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