Charlotte K Hager

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Verified

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• Professor: Bachelor of science in physiotherapy; PhD in Neurophysiology Clinical specialist in neurology and movement analysis
• Professor (Full) at Umeå University

BACKGROUND Regular physical activity is a crucial and an important modifiable lifestyle factor reducing the risk of recurrent incidents after stroke or transient ischemic attack (TIA). Mobile Health (mHealth) has emerged as a promising approach for providing long-term support for physical activity. However, little is known about how individuals pos...

Physical activity guidelines targeting different populations with and without chronic diseases or disabilities are required to meet the diverse functional and physiological needs experienced by different subgroups of people to achieve optimal health benefits. As the importance of physical activity guidelines in promoting optimal health and well-bei...

Objective Evaluate active knee joint position sense (JPS) throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR). Design Longitudinal. Setting Motion laboratory. Participants Twenty-two individuals post-ACLR and 22 activity-matched non-injured controls performed weight-bearing and non-weight-bearing knee JPS tests. The...

Background While telerehabilitation is a promising alternative to traditional rehabilitation, previous studies suggest that it is still underutilised by physiotherapists. The purpose of this study was to identify factors associated with the willingness, and use of, telerehabilitation among physiotherapists. Method An online survey, covering self-r...

Musculoskeletal trauma often leads to lasting psychological impacts stemming from concerns of future injuries. Often referred to as kinesiophobia or re-injury anxiety, such concerns have been shown to hinder return to physical activity and are believed to increase the risk for secondary injuries. Screening for re-injury anxiety is currently restric...

Re-injury anxiety after anterior cruciate ligament (ACL) injury is a key reason for not returning to sports and is suggested to increase secondary injury risk. Assessing movement-related anxiety is however limited to subjective questionnaires related to mixed constructs (e.g., kinesiophobia, self-efficacy). We aimed to capture objective electrocort...

Investigations of kinetic asymmetries during bilateral squats following anterior cruciate ligament reconstruction (ACLR) are limited to mainly cross‐sectional studies and discrete value data extracted at specific knee angles. We assessed loading asymmetries during squats longitudinally throughout rehabilitation using curve analysis and compared pat...

Background: Sports function and psychological readiness to return to sports (RTS) are important outcomes when evaluating rehabilitation after anterior cruciate ligament reconstruction (ACLR). It is, however, unclear which specific factors contribute most to these outcomes. Purpose: To determine associations between demographic characteristics, o...

Background: The functional integration of the jaw and neck motor systems, of great importance to everyday oral activities, is established in early childhood. Detailed characterization of this developmental progress is largely unknown. Objective: To establish developmental changes in jaw-neck motor function in children over the ages 6 to 13 years...

Background Most young adults and adolescents in the United Arab Emirates (UAE) do not meet the established internationally recommended physical activity levels per day. The Arab Teen Lifestyle Study (ATLS) physical activity questionnaire has been recommended for measuring self-reported physical activity of Arab adolescents and young adults (aged 14...

Background Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered pr...

Athletes with an anterior cruciate ligament (ACL) injury followed by ACL reconstruction (ACLR) often perform various testing to guide return to sport, but preinjury data are rarely available for comparison. This longitudinal case-control study reports absolute value and between-leg symmetry data on maximal performances for single-leg hop height and...

Introduction Studies indicate that brain response during proprioceptive tasks predominates in the right hemisphere. A right hemisphere lateralization for proprioception may help to explain findings that right-limb dominant individuals perform position matching tasks better with the non-dominant left side. Evidence for proprioception-related brain r...

Background: Psychophysiological consequences often persist following musculoskeletal trauma and can result in vastly decreased quality of life. Re-injury anxiety is particularly common among individuals following anterior cruciate ligament (ACL) injury. Existing assessments of re-injury anxiety are, however, restricted to subjective suboptimal ques...

Purpose: Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke. Materials and methods: Semi-structured interviews were performed with...

Background The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. Objective The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. Methods A systematic review with meta-analysis (...

Background Between-leg symmetry in 1-leg hop and knee strength performances is considered important after anterior cruciate ligament reconstruction (ACLR) to facilitate a safer return to sport. While few athletes with ACLR demonstrate symmetry in test batteries, reference data for noninjured athletes are lacking, thus questioning how ACLR-specific...

Background An anterior cruciate ligament (ACL) rupture may result in poor sensorimotor knee control and, consequentially, adapted movement strategies to help maintain knee stability. Whether patients display atypical lower limb mechanics during weight acceptance of stair descent at different time frames after ACL reconstruction (ACLR) is unknown....

Efficient neuromuscular coordination of the thigh muscles is crucial in maintaining dynamic knee stability and thus reducing anterior cruciate ligament (ACL) injury/re-injury risk. This cross-sectional study measured electromyographic (EMG) thigh muscle co-contraction patterns during a novel one-leg double-hop test among individuals with ACL recons...

Objectives To evaluate knee joint position sense (JPS) among individuals with anterior cruciate ligament reconstruction (ACLR), cleared for return to sport, and investigate whether JPS errors are associated with outcomes of a functional obstacle clearance test (OC; downward vision occluded). Design Cross-sectional. Setting Controlled laboratory....

Thigh muscle weakness prevails following anterior cruciate ligament (ACL) injury, as usually evaluated by peak concentric quadriceps strength. Assessment throughout the range of motion (ROM), and for antagonists may provide more comprehensive information. We evaluated angle-specific torque profiles and ratios of isokinetic thigh muscle strength in...

Background Threshold to detect passive motion (TTDPM) tests of the knee joint are commonly implemented among individuals with anterior cruciate ligament (ACL) injury to assess proprioceptive acuity. Their psychometric properties (PMPs), i.e. reliability, validity and responsiveness, are however unclear. This systematic review aimed to establish the...

Knee proprioception deficits and neuroplasticity have been indicated following injury to the anterior cruciate ligament (ACL). Evidence is, however, scarce regarding brain response to knee proprioception tasks and the impact of ACL injury. This study aimed to identify brain regions associated with the proprioceptive sense of joint position at the k...

Background Instrumented gait analysis post-stroke is becoming increasingly more common in research and clinics. Although overall standardized procedures are proposed, an almost infinite number of potential variables for kinematic analysis is generated and there remains a lack of consensus regarding which are the most important for sufficient evalua...

Background There is limited knowledge about which risk factors that contribute to the high numbers of contra-lateral anterior cruciate ligament (C-ACL) injury after primary ACL injury. Objective To systematically review intrinsic risk factors for sustaining a C-ACL injury. Design A systematic review with meta-analysis according to the PRISMA guid...

Background Underlying factors contributing to increased risk of graft rupture after anterior cruciate ligament reconstruction (ACLR) are not well described. Objective To systematically review intrinsic risk factors for sustaining a graft rupture. Design A systematic review with meta-analysis according to the PRISMA guidelines. Four databases (MED...

Knee proprioception deficits and neuroplasticity have been indicated following injury to the anterior cruciate ligament (ACL). Evidence is however scarce regarding brain response to knee proprioception tasks and the impact of ACL injury. Twenty-one persons with unilateral ACL reconstruction (mean 23 months post-surgery) of either the right (n = 10)...

Polymorphisms in VEGFA and KDR encoding proteins have been associated with anterior cruciate ligament (ACL) injury risk. We leveraged a collective sample from Sweden, Poland, and Australia to investigate the association of functional polymorphisms in VEGFA and KDR with susceptibility to ACL injury risk. Using a case–control genetic association appr...

Objective The purpose of this study was to determine whether fear of re-injury is manifested in joint kinematics and muscle activation patterns during landings of a standardized rebound side-hop (SRSH), or in patient-reported outcome measures (PROMs), among individuals with anterior cruciate ligament reconstruction (ACLR). Methods In this cross-se...

Objective: To investigate the feasibility of a virtual reality exercise intervention within an interdisciplinary rehabilitation programme for persons with chronic neck pain. The effects of the intervention on symptom severity, variables related to chronic neck pain, and patients' experience of exercises were assessed. Methods: Nine women and 3 m...

Purpose: Individual perspectives of long-term consequences decades after anterior cruciate ligament (ACL) injury are unexplored. We addressed experiences and the impact on life of former athletes >20 years post-ACL injury. Methods: Individual interviews, analysed using Grounded Theory, were conducted with 18 persons injured mainly during soccer...

Background: Knee proprioception is believed to be deficient after anterior cruciate ligament (ACL) injury. Tests of joint position sense (JPS) are commonly used to assess knee proprioception, but their psychometric properties (PMPs) are largely unknown. Purpose: To evaluate the PMPs (reliability, validity, and responsiveness) of existing knee JPS...

Background The risk of sustaining a contra-lateral anterior cruciate ligament (C-ACL) injury after primary unilateral ACL injury is high. C-ACL injury often contributes to a further decline in function and quality of life, including failure to return to sport. There is, however, very limited knowledge about which risk factors that contribute to C-A...

The ability to perform individual finger movements, highly important in daily activities, involves visual monitoring and proprioception. We investigated the influence of vision on the spatial and temporal control of independent finger movements, for the dominant and non-dominant hand and in relation to sex. Twenty-six healthy middle-aged to old adu...

Motion capture systems enable in-depth interpretations of human movements based on data from three-dimensional joint angles and moments. Such analyses carry important bearings for evaluation of movement control during for instance hop landings among sports-active individuals from a performance perspective but also in rehabilitation. Recent statisti...

Three-dimensional human motion analysis provides in-depth understanding in order to optimize sports performance or rehabilitation following disease or injury. Recent developments of statistical methods for functional data allow for novel ways to analyze often complex biomechanical data. Even so, for such methods as well as for traditional well-esta...

Objective To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training/sham) on knee proprioception following anterior cruciate ligament (ACL) injury. Design Systematic Review. Data sources PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index...

Introduction: Movement related impairments and limitations in walking are common long-term after stroke. This multi-arm randomized controlled trial explored the impact of training with an electromechanically assisted gait training (EAGT) system, i.e., the Hybrid Assistive Limb® (HAL), when integrated with conventional rehabilitation focused on gait...

Background Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-s...

Sensorimotor deficits, particularly proprioceptive, are often reported following rupture of the anterior cruciate ligament (ACL). High secondary injury rates and long‐term negative consequences suggest that these deficits are not properly identified using current assessment methods. We explored a novel obstacle clearance test to evaluate sensorimot...

We compared knee landing mechanics with presumed relation to risk of anterior cruciate ligament (ACL) injury among three single-leg hop tests and between legs in individuals with unilateral ACL reconstruction. Thirty-four participants (>10 months' post-surgery, 23 females) performed the standardised rebound side hop (SRSH), maximal hop for distance...

Objectives We aimed to assess the test-retest reliability of a supine and standing knee joint position sense (JPS) test, respectively, and whether they discriminate knees with anterior cruciate ligament (ACL) injury from asymptomatic knees. Design Repeated measures and cross-sectional. Setting Research laboratory. Participants For test-retest re...

Introduction People with anterior cruciate ligament (ACL) reconstruction (ACLR) are at high risk of sustaining a graft rupture and/or contra-lateral ACL injury. The main factors that may predispose individuals for subsequent ACL injuries are, however, not established. To reduce the risk of reinjuries, it is of particular interest to identify modifi...

Background Whole-body movement adjustments during gait are common post-stroke, but comprehensive ways of quantifying and evaluating gait from a whole-body perspective are lacking. Research question Can novel kinematic variables related to Center of Mass (CoM) position discriminate side asymmetries as well as coordination between the upper and lowe...

BACKGROUND AND AIM: Neuromuscular training may have the potential to enhance knee proprioception in individuals with anterior cruciate ligament (ACL) injuries. To date, there is however no systematic review on the effects of such training on restoring knee proprioception (if deficient) following ACL injury. Our systematic review summarizes the leve...

Individuals with knee osteoarthritis (OA) commonly demonstrate impaired postural control. We aimed to systematically review psychometric properties of tests that assess postural control in people with knee OA and secondly, to determine domains of postural control measured by these tests. PubMed, CINAHL, Embase and Web of Science databases were sear...

Background Atypical knee joint biomechanics after anterior cruciate ligament reconstruction (ACLR) are common. It is, however, unclear whether knee robustness (ability to tolerate perturbation and maintain joint configuration) and whole body movement strategies are compromised after ACLR. Purpose To investigate landing control after ACLR with rega...

Rotator cuff tendinopathy (RCT), anterior cruciate ligament (ACL) ruptures and carpal tunnel syndrome (CTS), are examples of chronic (RCT and CTS) and acute (ACL ruptures) musculoskeletal soft tissue injuries. These injuries are multifactorial in nature, with several identified intrinsic and extrinsic risk factors. Previous studies have implicated...

Unanticipated land-and-cut maneuvers might emulate lower limb mechanics associated with anterior cruciate ligament (ACL) injury. Reliability studies on landing mechanics of such maneuvers are however lacking. This study investigated feasibility and within-session reliability of landing mechanics of a novel one-leg double-hop test, mimicking a land-...

The purpose was to evaluate the dynamic knee control during a drop jump test following injury of the anterior cruciate ligament injury (ACL) using finite helical axes. Persons injured 17–28 years ago, treated with either physiotherapy (ACLPT, n = 23) or reconstruction and physiotherapy (ACLR, n = 28) and asymptomatic controls (CTRL, n = 22) perform...

Background: Research indicates reduced knee function and stability decades after anterior cruciate ligament (ACL) injury. Assessment requires reliable functional tests that discriminate such outcomes from asymptomatic knees, while providing suitable loading for different populations. The One-leg rise (OLR) test is common in clinics and research bu...

Background: A functional integration between the jaw and neck regions during purposive jaw movements is well described in adults, but there is a lack of knowledge of such integration during jaw function in children. Objectives: To determine the movement integration between the jaw and neck during jaw motor tasks in 6-year-olds, whether there is...

A hip prosthesis design with larger femoral head size may improve functional outcomes compared to the conventional total hip arthroplasty (THA) design. Our aim was to compare the range of motion (RoM) in lower body joints during squats, gait and stair walking using a wearable movement analysis system based on inertial measurement units (IMUs) in th...

Investigation of three independent populations strengthens the hypothesis that genetic loci within the proteoglycan and angiogenesis associated pathways predispose to anterior cruciate ligament injury.

Objectives: To investigate the functional effect of genetic polymorphisms of the inflammatory pathway on structural extracellular matrix components (ECM) and the susceptibility to an anterior cruciate ligament (ACL) injury. Design: Laboratory study, case-control study. Methods: Eight healthy participants were genotyped for interleukin (IL)1B r...

Background: We designed a novel one-leg double-hop test emulating a cutting maneuver that might challenge anterior cruciate ligament (ACL) integrity. A good neuromuscular control of the thigh muscles is crucial to maintain dynamic knee stability during the task. Therefore, there is a need to assess thigh muscles cocontraction strategies in order to...

Background: A change-of-direction (cutting) maneuver might challenge knee stability or anterior cruciate ligament (ACL) integrity during an unanticipated condition compared to its preplanned counterpart. Therefore, we proposed a novel one-leg double-hop test including a forward hop followed by a 45°-diagonal hop in medial (UMDH) or lateral directio...

Athletes exposed to rapid maneuvers need a high level of dynamic knee stability and robustness, while also controlling whole body movement, to decrease the risk of non‐contact knee injury. The effects of high‐level athletic training on such measures of movement control have not, however, been thoroughly evaluated. This study investigated whether el...

Introduction An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively review...

Abstract Background Impairments in dexterity after stroke are commonly assessed by the Nine Hole Peg Test (NHPT), where the only outcome variable is the time taken to complete the test. We aimed to kinematically quantify and to compare the motor performance of the NHPT in persons post-stroke and controls (discriminant validity), to compare kinemati...

Despite a vast literature on one-leg hops and cutting maneuvers assessing knee control pre/post-injury of the anterior cruciate ligament (ACL), comprehensive and reliable tests performed under unpredictable conditions are lacking. This study aimed to: 1) assess the feasibility of an innovative, knee-challenging, one-leg double-hop test consisting o...

We propose a novel one-leg standardised rebound side-hop test (SRSH) specifically designed for detailed analysis of landing mechanics. Anterior cruciate ligament reconstructed persons (ACLR, n = 30) and healthy-knee controls (CTRL, n = 30) were tested for within-session and test-retest (CTRL only, n = 25) reliability and agreement. Trunk, hip and k...

Although trainers and athletes consider “good timing skills” critical for optimal sport performance, little is known in regard to how sport-specific skills may benefit from timing training. Accordingly, this study investigated the effects of timing training on soccer skill performance and the associated changes in functional brain response in elite...

AIM: To evaluate the effects of hop direction (UMDH vs. ULDH) and leg (operated vs. uninjured) using multivariate analysis on a large set of trunk and lower limb biomechanical variables observed during the novel test in individuals with a unilateral ACL reconstruction (ACLR).

Introduction: The aim was to evaluate if pain, disability, and work productivity are influenced by physical and psychosocial work exposures as well as by stress, up to 1 year after a randomized controlled trial treatment intervention, and to determine whether any such association differed between treatment and control groups. Methods: Ninety-sev...

Background: Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop-jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts. Methods: Subjects wit...

Background: Recent studies highlight the need for understanding movement control of adjacent joints when evaluating knee function following anterior cruciate ligament (ACL) injury. However, while short-term adaptations to lower-extremity joint coupling have been studied, little is known about any potential long-term adaptations in neuromuscular co...

Aim Establishing the effects of low intensity cycling (LC), moderate intensity cycling (MC), and standing at a simulated office workstation on pain modulation, work performance, and metabolic expenditure. Methods 36 healthy adults (21 females), mean age 26.8 (SD 7.6) years, partook in this randomized 3 × 3 crossover trial with 75 minutes of LC on...

Study design: Human volunteers were exposed experimentally to single-sided mechanical shocks (SSMS) and double-sided mechanical shocks (DSMS) while seated. Objective: To describe and contrast seated postural reactions due to SSMS or DSMS in healthy male adults. Summary of background data: Mechanical shocks to the body, caused when driving on i...

Purpose Clinical test batteries for evaluation of knee function after injury to the Anterior Cruciate Ligament (ACL) should be valid and feasible, while reliably capturing the outcome of rehabilitation. There is currently a lack of consensus as to which of the many available assessment tools for knee function that should be included. The present ai...

PurposeLittle is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL...

Background: Limited knowledge exists regarding the impact of symptomatic knee osteoarthritis (OA) on the overall gait pattern; and whether gait deviations are associated with performance-based measures (PBMs) and patient-reported outcomes (PROs). This cross-sectional study evaluated overall gait patterns in patients with knee OA using the Gait Dev...

Background Upper limb coordination in persons post-stroke may be estimated by the commonly used Finger-to-Nose Test (FNT), which is also part of the Fugl-Meyer Assessment. The total movement time (TMT) is used as a clinical outcome measure, while kinematic evaluation also enables an objective quantification of movement quality and motor performance...