Chapter 15: The Ankle and Lower Leg. Bones of Lower Leg and Foot.
The association between lower leg impairments and ......The association between lower leg...
Transcript of The association between lower leg impairments and ......The association between lower leg...
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The association between lower leg impairments and RaceRunning performance
Towards a classification system of RaceRunning as a Paralympic event
Nicola Tennant, Physiotherapist RaceRunning ScotlandSadaf Jahed, MSc Physiotherapy 2015/16, QMUMartine Verheul, University of EdinburghMarietta van der Linden, Queen Margaret University, Edinburgh
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The association between lower leg impairments and RaceRunning performance
Marietta van der Linden Nicola Tennant
Sadaf JahedMartine Verheul
Towards an evidence based classification system of RaceRunning as a Paralympic event
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What is RaceRunning?
• Allows athletes with limited or no walking ability to propel themselves independently
• Expected health benefits which the majority would not experience from any other sport: bone health & cardiovascular health
• Light weight ‘trike’ with chest support and without pedals
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RaceRunning propulsion stylesBecause of the design of the running bike and the range of abilities of the athletes, a range of propulsion techniques is used.
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RaceRunning propulsion stylesBecause of the design of the running bike and the range of abilities of the athletes, a range of propulsion techniques is used.
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Current Para-athletics classification for track athletes with
hypertonia, ataxia or athetosis
• Ambulant athletes (T35-T38)
• Wheelchair athletes (T31-T34)
RaceRunning as a future para-athletic event?
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Evidence based IPC classification
Step 2b Sports specific measure of performance
Step 2a: Valid measures of impairments
Step 3: Association between valid measures of impairment and sports specific measure of performance
Step 1: Eligible impairment types
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ICF 1 CPISRA RR classification CP literature2
b735 Muscle tone functions
Spasticity: ASAS MAS, ASAS, instrumented spasticity measures
b760 Control of voluntary movement functions
Ability to control individual joint movements
Selective motor control: SCALE/SMC
Trunk control TCMS/TIS
b710 Mobility of joint functions
Range of motion (manual goniometry)
Range of motion (manual goniometry)
b730 Muscle power functions
Propulsion power MMT & isokinetics
Step2a: Valid measures of impairments
1Schiarti et al. (2015) iCF Body structures and Functions for children and youth with CP2Balzer et al. (2017), Kim & Park (2011), Ross et al. (2007), Desloovere et al. (2006)
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Evidence based IPC classification
Step 2b Sports specific measure of performance
Running speed
Step 2a: Valid measures of impairments: ASAS/MAS,
SCALE, ROM, MMT
Step 3: Association between valid measures of impairment and sports specific measure of performance
Step 1: Eligible impairment types
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Sports specific measure
• Maximum Static Step length
Step with right foot
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Participating athletes (2016)
• 16 males, 15 females
• Average age: 23(±7), range 14-42
• CP (29) TBI (1), Brain Tumour (1)
• Hypertonia (17), ataxia (3), athetosis (1)
mixed (8), NA (2)
• RR1 (11) RR2(12) RR3(8)
• GMFCS II (9), III (9), IV (11), V (2)
• Years RR : 4.3(2.9) years (1.5-11)
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RESULTS…
• Lower limb spasticity (ASAStot)
• Lower limb spasticity (MAStot)
• Lower limb Muscle strength (MMTtot)
• Selective Voluntary Motor Control (SCALE)
• Passive knee extension
• Maximum static step length
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Australian Spasticity Assessment Score
0.00
0.50
1.00
1.50
2.00
2.50
0.00 7.50 15.00 22.50 30.00
Total ASAS score
DL
spee
d
Top 7 & more than 2 yrs RR experience
rho=0.48
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RESULTS…
• Lower limb spasticity (ASAStot)
• Lower limb spasticity (MAStot)
• Lower limb Muscle strength (MMTtot)
• Selective Voluntary Motor Control (SCALE)
• Passive knee extension
• Maximum static step length
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Modified Ashworth Scale
0.00
0.50
1.00
1.50
2.00
2.50
0.00 7.50 15.00 22.50 30.00
• Top 7 & more than 2 yrs RR experience
DL
spee
d
Total MAS score
rho=0.47
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RESULTS…
• Lower limb spasticity (ASAStot)
• Lower limb spasticity (MAStot)
• Lower limb Muscle strength (MMTtot)
• Selective Voluntary Motor Control (SCALE)
• Passive knee extension
• Maximum static step length
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Manual Muscle Test
0.00
0.50
1.00
1.50
2.00
2.50
0.00 27.50 55.00 82.50 110.00 137.50
Total MMT score (no impairment =zero)
DL
spee
d
Top 7 & more than 2 yrs RR experience
rho=0.43
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RESULTS…
• Lower limb spasticity (ASAStot)
• Lower limb spasticity (MAStot)
• Lower limb Muscle strength (MMTtot)
• Selective Voluntary Motor Control (SCALE)
• Passive knee extension
• Maximum static step length
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SCALE
0.00
0.50
1.00
1.50
2.00
2.50
0.00 5.75 11.50 17.25 23.00
Top 7 & more than 2 yrs RR experience
DL
spee
d
Total SCALE no impairment of selective motor control = 20
rho=0.40
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RESULTS…
• Lower limb spasticity (ASAStot)
• Lower limb spasticity (MAStot)
• Lower limb Muscle strength (MMTtot)
• Selective Voluntary Motor Control (SCALE)
• Passive knee extension
• Maximum static step length
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Passive knee extension
0.00
0.50
1.00
1.50
2.00
2.50
-75.00 -56.25 -37.50 -18.75 0.00 18.75
DL
spee
d
flexion extension
Top 7 & more than 2 yrs RR experience
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RESULTS…
• Lower limb spasticity (ASAStot)
• Lower limb spasticity (MAStot)
• Lower limb Muscle strength (MMTtot)
• Selective Voluntary Motor Control (SCALE)
• Passive knee extension
• Maximum static step length
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Maximum static step length
0.00
0.50
1.00
1.50
2.00
2.50
-37.50 0.00 37.50 75.00 112.50
Step length (cm)
DL
spe
ed
Top 7 & more than 2 yrs RR experience
rho=0.48
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So what do we know now?
• Spasticity, lack of muscle strength, lack of selective motor control and a knee flexion contracture of ≥ 20° are negatively associated with 100 m race speed.
• Experience of the athlete may need to be considered when interpreting results.
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21st International RaceRunning Camp & Cup, Copenhagen, July 2017
• Trunk Control Measurement Scale
• Multi joint co-ordination test
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0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
-5 0 5 10 15 20 25 30
dim
ensio
nle
ss r
unnin
g s
peed
impairment score (higher score, less impaired)
Total score with beta coefficients for SCALE, ASAS & TCMS
RR1
RR2
RR3
ataxia,
athetosis
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Ongoing & future research
• Expert consensus (Delphi)
• Performance measures (motion analysis)
• Ratio scale measures
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THANK YOU!
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Manual Muscle Testing
0 None No visible or palpable contraction
1 Trace Visible or palpable contraction with no motion
2 Poor Full ROM gravity eliminated
3 Fair Full ROM against gravity
4 Good Full ROM against gravity, moderate resistance
5 normal Full ROM against gravity, maximal resistance
SCORE
Outer 0 17
1 16
2 15
3 14
4 13
5 12
Mid 0 11
1 10
2 9
3 8
4 7
5 6
Inner 0 5
1 4
2 3
3 2
4 1
5 0
Daniels and Worthingham Scale
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METHODS:Selected impairment measures
• Spasticity (MAS, ASAS1)(hip flexors, hip adductors, knee extensors, plantar flexors)
• Muscle strength (MMT)
(hip extensors, hip abductors, hip flexors, knee extensors)
• Selective voluntary motor control (SCALE2)
• Passive Range of Motion (goniometry)
1Love et al 2Fowler et al, Balzer et al