Validity Indices of the King-Devick Concussion Test in Hockey Players.

OBJECTIVE: To compare the validity indices of the King-Devick (KD) test in hockey players using any increase in test time over baseline to a 6-second increase as a positive concussion test. We hypothesized the KD test using the 6-second change would yield greater validity indices. DESIGN: Prospective observational cohort study. SETTING: Sports complex. PARTICIPANTS: Sixty-five male hockey players aged 13 to 20 years. INDEPENDENT VARIABLE: Concussion diagnosis. MAIN OUTCOME MEASURES: Time to complete the KD test. Sensitivity (SN), specificity (SP), and the positive likelihood ratios (LRs+) were calculated using 2 thresholds for a positive test: (1) any increase in time and (2) an increase of 6 seconds or greater. RESULTS: Eighteen players (27.7%) were diagnosed with a concussion. Using any increase in time as a positive test yielded the following: SN 72.2%, SP 78.7%, LR+ 3.4, and LR- 0.4. Using the 6-second threshold yielded the following: SN 44.4%, SP 93.6%, LR+ 7.0, and LR- 0.6. A receiver operator curve analysis confirmed 6.40 seconds or greater maximized the LR+. CONCLUSIONS: A 6-second or greater increase in the KD test performance provides greater validity in diagnosing concussion as compared with any increase in performance time.

Qualitative and quantitative evaluation of an interprofessional workshop between physical therapy and medical students.

Interprofessional education (IPE) is an important component of medical education, preparing students for the collaboration necessary for high-quality patient care. This study aimed to compare IPE readiness in pre-qualification physical therapy (PT) and medical (MD) students before and after an interprofessional workshop and identify factors influencing the workshop's perceived educational value. In two consecutive years, students were surveyed with the Readiness for Interprofessional Learning Scale (RIPLS) following a four-hour, case-based workshop. During the second year, students were also surveyed before the workshop and answered open-ended questions about its educational value. PT and MD students had similar mean pre-workshop RIPLS scores (83.0, SD 5.3 vs. 80.7, SD 7.9; p = .27), but post-workshop scores were higher among PT students (86.3, SD 6.5 vs. 80.3, SD 8.8; p < .001). Qualitative thematic analysis of responses to open-ended questions revealed students valued IPE within the workshop. However, MD students in particular identified improvement opportunities in workshop delivery, timing, and content. These factors undermined the perceived educational value for MD students and may have contributed to their lower post-workshop RIPLS scores. This study suggests that a brief workshop can improve readiness for IPE among pre-professional students and highlights the importance of content, delivery, and timing to IPE success.

Influence of Neck Laceration Protectors on Cervical Range of Motion.

OBJECTIVE: To examine the effect of a hockey neck laceration protector (NLP) on cervical range of motion (ROM) along with the athlete's perception on comfort and restrictiveness. Our hypothesis was that all styles of NLPs would limit cervical ROM compared to no NLP, and that certain designs of NLPs would be perceived as more restrictive and less comfortable. DESIGN: Cross-sectional observational analytic. SETTING: Outpatient sports medicine clinic. PARTICIPANTS: Forty-six male and female high school hockey players (age 14-18). INDEPENDENT VARIABLES: Four commercially available NLPs and no NLP. MAIN OUTCOME MEASURES: Cervical ROM and participant feedback regarding restrictiveness and comfort. RESULTS: ROM values while wearing any of the NLPs were significantly less than no NLP for all cervical motion measurements (P < 0.05) with the exception of the Bauer Premium NLP for left rotation (P = 0.792). Significant differences were found between the 4 NLPs in terms of perceived restrictiveness and comfort (P < 0.05). CONCLUSIONS: NLPs may reduce the risk of a neck laceration, but appear to have a negative impact on cervical ROM. This study challenges manufactures to design NLPs that cover vulnerable neck anatomy but do not limit a player's ROM. NLP designs that are most comfortable and least restrictive are recommended.

Concussion in Ice Hockey: Current Gaps and Future Directions in an Objective Diagnosis.

OBJECTIVE: This review provides an update on sport-related concussion (SRC) in ice hockey and makes a case for changes in clinical concussion evaluation. Standard practice should require that concussions be objectively diagnosed and provide quantitative measures of the concussion injury that will serve as a platform for future evidence-based treatment. METHODS: The literature was surveyed to address several concussion-related topics: research in ice hockey-related head trauma, current subjective diagnosis, promising components of an objective diagnosis, and current and potential treatments. MAIN RESULTS: Sport-related head trauma has marked physiologic, pathologic, and psychological consequences for athletes. Although animal models have been used to simulate head trauma for pharmacologic testing, the current diagnosis and subsequent treatment in athletes still rely on an athlete's motivation to report or deny symptoms. Bias-free, objective diagnostic measures are needed to guide quantification of concussion severity and assessment of treatment effects. Most of the knowledge and management guidelines of concussion in ice hockey are generalizable to other contact sports. CONCLUSIONS: There is a need for an objective diagnosis of SRC that will quantify severity, establish a prognosis, and provide effective evidence-based treatment. Potential methods to improve concussion diagnosis by health care providers include a standardized concussion survey, the King-Devick test, a quantified electroencephalogram, and blood analysis for brain cell-specific biomarkers.

The most cut-resistant neck guard for preventing lacerations to the neck.

OBJECTIVE: To evaluate the effectiveness of a variety of neck guard brands when contacted by a sharpened hockey skate blade. DESIGN: Analytic experimental. SETTING: Laboratory. PARTICIPANTS: Neck surrogate. INTERVENTIONS: Forty-six samples of 14 different types of neck guards were tested on a custom-made laceration machine using a neck surrogate. Closed-cell polyethylene foam was placed between the neck surrogate and the protective device. MAIN OUTCOME MEASURES: The effectiveness of the neck guard was evaluated by observation of the foam after the simulated slicing action of the skate blade. Two sets of tests were performed on each device sample including low and high force. For low-force tests, initial compression loads of 100, 200, and 300 N were applied between the neck surrogate for each of 2 orientations of the blade at 45 and 90 degrees. For high-force tests, representing a more severe simulation, the applied load was increased to 600 N and a blade angle fixed at 45 degrees. All tests were performed at a blade speed of 5 m/s. RESULTS: Only 1 product, the Bauer N7 Nectech, failed during the 300-N compression tests. All of the neck guards failed during 600-N test condition except for the Skate Armor device and 1 of the 3 Reebok 11K devices. CONCLUSIONS: A skate blade angle of 45 degrees increased the likelihood of a neck laceration compared with a skate blade angle of 90 degrees due to decreased contact area. Damage to the neck guard is not an indicator of the cut resistance of a neck guard. Neck protectors with Spectra fibers were the most cut resistant. CLINICAL RELEVANCE: The study provides data for the selection of neck guards and neck guard materials that can reduce lacerations to the neck.

Reliability of hip internal rotation range of motion measurement using a digital inclinometer.

PURPOSE: Assessment of hip internal rotation (IR) is a critical element in the evaluation of a painful hip, yet there currently exists no consistent method of determining this measurement. The purpose of this study is to report the intra-rater and inter-rater reliability of active and passive hip IR measurement using a digital inclinometer. METHODS: Twenty-five subjects (8 men, 17 women) with asymptomatic hip joints, and no known pathology between the ages of 22 and 42 participated. Two examiners measured hip IR for each subject using a digital inclinometer while visually monitoring pelvic motion. Measurements included passive IR, active IR, and active IR while internally rotating both legs simultaneously. Statistical analysis was performed including intra-rater and inter-rater reliability. RESULTS: There was no significant difference in measured IR values. Mean range of motion values for all techniques and both examiners ranged from 30.7° to 32.8°. Intra-rater reliability for examiner 1 ranged from 0.84 to 0.92. Inter-rater reliability ranged from 0.89 to 0.93. Of the methods utilized, active IR of a single leg was the most responsive technique with a minimal detectable change value of 5.4°. CONCLUSIONS: Clinical assessment of hip IR range of motion can be performed efficiently and reliably with a digital inclinometer along with visual monitoring of the pelvis for unwanted motion. Findings from this study support unilateral active hip IR in a seated position as a reliable and responsive technique for obtaining hip IR measurements.

Effects of examiner strength on reliability of hip-strength testing using a handheld dynamometer.

CONTEXT: Hip-muscle impairments are associated with a variety of lower-extremity dysfunctions. Accurate assessment in the clinical setting can be challenging due to the strength of hip muscles relative to examiner strength. OBJECTIVE: To examine the influence of examiner strength and technique on manual hip-strength testing using a handheld dynamometer. DESIGN: Repeated measures. SETTING: Research laboratory. PARTICIPANTS: 30 active adults (age 24 ± 1.4 y). INTERVENTIONS: Three examiners of different strength performed manual muscle tests (MMT) in 2 different positions for hip extension, abduction, and external rotation using a MicroFet handheld dynamometer. Examiner strength was quantified via a 1-repetition-maximum leg press and chest press with a Keiser A420 pneumatic resistance machine. MAIN OUTCOME MEASURES: Intrarater reliability (ICC3,1), interrater reliability (ICC2,1), and measured torque values. RESULTS: Intrarater reliability for all measurements ranged from .82 to .97. Interrater reliability ranged from .81 to .98. Main effects for hip extension revealed a significant difference in torque values between examiners and between techniques. For the short-lever hipabduction and seated hip-external-rotation tests, there was a significant difference between examiners. There was no significant difference in measured torque values between examiners with the long-lever hip-abduction or the prone hip-external-rotation tests. CONCLUSIONS: MMT of the hip may be performed with high reliability by examiners of different strength. To obtain valid MMT measurements of hip muscles, examiners must consider their own strength and testing techniques employed. The authors recommend a long-lever technique for hip abduction and a prone position for testing hip external rotation to minimize the influence of examiner strength. Both positions appear to provide mechanical advantages to the examiner compared with the alternative techniques. The authors are unable to recommend a preferred hip-extension-testing technique to minimize the influence of examiner strength.

Detecting Artificial Intelligence-Generated Personal Statements in Professional Physical Therapist Education Program Applications: A Lexical Analysis.

OBJECTIVE: The objective of this study was to compare the lexical sophistication of personal statements submitted by professional physical therapist education program applicants with those generated by OpenAI's Chat Generative Pretrained Transformer (ChatGPT). METHODS: Personal statements from 152 applicants and 20 generated by ChatGPT were collected, all in response to a standardized prompt. These statements were coded numerically, then analyzed with recurrence quantification analyses (RQAs). RQA indices including recurrence, determinism, max line, mean line, and entropy were compared with t-tests. A receiver operating characteristic curve analysis was used to examine discriminative validity of RQA indices to distinguish between ChatGPT and human-generated personal statements. RESULTS: ChatGPT-generated personal statements exhibited higher recurrence, determinism, mean line, and entropy values than did human-generated personal statements. The strongest discriminator was a 13.04% determinism rate, which differentiated ChatGPT from human-generated writing samples with 70% sensitivity and 91.4% specificity (positive likelihood ratio = 8.14). Personal statements with determinism rates exceeding 13% were 8 times more likely to have been ChatGPT than human generated. CONCLUSION: Although RQA can distinguish artificial intelligence (AI)-generated text from human-generated text, it is not absolute. Thus, AI introduces additional challenges to the authenticity and utility of personal statements. Admissions committees along with organizations providing guidelines in professional physical therapist education program admissions should reevaluate the role of personal statements in applications. IMPACT: As AI-driven chatbots like ChatGPT complicate the evaluation of personal statements, RQA emerges as a potential tool for admissions committees to detect AI-generated statements.

Reliability of the dial test using a handheld inclinometer.

PURPOSE: The primary purpose of this study was to investigate the intra-tester and inter-tester reliability of the dial test using a handheld digital inclinometer. Additionally, we examined the responsiveness of the test, and side-to-side differences for meaningful comparison. MATERIALS/METHODS: Twenty-four healthy subjects (22.5 ± 2.8 years) participated in the study. The dial test was performed on both knees at 30° and 90° of knee flexion with the subject supine. While maintaining a neutral position of the ankle, an inclinometer was positioned parallel to the medial border of the foot to quantify external rotation of the tibia. Two examiners performed the dial test in a blinded manner. The minimal detectable change across repeated measures and side-to-side difference was calculated. RESULTS: Intra-tester reliability for examiner 1 (E1) was 0.83 at 30° knee flexion and 0.89 at 90° knee flexion. Reliability values for examiner 2 (E2) were 0.86 at 30° and 0.87 at 90° knee flexion. Inter-tester reliability was 0.74 at 30° and 0.83 at 90°. The minimal detectable change (MDC) for E1 at 30° was ±9.4° and ±7.4° at 90°. For E2, the MDC value was ±9.1° at 30° and ±8.3° at 90°. Ninety-five percent limits of agreement for side-to-side difference was 16.1° and 11.3° ° for E1 at 30° and 90° and for E2 13.9° at 30° and 14.1° at 90°. CONCLUSIONS: This instrumented dial test using a handheld digital inclinometer to measure external rotation can be performed with acceptable reliability in the clinical setting. A difference of 10° between two measurements on the same knee suggests that a meaningful change has occurred. For right to left comparison, differences greater than 15° suggest clinical significance. LEVEL OF EVIDENCE: III.

Skating crossovers on a motorized flywheel: a preliminary experimental design to test effect on speed and on crossovers.

Ice hockey requires frequent skater crossovers to execute turns. Our investigation aimed to determine the effectiveness of training crossovers on a motorized, polyethylene high-resistance flywheel. We hypothesized that high school hockey players training on the flywheel would perform as well as their peers training on ice. Participants were 23 male high-school hockey players (age 15-19 years). The study used an experimental prospective design to compare players who trained for 9 sessions on the 22-foot flywheel with players who trained for 9 sessions on a similarly sized on-ice circle. Both groups were compared with control subjects who were randomly selected from the same participant pool as those training on ice. All players were tested before and after their 3-week training regimens, and control subjects were asked to not practice crossovers between testing. Group 1 trained in a hockey training facility housing the flywheel, and group 2 trained in the ice hockey arena where testing occurred. Primary outcome measures tested in both directions were: (a) speed (time in seconds) required to skate crossovers for 3 laps of a marked face-off circle, (b) cadence of skating crossovers on the similarly sized circles, and (c) a repeat interval speed test, which measures anaerobic power. No significant changes were found between groups in on-ice testing before and after training. Among the group 1 players, 7 of 8 believed they benefited from flywheel training. Group 2 players, who trained on ice, did not improve performance significantly over group 1 players. Despite the fact that no significant on-ice changes in performance were observed in objective measures, players who trained on the flywheel subjectively reported that the flywheel is an effective cost-effective alternative to training on ice. This is a relevant finding when placed in context with limited availability of on-ice training.

Machine Learning in Admissions?: Use of Chi-Square Automatic Interaction Detection (CHAID) to Predict Matriculants to Physical Therapy School.

PURPOSE: Machine learning algorithms provide methods by which patterns in admissions data may be discovered that predict admissions yields in education programs. We used a chi-square automatic interaction detection (CHAID) analysis to examine characteristics that predict applicants most likely to matriculate into a physical therapy program after being admitted. METHODS: Data from applicants admitted to our physical therapy program from the 2015-2016 through 2021-2022 admissions cycles were evaluated (n=413). Variables included applicants' ages, grade point averages, graduate record examination (GRE) scores, admissions and behavioral interview scores, sex/gender, race/ethnicity, home state classification, undergraduate major classification, institutional classification, socioeconomic status, and first generation to college status. A CHAID algorithm identified which variables predicted matriculation after being admitted. RESULTS: Overall, 47.2% of admitted applicants matriculated. The CHAID algorithm generated a 3-level model with 5 terminal nodes that classified matriculants with 64.9% accuracy. Applicants more likely to matriculate than to decline an admission offer included in-state applicants and White/Caucasian border-state/out-of-state applicants with GPAs below 3.65. DISCUSSION: While findings are program-specific, the CHAID analysis provides a tool to analyze admissions data that admissions committees may use to analyze their admissions processes and outcomes.

Recurrence quantification analysis of isokinetic strength tests: A comparison of the anterior cruciate ligament reconstructed and the uninjured limb.

BACKGROUND: Despite widespread use of return to sport testing following anterior cruciate ligament reconstruction, studies suggest inadequacy in current testing criteria, such as limb symmetry index calculations, to determine athletes' readiness to return to play. Recurrence quantification analysis, an emerging non-linear data analysis tool, may reveal subtle neuromuscular differences between the injured and uninjured limb that are not captured by traditional testing. We hypothesized that isokinetic torque curve data of the injured limb would demonstrate lower determinism and entropy as compared to the uninjured limb. METHODS: 102 patients (44 M, 58F, 10 ± 1 months post-anterior cruciate ligament reconstruction) underwent isokinetic quadriceps strength testing using a HumacNorm dynamometer. Patients completed maximum effort knee extension and flexion at 60°/sec. Data were post-processed with a MATLAB CRQA Graphical User Interface and determinism and entropy values were extracted. Paired-sample t-tests (α = 0.05) were used to compare data from the injured and uninjured limb. FINDINGS: Determinism and entropy values in the torque curves were lower in the injured limb than the uninjured limb (p < 0.001). Our findings indicate there is less predictability and complexity present in the torque signals of injured limbs. INTERPRETATION: Recurrence quantification analysis can be used to assess neuromuscular differences between limbs in patients who have undergone anterior cruciate ligament reconstruction. Our findings offer further evidence that there are changes to the neuromuscular system which persist following reconstruction. Further investigation is needed to establish thresholds of determinism and entropy values needed for safe return to sport and to evaluate the utility of recurrence quantification analysis as a return to sport criterion.

Acute effects of an isometric neck warm-up programme on neck performance characteristics and ultrasound-based morphology.

OBJECTIVE: Athletic performance can be enhanced immediately after an isometric warm-up, a phenomenon termed post-activation performance enhancement (PAPE). While isometric warm-ups can improve lower extremity sprint and jump performance, neck-specific isometric warm-ups need development and validation for mild traumatic brain disorders and neck pain. This study examined acute effects of isometric warm-ups on neck performance and morphology. METHODS: Arm 1: Twenty-six adults (13 M:13F) completed neck performance testing before and after a 10-minute neck isometric warm-up or stationary bike (sham) between two visits. Testing included visual-motor reaction time, peak force, rate of force development, force steadiness, and force replication/proprioception measured by a 6-axis load cell. An inclinometer assessed range-of-motion. Paired t-tests and two-way ANOVA examined effects of neck/bike warm-up and interaction effects, respectively. Arm 2: 24 adults (11 M:13F) completed ultrasound scans of cervical muscles: before 20-minute rest (sham), and before/after a 5-min neck isometric warm-up. Longus colli cross-sectional area and sternocleidomastoid/upper trapezius thickness and stiffness, and cervical extensors thickness was assessed. One-way ANOVA compared morphological values at sham, before, and after warm-up. Significance was set at p < 0.05. RESULTS: Isometric neck warm-up increased rate of force development in flexion (p = 0.022), extension (p = 0.001-0.003), right lateral flexion (p = 0.004-0.032), left lateral flexion (p = 0.005-0.014), while peak force improved only in left lateral flexion (p = 0.032). Lateral flexion range-of-motion increased after neck warm-up (p = 0.003-0.026). Similarly, longus colli cross-sectional area (p = 0.016) and sternocleidomastoid thickness (p = 0.004) increased. CONCLUSIONS: Increased neck performance characteristics and morphology are likely due to PAPE effects of isometric neck warm-up. For coaches and athletes, simple isometric contractions could be added to existing warm-ups to reduce prevalence, incidence, and severity of mild traumatic brain injuries and neck pain.

Relationship of off-ice and on-ice performance measures in high school male hockey players.

The purpose of this study was to examine the relationship of off-ice performance measures with on-ice turning, crossover, and forward skating performance in high school male hockey players. Thirty-eight players aged 15-18 (mean age ± SD: 16.4 ± 1.1 years; height: 177.9 ± 6.8 cm; weight: 72.5 ± 8.9 kg) participated in this study. On-ice tests included a forward sprint, short radius turns, and crossover turns. Off-ice tests included a 40-yd sprint, vertical jumps, horizontal jumps, and a dynamic balance test using a Y balance testing device. Five off-ice variables correlated with all on-ice performance measures. These variables included the 40-yd sprint, lateral bound right to left limb, double limb horizontal hop, balance on right in posterolateral direction, and composite balance performance on the right. Hierachical regression demonstrated that off-ice sprint time was most predictive of on-ice skating performance, accounting for 65.4% of the variability in forward skate time, 45.0% of the variability in left short radius time, 21.8% of the variance in right short radius time, 36.2% of the variance in left crossover time, and 30.8% of the variability in right crossover time. When using off-ice tests to evaluate hockey players, the 40-yd sprint is the best predictor of skating performance. Based on our regression equation, for every 1-second difference in the 40-yd sprint time, there will be approximately a 0.6-second difference in the 34.5-m on-ice sprint. The 40-yd sprint predicts forward skating performance and to a lesser degree; it also predicts crossover and tuning performance.

Recurrence Quantification Analysis of Personal Statements from Applicants to a Physical Therapy Doctoral Program: A Cross-Sectional Analysis.

PURPOSE: We examined lexical sophistication of written personal statements from physical therapy applicants to determine whether recurrence quantification analysis (RQA) indices distinguish higher- versus lower-scored candidates and correlate with other admissions variables. METHODS: Written personal statements were extracted from 152 applications, coded numerically, and analyzed with RQA. Along with other RQA indices, determinism-representing predictability of words and phrases-was quantified. A receiver operating characteristic (ROC) curve analysis was used to examine discriminative validity of RQA indices to distinguish between top-10 and bottom-10 candidates. Correlation coefficients between RQA indices and other admissions variables (grade point averages, standardized exam, behavioral interview, and cumulative admissions scores) were also examined. RESULTS: Determinism in personal statements was lower in top-scored (mean 7.38%) than bottom-scored candidates (mean 11.29%, p = 0.015), differentiated between them with 70% sensitivity (95% CI 34.8%-93.3%) and 100% specificity (95% CI 69.2%-100%), and correlated negatively with candidates' behavioral interview scores (r = -0.168, p = 0.039). DISCUSSION: The greater expressive lexical sophistication characterized by lower determinism in personal statements provides information about candidates' writing proficiency as a component of their communication abilities that may not otherwise be assessed in traditional admissions variables.

ELECTROMYOGRAPHIC ANALYSIS OF HIP MUSCLE ACTIVATION DURING A SINGLE LIMB SQUAT LATERAL SLIDE EXERCISE.

BACKGROUND: Slider exercises, which may use a gliding disc or "slider", are dynamic exercises used for strengthening. They are proposed to increase challenge as the friction between the body and ground is decreased which increases the demands on muscles of the weight bearing limb. HYPOTHESIS AND PURPOSE: The purposes of this study were (1) to compare the electromyographic (EMG) activity level of hip muscles of the weight bearing limb while performing a single limb slide squat to that of a standard isometric squat and (2) to investigate the influence of trunk position on hip EMG activity. It was hypothesized that the single limb slide squat would elicit greater hip EMG activity than an isometric squat and trunk position would influence EMG activity. STUDY DESIGN: Analytic, observational cross-sectional study design.Methods: Twenty healthy male participants (age = 23.7 ± 1.3) volunteered. EMG hip muscle activation of the stance leg was measured during a single limb slide squat and as a comparison, the same leg during a standard double limb isometric squat. Both exercises where performed with a knee flexion angle of 60˚ and the trunk positioned 40˚ (flexed trunk) and 60˚ (upright trunk) relative to the floor. Surface electrodes were used to collect EMG data. RESULTS: EMG activity of the gluteus maximus, gluteus medius, biceps femoris and rectus femoris was significantly greater with both single limb slide exercises as compared to both squat exercises. EMG activity was greater with the flexed trunk as compared to the upright trunk for the biceps femoris. CONCLUSION: Slider exercises produced a moderate or high level of activation for all muscles whereas all squat exercises produced a low-level activation. LEVEL OF EVIDENCE: Level 3 Mechanism-based reasoning intervention study trial.

The use of motor learning and neural plasticity in rehabilitation for ataxic hemiparesis: A case report.

Background and Purpose: Although the principles of neural plasticity for stroke rehabilitation are well established, specific intervention plans for patients with ataxia following a lacunar infarct are not well described. The purpose of this case report is to describe the intervention program for a patient with ataxic hemiparesis based on principles of motor learning and neural plasticity. Case Description: An 83-year-old, socially active male presented to the emergency department with right-sided upper extremity weakness and ataxia. The patient's acute hospital course included 4 days in a stoke unit, followed by 13 days in inpatient rehabilitation. Intervention: A 3-phase graded mobility and coordination plan was used during inpatient rehabilitation. Interventions included function-based training with repeated ambulation, coordination activities for the upper and lower extremities, and strengthening to help the patient achieve his goal of walking "without gait deviations." The concepts of motor learning and neural plasticity were utilized for timing and feedback on patient errors when implementing this novel program. Outcomes: The patient's level of assistance for mobility and activities of daily living improved from minimal assistance to modified independence without use of an assistive device. The Dynamic Gait Index score improved from 16/24 to 20/24 suggesting a decreased fall risk. Discussion: This case report describes a novel intervention strategy for a patient with ataxia following a lacunar stroke. The application of the principles of neural plasticity and motor learning was the foundation for a function-based plan of care.

Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles.

CONTEXT: Neck pain (NP), neck injuries, and concussions are more prevalent in female athletes than in their male counterparts. Females exhibit less neck girth, strength, and stiffness against a perturbation. As part of the clinical examination for individuals with NP, ultrasound (US)-based imaging of the cervical muscles has become common. Muscle size or thickness and stiffness can be measured with US-based B-mode and shear-wave elastography (SWE), respectively. Information on reliability, normative values, and sex differences based on US-based muscle size or thickness and stiffness in young and athletic individuals is limited. OBJECTIVE: To evaluate sex differences in US-based muscle size or thickness and biomechanical properties of the cervical-flexor and -extensor muscles. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 13 women (age = 23.7 ± 1.9 years, height = 167.1 ± 6.1 cm, mass = 63.8 ± 5.6 kg) and 11 men (age = 25.6 ± 4.9 years, height = 178.7 ± 8.3 cm, mass = 78.9 ± 12.0 kg). MAIN OUTCOME MEASURE(S): The same examiner collected all measures, using US B-mode to scan the cross-sectional area and thickness of the longus colli (LC), sternocleidomastoid (SCM), cervical-extensor muscles, and upper trapezius (UT) muscle. The US SWE-mode was used to measure the stiffness of the SCM and UT. Independent t tests or Mann-Whitney U tests were calculated to determine sex differences. The intraclass correlation coefficient (ICC) measured intrarater test-retest reliability. RESULTS: Men had thicker SCMs than women (P = .01). No sex differences were present for longus colli cross-sectional area, cervical-extensor muscle thickness, or UT thickness (P > .05). In addition, no sex differences were evident for SCM (P = .302) or UT (P = .703) SWE stiffness. Reliability was good to excellent (ICC = 0.715-0.890) except for SCM SWE stiffness (ICC = 0.554). CONCLUSIONS: The only sex difference was in SCM thickness. However, smaller SCMs in women did not result in less SCM SWE stiffness. We provided normative values for US-based imaging of the cervical-flexor and -extensor muscles in young and athletic men and women.

Responsiveness of a Balance Assessment Using a Mobile Application.

BACKGROUND: Balance assessment is used by clinicians as part of athlete concussion screening. The King-Devick (K-D) Balance app is designed to provide an objective balance assessment value. The purpose of this study was to investigate the responsiveness of a balance assessment using the K-D Balance app. HYPOTHESIS: The K-D Balance app will demonstrate acceptable responsiveness for balance assessment. STUDY DESIGN: Repeated-measures study. LEVEL OF EVIDENCE: Level 5. METHODS: A convenience sample of 25 participants between the ages of 20 and 25 years completed testing procedures. A battery of balance tests using the K-D Balance app on an iPhone were conducted 1 week apart. After a 5-minute warm-up, 3 stances were assessed: double leg, tandem right, and tandem left. The K-D Balance app guided the test positions and test times. A value representing movement was generated by the app algorithm. Analysis included descriptive statistics along with intraclass correlation coefficient and minimal detectable change (MDC). RESULTS: The median score of the K-D test was 0.5 for session 1 and 0.4 for session 2. The ICC was 0.42 (95% CI, 0.04-0.70), and the MDC was 1.58. CONCLUSION: The MDC value of 1.58 represents the threshold of meaningful change in balance, as measured with the K-D Balance app. CLINICAL RELEVANCE: Clinicians can use the results of this study to objectively assess changes in balance over time using the K-D Balance app.

Skate blade neck lacerations: a survey and case follow-up.

OBJECTIVE: To learn about neck lacerations caused by skate blades in hockey. DESIGN: A retrospective Web-based survey and follow-up of registered USA Hockey players. SETTING: Three hundred twenty-eight thousand eight hundred twenty-one of 457 038 registered USA Hockey players with a current e-mail address were contacted and invited to participate in the survey. PARTICIPANTS: Of 26 589 players (5.8% of all USA registered players) who responded to the survey, 247 were excluded due to incomplete data. Of 26 342 surveys analyzed, 23 199 respondents were men (88%), 3015 women (11.4%), and 128 (0.5%) did not designate gender. INTERVENTION: An original survey instrument was developed, formatted, and linked to a Mayo Clinic Web site. MAIN OUTCOME MEASURES: Neck lacerations from a skate blade, including mechanism, severity, treatment required, and the type of neck protector worn. RESULTS: Of the 26 342 respondents, 11 935 (45.4%) currently wear neck protection and 485 (1.8%) have sustained a neck laceration. When the laceration occurred, 132 of the players (27%) were wearing neck protection. Interviews with 33 injured players established that lacerations were superficial: 20 (61%) required bandaging only, 11 were sutured, and 2 were glued. CONCLUSION: Based on this survey, the currently available neck laceration protectors do not eliminate the risk of a neck laceration from a skate blade.