinematics and interpretation of research findings.

    Objectives: The aim of the following review is to critically examine the specific methodologies used by researchers when collecting three-dimensional kinematic data on transtibial amputees and to provide an overview of the methods used.

    Study design: Systematic review.

    Methods: A systematic review of the literature between January 1984 and June 2009 was conducted. A total of 68 papers were identified for review based on the following criteria: experimental research design, collection of three-dimensional kinematic data of lower-extremity joints, and inclusion of transtibial amputees as experimental subjects.

    Results: A number of methodological shortcomings were identified in the papers reviewed.

    Conclusions: The authors recommend that future studies more appropriately address the product name and number of prosthetic components used; how the position of reflective markers on the prosthesis is defined; presentation of data from both sound and affected sides; and definition of the neutral position of the ankle when reporting kinematic data. Where possible, the authors recommend use of a control group.

  • 28.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Ramstrand, Nerrolyn
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Sagittal plane position of the functional joint centre of prosthetic foot-ankle mechanisms2010Ingår i: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 25, nr 7, s. 713-720Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The use of motion analysis techniques in amputee rehabilitation often utilizes kinematic data from the prosthetic limb. A problem with methods currently used is that the joint positions of the prosthetic ankle are assumed to be in the same position as that of an intact ankle. The aim of this study was to identify both traditional anatomical joint centres as well as functional joint centres in a selection of commonly used prosthetic feet. These coordinates were then compared across feet and compared to the contralateral intact ankle joint.

    Methods: Six prosthetic feet were !t to a unilateral trans-tibial amputee on two separate occasions. The subject's intact limb was used as a control. Three-dimensional kinematics were collected to determine the sagittal position of the functional joint centre for the feet investigated.

    Findings: None of the prosthetic feet had a functional joint centre that was within the 95% CI for that of an intact ankle (both x- and y-coordinate position), nor any of the other prosthetic feet investigated. The repeatability of the method was found to be adequate, with 95% CI of the difference (test–retest) of the prosthetic feet similar to that for the intact ankle and within clinically accepted levels of variability.

    Interpretation: The motion of the prosthetic feet tested is clearly different from that of an intact ankle. Kinematic methods that assume ankle constraints based on an intact ankle are subject to systematic error as this does not refect the real motion of the prosthetic foot.

  • 29.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering.
    Ramstrand, Simon
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Validation of the Inverted Pendulum Model in standing for transtibial prosthesis users2016Ingår i: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 31, s. 100-106Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In balance assessment it is often the case that variables associated with center of pressure are used as outcomes to draw conclusions about an individuals balance.  Validity of these outcomes rests upon assumptions that movement of the center of pressure is inter-dependent on movement of the center of mass.  This dependency is mechanical and is referred to as the Inverted Pendulum Model.  As prosthesis users lack an anatomical ankle it is not given this model is valid in this group.  The following study aimed to validate the Inverted Pendulum Model both kinematically and kinetically, in transtibial prosthesis users and a control group.  

    Methods: Prosthesis users (n=6) and matched control participants (n=6) stood quietly while force and motion data were collected under three sensory conditions (eyes-open, eyes-closed, and weight-bearing feedback) under both the prosthetic and intact limb.  Correlation coefficients were used to investigate the relationships between height of markers and center of masses and their excursion in the mediolateral/anteroposterior-directions, difference between center of pressure and center of mass and the center of mass acceleration in the mediolateral/anteroposterior directions, magnitude of the mediolateral/anteroposterior-component forces and center of mass acceleration, angular position of ankle and excursion in the mediolateral/anteroposterior-directions, and integrated force signals.  

    Findings: Results indicate kinematic validity of similar magnitudes (mean (SD) marker-displacement) between prosthesis users and control group for the mediolateral- (  = 0.77 (0.17); 0.74 (0.19)) and anteroposterior-directions (  = 0.88 (0.18); 0.88 (0.19)).  Correlation between the difference of center of pressure and center of mass and the center of mass acceleration was negligible on the prosthetic side (0.08 (0.06)) vs. the control group (-0.51(0.13)). 

    Interpretation: Results indicate kinematic validity of the Inverted Pendulum Model in transtibial prosthesis users but that kinetic validity is questionable, particularly on the side with a prosthesis.

  • 30.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT.
    Rudholmer, E.
    Barnett, C. T.
    A limits of stability protocol utilizing measures of the center of mass and center of pressure in transtibial prosthesis users: learning effects and reliability2017Konferensbidrag (Refereegranskat)
  • 31.
    Rusaw, David
    et al.
    Högskolan i Jönköping, Hälsohögskolan, HHJ, Avd. för rehabilitering. Högskolan i Jönköping, Hälsohögskolan, HHJ. ADULT. Högskolan i Jönköping, Hälsohögskolan, HHJ. Ortopedteknisk plattform.
    Rudholmer, Elin
    Högskolan i Jönköping, Hälsohögskolan.
    Barnett, Cleveland T.
    School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom.
    Development of a limits of stability protocol for use in transtibial prosthesis users: Learning effects and reliability of outcome variables2017Ingår i: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 58, s. 539-545Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aims of this study were to empirically quantify reliability and learning effects of a Limits of Stability protocol for transtibial prosthesis users. Outcome variables from center of pressure and center of mass were tested on: 1) multiple test repetitions within a single test occasion; and 2) between multiple test occasions. Trantibial prosthesis users (n=7) and matched controls (n=7) executed five trials of the Limits of Stability protocol on two occasions per day, on two consecutive days. Inter-trial learning effects and reliability of outcomes extracted via center of mass and center of pressure were evaluated utilizing standard biomechanics laboratory equipment. Reliability was good to excellent except the reaction time variable which was poor (Pooled 95%CI of ICC=0.248-0.484). An inter-trial learning effect was present in directional control for prosthesis users when the first trial was included in analysis (center of mass: 95%CI of r=0.065-0.239; center of pressure: 95%CI of r=0.076-0.249). The use of standard biomechanics lab equipment can produce reliable results for the Limits of Stability protocol. Researchers should be aware of low reliability of reaction time variable in the protocol assessed and should execute at least one practice trial prior to that which is used in subsequent analysis.

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