Publications by authors named "Sonja de Groot"

138 Publications

Changes in body composition during and after inpatient rehabilitation in people with recent spinal cord injury.

Spinal Cord Ser Cases 2021 Sep 28;7(1):88. Epub 2021 Sep 28.

Amsterdam Rehabilitation Research Center Reade, Amsterdam, The Netherlands.

Study Design: Prospective cohort study.

Objectives: To investigate changes in body composition parameters in people with recent spinal cord injury (SCI) during their first inpatient rehabilitation and up to 1 year after discharge and whether those potential changes over time varied between different personal and lesion characteristics groups.

Setting: Rehabilitation center, the Netherlands.

Methods: People with recent SCI (≥18 years; n = 53) were tested around admission (T0) and discharge (T1) of inpatient rehabilitation. A sub-group (n = 19) was measured 1 year after discharge (T2). Personal and lesion characteristics were registered at T0. Anthropometry (height, body mass, body mass index, and waist circumference) was performed at T0, T1, and T2. Bioelectrical impedance analysis (BIA) was measured at T0 and T1.

Results: During inpatient rehabilitation, no significant changes in all body composition parameters were found. During the first year after discharge, body mass index (26.8 kg/m) significantly increased compared with the level at both admission (25.4 kg/m; p = 0.01, 95% CI: 0.32-2.52) and discharge (25.1 kg/m; p = 0.02, 95% CI: 0.26-3.00). People with paraplegia showed an increase in absolute waist circumference (6.5%) compared with people with tetraplegia who showed a net decrease (-5.5%) in the year after discharge (p = 0.047, 95% CI: 0.27-33.62).

Conclusions: A stable body composition during inpatient rehabilitation is followed by an increased BMI in the year after discharge in people with recent SCI. People with paraplegia showed an increase in absolute waist circumference compared with people with tetraplegia who showed a net decrease in the year after discharge.
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http://dx.doi.org/10.1038/s41394-021-00446-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479094PMC
September 2021

Accuracy of bioelectrical impedance analysis and skinfold thickness in the assessment of body composition in people with chronic spinal cord injury.

Spinal Cord 2021 Aug 12. Epub 2021 Aug 12.

Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.

Study Design: Cross-sectional study.

Objectives: This study: (1) investigated the accuracy of bioelectrical impedance analysis (BIA) and skinfold thickness relative to dual-energy X-ray absorptiometry (DXA) in the assessment of body composition in people with spinal cord injury (SCI), and whether sex and lesion characteristics affect the accuracy, (2) developed new prediction equations to estimate fat free mass (FFM) and percentage fat mass (FM%) in a general SCI population using BIA and skinfolds outcomes.

Setting: University, the Netherlands.

Methods: Fifty participants with SCI (19 females; median time since injury: 15 years) were tested by DXA, single-frequency BIA (SF-BIA), segmental multi-frequency BIA (segmental MF-BIA), and anthropometry (height, body mass, calf circumference, and skinfold thickness) during a visit. Personal and lesion characteristics were registered.

Results: Compared to DXA, SF-BIA showed the smallest mean difference in estimating FM%, but with large limits of agreement (mean difference = -2.2%; limits of agreement: -12.8 to 8.3%). BIA and skinfold thickness tended to show a better estimation of FM% in females, participants with tetraplegia, or with motor incomplete injury. New equations for predicting FFM and FM% were developed with good explained variances (FFM: R = 0.94; FM%: R = 0.66).

Conclusions: None of the measurement techniques accurately estimated FM% because of the wide individual variation and, therefore, should be used with caution. The accuracy of the techniques differed in different subgroups. The newly developed equations for predicting FFM and FM% should be cross-validated in future studies.
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http://dx.doi.org/10.1038/s41393-021-00682-wDOI Listing
August 2021

Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study.

JMIR Form Res 2021 08 9;5(8):e24909. Epub 2021 Aug 9.

see Acknowledgments, .

Background: Maintaining a healthy lifestyle is important for wheelchair users' well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population.

Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness.

Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g).

Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57).

Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale.
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http://dx.doi.org/10.2196/24909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386360PMC
August 2021

Response to Letter to the Editor on "Traditional Cardiovascular Risk Factors Strongly Underestimate the 5-Year Occurrence of Cardiovascular Morbidity and Mortality in Spinal Cord Injured Individuals".

Arch Phys Med Rehabil 2021 Jul 18. Epub 2021 Jul 18.

Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands.

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http://dx.doi.org/10.1016/j.apmr.2021.05.019DOI Listing
July 2021

Vascular adaptations in nonstimulated areas during hybrid cycling or handcycling in people with a spinal cord injury: a pilot study of 10 cases.

Spinal Cord Ser Cases 2021 Jun 30;7(1):54. Epub 2021 Jun 30.

Vrije University Amsterdam and Reade, Amsterdam, The Netherlands.

Study Design: Sub-study of a randomized controlled trial.

Objectives: To examine if hybrid cycling (cycling with the legs via electrical stimulation combined with voluntary handcycling) compared to handcycling leads to different systemic vascular adaptations in individuals with a long-term spinal cord injury (SCI).

Setting: Two rehabilitation centers in the Netherlands.

Methods: Ten individuals with a SCI trained on a hybrid bicycle (N = 5) or a handcycle (N = 5) for 16 weeks twice a week. Prior to and following the training the intima media thickness (IMT) of the common coronary artery (CCA) and superficial femoral artery (SFA) were measured and the flow-mediated dilation (FMD) of the brachial artery (BA) was analyzed.

Results: Before training, there were no significant differences in any of the outcome measures between the groups. We found no change in CCA IMT (pre: 0.616 mm, post: 0.586 mm), or in SFA (pre: 0.512 mm, post: 0.520 mm) after hybrid cycling. We also found no change in FMD % of BA after hybrid cycling (pre: 9.040%, post: 9.220%). There were no changes in CCA IMT, SFA IMT, and FMD% after handcycling either.

Conclusions: It appears that 16 weeks of twice-weekly training of up to 30 min on a hybrid bicycle or handcycle does not lead to systemic vascular adaptations. A larger sample size and training protocol with more frequent and higher intensity training (which might involve a home-based setting and an adapted period prior to the training) might show different results.
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http://dx.doi.org/10.1038/s41394-021-00417-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245507PMC
June 2021

RehabMove2018: active lifestyle for people with physical disabilities; mobility, exercise & sports.

Disabil Rehabil 2021 Jun 29:1-2. Epub 2021 Jun 29.

Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

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http://dx.doi.org/10.1080/09638288.2021.1940319DOI Listing
June 2021

A Role for Trunk Function in Elite Recumbent Handcycling Performance?

J Sports Sci 2021 Jun 3:1-10. Epub 2021 Jun 3.

Swedish School of Sport and Health Science (GIH), Stockholm, Sweden.

Handcycling classification considers trunk function, but there is limited scientific evidence of trunk involvement in recumbent performance. This study investigated the association between trunk function and recumbent handcycling performance of athletes without upper-limb impairments (H3-H4 sport classes). The study was divided into two parts. First, 528 time-trial results from 81 handcyclists with spinal cord injury (SCI) were obtained between 2014 and 2020. Average time-trial velocity was used as performance measure and SCI level as trunk function determinant. Multilevel regression analysis was performed to analyse differences in performance among SCI groups while correcting for lesion completeness, sex, and age. Second, in 26 handcyclists, standardised trunk flexion strength was measured with a handheld dynamometer. Peak and mean power-output from a sprint test and time-trial average velocity were used as performance measures. Spearman correlations were conducted to investigate the association between trunk strength and performance. Results showed that the different SCI groups did not exhibit significant differences in performance. Furthermore, trunk flexion strength and performance exhibited non-significant weak to moderate correlations (for time-trial speed: rs = 0.36; p = 0.07). Results of both analyses suggest that trunk flexion strength does not seem to significantly impact recumbent handcycling performance in athletes without upper-limb impairments.
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http://dx.doi.org/10.1080/02640414.2021.1930684DOI Listing
June 2021

Comparison of two Borg exertion scales for monitoring exercise intensity in able-bodied participants, and those with paraplegia and tetraplegia.

Spinal Cord 2021 May 26. Epub 2021 May 26.

Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.

Study Design: Cross-sectional cohort study.

Objectives: To compare ratings of perceived exertion (RPE) on Borg's 6-20 RPE scale and Category Ratio 10 (CR10) in able-bodied (AB) participants during upper and lower body exercise, and recreationally active participants with paraplegia (PARA) and athletes with tetraplegia (TETRA) during upper body exercise only.

Setting: University and rehabilitation centre-based laboratories in UK and Netherlands.

Methods: Twenty-four participants were equally split between AB, PARA, and TETRA. AB performed maximal tests using cycle (AB-CYC) and handcycle (AB-HC) ergometry. PARA and TETRA performed maximal handcycle and wheelchair propulsion tests, respectively. Oxygen uptake (V̇O) and blood lactate concentration were monitored throughout. RPE was rated each stage on Borg's RPE scale and CR10. Thresholds were identified according to log-V̇O plotted against log-blood lactate (LT), and 1.5 mmol L greater than LT (LT).

Results: RPE from both scales were best fit against each other using a quadratic model, with high goodness of fit between scales that was independent of exercise mode and participant group (range R: 0.965-0.970, P < 0.005). Though percentage peak V̇O was significantly greater in TETRA (P < 0.005), there was no difference in RPE at LT or LT between groups on Borg's RPE scale or CR10.

Conclusion: Strong association between Borg's RPE scale and CR10 suggests they can be used interchangeably. RPE at lactate thresholds were independent of mode of exercise and level of spinal cord injury. However, inter-individual variation precludes from making firm recommendations about using RPE for prescribing homogenous exercise intensity.
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http://dx.doi.org/10.1038/s41393-021-00642-4DOI Listing
May 2021

The relation between sprint power and road time trial performance in elite para-cyclists.

J Sci Med Sport 2021 Nov 3;24(11):1193-1198. Epub 2021 May 3.

Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands; Rehabilitation Research Center Amsterdam, Reade Amsterdam, the Netherlands. Electronic address:

Objectives: Whilst cycling performance has been studied extensively, very little is known about the performance of para-cyclists. This study assessed the relation between sprint power and road time trial performance in elite para-cyclists, and whether this relation differed based on impairment type and type of bike used.

Design: Cross-sectional.

Methods: During international para-cycling events, 168 athletes (88 bicycles, 17 tricycles, 56 recumbent handbikes and 7 kneeling handbikes) performed 20-s sport-specific sprint tests (mean power output (POmean) W), and their road time trial performance (average speed (km/h)) was taken from the official results. Multilevel regression models to assess the relation of sprint with time trial performance were composed for i. leg-cyclists: bicycle and tricycle and ii. arm-cyclists: recumbent- and kneeling handbike, adjusted for identified confounders. Furthermore, impairment type (categorized as i) muscle power/range of motion, ii) limb deficiency/leg length difference, and iii) coordination) and bike type were tested as effect modifiers.

Results: POmean ranged from 303 ± 12 W for recumbent handcyclists to 482 ± 156 W for bicyclists. POmean was significantly related to time trial performance, for both leg-cyclists (β = 0.010, SE = 0.003, p < 0.01) and arm-cyclists (β = 0.029; SE = 0.005, p < 0.01), and impairment type and bike type were not found to be effect modifiers.

Conclusions: Sprint power was related to road time trial performance in all para-cyclists, with no differences found in this relation based on impairment type nor bike type. For those competing on a bicycle, tricycle, recumbent- or kneeling handbike, sprint tests might therefore be useful to predict or monitor time trial performance.
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http://dx.doi.org/10.1016/j.jsams.2021.04.014DOI Listing
November 2021

Inertial measurement units to estimate drag forces and power output during standardised wheelchair tennis coast-down and sprint tests.

Sports Biomech 2021 Apr 26:1-19. Epub 2021 Apr 26.

Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

The purpose of this study was to describe and explore an inertial measurement unit-based method to analyse drag forces and external power loss in wheelchair tennis, using standardised coast-down and 10 m sprint tests. Drag forces and power output were explored among different wheelchair-athlete combinations and playing conditions (tyre pressure, court-surface). Eight highly trained wheelchair tennis players participated in this study. Three inertial measurement units (IMUs) were placed on the frame and axes of the wheels of their wheelchair. All players completed a set of three standardised coast-down trials and two 10 m sprints with different tyre pressures on hardcourt surface. One athlete completed additional tests on a clay/grass tennis-court. Coast-down based drag forces of 4.8-7.2 N and an external power loss of 9.6-14.4 W at a theoretical speed of 2 m/s were measured on hardcourt surface. A higher tyre pressure led to lower drag forces during coast-down tests on hardcourt surface (F (4) = 10.7, p = 0.03). For the single athlete, there was an external power loss of 10.4, 15.6 and 49.4 W, respectively, for the hardcourt, clay and grass. The current prediction of power output was implemented during coast-down testing; unfortunately, the power prediction during 10 m sprints was difficult to accomplish.
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http://dx.doi.org/10.1080/14763141.2021.1902555DOI Listing
April 2021

Criterion Validity of a Field-Based Assessment of Aerobic Capacity in Wheelchair Rugby Athletes.

Int J Sports Physiol Perform 2021 Mar 2:1-6. Epub 2021 Mar 2.

Purpose: To confirm whether peak aerobic capacity determined during laboratory testing could be replicated during an on-court field-based test in wheelchair rugby players.

Methods: Sixteen wheelchair rugby players performed an incremental speed-based peak oxygen uptake (V˙O2peak) test on a motorized treadmill (TM) and completed a multistage fitness test (MFT) on a basketball court in a counterbalanced order, while spirometric data were recorded. A paired t test was performed to check for systematic error between tests. A Bland-Altman plot for V˙O2peak illustrated the agreement between the TM and MFT results and how this related to the boundaries of practical equivalence.

Results: No significant differences between mean V˙O2peak were reported (TM: 1.85 [0.63] vs MFT: 1.81 [0.63] L·min-1; P = .33). Bland-Altman plot for V˙O2peak suggests that the mean values are in good agreement at the group level; that is, the exact 95% confidence limits for the ratio systematic error (0.95-1.02) are within the boundaries of practical equivalence (0.88-1.13) showing that the group average TM and MFT values are interchangeable. However, consideration of the data at the level of the individual athlete suggests that the TM and MFT results were not interchangeable because the 95% ratio limits of agreement either coincide with the boundaries of practical equivalence (upper limit) or fall outside (lower limit).

Conclusions: Results suggest that the MFT provides a suitable test at a group level with this cohort of wheelchair rugby players for the assessment of V˙O2peak (range 0.97-3.64 L·min-1), yet caution is noted for interchangeable use of values between tests for individual players.
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http://dx.doi.org/10.1123/ijspp.2020-0517DOI Listing
March 2021

Feasibility of overnight electrical stimulation-induced muscle activation in people with a spinal cord injury. A Pilot study.

Spinal Cord Ser Cases 2020 01 24;6(1). Epub 2020 Jan 24.

Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands.

Study Design: We investigated whether overnight ES is a feasible method to activate gluteal, quadriceps, and hamstrings muscles in a two-week experiment. Electrical stimulation (ES) induced muscle contractions have proven positive effects on risk factors for developing pressure ulcers in people with a spinal cord injury (SCI). Therefore prolonged overnight ES-induced muscle activation is interesting, but has never been studied.

Objective: To study feasibility of ES-induced leg muscle activation. In eight participants with motor complete SCI gluteal, hamstrings and quadriceps muscles were activated with a 2-weeks overnight stimulation protocol, 8 h per night, using specially developed ES-shorts.

Setting: The Netherlands.

Methods: Muscle fatigue was determined with a muscle contraction sensor. Questionnaires on sleep quality (SQ) and the ES-shorts usability were taken.

Results: After 8 h of activation muscles still contracted, although fatigue occurred, and mean contraction size was lower at the end of a cycle (p = 0.03). SQ (0-100) after intervention was 75, and 66 after 4 weeks without overnight ES (p = 0.04) indicating ES improves sleep quality. The usability of the ES-shorts was good.

Conclusions: This study shows that overnight ES-induced muscle activation using ES-shorts in SCI is a new, feasible method that does not interfere with sleep. The nightly use of the ES-shorts might be considered as an important part of the daily routine in SCI.
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http://dx.doi.org/10.1038/s41394-019-0254-0DOI Listing
January 2020

Exercise for people with SCI: so important but difficult to achieve.

Spinal Cord 2021 01 19;59(1):1-2. Epub 2021 Jan 19.

Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1038/s41393-020-00587-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813972PMC
January 2021

The interaction between wheelchair configuration and wheeling performance in wheelchair tennis: a narrative review.

Sports Biomech 2021 Jan 12:1-22. Epub 2021 Jan 12.

University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, The Netherlands.

The number of wheelchair tennis players is rising internationally, yet from a scientific perspective little is known about wheelchair tennis performance. Wheelchair tennis is more complex compared to other wheelchair court sports, due to the wheelchair/racket interaction. The purpose of this narrative review was to gain insight into the influence of wheelchair configuration, i.e., the individual set-up of a wheelchair, on wheelchair tennis performance, more specifically on wheelchair mobility performance and propulsion technique. Wheelchair propulsion while holding a racket has had little attention in both the wheelchair mobility performance and wheelchair propulsion technique area. It is shown that the propulsion technique and wheelchair mobility performance are negatively affected by the racket. Based on the current literature, the influence of wheelchair configuration on wheeling performance in wheelchair tennis can mainly be described from a broader wheelchair court sport perspective, due to the lack of specific publications about wheelchair tennis. In the future more research should be conducted on wheeling performance and wheelchair configuration in wheelchair tennis, to attain a more proper scientific foundation for optimising wheelchair tennis performance.
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http://dx.doi.org/10.1080/14763141.2020.1840617DOI Listing
January 2021

The Course of Physical Capacity in Wheelchair Users During Training for the HandbikeBattle and at 1-Yr Follow-up.

Am J Phys Med Rehabil 2021 09;100(9):858-865

From the Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee (IK, LJMV); University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen (IK, LHVvdW, SdG); Amsterdam Rehabilitation Research Center | Reade, Amsterdam (IK, SdG); Center of Excellence for Rehabilitation Medicine, UMCU Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht (MWMP); University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen (MWMP, AG, LHVvdW); Department of Rehabilitation, Sint Maartenskliniek, Nijmegen (LMW); and Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands (SdG).

Objective: The aims of this study were (1) to compare physical capacity at 1-yr follow-up with physical capacity before and after the training period for the HandbikeBattle event and (2) to identify determinants of the course of physical capacity during follow-up.

Design: This was a prospective observational study. Former rehabilitation patients (N = 33) with health conditions such as spinal cord injury or amputation were included. A handcycling/arm crank graded exercise test was performed before (January, T1) and after the training period (June, T2) and at 1-yr follow-up (June, T4). Outcomes were peak power output (W) and peak oxygen uptake (L/min). Determinants were sex (male/female); age (years); classification; physical capacity, musculoskeletal pain, exercise stage of change, and exercise self-efficacy at T1; and HandbikeBattle participation at T4.

Results: Multilevel regression analyses showed that peak power output and peak oxygen uptake increased during the training period and did not significantly change during follow-up (T1: 112 ± 37 W, 1.70 ± 0.48 L/min; T2: 130 ± 40 W, 2.07 ± 0.59 L/min; T4: 126 ± 42 W, 2.00 ± 0.57 L/min). Participants who competed again in the HandbikeBattle showed slight improvement in physical capacity during follow-up, whereas participants who did not compete again showed a decrease.

Conclusion: Physical capacity showed an increase during the training period and remained stable after 1-yr follow-up. Being (repeatedly) committed to a challenge might facilitate long-term exercise maintenance.
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http://dx.doi.org/10.1097/PHM.0000000000001658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360672PMC
September 2021

Improvements in Muscle Strength Are Associated With Improvements in Walking Capacity in Young Children With Cerebral Palsy: A Secondary Analysis.

Pediatr Phys Ther 2021 01;33(1):24-30

Amsterdam Rehabilitation Research Center/Reade (Drs van Vulpen and de Groot), Amsterdam, the Netherlands; Centre for Human Movement Sciences, University Medical Center Groningen, University of Groningen (Dr de Groot), Groningen, the Netherlands; Department of Rehabilitation Medicine, School for Public Health and Primary Care (CAPHRI) (Dr Rameckers), Maastricht University, Maastricht, the Netherlands, and Rehabilitation Science, University of Hasselt (Dr Rameckers), Hasselt, Belgium, and Adelante Center of Expertise in Rehabilitation and Audiology (Dr Rameckers), Valkenburg and Hoensbroek, the Netherlands, and University for Professionals for Pediatric Physical Therapy, AVANSplus (Dr Rameckers), Breda, the Netherlands; Amsterdam Movement Sciences, Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam (Drs Becher and Dallmeijer), Amsterdam, the Netherlands.

Purpose: To evaluate whether changes in lower-limb muscle strength explain changes in walking capacity during 14-week periods of usual care, power training and follow-up for children with spastic cerebral palsy.

Methods: Secondary analysis of a previously conducted double-baseline controlled trial of 22 children with spastic cerebral palsy. Generalized estimating equations were used to evaluate the relationships between within-subject changes in isometric muscle strength and walking capacity over 3 periods.

Results: Changes in hip abductor strength were associated with changes in the Muscle Power Sprint Test, changes in gastrocnemius and hip abductor strength were associated with changes in the Shuttle Run Test, and changes in gastrocnemius strength were associated with changes in the 1-minute walk test. All associations supported better walking capacity with increased strength.

Conclusion: Walking capacity, especially sprint capacity, can be improved by increasing strength by functional power training in this population.
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http://dx.doi.org/10.1097/PEP.0000000000000764DOI Listing
January 2021

Training for the HandbikeBattle: an explorative analysis of training load and handcycling physical capacity in recreationally active wheelchair users.

Disabil Rehabil 2020 Nov 4:1-10. Epub 2020 Nov 4.

University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.

Purpose: (1) to analyze training characteristics of recreationally active wheelchair users during handcycle training, and (2) to examine the associations between training load and change in physical capacity.

Methods: Former rehabilitation patients ( = 60) with health conditions such as spinal cord injury or amputation were included. Participants trained for five months. A handcycling/arm crank graded exercise test was performed before and after the training period. Outcomes: peak power output per kg (POpeak/kg) and peak oxygen uptake per kg (VOpeak/kg). Training load was defined as Training Impulse (TRIMP), which is rating of perceived exertion (sRPE) multiplied by duration of the session, in arbitrary units (AU). Training intensity distribution (TID) was also determined (time in zone 1, RPE ≤4; zone 2, RPE 5-6; zone 3, RPE ≥7).

Results: Multilevel regression analyses showed that TRIMP was not significantly associated with change in physical capacity. Time in zone 2 (RPE 5-6) was significantly associated with ΔVOpeak, %ΔVOpeak, ΔVOpeak/kg and %ΔVOpeak/kg.

Conclusion: Training at RPE 5-6 was the only determinant that was significantly associated with improvement in physical capacity. Additional controlled studies are necessary to demonstrate causality and gather more information about its usefulness, and optimal handcycle training regimes for recreationally active wheelchair users.IMPLICATIONS FOR REHABILITATIONMonitoring of handcycle training load is important to structure the training effort and intensity over time and to eventually optimize performance capacity. This is especially important for relatively untrained wheelchair users, who have a low physical capacity and a high risk of overuse injuries and shoulder pain.Training load can be easily calculated by multiplying the intensity of the training (RPE 0-10) with the duration of the training in minutes.Results on handcycle training at RPE 5-6 intensity in recreationally active wheelchair users suggests to be promising and should be further investigated with controlled studies.
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http://dx.doi.org/10.1080/09638288.2020.1839974DOI Listing
November 2020

Evaluation of cardiovascular disease risk in individuals with chronic spinal cord injury.

Spinal Cord 2021 Jul 17;59(7):716-729. Epub 2020 Oct 17.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.

Study Design: Multicentre, cross-sectional study.

Objectives: To identify which markers of obesity, injury characteristics and autonomic function variables are related to cardiovascular disease (CVD) risk after spinal cord injury (SCI), and establish cut-points for detection and risk management.

Setting: Eight SCI rehabilitation centres in the Netherlands.

Methods: Individuals (n = 257) with a traumatic, chronic (≥10 years) SCI, with age at injury between 18 and 35 years, completed a self-report questionnaire and a one-day visit to a rehabilitation centre for testing. Three anthropometric measures were tested: body mass index (BMI); waist circumference (WC); and waist-to-height ratio (WHtR). Injury characteristics included: American Spinal Injury Association impairment scale (AIS); duration of injury (DOI); and neurological level of injury (LOI). Cardiovascular autonomic function was assessed from peak heart rate during maximal exercise (HR). Systolic arterial pressure (SAP) and aerobic capacity (VO) were also determined. CVD risk was calculated using the Framingham risk score (FRS).

Results: All anthropometric variables were associated with FRS, with WC showing the strongest correlation (r = 0.41, p < 0.001) and greatest area under the curve (0.73) for 10-year CVD risk (%). WC, DOI, SAP, HR, LOI, and VO (variable importance: 0.81, 1.0, 0.98, 0.98, 0.66, 0.68, respectively) were important predictive variables for 10-year CVD risk in individuals with SCI.

Conclusions: We confirm that WC is a simple, practical measure of CVD risk, and along with DOI and markers of cardiovascular autonomic function, plays a role in the increased CVD risk following SCI.
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http://dx.doi.org/10.1038/s41393-020-00566-5DOI Listing
July 2021

Do Handcycling Time-Trial Velocities Achieved by Para-Cycling Athletes Vary Across Handcycling Classes?

Adapt Phys Activ Q 2020 Oct 6;37(4):461-480. Epub 2020 Oct 6.

Swedish School of Sport.

The classification system for handcycling groups athletes into five hierarchical classes, based on how much their impairment affects performance. Athletes in class H5, with the least impairments, compete in a kneeling position, while athletes in classes H1 to H4 compete in a recumbent position. This study investigated the average time-trial velocity of athletes in different classes. A total of 1,807 results from 353 athletes who competed at 20 international competitions (2014-2018) were analyzed. Multilevel regression was performed to analyze differences in average velocities between adjacent pairs of classes, while correcting for gender, age, and event distance. The average velocity of adjacent classes was significantly different (p < .01), with higher classes being faster, except for H4 and H5. However, the effect size of the differences between H3 and H4 was smaller (d = 0.12). Hence, results indicated a need for research in evaluating and developing evidence-based classification in handcycling, yielding a class structure with meaningful performance differences between adjacent classes.
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http://dx.doi.org/10.1123/apaq.2019-0143DOI Listing
October 2020

Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review.

Disabil Rehabil 2020 Sep 9:1-15. Epub 2020 Sep 9.

Center for Human Movement Sciences Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Aim: In this narrative review the potential and importance of handcycling are evaluated. Four conceptual models form the framework for this review; (1) the International Classification of Functioning, Disability and Health; (2) the Stress-Strain-Capacity model; (3) the Human-Activity-Assistive Technology model; and (4) the power balance model for cyclic exercise.

Methods: Based on international handcycle experience in (scientific) research and practice, evidence-based benefits of handcycling and optimization of handcycle settings are presented and discussed for rehabilitation, daily life and recreational sports.

Results: As the load can be distributed over the full 360 cycle in handcycling, peak stresses in the shoulder joint and upper body muscles reduce. Moreover, by handcycling regularly, the physical capacity can be improved. The potential of handcycling as an exercise mode for a healthy lifestyle should be recognized and advocated much more widely in rehabilitation and adapted sports practice.The interface between handcycle and its user should be optimized by choosing a suitable person-specific handcycle, but mainly by optimizing the handcycle dimensions to one's needs and desires. These dimensions can influence efficient handcycle use and potentially improve both endurance and speed of handcycling.

Conclusion: To optimize performance in rehabilitation, daily life and recreational sports, continued and more systematic research is required.Implications for rehabilitationHandcycling allows users to travel farther distances at higher speeds and to train outdoors. It should be recognized as an alternative exercise modality for daily outdoor use, also already in early rehabilitation, while it contributes to a healthy lifestyle.To individualize handcycle performance, the user-handcycle (assistive device) interface as well as the vehicle mechanics should be optimized to minimize external power and reduce friction, so that the upper body capacity can be efficiently used.To optimize handcycling individual performance, both the physiological and biomechanical aspects of handcycling should be considered when monitoring or testing handcycle exercise.
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http://dx.doi.org/10.1080/09638288.2020.1815872DOI Listing
September 2020

Traditional Cardiovascular Risk Factors Strongly Underestimate the 5-Year Occurrence of Cardiovascular Morbidity and Mortality in Spinal Cord Injured Individuals.

Arch Phys Med Rehabil 2021 01 27;102(1):27-34. Epub 2020 Aug 27.

Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address:

Objectives: To explore whether traditional models of cardiovascular disease (CVD) risk prediction correctly predict CVD events across a median 5.7-year follow-up period in individuals with spinal cord injury (SCI) and whether adding SCI-related characteristics (ie, lesion level) to the prediction model can improve the prognostic value.

Design: Retrospective analysis of patient records.

Setting: Observation at the start of active rehabilitation of participants in a multicenter cohort study, "Restoration of (Wheelchair) Mobility in SCI Rehabilitation," in the Netherlands.

Participants: Patients with SCI (N=200) The patients were 74% men, aged 40±14 years, and with an American Spinal Injury Association (ASIA) impairment score of A through D. Forty percent had tetraplegia, and 69% were motor complete.

Interventions: Risk profiling/not applicable.

Main Outcome Measures: Survival status and cardiovascular morbidity and mortality qwere obtained from medical records. Five-year Framingham Risk Scores (FRS) and the FRS ability to predict events assessed using receiver operating characteristic (ROC) curves with corresponding areas under the curve (AUC) and 95% confidence intervals (CI). Kaplan-Meier curves and the log-rank test were used to assess the difference in clinical outcome between participants with an FRS score lower or higher than the median FRS score for the cohort. SCI-related factors associated with CVD events, ASIA impairment, motor completeness, level of injury, and sports participation before injury were explored using univariate and multivariate Cox proportional hazard regression.

Results: The median 5-year FRS was 1.36%. Across a median follow-up period of 5.7 years, 39 developed a CVD event, including 10 fatalities. Although the FRS markedly underestimated the true occurrence of CVD events, the Kaplan-Meier curves and the log-rank test showed that the risk ratio for individuals with an FRS score less than the median FRS (eg, low risk) versus a score greater than the median FRS (high risk) was 3.2 (95% CI, 1.6-6.5; P=.001). Moreover, ROC with corresponding AUCs suggests acceptable accuracy of the FRS to identify individuals with increased risk for future CVD events (ROC AUC of 0.71; 95% CI, 0.62-0.82). Adding ASIA impairment (0.74; 95% CI, 0.66-0.82), motor impairment (0.74; 95% CI, 0.66-0.83), level of injury (0.72; 95% CI, 0.63-0.81), or active engagement in sport before injury (0.72; 95% CI, 0.63-0.88) to the FRS did not improve the level of discrimination.

Conclusions: Our 5.7-year retrospective study reveals that cardiovascular risk factors and risk models markedly underestimate the true risk for CVD events in individuals with SCI. Nonetheless, these markers successfully distinguish between SCI individuals at high versus low risk for future CVD events. Our data may have future clinical implications, both related to (cutoff values of) CVD risk factors, but also for (earlier) prescription of (non)pharmacologic strategies against CVD in SCI individuals.
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http://dx.doi.org/10.1016/j.apmr.2020.07.013DOI Listing
January 2021

Rehabilitation: mobility, exercise & sports; a critical position stand on current and future research perspectives.

Disabil Rehabil 2020 Aug 17:1-16. Epub 2020 Aug 17.

Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of "RehabMove" congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration.

Methods: This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress.

Results: The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate "human and technology asset management" at both individual and organization levels and over the lifespan.

Conclusions: With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention.IMPLICATIONS FOR REHABILITATIONContinued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences.Notions from "human and technology asset management and ergonomics" are fundamental to rehabilitation practice and research.The rehabilitation concept will further merge into general health care and the quality there-off.
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http://dx.doi.org/10.1080/09638288.2020.1806365DOI Listing
August 2020

Sport participation after the HandbikeBattle: benefits, barriers, facilitators from the event-a follow-up survey.

Spinal Cord Ser Cases 2020 06 29;6(1):54. Epub 2020 Jun 29.

University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.

Objectives: To investigate sports participation among individuals in the HandbikeBattle project 1.5-5.5 years after the event, the barriers and facilitators to sport participation and benefits of participating in the event.

Setting: Former participants of the HandbikeBattle, a handcycling race on an Austrian mountain.

Methods: Handcyclists who took part in one or more HandbikeBattle events in 2013-2017 were invited to complete a survey in December 2018. Questions were asked on benefits of participating in this event, current sport participation, and experienced barriers and facilitators regarding current sport participation.

Results: Respondents (N = 96 (N = 59 with spinal cord injury (SCI) or Spina Bifida (SB)), response rate = 47%) reported benefits from this event regarding their fitness level (90%), personal development (81%), daily life activities (66%), and health (64%). Median current sport participation was 5 h/week (IQR: 3-8). Most frequently indicated personal barriers for sports participation were: lack of time (31%), disability (17%), and pain (15%). Most frequently mentioned environmental barriers were: transportation time to sport accommodation (19%), and lack of peers to do sports with (16%). Most important facilitators were motivation to improve health and/or fitness (92%), fun and/or relaxation (85%). The results for the subgroup with SCI were comparable with the results of the total group.

Conclusions: Results highlight the role sports challenges can have in establishing a sustainable active life lifestyle among people with disabilities.
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http://dx.doi.org/10.1038/s41394-020-0301-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324566PMC
June 2020

Determining and Controlling External Power Output During Regular Handrim Wheelchair Propulsion.

J Vis Exp 2020 02 5(156). Epub 2020 Feb 5.

Center for Human Movement Sciences, University Medical Center Groningen; Center for Rehabilitation, University Medical Center Groningen.

The use of a manual wheelchair is critical to 1% of the world's population. Human powered wheeled mobility research has considerably matured, which has led to improved research techniques becoming available over the last decades. To increase the understanding of wheeled mobility performance, monitoring, training, skill acquisition, and optimization of the wheelchair-user interface in rehabilitation, daily life, and sports, further standardization of measurement set-ups and analyses is required. A crucial stepping-stone is the accurate measurement and standardization of external power output (measured in Watts), which is pivotal for the interpretation and comparison of experiments aiming to improve rehabilitation practice, activities of daily living, and adaptive sports. The different methodologies and advantages of accurate power output determination during overground, treadmill, and ergometer-based testing are presented and discussed in detail. Overground propulsion provides the most externally valid mode for testing, but standardization can be troublesome. Treadmill propulsion is mechanically similar to overground propulsion, but turning and accelerating is not possible. An ergometer is the most constrained and standardization is relatively easy. The goal is to stimulate good practice and standardization to facilitate the further development of theory and its application among research facilities and applied clinical and sports sciences around the world.
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http://dx.doi.org/10.3791/60492DOI Listing
February 2020

Changes in Quality of Life During Training for the HandbikeBattle and Associations With Cardiorespiratory Fitness.

Arch Phys Med Rehabil 2020 06 29;101(6):1017-1024. Epub 2020 Jan 29.

Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands.

Objective: To investigate (1) changes in life satisfaction and mental health during 5 months of training for the HandbikeBattle and 4 months of follow-up; (2) associations between changes in handcycling cardiorespiratory fitness and changes in life satisfaction and mental health during the training period.

Design: This is a multicenter prospective cohort study with the following measurements: the start of the training (T1), after the 5-month training period, before the event (T2), and after 4 months of follow-up (T3). At T1, T2, and T3, questionnaires were filled out. At T1 and T2, a graded exercise test was performed to measure cardiorespiratory fitness (peak oxygen consumption [Vopeak] and peak power output [POpeak]).

Setting: Ten Dutch rehabilitation centers training for the HandbikeBattle event.

Participants: Patients with a rehabilitation history (N=136) and health conditions such as spinal cord injury, amputation, or multiple trauma history.

Interventions: Not applicable.

Main Outcome Measure: Life satisfaction as the sum score of 2 questions (range, 2-13) and the Mental Health subscale of the 36-item Short Form Health Survey (range, 0-100).

Results: Multilevel regression analyses showed that life satisfaction increased during the training period and did not significantly change during follow-up (mean ± SD, T1: 8.2±2.2; T2: 8.6±2.3; T3: 8.5±2.4). Mental health showed no change over time (T1: 77.7±14.5; T2: 77.8±14.5; T3: 75.7±16.5). An improvement in cardiorespiratory fitness was associated with an increase in life satisfaction (POpeak, ß=0.014, P=.046; Vopeak, ß=1.068, P=.04). There were no associations between improvement in cardiorespiratory fitness and an increase in mental health (POpeak, P=.66; Vopeak, P=.33).

Conclusions: This study shows a positive course of life satisfaction during training for the HandbikeBattle. An improvement in cardiorespiratory fitness was longitudinally associated with an increase in life satisfaction. Mental health showed no changes over time.
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http://dx.doi.org/10.1016/j.apmr.2019.12.015DOI Listing
June 2020

Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation: Perspectives of rehabilitation professionals and wheelchair users.

PLoS One 2020 31;15(1):e0228465. Epub 2020 Jan 31.

Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands.

Objective: This study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users.

Methods: Five focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model.

Results: Reported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends.

Conclusions: Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228465PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993975PMC
April 2020

Feasibility of overnight electrical stimulation-induced muscle activation in people with a spinal cord injury. A Pilot study.

Spinal Cord Ser Cases 2020 24;6. Epub 2020 Jan 24.

Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands.

Study Design: We investigated whether overnight ES is a feasible method to activate gluteal, quadriceps, and hamstrings muscles in a two-week experiment. Electrical stimulation (ES) induced muscle contractions have proven positive effects on risk factors for developing pressure ulcers in people with a spinal cord injury (SCI). Therefore prolonged overnight ES-induced muscle activation is interesting, but has never been studied.

Objective: To study feasibility of ES-induced leg muscle activation. In eight participants with motor complete SCI gluteal, hamstrings and quadriceps muscles were activated with a 2-weeks overnight stimulation protocol, 8 h per night, using specially developed ES-shorts.

Setting: The Netherlands.

Methods: Muscle fatigue was determined with a muscle contraction sensor. Questionnaires on sleep quality (SQ) and the ES-shorts usability were taken.

Results: After 8 h of activation muscles still contracted, although fatigue occurred, and mean contraction size was lower at the end of a cycle ( = 0.03). SQ (0-100) after intervention was 75, and 66 after 4 weeks without overnight ES ( = 0.04) indicating ES improves sleep quality. The usability of the ES-shorts was good.

Conclusions: This study shows that overnight ES-induced muscle activation using ES-shorts in SCI is a new, feasible method that does not interfere with sleep. The nightly use of the ES-shorts might be considered as an important part of the daily routine in SCI.
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http://dx.doi.org/10.1038/s41394-019-0254-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981179PMC
July 2021

Motor learning outcomes of handrim wheelchair propulsion during active spinal cord injury rehabilitation in comparison with experienced wheelchair users.

Disabil Rehabil 2021 05 26;43(10):1429-1442. Epub 2019 Oct 26.

Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Purpose: To investigate changes in wheelchair propulsion technique and mechanical efficiency across first five weeks of active inpatient spinal cord injury rehabilitation and to compare the outcomes at discharge with experienced wheelchair users with spinal cord injury.

Methods: Eight individuals with recent spinal cord injury performed six weekly submaximal exercise tests. The first and last measurement additionally contained a wheelchair circuit and peak graded exercise test. Fifteen experienced individuals performed all above-mentioned tests on one occasion.

Results: Mechanical efficiency and propulsion technique did not change during the five weeks of inpatient rehabilitation. Peak power output during peak graded test and performance time on the wheelchair circuit improved between the first and the last week. No difference in propulsion technique, peak power output, and performance time was found between the persons with a recent injury and the experienced group. Mechanical efficiency was higher after the correction for the difference in relative power output in the experienced group.

Conclusion: The group with a recent injury did not improve mechanical efficiency and propulsion technique over the period of active rehabilitation, despite significant improvements on the wheelchair circuit and in work capacity. The only significant difference between the groups was found in mechanical efficiency.Implications for rehabilitationThe lack of time-dependent changes in mechanical efficiency and propulsion technique in the group with a recent spinal cord injury, combined with the lack of differences in technique, work capacity and on the wheelchair circuit between the groups, suggest that important adaptations of motor learning may happen even earlier in rehabilitation and emphasize that the group in active rehabilitation was relatively skilled.Standardized observational analyses of handrim wheelchair propulsion abilities during early spinal cord injury rehabilitation provide detailed understanding of wheelchair technique, skill as well as wheelchair propulsion capacity.Measurement of external power output is critical to interpretation of gross efficiency, propulsion technique, and capacity.Wheelchair quality and body weight - next to wheelchair fitness and skill - require careful consideration both in early rehabilitation as well as in the chronic phase of spinal cord injury.
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http://dx.doi.org/10.1080/09638288.2019.1668484DOI Listing
May 2021

The influence of protocol design on the identification of ventilatory thresholds and the attainment of peak physiological responses during synchronous arm crank ergometry in able-bodied participants.

Eur J Appl Physiol 2019 Oct 21;119(10):2275-2286. Epub 2019 Aug 21.

Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Purpose: To examine the effects of stage duration on power output (PO), oxygen uptake (VO), and heart rate (HR) at peak level and ventilatory thresholds during synchronous arm crank ergometry.

Methods: Nineteen healthy participants completed a ramp, 1-min stepwise, and 3-min stepwise graded arm crank exercise test. PO, VO and HR at the first and second ventilatory threshold (VT1, VT2) and peak level were compared among the protocols: a repeated measures analysis of variance was performed to test for systematic differences, while intraclass correlation coefficients (ICC) and Bland-Altman plots were calculated to determine relative and absolute agreement.

Results: Systematic differences among the protocols were found for PO at VT1, VT2, and peak level. At peak level, PO differed significantly among all protocols (ramp: 115 ± 37 W; 1-min stepwise: 108 ± 34 W; 3-min stepwise: 94 ± 31 W, p ≤ 0.01). No systematic differences for HR or VO were found among the protocols. VT1 and VT2 were identified at 52% and 74% of VOpeak, respectively. The relative agreement among protocols varied (ICC 0.02-0.97), while absolute agreement was low with small-to-large systematic error and large random error.

Conclusions: PO at VTs and peak level was significantly higher in short-stage protocols compared with the 3-min stepwise protocol, whereas HR and VO showed no differences. Therefore, training zones based on PO determined in short-stage protocols might give an overestimation. Moreover, due to large random error in HR at VTs between the protocols, it is recommended that different protocols should not be used interchangeably within individuals.
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http://dx.doi.org/10.1007/s00421-019-04211-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763408PMC
October 2019

Effects of functional power training on gait kinematics in children with cerebral palsy.

Gait Posture 2019 09 16;73:168-172. Epub 2019 Jul 16.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands. Electronic address:

Background: Muscle weakness is one of the most prevalent symptoms in children with cerebral palsy (CP). Although recent studies show that functional power training can improve strength and functional capacity in young children with CP, effects on specific gait parameters have not previously been reported.

Research Question: What are the effects of functional power training on gait in children with CP? Specifically, we investigated effects of training on gait kinematics and spatiotemporal parameters, and whether these were dependent on walking speed.

Methods: Ten children with CP (age 5-10 years, GMFCS I-II) participated in a functional power training program. At the start and end of the program, children underwent 3D gait analysis on a treadmill at a gradual range of walking speeds (70-175% of their comfortable walking speed). Multilevel (linear mixed model) analysis was used to evaluate effects pre-post training at different walking velocities.

Results: Although children's self-chosen comfortable walking speed improved (0.71 ± 0.25 to 0.85 ± 0.25 m/s, p < .05), effects on gait kinematics at similar speed were limited and only exceeded statistical and clinically meaningful thresholds when children walked at higher walking speed. At fast speeds, improvements up to 5° were found in knee and hip extension during stance (p < .01).

Significance: This study demonstrates that gait kinematics can improve after functional power training, but the magnitude of effects is dependent on walking speed. In this light, improvements are underestimated when evaluating gait at pre-training comfortable walking speed only.
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http://dx.doi.org/10.1016/j.gaitpost.2019.06.023DOI Listing
September 2019
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