Dieter Rosenbaum | University of Münster (original) (raw)

Papers by Dieter Rosenbaum

Background. Since 2006, the Italian National Institute of Health (ISS) has been conducting indepe... more Background. Since 2006, the Italian National Institute of Health (ISS) has been conducting independent scientific activities to standardize the technical assessment of plantar pressure measurement devices (PMDs). Material and methods. On the basis of the ISS results, in 2010 the Pedobarographic Group of the International Foot and Ankle Biomechanics community (i-FAB-PG) promoted a consensus activity about the main technical requirements for the appropriate use of PMDs. The activity relied on a moodlebased on-line forum, documents exchange, discussions, reviews, meetings and a final survey. Results. The participation of clinical and technical researchers, users, and manufacturers, contributed to the delivery of the hereby reported recommendations which specifically regard Medical PMDs in the form of platforms. Conclusions. The i-FAB-PG community reached overall agreement on the recommendations, with a few minor objections which are reported and commented in the document. Relevance. The present document, the highest result achievable within a small scientific community, will hopefully represent the starting point of the wider process of establishing official international guidelines or standards, within scientific communities and standardization organizations.

Journal of Foot and Ankle Research

Background: The peripheral complications of diabetes mellitus remain a significant risk to lower-... more Background: The peripheral complications of diabetes mellitus remain a significant risk to lower-limb morbidity. In New Zealand, risk of diabetes, comorbidity and lower-limb amputation are highly-differential between demographic groups, particularly ethnicity. There is growing and convincing evidence that the use of pedobarographyor plantar pressure measurementcan usefully inform diabetic foot care, particularly with respect to the prevention of re-ulceration among high-risk patients. Methods: For the current feasibility study, we embedded pedobarographic measurements into three unique diabetic foot clinic settings in the New Zealand context, and collected pedobarographic data from n = 38 patients with diabetes using a platform-based (Novel Emed) and/or in-shoe-based system (Novel Pedar). Our aim was to assess the feasibility of incorporating pedobarographic testing into the clinical care of diabetic feet in New Zealand. Results and Conclusions: We observed a high response rate and positive self-reported experience from participants. As part of our engagement with participants, we observed a high degree of lower-limb morbidity, including current ulceration and chronic foot deformities. The median time for pedobarographic testing (including study introduction and consenting) was 25 min. Despite working with a high-risk population, there were no adverse events in this study. In terms of application of pedobarography as a clinical tool in the New Zealand context, the current feasibility study leads us to believe that there are two avenues that deserve further investigation: a) the use of pedobarography to inform the design and effectiveness of offloading devices among high-risk diabetic patients; and b) the use of pedobarography as a means to increase offloading footwear and/or orthoses compliance among high-risk diabetic patients. Both of these objectives deserve further examination in New Zealand via clinical trial.

Monatsschrift Kinderheilkunde

Aufgrund kontinuierlich verbesserter Überlebensraten nach einer Krebserkrankung im Kindes- und Ju... more Aufgrund kontinuierlich verbesserter Überlebensraten nach einer Krebserkrankung im Kindes- und Jugendalter rücken vermehrt die Spätfolgen der Erkrankung und Therapie in den Vordergrund. Neben funktionellen Beeinträchtigungen wurde ein erhöhtes Risiko für eine eingeschränkte Alltagsaktivität beobachtet (Ginsberg et al., 2010). Eine Rehabilitationsmaßnahme soll die betroffenen Kinder und Jugendliche in der Entwicklung ihrer motorischen Fähigkeiten zur Vermeidung oder Einschränkung von Spätfolgen unterstützen. Dieser Beitrag untersucht den Einfluss einer vierwöchigen stationären Rehabilitationsmaßnahme in der Kinderklinik Bad Oexen hinsichtlich der Entwicklung des Gangbilds, der Alltagsaktivität und der Lebensqualität nach einer Krebserkrankung im Kindes- und Jugendalter.

Die Auswirkungen einer Hirn- oder Knochentumorerkrankung auf das Gangbild von Kindern und Jugendl... more Die Auswirkungen einer Hirn- oder Knochentumorerkrankung auf das Gangbild von Kindern und Jugendlichen sind bisher wissenschaftlich unzureichend untersucht. Während funktionelle Einschränkungen in der Regel über Fragebogenerhebungen (MSTS, TESS) beurteilt werden, sind objektiv erhobene Daten zum Gangbild von Kindern und Jugendlichen kaum vorhanden. Dieser Beitrag beschreibt Veränderungen im Bewegungsverhalten, die nach einer Hirn- oder Knochentumorerkrankung beobachtetet werden. Zudem werden Unterschiede zwischen den Diagnosegruppen sowie Entwicklungen beschrieben, die sich im Anschluss an eine vierwöchige stationäre Rehabilitationsmaßnahme erwarten lassen.

Fragestellung: Im Kindes- und Jugendalter führen Erkrankungen an Weichteil- und Knochentumoren un... more Fragestellung: Im Kindes- und Jugendalter führen Erkrankungen an Weichteil- und Knochentumoren und ihre Therapie insbesondere im Bereich der unteren Extremitäten regelhaft zu deutlichen Beeinträchtigungen der Gehfähigkeit [1]. In unserem Projekt wird untersucht, ob und in welchem Maße Kinder und Jugendliche, die an derartigen Einschränkungen leiden, von rehabilitativen Maßnahmen im Sinne der Verbesserung des Gangbildes und der Alltagsaktivität profitieren. Darüber hinaus geht die Untersuchung der Frage nach, ob sich das Aktivitätsniveau nachhaltig verbessert. Methodik: 39 Kinder und Jugendliche im Alter von 13,2±3,7 Jahren nach Knochen- und Weichteiltumorerkrankung wurden nach Aufklärung und schriftlichem Einverständnis zu Beginn und kurz vor Ende ihrer vierwöchigen stationären Rehabilitationsmaßnahme im Rahmen einer single center Studie in einer spezialisierten Rehabilitationsklinik mit den folgenden Methoden untersucht: Druckverteilungsmessung (DVM, Novel) und videobasierte Gangan...

Medicine & Science in sports & Exercise, 1992

One of several factors suspected in the development of lateral epicondylitis, often referred to a... more One of several factors suspected in the development of lateral epicondylitis, often referred to as tennis elbow, is the impact-induced vibration of the racket-and-arm system at ball contact. Using two miniature accelerometers at the wrist and the elbow of 24 tennis players, the effects of 23 different tennis racket constructions were evaluated in a simulated backhand stroke situation. The influences of body weight, skill level, and tennis racket construction onto the magnitude of vibrations at wrist and elbow were investigated. Amplitudes, integrals, and fourier components were used to characterize arm vibration. More than fourfold reductions in acceleration amplitude and integral were found between wrist and elbow. Off-center as compared with center ball impacts resulted in approximately three times increased acceleration values. Between subjects, body weight as well as skill level were found to influence arm vibration. Compared with proficient players, a group of less skilled subjects demonstrated increased vibration loads on the arm. Between different racket constructions, almost threefold differences in acceleration values could be observed. Increased racket head size as well as a higher resonance frequency of the racket were found to reduce arm vibration. The vibration at the arm after ball impact showed a strong inverse relationship (r = -0.88) with the resonance frequency of tennis rackets.

Medicine & Science in Sports & Exercise, 2010

Physical activities are important for the development of children and increasing evidence suggest... more Physical activities are important for the development of children and increasing evidence suggests beneficial effects of physical activity promotion during cancer treatment as well. The present study aimed at evaluating the current need of exercise interventions in pediatric cancer patients undergoing acute treatment and identifying risk factors for inactivity. Data about self-reported physical activity before and during treatment was collected in a cross-sectional design with the physical activity questionnaire from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in a modified cancer specific version. One hundred thirty pediatric cancer patients with various entities were questioned 3.0 ± 1.6 months since diagnosis. Patients' activity levels before diagnosis mainly matched reference values for healthy children in Germany. Reductions during treatment affected all dimensions of daily physical activities and minutes of exercise per week decreased significantly (P < 0.001). Largest reductions of physical activities during treatment were identified for bone tumor patients and in-patient stays. Due to the well known importance of physical activity during childhood and the identified risk of inactivity during cancer treatment, supervised exercise interventions should be implemented into acute treatment phase to enhance activity levels and ensure a continuously support by qualified exercise professionals.

Journal of Sports Sciences, 1995

... We focused on the acute effects of two extremes of preparatory exer-cises on Achilles tendon ... more ... We focused on the acute effects of two extremes of preparatory exer-cises on Achilles tendon tap reflexes: (1) a muscle-spe-cific exercise (ie passive, static hold-relax stretching) and (2) a general whole-body preparation (ie a 10-min warm-up of treadmill running following the ...

Journal of Biomechanics, 2002

The Standardization and Terminology Committee (STC) of the International Society of Biomechanics ... more The Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) proposes a general reporting standard for joint kinematics based on the Joint Coordinate System (JCS). first proposed by Grood and Suntay for the knee joint in 1983 (J. Biomech. ...

Archives of Orthopaedic and Trauma Surgery, 2009

Custom-made prosthesis in primary hip arthroplasty based on the concept of a better press-fitting... more Custom-made prosthesis in primary hip arthroplasty based on the concept of a better press-fitting to reach superior clinical results in comparison to conventional implants. Mid-term results provide a more complete picture with respect to gait and electromyographic analyses. The custom-made femoral component (Adaptiva) was implanted in 24 hips and compared to 23 hips with a conventional implant (Alloclassic-SL). The mean retrospective follow-up times were 3.9 (3-4.9) years and 4.8 (3.1-5.1) years. Clinically, the Harris Hip Score (HHS) and the SF 36 were recorded. Motion analysis data (body kinematics, kinetics and muscle activities) were recorded with 3D gait analysis. Neither the HHS nor the SF-36 revealed any statistical differences between the two groups (P > 0.05). The radiographic parameters did not show the intended physiologic load transfer. Periprosthetic changes indicated a more distal load transfer of the customized stem. Gait analysis revealed in comparison to the controls (45.03 degrees ), a reduced mean hip range of motion in the sagittal plane by 11.4% (39.9 degrees ) in the customized stem group versus 17.4% (37.2 degrees ) in the conventional stem group. In keeping with the limited range of hip motion kinematic impairments of the ipsilateral knee and ankle joints were detected. The electromyographic amplitudes of the tensor fasciae latae and gluteus medius muscles both for stabilizing the hip joint in the stance phase were significantly higher in both groups. Compared to a conventional cementless hip prosthesis the custom-made device did not improve the mid-term clinical and radiographic outcome. Despite the individualized reconstruction of the biomechanical hip geometry objective gait analysis failed to show a benefit.

Journal of Pediatric Hematology/Oncology, 2015

Reduced motor performance can negatively affect physical activity and social partake after childh... more Reduced motor performance can negatively affect physical activity and social partake after childhood cancer. Especially in bone tumor patients, who are at risk of physical limitations due to surgical interventions, motor performance has not yet been sufficiently investigated. Therefore, this study aimed at assessing motor performance in pediatric bone tumor patients. Motor performance was measured within 2 years posttreatment using the MOON (test for MOtor performance in pediatric ONcology) test. This instrument enables quantitative data collection even in physically impaired patients for comparison with age-matched and sex-matched reference values. Twenty-one patients (13 male) ages 15.2±2.1 years (median: 15 y, 10 to 19 y) and 9.4±7.4 months posttreatment (median: 6 mo, 2 to 24 mo) were tested. Motor performance was slightly reduced in muscular endurance of the legs; significantly reduced in speed, flexibility, eye-hand coordination, and muscular explosive strength (P<0.001), whereas patients' hand grip strength and static balance were superior to the reference values. Follow-up duration, body mass index, and tumor localization apparently affected motor performance. These findings show serious reductions in motor performance within 2 years after bone tumor treatment and highlight the need for interventions to improve motor performance. The results should be used to advise and support patients to engage in suitable physical and sports activities.

The Journal of Bone and Joint Surgery

Rotationplasty is considered to be a treatment option for patients who have had a primary maligna... more Rotationplasty is considered to be a treatment option for patients who have had a primary malignant bone tumor of the distal part of the femur or the proximal part of the tibia. The present study was performed to evaluate the muscle activity, the kinetics (range of motion of the hip and knee joints), and the kinematics (joint moments) after rotationplasty and to determine whether there was an association between these parameters and the functional outcome. Forty-three patients who had been managed with rotationplasty for the treatment of a femoral or tibial bone tumor were evaluated clinically and functionally. The mean age (and standard deviation) at the time of follow-up was 24.4 +/- 10.7 years (range, eight to sixty-eight years), the mean age at the time of the procedure was 17.8 +/- 10.2 years (range, seven to sixty-three years), and the mean duration of follow-up was 6.7 +/- 4.9 years (range, 0.7 to eighteen years). Instrumented gait and electromyographic analyses were performed. The qualitative data were compared with the functional outcome, which was determined with the functional evaluation score of the Musculoskeletal Tumor Society. Gait analysis revealed a fairly normal walking pattern with a slight limp and a lateral lean of the trunk over the ipsilateral limb that led to a reduced joint moment in the hip (moment on involved side, 68 percent [compared with a control group]; moment on uninvolved side, 81 percent). The ranges of motion of the hips (uninvolved side, 42.0 +/- 8.2 degrees; involved side, 42.4 +/- 8.0 degrees) and the knees (uninvolved side, 59.7 +/- 5.0 degrees; involved side [former ankle joint], 58.1 +/- 11.6 degrees) were symmetrical even though the knee-motion pattern of the involved limb indicated a slightly reduced extensor mechanism in 51 percent (twenty-two) and a markedly reduced extensor mechanism in 35 percent (fifteen) of the forty-three patients. Electromyography revealed function of the muscles of the involved limb, with comparable amplitudes in the involved and uninvolved limbs. The leg muscles of the involved limb were active in the stance phase (the soleus and the lateral and medial heads of the gastrocnemius) and the swing phase (the peroneus longus and the tibialis anterior) according to their function in relation to the new knee joint. The patients had a good functional result, with a mean score of 23.9 +/- 2.7 of 30 points. With the numbers available for study, we could not show the duration of follow-up to be related to the overall outcome, but the age at the time of the operation was related to the total functional score as well as to gait and walking ability (p < 0.05). The results of the electromyographic and gait analyses demonstrated good functional restoration of gait following rotationplasty.

Monatsschrift Kinderheilkunde

Objective: As survival rates of bone sarcoma patients have been raised owing to improved treatmen... more Objective: As survival rates of bone sarcoma patients have been raised owing to improved treatment strategies the focus of investigations is now on the medical, social, and economic sequelae of intensive multimodal treatment. The ongoing study (NCT00824083: “Functional and clinical long-term outcome of Ewing sarcoma treatment”; shortcut: SAM-Ewing; 2009–2014) aims to assess the long-term outcome in a representative sample of survivors of Ewing sarcoma. The data recorded combined with standardized treatment data covering a 30-year period will produce a data pool that is unique for its magnitude. Methods: The study provides for the assessment of the functional outcome, quality of life and the psychological status by means of validated tools (e. g., TESS, SF36 and BIS/BAS) and objectively measuring daily activity patterns by using the StepWatch Activity Monitor (SAM) in 900 long-term Ewing sarcoma survivors and a 1:2 matched control group of healthy subjects. Information on sarcoma tre...

Pediatric Blood & Cancer

Purpose: The main focus of tumor treatment is to cure the disease. This challenging struggle has ... more Purpose: The main focus of tumor treatment is to cure the disease. This challenging struggle has resulted in survival rates of up to 75% in localized Ewing sarcomas. Rising survival rates has led to increasing interest in long-term consequences of intensive multimodal bone tumor treatment. The ongoing cohort study 'Functional and Clinical Long-Term Outcome of Ewing Sarcoma Treatment* is aimed at analysing functional outcome and quality-of-life in long-term survivors of Ewing sarcoma with subjective and objective measurement tools. Method: Survivors of Ewing sarcoma diagnosed from 1980-2009 are recruited from phase III trials of the German Society of Pediatric Hematology and Oncology (GPOH). A first cohort of 118 former patients (47.5% female) with the longest follow-up was analyzed. Median follow-up was 22.3 years (range 12.8-28.9). Median age was 37.7 years (range 20.1-63.2). Outcome measures were a multi-tool questionnaire, i.e., including the Short Form Health Survey (SF-36),...

Journal of Cancer Research and Clinical Oncology

Objective: Substantial progress has been made in the management of childhood bone tumors over the... more Objective: Substantial progress has been made in the management of childhood bone tumors over the last 25 years. The current 10-year survival rate in localized Ewing sarcoma is approximately 70%, however, long-term impact of multidisciplinary treatment is not well documented. Also no data are available on the effect of multimodal therapy on the level of physical activity. The aim of this study was to objectively quantify the level of activity in long-term survivors of Ewing sarcoma using a continuous measurement device. All patients were treated according the consecutive Ewing sarcoma trials of the German Society of Pediatric Hematology and Oncology (GPOH). Methods: Subject of this analysis is a first series of 118 long-term survivors of Ewing sarcoma, initially diagnosed between 1981 and 1998. The median age at diagnosis was 14 years (range 2–45), median age at time of assessment was 38 years (range 20–63). Initial local therapy was surgery alone in 25 patients (21%), surgery and i...

Background. Since 2006, the Italian National Institute of Health (ISS) has been conducting indepe... more Background. Since 2006, the Italian National Institute of Health (ISS) has been conducting independent scientific activities to standardize the technical assessment of plantar pressure measurement devices (PMDs). Material and methods. On the basis of the ISS results, in 2010 the Pedobarographic Group of the International Foot and Ankle Biomechanics community (i-FAB-PG) promoted a consensus activity about the main technical requirements for the appropriate use of PMDs. The activity relied on a moodlebased on-line forum, documents exchange, discussions, reviews, meetings and a final survey. Results. The participation of clinical and technical researchers, users, and manufacturers, contributed to the delivery of the hereby reported recommendations which specifically regard Medical PMDs in the form of platforms. Conclusions. The i-FAB-PG community reached overall agreement on the recommendations, with a few minor objections which are reported and commented in the document. Relevance. The present document, the highest result achievable within a small scientific community, will hopefully represent the starting point of the wider process of establishing official international guidelines or standards, within scientific communities and standardization organizations.

Journal of Foot and Ankle Research

Background: The peripheral complications of diabetes mellitus remain a significant risk to lower-... more Background: The peripheral complications of diabetes mellitus remain a significant risk to lower-limb morbidity. In New Zealand, risk of diabetes, comorbidity and lower-limb amputation are highly-differential between demographic groups, particularly ethnicity. There is growing and convincing evidence that the use of pedobarographyor plantar pressure measurementcan usefully inform diabetic foot care, particularly with respect to the prevention of re-ulceration among high-risk patients. Methods: For the current feasibility study, we embedded pedobarographic measurements into three unique diabetic foot clinic settings in the New Zealand context, and collected pedobarographic data from n = 38 patients with diabetes using a platform-based (Novel Emed) and/or in-shoe-based system (Novel Pedar). Our aim was to assess the feasibility of incorporating pedobarographic testing into the clinical care of diabetic feet in New Zealand. Results and Conclusions: We observed a high response rate and positive self-reported experience from participants. As part of our engagement with participants, we observed a high degree of lower-limb morbidity, including current ulceration and chronic foot deformities. The median time for pedobarographic testing (including study introduction and consenting) was 25 min. Despite working with a high-risk population, there were no adverse events in this study. In terms of application of pedobarography as a clinical tool in the New Zealand context, the current feasibility study leads us to believe that there are two avenues that deserve further investigation: a) the use of pedobarography to inform the design and effectiveness of offloading devices among high-risk diabetic patients; and b) the use of pedobarography as a means to increase offloading footwear and/or orthoses compliance among high-risk diabetic patients. Both of these objectives deserve further examination in New Zealand via clinical trial.

Monatsschrift Kinderheilkunde

Aufgrund kontinuierlich verbesserter Überlebensraten nach einer Krebserkrankung im Kindes- und Ju... more Aufgrund kontinuierlich verbesserter Überlebensraten nach einer Krebserkrankung im Kindes- und Jugendalter rücken vermehrt die Spätfolgen der Erkrankung und Therapie in den Vordergrund. Neben funktionellen Beeinträchtigungen wurde ein erhöhtes Risiko für eine eingeschränkte Alltagsaktivität beobachtet (Ginsberg et al., 2010). Eine Rehabilitationsmaßnahme soll die betroffenen Kinder und Jugendliche in der Entwicklung ihrer motorischen Fähigkeiten zur Vermeidung oder Einschränkung von Spätfolgen unterstützen. Dieser Beitrag untersucht den Einfluss einer vierwöchigen stationären Rehabilitationsmaßnahme in der Kinderklinik Bad Oexen hinsichtlich der Entwicklung des Gangbilds, der Alltagsaktivität und der Lebensqualität nach einer Krebserkrankung im Kindes- und Jugendalter.

Die Auswirkungen einer Hirn- oder Knochentumorerkrankung auf das Gangbild von Kindern und Jugendl... more Die Auswirkungen einer Hirn- oder Knochentumorerkrankung auf das Gangbild von Kindern und Jugendlichen sind bisher wissenschaftlich unzureichend untersucht. Während funktionelle Einschränkungen in der Regel über Fragebogenerhebungen (MSTS, TESS) beurteilt werden, sind objektiv erhobene Daten zum Gangbild von Kindern und Jugendlichen kaum vorhanden. Dieser Beitrag beschreibt Veränderungen im Bewegungsverhalten, die nach einer Hirn- oder Knochentumorerkrankung beobachtetet werden. Zudem werden Unterschiede zwischen den Diagnosegruppen sowie Entwicklungen beschrieben, die sich im Anschluss an eine vierwöchige stationäre Rehabilitationsmaßnahme erwarten lassen.

Fragestellung: Im Kindes- und Jugendalter führen Erkrankungen an Weichteil- und Knochentumoren un... more Fragestellung: Im Kindes- und Jugendalter führen Erkrankungen an Weichteil- und Knochentumoren und ihre Therapie insbesondere im Bereich der unteren Extremitäten regelhaft zu deutlichen Beeinträchtigungen der Gehfähigkeit [1]. In unserem Projekt wird untersucht, ob und in welchem Maße Kinder und Jugendliche, die an derartigen Einschränkungen leiden, von rehabilitativen Maßnahmen im Sinne der Verbesserung des Gangbildes und der Alltagsaktivität profitieren. Darüber hinaus geht die Untersuchung der Frage nach, ob sich das Aktivitätsniveau nachhaltig verbessert. Methodik: 39 Kinder und Jugendliche im Alter von 13,2±3,7 Jahren nach Knochen- und Weichteiltumorerkrankung wurden nach Aufklärung und schriftlichem Einverständnis zu Beginn und kurz vor Ende ihrer vierwöchigen stationären Rehabilitationsmaßnahme im Rahmen einer single center Studie in einer spezialisierten Rehabilitationsklinik mit den folgenden Methoden untersucht: Druckverteilungsmessung (DVM, Novel) und videobasierte Gangan...

Medicine & Science in sports & Exercise, 1992

One of several factors suspected in the development of lateral epicondylitis, often referred to a... more One of several factors suspected in the development of lateral epicondylitis, often referred to as tennis elbow, is the impact-induced vibration of the racket-and-arm system at ball contact. Using two miniature accelerometers at the wrist and the elbow of 24 tennis players, the effects of 23 different tennis racket constructions were evaluated in a simulated backhand stroke situation. The influences of body weight, skill level, and tennis racket construction onto the magnitude of vibrations at wrist and elbow were investigated. Amplitudes, integrals, and fourier components were used to characterize arm vibration. More than fourfold reductions in acceleration amplitude and integral were found between wrist and elbow. Off-center as compared with center ball impacts resulted in approximately three times increased acceleration values. Between subjects, body weight as well as skill level were found to influence arm vibration. Compared with proficient players, a group of less skilled subjects demonstrated increased vibration loads on the arm. Between different racket constructions, almost threefold differences in acceleration values could be observed. Increased racket head size as well as a higher resonance frequency of the racket were found to reduce arm vibration. The vibration at the arm after ball impact showed a strong inverse relationship (r = -0.88) with the resonance frequency of tennis rackets.

Medicine & Science in Sports & Exercise, 2010

Physical activities are important for the development of children and increasing evidence suggest... more Physical activities are important for the development of children and increasing evidence suggests beneficial effects of physical activity promotion during cancer treatment as well. The present study aimed at evaluating the current need of exercise interventions in pediatric cancer patients undergoing acute treatment and identifying risk factors for inactivity. Data about self-reported physical activity before and during treatment was collected in a cross-sectional design with the physical activity questionnaire from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in a modified cancer specific version. One hundred thirty pediatric cancer patients with various entities were questioned 3.0 ± 1.6 months since diagnosis. Patients' activity levels before diagnosis mainly matched reference values for healthy children in Germany. Reductions during treatment affected all dimensions of daily physical activities and minutes of exercise per week decreased significantly (P < 0.001). Largest reductions of physical activities during treatment were identified for bone tumor patients and in-patient stays. Due to the well known importance of physical activity during childhood and the identified risk of inactivity during cancer treatment, supervised exercise interventions should be implemented into acute treatment phase to enhance activity levels and ensure a continuously support by qualified exercise professionals.

Journal of Sports Sciences, 1995

... We focused on the acute effects of two extremes of preparatory exer-cises on Achilles tendon ... more ... We focused on the acute effects of two extremes of preparatory exer-cises on Achilles tendon tap reflexes: (1) a muscle-spe-cific exercise (ie passive, static hold-relax stretching) and (2) a general whole-body preparation (ie a 10-min warm-up of treadmill running following the ...

Journal of Biomechanics, 2002

The Standardization and Terminology Committee (STC) of the International Society of Biomechanics ... more The Standardization and Terminology Committee (STC) of the International Society of Biomechanics (ISB) proposes a general reporting standard for joint kinematics based on the Joint Coordinate System (JCS). first proposed by Grood and Suntay for the knee joint in 1983 (J. Biomech. ...

Archives of Orthopaedic and Trauma Surgery, 2009

Custom-made prosthesis in primary hip arthroplasty based on the concept of a better press-fitting... more Custom-made prosthesis in primary hip arthroplasty based on the concept of a better press-fitting to reach superior clinical results in comparison to conventional implants. Mid-term results provide a more complete picture with respect to gait and electromyographic analyses. The custom-made femoral component (Adaptiva) was implanted in 24 hips and compared to 23 hips with a conventional implant (Alloclassic-SL). The mean retrospective follow-up times were 3.9 (3-4.9) years and 4.8 (3.1-5.1) years. Clinically, the Harris Hip Score (HHS) and the SF 36 were recorded. Motion analysis data (body kinematics, kinetics and muscle activities) were recorded with 3D gait analysis. Neither the HHS nor the SF-36 revealed any statistical differences between the two groups (P > 0.05). The radiographic parameters did not show the intended physiologic load transfer. Periprosthetic changes indicated a more distal load transfer of the customized stem. Gait analysis revealed in comparison to the controls (45.03 degrees ), a reduced mean hip range of motion in the sagittal plane by 11.4% (39.9 degrees ) in the customized stem group versus 17.4% (37.2 degrees ) in the conventional stem group. In keeping with the limited range of hip motion kinematic impairments of the ipsilateral knee and ankle joints were detected. The electromyographic amplitudes of the tensor fasciae latae and gluteus medius muscles both for stabilizing the hip joint in the stance phase were significantly higher in both groups. Compared to a conventional cementless hip prosthesis the custom-made device did not improve the mid-term clinical and radiographic outcome. Despite the individualized reconstruction of the biomechanical hip geometry objective gait analysis failed to show a benefit.

Journal of Pediatric Hematology/Oncology, 2015

Reduced motor performance can negatively affect physical activity and social partake after childh... more Reduced motor performance can negatively affect physical activity and social partake after childhood cancer. Especially in bone tumor patients, who are at risk of physical limitations due to surgical interventions, motor performance has not yet been sufficiently investigated. Therefore, this study aimed at assessing motor performance in pediatric bone tumor patients. Motor performance was measured within 2 years posttreatment using the MOON (test for MOtor performance in pediatric ONcology) test. This instrument enables quantitative data collection even in physically impaired patients for comparison with age-matched and sex-matched reference values. Twenty-one patients (13 male) ages 15.2±2.1 years (median: 15 y, 10 to 19 y) and 9.4±7.4 months posttreatment (median: 6 mo, 2 to 24 mo) were tested. Motor performance was slightly reduced in muscular endurance of the legs; significantly reduced in speed, flexibility, eye-hand coordination, and muscular explosive strength (P<0.001), whereas patients' hand grip strength and static balance were superior to the reference values. Follow-up duration, body mass index, and tumor localization apparently affected motor performance. These findings show serious reductions in motor performance within 2 years after bone tumor treatment and highlight the need for interventions to improve motor performance. The results should be used to advise and support patients to engage in suitable physical and sports activities.

The Journal of Bone and Joint Surgery

Rotationplasty is considered to be a treatment option for patients who have had a primary maligna... more Rotationplasty is considered to be a treatment option for patients who have had a primary malignant bone tumor of the distal part of the femur or the proximal part of the tibia. The present study was performed to evaluate the muscle activity, the kinetics (range of motion of the hip and knee joints), and the kinematics (joint moments) after rotationplasty and to determine whether there was an association between these parameters and the functional outcome. Forty-three patients who had been managed with rotationplasty for the treatment of a femoral or tibial bone tumor were evaluated clinically and functionally. The mean age (and standard deviation) at the time of follow-up was 24.4 +/- 10.7 years (range, eight to sixty-eight years), the mean age at the time of the procedure was 17.8 +/- 10.2 years (range, seven to sixty-three years), and the mean duration of follow-up was 6.7 +/- 4.9 years (range, 0.7 to eighteen years). Instrumented gait and electromyographic analyses were performed. The qualitative data were compared with the functional outcome, which was determined with the functional evaluation score of the Musculoskeletal Tumor Society. Gait analysis revealed a fairly normal walking pattern with a slight limp and a lateral lean of the trunk over the ipsilateral limb that led to a reduced joint moment in the hip (moment on involved side, 68 percent [compared with a control group]; moment on uninvolved side, 81 percent). The ranges of motion of the hips (uninvolved side, 42.0 +/- 8.2 degrees; involved side, 42.4 +/- 8.0 degrees) and the knees (uninvolved side, 59.7 +/- 5.0 degrees; involved side [former ankle joint], 58.1 +/- 11.6 degrees) were symmetrical even though the knee-motion pattern of the involved limb indicated a slightly reduced extensor mechanism in 51 percent (twenty-two) and a markedly reduced extensor mechanism in 35 percent (fifteen) of the forty-three patients. Electromyography revealed function of the muscles of the involved limb, with comparable amplitudes in the involved and uninvolved limbs. The leg muscles of the involved limb were active in the stance phase (the soleus and the lateral and medial heads of the gastrocnemius) and the swing phase (the peroneus longus and the tibialis anterior) according to their function in relation to the new knee joint. The patients had a good functional result, with a mean score of 23.9 +/- 2.7 of 30 points. With the numbers available for study, we could not show the duration of follow-up to be related to the overall outcome, but the age at the time of the operation was related to the total functional score as well as to gait and walking ability (p < 0.05). The results of the electromyographic and gait analyses demonstrated good functional restoration of gait following rotationplasty.

Monatsschrift Kinderheilkunde

Objective: As survival rates of bone sarcoma patients have been raised owing to improved treatmen... more Objective: As survival rates of bone sarcoma patients have been raised owing to improved treatment strategies the focus of investigations is now on the medical, social, and economic sequelae of intensive multimodal treatment. The ongoing study (NCT00824083: “Functional and clinical long-term outcome of Ewing sarcoma treatment”; shortcut: SAM-Ewing; 2009–2014) aims to assess the long-term outcome in a representative sample of survivors of Ewing sarcoma. The data recorded combined with standardized treatment data covering a 30-year period will produce a data pool that is unique for its magnitude. Methods: The study provides for the assessment of the functional outcome, quality of life and the psychological status by means of validated tools (e. g., TESS, SF36 and BIS/BAS) and objectively measuring daily activity patterns by using the StepWatch Activity Monitor (SAM) in 900 long-term Ewing sarcoma survivors and a 1:2 matched control group of healthy subjects. Information on sarcoma tre...

Pediatric Blood & Cancer

Purpose: The main focus of tumor treatment is to cure the disease. This challenging struggle has ... more Purpose: The main focus of tumor treatment is to cure the disease. This challenging struggle has resulted in survival rates of up to 75% in localized Ewing sarcomas. Rising survival rates has led to increasing interest in long-term consequences of intensive multimodal bone tumor treatment. The ongoing cohort study 'Functional and Clinical Long-Term Outcome of Ewing Sarcoma Treatment* is aimed at analysing functional outcome and quality-of-life in long-term survivors of Ewing sarcoma with subjective and objective measurement tools. Method: Survivors of Ewing sarcoma diagnosed from 1980-2009 are recruited from phase III trials of the German Society of Pediatric Hematology and Oncology (GPOH). A first cohort of 118 former patients (47.5% female) with the longest follow-up was analyzed. Median follow-up was 22.3 years (range 12.8-28.9). Median age was 37.7 years (range 20.1-63.2). Outcome measures were a multi-tool questionnaire, i.e., including the Short Form Health Survey (SF-36),...

Journal of Cancer Research and Clinical Oncology

Objective: Substantial progress has been made in the management of childhood bone tumors over the... more Objective: Substantial progress has been made in the management of childhood bone tumors over the last 25 years. The current 10-year survival rate in localized Ewing sarcoma is approximately 70%, however, long-term impact of multidisciplinary treatment is not well documented. Also no data are available on the effect of multimodal therapy on the level of physical activity. The aim of this study was to objectively quantify the level of activity in long-term survivors of Ewing sarcoma using a continuous measurement device. All patients were treated according the consecutive Ewing sarcoma trials of the German Society of Pediatric Hematology and Oncology (GPOH). Methods: Subject of this analysis is a first series of 118 long-term survivors of Ewing sarcoma, initially diagnosed between 1981 and 1998. The median age at diagnosis was 14 years (range 2–45), median age at time of assessment was 38 years (range 20–63). Initial local therapy was surgery alone in 25 patients (21%), surgery and i...