Sports nutrition knowledge in athletes with a spinal cord injury and coaches of para sports.

Sports nutrition for athletes with a spinal cord injury (SCI) is complex, making it challenging for athletes to stay informed. The aim of this study was to assess sports nutrition knowledge in athletes with an SCI and coaches of para sports. The secondary aim was to report sources of sports nutrition information. Eighty athletes and 26 coaches across various adapted sports were recruited. The Nutrition for Sport Knowledge Questionnaire was used to assess nutrition knowledge for both groups. Athletes achieved their highest score among the alcohol (65 ± 19%) category and the lowest in sports nutrition (43 ± 17%). Coaches demonstrated the most knowledge in the alcohol (73 ± 17%) category and lowest knowledge in the supplementation (45 ± 19%) category. Both groups relied on the internet, dietitians, and coaches for sports nutrition information. Future studies should explore the effects of nutrition education on nutrition knowledge and dietary intakes among these populations.

Walking aid training as a clinical competence in Canadian entry-to-practice professional academic programs.

PURPOSE: Multiple healthcare professionals fit walking aids (WA) and train individuals on their use. The purpose of this investigation was to describe curricula on WA fitting and training in Canadian entry-to-practice professional programs. MATERIALS AND METHODS: An online survey was administered to leads from all accredited programs (n = 199). Seventeen questions asked about the importance of WA education, instructional methods and time dedicated to WA fitting and skills training, and how the pandemic had affected WA curriculum delivery. RESULTS: Responses were received from 97 programs. While most occupational therapy (OT, 8/15), physiatry (PM&R, 5/9), and physical therapy (PT, 12/19) trainees received more than 3 h of instruction on WA fitting, most nursing (29/40) and pharmacy (7/8) programs spent less than 3 h on this topic. Most OT (9/15) and PT (15/19) programs spent more than 3 h on WA skills training whereas most nursing (25/40), pharmacy (4/8), and PM&R (5/9) programs spent less than 3 h on this subject. Across all programs, 52% educated students on adapting activities of daily living for WA while 18% provided education on WA maintenance and repair. Only 19/89 programs consulted a formal WA skills training resource for curriculum development. Seventeen of 55 programs modified their WA curricula due to the pandemic. CONCLUSIONS: There is a wide range in curricular approaches to WA education in Canadian professional programs. This highlights the need for a standardised WA education program to guide curricular development to ultimately improve safe WA use for clients with short- and long-term mobility impairments.IMPLICATIONS FOR REHABILITATIONCurricula on walking aids is extremely variable within and between programs.Navigating terrains, adapting activities of daily living, and maintenance are poorly taught.There is a need for a national standardized curriculum on walking aids.This curriculum should be modular and designed for practitioners, students, and patients.

Overhead arm positioning in the rehabilitation of elbow dislocations: An in vitro biomechanical study.

STUDY DESIGN: In vitro biomechanical study. INTRODUCTION: Elbow stiffness is a common complication following elbow dislocation. Overhead exercises have been proposed to initiate early motion to reduce stiffness through employing gravity to stabilize the elbow. The implications of this position with regard to elbow kinematics after dislocation have not been reported. PURPOSE OF THE STUDY: To determine the influence of the overhead position on elbow stability following combined medial and lateral collateral ligament (MCL and LCL) injuries. METHODS: Passive and simulated active extension were performed on 11 cadaveric elbows with the arm in the overhead, dependent, and horizontal positions and with the forearm in pronation, neutral, and supination. Internal-external rotation (IER) and varus-valgus angulation (VVA) of the ulnohumeral joint were assessed for the intact elbow and after simulated MCL-LCL injury. Repeated-measures analyses of variance were conducted to analyze the effects of elbow state, arm position, forearm rotation, and extension angle. RESULTS: During passive extension with the arm overhead, the pronated position resulted in more internal rotation than supination (-2.6 ± 0.7°, P = .03). There was no effect of forearm rotation on VVA. The overhead position increased internal rotation relative to the dependent position when the forearm was neutral (-8.5 ± 2.5°, P = .04) and relative to the horizontal position when the forearm was supinated (-12.7 ± 2.2°, P= .02). During active extension, pronation increased valgus angle compared to the neutral (+1.2 ± 0.3°, P= .04) and supinated (+1.5 ± 0.4°, P= .03) positions, but did not affect IER. There was no difference between active and passive motion with the arm overhead (P > .05). DISCUSSION: Movement of the injured elbow in the overhead position most closely replicated kinematics of the intact elbow compared to the other arm positions. CONCLUSIONS: Overhead elbow extension results in similar kinematics between an intact elbow and an elbow with MCL and LCL tears. As such, therapists might consider early motion in this position to reduce the risk of elbow stiffness after dislocation.

Injuries Associated with Crutch Use: A Narrative Review.

Crutches are commonly prescribed in physiatric settings to help offload the lower extremities. Crutch use, however, results in abnormal and repetitive weight-bearing through the upper extremities that may result in secondary injury. This narrative review investigates injury types and risk factors associated with crutch use in order to guide healthcare providers on injury prevention strategies. Medline, EMBASE, CINAHL, and the Cochrane Library were systematically reviewed for publications between 1950 and 2018 on neurological, musculoskeletal, or vascular complications associated with crutch use. Titles and abstracts (n = 2395) were screened by two authors. Sixty studies were eligible. Articles were reviewed for level of evidence, crutch type, participant characteristics, and injury characteristics. There were 42 axillary crutch studies, 12 forearm crutch studies, and 6 studies that did not specify crutch type. These studies incorporated 622 individuals, and most were case series or case reports (n = 54). Axillary crutch use was most commonly associated with axillobrachial arterial complications due to pressure from the axillary bar (n = 34). Forearm crutch use was most commonly associated with compressive neuropathies due to pressure from the forearm cuff (n = 6). Improper crutch fitting and/or use were identified as contributing factors to injury in 22 cases. Duration of crutch use and medical comorbidities also influenced the types of injuries seen. There are rare but potentially serious complications associated with crutch use. When prescribing crutches, clinicians should ensure they are properly fit, engage in appropriate gait training, be aware of common crutch-related injuries, and consider potential patient-specific injury risk factors in order to minimize injury risk.

The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study.

BACKGROUND: Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. PURPOSE: (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. STUDY DESIGN: Controlled laboratory study. METHODS: Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. RESULTS: When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (-10.3°± 2.5°, P = .006) but not supination (P = .61). CONCLUSION: In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. CLINICAL RELEVANCE: After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.

Optimizing the rehabilitation of elbow lateral collateral ligament injuries: a biomechanical study.

BACKGROUND: Elbow lateral collateral ligament (LCL) injury may arise after trauma or lateral surgical approaches. The optimal method of rehabilitating the LCL-insufficient elbow is unclear. Therapists often prescribe active motion exercises with the forearm pronated. Recently, overhead exercises have become popular as they may enable gravity to compress the elbow joint, improving stability, although this has not been proved biomechanically. This investigation aimed to quantify the effects of several variables used in LCL injury rehabilitation on elbow stability. METHODS: Seven cadaveric specimens were tested in a custom elbow motion simulator in 3 arm positions (overhead, dependent, and varus) and 2 forearm positions (pronation and supination) during passive and simulated active elbow extension. Three injury patterns were studied (intact, LCL injury, and LCL with common extensor origin injury). An electromagnetic tracking device measured ulnohumeral kinematics. RESULTS: Following combined LCL and common extensor origin injury, overhead positioning enhanced elbow stability relative to the other arm positions (P < .01 in pronation; P = .04 in supination). Active motion stabilized the LCL-deficient elbow in the dependent (P = .02) and varus (P < .01) positions. Pronation improved stability in the overhead (P = .05), dependent (P = .06), and varus (P < .01) positions. CONCLUSIONS: Rehabilitation with the arm overhead improves elbow stability after LCL injury. Initiating earlier range of motion in this "safe position" might decrease elbow stiffness and allow optimal ligament healing. If exercises are done in the dependent position, active motion with forearm pronation should be encouraged. Varus arm positioning should be avoided.

The influence of a polymer damper on swing-through crutch gait biomechanics.

Forearm crutch technology has evolved slowly compared to other assistive mobility devices, despite the highly repetitive nature of forearm crutch gait and the high incidence of overuse injuries. Using 13 able-bodied volunteers between the ages of 19 and 27, we compared the ground reaction forces of a novel crutch design featuring an elastomeric polymer situated below the handle to an identical design without a damper system and to a commercially available generic rigid forearm crutch model. There were no differences in peak vertical force or impulse between crutches. The crutch with the damper system demonstrated a significantly smaller peak braking force and impulse compared to the generic forearm crutch model. However, the crutch with the damper system demonstrated a significantly larger peak propulsive force and impulse compared to both crutch models. This finding indicates that a forearm crutch with a damper system may help to propel the crutch forward when walking on level surfaces, which could impact forward momentum.