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See detailReproducibility of a tennis serve protocol
Tubez, François ULg; FORTHOMME, Bénédicte ULg; Croisier, Jean-Louis ULg et al

Conference (2016, July 08)

INTRODUCTION Serve in modern tennis game is a real offensive weapon for players. In kinematic analysis, it is the most studied stroke of this game because it is the only stroke played in a closed skill ... [more ▼]

INTRODUCTION Serve in modern tennis game is a real offensive weapon for players. In kinematic analysis, it is the most studied stroke of this game because it is the only stroke played in a closed skill. Players have a maximum of control on this stroke. It is unclear whether 3D kinematic tests are reproducible for the same player under identical conditions and if a familiarization session is necessary. In practice, with professional players, who have little time available to perform tests, familiarization sessions are difficult. The aim of our study is to measure the reproducibility of a 3D serve protocol test. METHODS Nine tennis players (righties, regional level, 20 ± 2 years) were asked to hit first flat serves in a 1 m² area placed on the "T" zone of deuce diagonal of the tennis court. Two identical tests are performed one week apart. For each test, we selected the three best serves of the 25 trials (with the highest speed and the highest accuracy). Kinetics measurements were performed using a 3D analysis system (Codamotion), a force platform (Kistler) and a radar gun. 28 markers were placed on the players’ bodies to measure kinematics of the movements: ankles, knees, hips, trunk, shoulder, elbow and wrist dominant side. We measured ball speed, leg drive, linear velocity of the racket and joints, joints range of motion and maximum angular velocities at different positions (armed, maximum external rotation and impact) (1). RESULTS All analyzed parameters (linear speeds of racket and joints, leg drive force, joint angles and angular velocities) are reproducible with exception of a small part of them. Our study shows that 5,7% (7 of 122 measurements) joint position parameters and 8,3% (4 of 48 measures) angular velocity parameters are not reproducible from a session to another. DISCUSSION Various errors sources encountered in 3D analysis can justify the presence of non-reproducible parameters (2-3). However, after this work, we can state that the established protocol provides reproducible results when analyzing the tennis serve. [less ▲]

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See detailValidity and reliability of the French translation of the Patient-Related Tennis Elbow Evaluation Questionnaire
Kaux, Jean-François ULg; DELVAUX, François ULg; SCHAUS, Jean ULg et al

in Crossing borders through sport science (2016, July)

Background: The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire was created to measure pain and ... [more ▼]

Background: The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire was created to measure pain and functional disabilities specifically reported in patient with lateral epicondylitis (tennis elbow). Developed in English, this questionnaire has since then been translated into several languages but not in French. Objectives: The aims of the study were to translate and cross-culturally adapt the PRTEE questionnaire into French and to evaluate the reliability and validity of this new version of the questionnaire (PRTEE-F). Methods: The PRTEE was cross-culturally adapted into French according to the international guidelines. To assess the reliability and validity of the PRTEE-F, 115 participants filled in the PRTEE-F twice, and the Disabilities of Arm, Shoulder and Hand questionnaire (DASH) and the Short Form Health Survey (SF-36) once. Internal consistency (with Cronbach’s alpha), test-retest reliability (with intra-class correlation (ICC)), convergent and divergent validity (by calculating the Spearman’s correlation coefficients with the DASH and some sub scales of the SF-36, respectively) were assessed. Results: The PRTEE was translated in French without problem. PRTEE-F showed a good test-retest reliability for the overall score (ICC 0.83) and for each items (ICC 0.71-0.9) and a high internal consistency (Cronbach’s alpha = 0.98). The correlation analyses revealed high correlation coefficients between PRTEE-F and DASH (good convergent validity) and, as expected, a low or moderate correlations with the divergent subscales of the SF-36 (discriminant validity). There was no floor or ceiling effect. Conclusions: The PRTEE questionnaire was successfully cross-culturally adapted into French the PRTEE-F is reliable and valid for evaluating the French-speaking patient with lateral elbow tendinopathy. [less ▲]

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See detailA Comparison of 3D Methods for Identifying the Stance Phase in Treadmill Running for Both Rearfoot and Forefoot Runners
Deflandre, Dorian ULg; Schwartz, Cédric ULg; Weertz et al

in Journal of sports Science (2016), 4

We compared six 3D methods, OptoGait, and Myotest Run for the determination of contact time for runners with different foot strike patterns. Twenty male participants were divided into two groups: the heel ... [more ▼]

We compared six 3D methods, OptoGait, and Myotest Run for the determination of contact time for runners with different foot strike patterns. Twenty male participants were divided into two groups: the heel group, who attack the ground with the heel (n = 12), and the toe group, who attack the ground with the middle/front of the foot (n = 8). They performed trials at speeds of 8 km/h then 16 km/h. To detect foot strike, the use of peak velocity of 3D markers located on the heel, the fifth metatarsal, and the great toe provided the best results for both groups. To detect the toe off, the minimum vertical position of a 3D marker placed in line with the great toe gave the most satisfactory results for both groups. In this way, the values of contact time measured with the 3D methods are consistent. Values measured with OptoGait appear consistent too, while those of the Myotest Run underestimate the contact time for both speeds. 3D analysis provides interesting opportunities for calculation of contact time for both rearfoot and forefoot runners, using specific peak velocities to determine foot strike and marker displacement to determine toe off. [less ▲]

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See detailCross-cultural adaptation and validation of the victorian institute of sport assessment-patella questionnaire for French-speaking patients with patellar tendinopathy
Kaux, Jean-François ULg; Delvaux, François ULg; Oppong-Kyei, Julian et al

in Journal of Orthopaedic & Sports Physical Therapy (2016), 46(5), 384-393

Study Design Clinical measurement study. Background The Victorian Institute of Sports Assessment–Patellar tendinopathy questionnaire (VISA-P), originally developed in English, assesses the severity of ... [more ▼]

Study Design Clinical measurement study. Background The Victorian Institute of Sports Assessment–Patellar tendinopathy questionnaire (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. No French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P in French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in six steps: initial translation, translation merging, back translation to the original language, expert committee to reach a pre-final version, test of the pre-final version, and expert committee appraisal of a final version. Afterwards, the psychometric properties the final French version (VISA-PF) were assessed in 92 subjects, divided into three groups: pathological subjects (n = 28), asymptomatic subjects (n = 22) and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100 (asymptomatic subject), the average scores of the VISA-PF obtained were 53 (± 17) for the pathological group, 99 (± 2) for the healthy group and 86 (± 14) for the sports-risk group. The test-retest reliability of the VISA-PF was excellent and good internal consistency. Correlations between the VISA-PF and diverging validity of the SF-36 were low and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid and suitable for French-speaking patients with patellar tendinopathy. [less ▲]

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See detailMuscular and functional tridimensional analysis after hamstring strain
Paulus, Julien ULg; DELVAUX, François ULg; Schwartz, Cédric ULg et al

in European Journal of Physical and Rehabilitation Medicine (2016, April), 52(2), 263

Introduction The muscle injury, and more especially the hamstring strain, account for a large proportion of explosive top athletes injuries [1-3]. The subsequent down-time period has some sports and ... [more ▼]

Introduction The muscle injury, and more especially the hamstring strain, account for a large proportion of explosive top athletes injuries [1-3]. The subsequent down-time period has some sports and financial negatives consequences for the athlete, his team and/or his club [4, 5]. Despite the rehabilitation before return to play and prevention program, hamstring reinjury rates are still high (26% of all injuries) [6] and it's commonly accepted that a second injury is more severe than a first episode [2]. A more functional test could help the clinician in the return to play process decision to reduce the muscle injuries hamstring relapse. Purpose The aim of our methodology is to analyze, after medical clearance to resume sports activities, for athletes who suffered from grade II/III hamstring muscle strain, the biomechanics of the lower limbs during an explosive jump task. Method After (7,3±0,7 weeks) a grade II or III hamstring muscle tear, eight men (25±5,9 years), without past lower limb major injury, performed: - an isokinetic test (knee maximal flexion-extension in concentric at 60°.s-1 and 240°.s-1 and knee maximal flexion in eccentric at 30°.s-1); - a tridimensional biomechanics analysis of (bipodal and unipodal) squat jump and counter movement jump with Codamotion® system and Kistler® multicomponent force plates. Results A muscular lateral strength imbalance (±10% with p-value < 0,02) has been identified on the hamstring in concentric and eccentric by means of isokinetic testing, with the healthy side stronger than the pathologic. The main statistical significant outcome in the biomechanics analysis is the lower knee angle (±12% with p-value < 0,02) at the low point before the concentric pushing phase of the unipodal CMJ for the healthy leg than to the other one whereas there's no difference between both legs in an equivalent healthy population. Discussion & conclusion The tridimensional analysis appears to be complementary, not redundant, with the isokinetic strength testing due to the different nature of their informations obtained. It could be integrated in the return to play process decision expected the potentially interesting information about the player's biomechanics that it provides. References 1. Ekstrand, J., M. Hagglund, and M. Walden, Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med, 2011. 39(6): p. 1226-32. 2. Ekstrand, J., M. Hagglund, and M. Walden, Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med, 2011. 45(7): p. 553-8. 3. Lopez, V., Jr., et al., Profile of an American amateur rugby union sevens series. Am J Sports Med, 2012. 40(1): p. 179-84. 4. Price, R.J., et al., The Football Association medical research programme: an audit of injuries in academy youth football. Br J Sports Med, 2004. 38(4): p. 466-71. 5. Verrall, G.M., et al., Assessment of player performance following return to sport after hamstring muscle strain injury. J Sci Med Sport, 2006. 9(1-2): p. 87-90. 6. Brooks, J.H., et al., Incidence, risk, and prevention of hamstring muscle injuries in professional rugby union. Am J Sports Med, 2006. 34(8): p. 1297-306. [less ▲]

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See detailExploring the effect of a second closely-timed infiltration of platelet-rich plasma to treat proximal patellar tendinopathies
Kaux, Jean-François ULg; CROISIER, Jean-Louis ULg; FORTHOMME, Bénédicte ULg et al

in European Journal of Physical and Rehabilitation Medicine (2016, April), 54(Suppl. 1 No. 2), 199

Intorduction: Some clinical series have evaluated the effect of platelet-rich plasma (PRP) in the treatment of jumper’s knee. Although it is possible that a single infiltrative administration may prove to ... [more ▼]

Intorduction: Some clinical series have evaluated the effect of platelet-rich plasma (PRP) in the treatment of jumper’s knee. Although it is possible that a single infiltrative administration may prove to be an effective treatment for this indication, most of the existing studies evaluated the effects of 2 or 3 successive infiltrations. Purpose: The aim of this study was to evaluate whether 2 infiltrations of PRP proves more effective than a single treatment. Methods: Twenty patients suffering from chronic jumper’s knee were enrolled into the study and split into two randomized groups (1 or 2 infiltrations of PRP, respectively). The 3-month follow-up evaluation consisted of VAS, IKDC and VISA-P scores, along with algometer, isokinetic and ultrasounds evaluations. After 1 year, subjects were contacted to define their functional evolution. Results: The concentration of the PRP used for each infiltration was similar in both groups, and contained no red or white cells. Results revealed no difference in treatment efficacy between the groups. Discussion and Conclusion: The comparison between 1 or 2 infiltrations of PRP did not reveal any difference between the 2 groups at short to mid term. A second closely-timed infiltration of PRP to treat jumper’s knees is not necessary to improve the efficacy of this treatment in the short term. A second infiltration should perhaps be envisaged later, but this remains to be demonstrated. [less ▲]

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See detailIs isokinetic exercise dangerous for the heart?
Le Goff, Caroline ULg; Kaux, Jean-François ULg; Cavalier, Etienne ULg et al

in European Journal of Physical and Rehabilitation Medicine (2016, April), 52(suppl. 1 No. 2), 457

INTRODUCTION: Very strenuous exercises can be performed on an isokinetic dynamometer in order to evaluate the resistance to fatigue of different muscular groups. Good cardiac function is necessary in ... [more ▼]

INTRODUCTION: Very strenuous exercises can be performed on an isokinetic dynamometer in order to evaluate the resistance to fatigue of different muscular groups. Good cardiac function is necessary in order to perform these very intensive exercises; otherwise an acute myocardial dysfunction could theoretically appear in predisposed patients. PURPOSE: Our study aimed to observe the cardiovascular impact (by biological point of view) of maximal intense isokinetic eccentric and concentric protocols performed by a population of sedentary young men. METHOD: Resting (T0) and post-exercise (just after (T1), 3 hours (T2) and 24 hours after the exercise (T3)) blood samples were taken in 2 populations of young sedentary men: 12 subjects (22.5±1.15 yo) for the eccentric protocol and 18 subjects (22.4±2.6 yo) for the concentric protocol. These subjects performed an intense maximal isokinetic exercise of the quadriceps muscles involving 30 knee flexions–extensions for each leg. We evaluated markers of cardiovascular risk (highly sensitive troponin T (hs-TnT), N-Terminal Brain natriuretic peptide (NT-proBNP), myoglobin (MYO)), of inflammation (highly sensitive C-reactive protein (hsCRP)), muscle damage (creatine kinase (CK)) and of oxidative stress (myeloperoxidase (MPO), lipidic peroxides (POXL), reduced (GSH) and oxidised glutathione (GSSG)). Haemodynamic parameters were measured continuously using a Portapres, and respiratory parameters were measured using a Sensormedics Vmax 29C. RESULTS: All the physiological parameters measured presented statistically significant changes. For the eccentric exercise, no significant modification in cardiac (NT-proBNP, hs-TNT) and inflammation (hsCRP) biomarkers was observed. However, a significant increase for CK (T3), MYO (T2), MPO (T1), POXL (T1), GSSG (T3) and ratio GSH/GSSG (T2-T3) was shown. For the concentric exercise, the results showed significant increases for the CK (T1-T2-T3), MYO (T1-T2), GSH/GSSG (T1). Evolutionary trends were also observed for the following biomarkers: NT-proBNP (T1-T2-T3), MPO (T2), and GSSG (T4). DISCUSSION and CONCLUSIONS: No modification in cardiac biomarkers was observed after the maximal eccentric isokinetic exercise but some variations can be observed for these biomarkers after the concentric exercise. However, these changes do not exceed the reference values in healthy subjects. We were thus able to prove that the exercise could be performed without any risk to cardiac function in young sedentary subjects. Nevertheless, a significant level of oxidative stress was induced by both exercises. [less ▲]

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See detailPhysical and muscle performances among elderly nursing home residents.
Buckinx, Fanny ULg; Reginster, Jean-Yves ULg; Croisier, Jean-Louis ULg et al

in Osteoporosis International (2016, April), 27(Supplement 1), 217

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See detailThe Total Work Measured During a High Intensity Isokinetic Fatigue Test Is Associated With Anaerobic Work Capacity
Bosquet, Laurent; Guadec, Kenan; Berryman, Nicolas et al

in Journal of Sports Science and Medicine (2016), 15(1), 126130

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See detailTraumatologie du joueur de tennis
Kaux, Jean-François ULg; Schaus, Jean; Delvaux, François ULg et al

in Journal de Traumatologie du Sport (2016), 33(1), 43-47

Tennis is a racquet sport with approximately 10 million licensees and 26 million unaffiliated players in Europe. Tennis injuries represent 21%of those generated by rackets sports. Tennis players are ... [more ▼]

Tennis is a racquet sport with approximately 10 million licensees and 26 million unaffiliated players in Europe. Tennis injuries represent 21%of those generated by rackets sports. Tennis players are subject to traumatic and microtraumatic pathologies. This epidemiological review oftennis-related injuries addresses their type and locations, the cause and time of absence, the demographic and gender differences, as well as theinfluence of technique of play and type of field on their impact. [less ▲]

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See detailUsing platelet-rich plasma to treat jumper’s knees: Exploring the effect of a second closely-timed infiltration
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Forthomme, Bénédicte ULg et al

in Journal of Science and Medicine in Sport (2016), 19(3), 200-204

Some clinical series have evaluated the effect of platelet-rich plasma (PRP) in the treatment of proximal patellar tendinopathy. Although it is possible that a single infiltrative administration may prove ... [more ▼]

Some clinical series have evaluated the effect of platelet-rich plasma (PRP) in the treatment of proximal patellar tendinopathy. Although it is possible that a single infiltrative administration may prove to be an effective treatment for this indication, most of the existing studies evaluated the effects of two or three successive infiltrations. The aim of this study was to evaluate whether two infiltrations of PRP proves more effective than a single treatment. DESIGN: Prospective, randomized and comparative study of level 2. METHODS: Twenty patients suffering from chronic proximal patellar tendinopathy were enrolled into the study and split into two randomized groups (one or two infiltrations of PRP, respectively). The 3-month follow-up evaluation consisted of VAS, IKDC and VISA-P scores, along with algometer, isokinetic and ultrasounds evaluations. After 1 year, subjects were contacted to define their functional evolution. RESULTS: The concentration of the PRP used for each infiltration was similar in both groups, and contained no red or white cells. Results revealed no difference in treatment efficacy between the groups. CONCLUSIONS: The comparison between one or two infiltrations of PRP did not reveal any difference between the two groups at short to mid term. A second closely-timed infiltration of PRP to treat proximal patellar tendinopathies is not necessary to improve the efficacy of this treatment in the short term. [less ▲]

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See detailEffects of twelve weeks of aerobic or strength training in addition to standard care in Parkinson’s disease: a controlled study
Demonceau, Marie ULg; MAQUET, Didier ULg; Jidovtseff, Boris ULg et al

in European Journal of Physical and Rehabilitation Medicine (2016), 52

BACKGROUND: Physical exercises in addition to standard care (SC) in patients with Parkinson’s disease (PD) are now common practice in many care units. However, exercises can cover a wide range of ... [more ▼]

BACKGROUND: Physical exercises in addition to standard care (SC) in patients with Parkinson’s disease (PD) are now common practice in many care units. However, exercises can cover a wide range of interventions, and the specific effects of different interventions still deserve to be further investigated. AIM: To compare the effects of 12 weeks of two different types of physical exercises with SC in patients suffering from PD. DESIGN: Pseudo-randomized controlled trial. SETTING: University laboratory for outcomes, University Hospital Centre for interventions. POPULATION: Fifty-two outpatients suffering from mild to moderate PD at baseline. METHODS: Participants were allocated to 3 groups: the strength training (ST) group performed individualized upper and lower limbs strength training, the aerobic training (AE) group performed tailored gradual aerobic cycling, and the third group received SC. The effects of the interventions on body function were assessed by measuring isokinetic concentric peak torque for knee extension and flexion, peak oxygen consumption (VO2peak) and peak work load (PWL) during an incremental maximal cycling test. Changes in mobility were evaluated from spatial-temporal gait features measured by mean of an accelerometer system and the six-minute walk distance (6mwd) test. We used questionnaires to estimate health-related quality of life and habitual physical activity. RESULTS: No significant changes in any outcome measures occurred in the SC group. More than 80% of the participants adequately completed the AE and the ST interventions. The ST group significantly improved all peak torque measures (p≤0.01), except knee extension in the least affected side (p=0.13). This group also improved the PWL (p=0.009) and 6mwd (p=0.03). The AE group improved the VO2peak (p=0.02) and PWL (p<0.001). CONCLUSION: Physical fitness in patients with PD rapidly improved in compliance with training specificities, but better fitness hardly translated into better mobility and health-related quality of life. CLINICAL REHABILITATION IMPACT: Physiotherapists can efficiently propose physical conditioning to patients with mild to moderate PD, but these interventions are insufficient to improve gait and participation. Notwithstanding, ST is an efficient intervention for improving walking capacity. [less ▲]

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See detailPrévention et prophylaxie dans les gestes et les performances
Delvaux, François ULg; Croisier, Jean-Louis ULg

Learning material (2016)

Ce module de formation abordé au niveau MS Entraîneur est un parfait complément au module CG2_Th4_Mod_2 « Prévention des blessures du geste sportif ». Au niveau MS Educateur l’accent a été mis sur les ... [more ▼]

Ce module de formation abordé au niveau MS Entraîneur est un parfait complément au module CG2_Th4_Mod_2 « Prévention des blessures du geste sportif ». Au niveau MS Educateur l’accent a été mis sur les principaux facteurs de risque pouvant entraîner une blessure. Il s’agissait de principes généraux. Le module dont il est question s’attachera davantage à définir et à proposer un processus réflexif pour l’entraîneur mettant en relation la prise de conscience d'un risque de blessure constaté ou pressenti avec son organisation et son intervention dans l’entraînement du geste sportif ; autrement dit de la « prophylaxie » spécifique aux phases d’entraînement et de compétition. [less ▲]

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See detailPrévention des blessures du geste sportif
Delvaux, François ULg; Croisier, Jean-Louis ULg

Learning material (2016)

L’activité sportive, qu’elle soit pratiquée par des athlètes de haut niveau ou plus modestement à un degré amateur, génère un nombre important de blessures. Afin d’agir efficacement de manière préventive ... [more ▼]

L’activité sportive, qu’elle soit pratiquée par des athlètes de haut niveau ou plus modestement à un degré amateur, génère un nombre important de blessures. Afin d’agir efficacement de manière préventive, l’entraîneur doit d’abord être capable d’identifier les facteurs qui pourraient prédisposer ou déclencher la lésion. Ensuite, il pourra, le cas échéant, proposer une action sur ces différents facteurs de risque, ce qui devrait réduire l’incidence et/ou la sévérité des blessures. Dans ce module, nous décrirons les différents facteurs de risque de blessure communs à une majorité de sports. Le moniteur sportif éducateur pourra donc transposer à sa propre discipline les éléments les plus importants et proposer une action à visée préventive. [less ▲]

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See detailExtraction of temporal gait parameters using a reduced number of wearable accelerometers
Boutaayamou, Mohamed ULg; Denoël, Vincent ULg; Bruls, Olivier ULg et al

in Proceedings of the 9th International Conference on Bio-inspired Systems and Signal Processing (2016)

Wearable inertial systems often require many sensing units in order to reach an accurate extraction of temporal gait parameters. Reconciling easy and fast handling in daily clinical use and accurate ... [more ▼]

Wearable inertial systems often require many sensing units in order to reach an accurate extraction of temporal gait parameters. Reconciling easy and fast handling in daily clinical use and accurate extraction of a substantial number of relevant gait parameters is a challenge. This paper describes the implementation of a new accelerometer-based method that accurately and precisely detects gait events/parameters from acceleration signals measured from only two accelerometers attached on the heels of the subject’s usual shoes. The first step of the proposed method uses a gait segmentation based on the continuous wavelet transform (CWT) that provides only a rough estimation of motionless periods defining relevant local acceleration signals. The second step uses the CWT and a novel piecewise-linear fitting technique to accurately extract, from these local acceleration signals, gait events, each labelled as heel strike (HS), toe strike (TS), heel-off (HO), toe-off (TO), or heel clearance (HC). A stride-by-stride validation of these extracted gait events was carried out by comparing the results with reference data provided by a kinematic 3D analysis system (used as gold standard) and a video camera. The temporal accuracy ± precision of the gait events were for HS: 7.2 ms ± 22.1 ms, TS: 0.7 ms ± 19.0 ms, HO: ‒3.4 ms ± 27.4 ms, TO: 2.2 ms ± 15.7 ms, and HC: 3.2 ms ± 17.9 ms. In addition, the occurrence times of right/left stance, swing, and stride phases were estimated with a mean error of ‒6 ms ± 15 ms, ‒5 ms ± 17 ms, and ‒6 ms ± 17 ms, respectively. The accuracy and precision achieved by the extraction algorithm for healthy subjects, the simplification of the hardware (through the reduction of the number of accelerometer units required), and the validation results obtained, convince us that the proposed accelerometer-based system could be extended for assessing pathological gait (e.g., for patients with Parkinson’s disease). [less ▲]

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See detailPhysical and muscle performances among elderly nursing home residents. Results fo the senior cohort
Buckinx, Fanny ULg; Reginster, Jean-Yves ULg; CROISIER, Jean-Louis ULg et al

in Journal of Frailty & Aging (2016), 5(Supplement 1), 69

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