The Influence of Sports-Related Concussion on Cognition and Landing Biomechanics in Collegiate Athletes.

Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk.

Prediction of Diabetes Mellitus Progression Using Supervised Machine Learning.

Diabetic peripheral neuropathy (DN) is a serious complication of diabetes mellitus (DM) that can lead to foot ulceration and eventual amputation if not treated properly. Therefore, detecting DN early is important. This study presents an approach for diagnosing various stages of the progression of DM in lower extremities using machine learning to classify individuals with prediabetes (PD; n = 19), diabetes without (D; n = 62), and diabetes with peripheral neuropathy (DN; n = 29) based on dynamic pressure distribution collected using pressure-measuring insoles. Dynamic plantar pressure measurements were recorded bilaterally (60 Hz) for several steps during the support phase of walking while participants walked at self-selected speeds over a straight path. Pressure data were grouped and divided into three plantar regions: rearfoot, midfoot, and forefoot. For each region, peak plantar pressure, peak pressure gradient, and pressure-time integral were calculated. A variety of supervised machine learning algorithms were used to assess the performance of models trained using different combinations of pressure and non-pressure features to predict diagnoses. The effects of choosing various subsets of these features on the model's accuracy were also considered. The best performing models produced accuracies between 94-100%, showing the proposed approach can be used to augment current diagnostic methods.

Visual-Spatial Attentional Performance Identifies Lower Extremity Injury Risk in Adolescent Athletes.

OBJECTIVE: Strategies to identify lower extremity musculoskeletal (LEMSK) injury risk have been informed by prospectively identified biomechanical and neuromuscular risk factors. Emergent evidence suggests that cognitive and oculomotor performance may also contribute to LEMSK injury. The purpose of this study was to determine whether prospective cognitive and oculomotor measures identify adolescent athletes who sustain an in-season LEMSK injury. DESIGN: Prospective longitudinal study. SETTINGS: Controlled laboratory and athletic event settings. PARTICIPANTS: Four hundred eighty-eight adolescent male football and female soccer athletes aged 13 to 18 years. ASSESSMENT OF RISK FACTORS: Preseason baseline cognitive and oculomotor performance: Attention Network Task (ANT), cued task switching, King-Devick test, and near point of convergence. MAIN OUTCOME MEASURE: Incidence of LEMSK sprains and strains during a single competitive season. RESULTS: Attention Network Task-orienting network reaction time (RT) was the only cognitive or oculomotor measure significantly associated with LEMSK injury [B = 1.015, 95% confidence interval (CI): 1.01-1.024, P < 0.01]. Every 10 milliseconds increase in orienting network RT was associated with a 15% increased risk for LEMSK injury. Athletes demonstrating an orienting network RT ≥ 32.8 milliseconds had a higher risk for LEMSK injury relative to athletes below the cut-point (relative risk, 2.62; 95% CI, 1.52-4.52; odds ratio, 3.00; 95% CI, 1.63-5.52). CONCLUSIONS: Deficits in visual-spatial components of attention were associated with 2.62 times greater risk for LEMSK injury in adolescent athletes. The present results add evidence to suggest that visual-spatial attentional processing contributes to LEMSK injury and may supplement previously established LEMSK injury risk assessments.

Enhancing the Accuracy of Vertical Ground Reaction Force Measurement During Walking Using Pressure-Measuring Insoles.

Pressure-measuring insoles can be an attractive tool for measuring ground reaction force (GRF) since they are portable and can record multiple consecutive steps. Several researchers have, however, observed that these insoles are less accurate than instrumented force platforms. To address this issue, the authors identified transfer functions that best described each insole size to enhance the measurements of the vertical component of GRF during walking. GRF data were collected from 29 participants (6/23 male/female, 24.3 ± 6.7 yrs, 70.4 ± 23.9 kg, 1.66 ± 0.11 m) using Medilogic® pressure-measuring insoles and Kistler® force platforms for three walking trials. Participants provided the institutionally approved written consent (IRB #724468). The data from both instruments were preprocessed. A subset of the data was used to train the system identification toolbox (matlab) to identify the coefficients of several candidate transfer functions for each insole size. The resulting transfer functions were compared using all available data for each insole to assess which one modified the insole data to be closer to that of the force platform. All tested transfer functions moved the vertical component of GRF closer to the corresponding force platform data. Each insole size had a specific transfer model that that yielded the best results. Using system identification techniques produced transfer functions that, when using insole data of the vertical component of GRF as input, produced output that is comparable to the corresponding measurement using an instrumented force platform.

Use of Pressure-Measuring Insoles to Characterize Gait Parameters in Simulated Reduced-Gravity Conditions.

Prior researchers have observed the effect of simulated reduced-gravity exercise. However, the extent to which lower-body positive-pressure treadmill (LBPPT) walking alters kinematic gait characteristics is not well understood. The purpose of the study was to investigate the effect of LBPPT walking on selected gait parameters in simulated reduced-gravity conditions. Twenty-nine college-aged volunteers participated in this cross-sectional study. Participants wore pressure-measuring insoles (Medilogic GmBH, Schönefeld, Germany) and completed three 3.5-min walking trials on the LBPPT (AlterG, Inc., Fremont, CA, USA) at 100% (normal gravity) as well as reduced-gravity conditions of 40% and 20% body weight (BW). The resulting insole data were analyzed to calculate center of pressure (COP) variables: COP path length and width and stance time. The results showed that 100% BW condition was significantly different from both the 40% and 20% BW conditions, p < 0.05. There were no significant differences observed between the 40% and 20% BW conditions for COP path length and width. Conversely, stance time significantly differed between the 40% and 20% BW conditions. The findings of this study may prove beneficial for clinicians as they develop rehabilitation strategies to effectively unload the individual's body weight to perform safe exercises.

Footwear and footstrike change loading patterns in running.

Loading rates have been linked to running injuries, revealing persistent impact features that change direction among three-dimensional axes in different footwear and footstrike patterns. Extracting peak loads from ground reaction forces, however, can neglect the time-varying loading patterns experienced by the runner in each footfall. Following footwear and footstrike manipulations during laboratory-based overground running, we examined three-dimensional loading rate-time features in each direction (X, Y, Z) using principal component analysis. Twenty participants (9 M, 11 F, age: 25.3 ± 3.6 y) were analysed during 14 running trials in each of two footwear (cushioned and minimalist) and three footstrike conditions (forefoot, midfoot, rearfoot). Two principal components (PC) captured the primary loading rate-time features (PC1: 42.5% and PC2: 22.8% explained variance) and revealed interaction among axes, footwear, and footstrike conditions (PC1: F (2.1, 40.1) = 5.6, p = 0.007, η 2 = 0.23; PC2: F (2.0, 38.4) = 62.3, p < 0.001, η 2 = 0.77). Rearfoot running in cushioned footwear attenuated impact loads in the vertical direction, and forefoot running in minimalist footwear attenuated impact loads in the anterior-posterior and medial-lateral directions relative to forefoot running in cushioned shoes. Loading patterns depend on footwear and footstrike interactions, which require shoes that match the runner's footstrike pattern.

Landing Biomechanics in Adolescent Athletes With and Without a History of Sports-Related Concussion.

Recent evidence suggests previously concussed athletes are at greater risk for lower-extremity (LE) injuries than are controls. However, little is known regarding the influence of sports-related concussion (SRC) on landing biomechanics that may provide a mechanistic rationale for LE injury risk. The purpose of this investigation was to examine LE drop-landing biomechanics in adolescent athletes with and without a previous SRC history. Participants included 10 adolescent athletes with an SRC history and 11 controls from multiple sports. Three-dimensional kinematic and kinetic data associated with LE injury risk were analyzed across 5 trials for 30- and 60-cm landing heights. Multivariate analyses indicated group differences in landing patterns from the 30- (P = .041) and 60-cm (P = .015) landing heights. Follow-up analyses indicated that concussed adolescent athletes demonstrated significantly less ankle dorsiflexion and knee flexion versus controls when performing drop landings. Our findings suggest that previously concussed adolescent athletes complete drop-landing maneuvers with ankle and knee joint kinematic patterns that suggest greater risk for LE injury. While limitations such as sport variety and explicit LE injury history are present, the results of this study provide a possible biomechanical rationale for the association between SRC and LE injury risk.

Performance Differences Among Skilled Soccer Players of Different Playing Positions During Vertical Jumping and Landing.

Harry, JR, Barker, LA, James, CR, and Dufek, JS. Performance differences among skilled soccer players of different playing positions during vertical jumping and landing. J Strength Cond Res 32(2): 304-312, 2018-Both jumping and landing performance of skilled soccer players is diminished when task demands are increased. However, it is unclear if performance changes are specific to players of certain playing positions. Therefore, we assessed jumping and landing performance among skilled soccer players of different playing positions. Twenty-five National Collegiate Athletic Association (NCAA) Division 1 male soccer players (179.5 ± 7.8 cm, 75.5 ± 7.1 kg, 19.7 ± 1.2 years) performed maximum effort vertical jump landings (VJLs), whereas vertical ground reaction force (vGRF) data were obtained. Participants were stratified into goalkeeping (GK), defensive (DEF), midfield (MID), and attacking (ATT) group according to their primary playing position. One-way analyses of variance (α = 0.05) and effect sizes (ESs; large ≥ 0.80) were used to compare differences among groups. The jumping phase variables evaluated were jump height, unloading and amortization vGRF magnitudes, eccentric rate of force development, and the reactive strength index. Landing phase variables included the peak vGRF magnitude, vGRF loading rate, vGRF attenuation rate, and landing time. No statistically significant differences were detected for any jumping or landing variable (p ≥ 0.05). However, a number of large magnitude differences were detected during landing after ES calculations. Specifically, greater peak vGRF magnitudes were detected in DEF vs. both MID (ES = 1.08) and ATT (ES = 0.93), a greater vGRF loading rate occurred in DEF vs. MID (ES = 0.93), and a greater vGRF attenuation rate occurred in DEF vs. both MID (ES = 1.00) and AT (ES = 0.80). It is concluded that highly skilled soccer players possess position-specific abilities with respect to the landing phase of VJL. Skilled soccer players might experience enhanced training outcomes after VJL training regimens tailored to the specific demands of their primary playing position.

Bilateral Comparison of Vertical Jump Landings and Step-off Landings From Equal Heights.

Harry, JR, Silvernail, JF, Mercer, JA, and Dufek, JS. Bilateral comparison of vertical jump landings and step-off landings from equal heights. J Strength Cond Res 32(7): 1937-1947, 2018-The purpose of this investigation was to examine kinetic, kinematic, and temporal parameters during vertical jump landings (VJL) and step-off landings (STL) from equal heights. Five men (25.0 ± 1.6 years; 1.7 ± 0.4 m; 79.7 ± 7.1 kg) and 5 women (20.8 ± 1.6 years; 1.6 ± 0.4 m; 68.5 ± 7.1 kg) performed 15 VJL and 15 STL. Paired-samples t-tests (α = 0.05) compared impact velocity and the times to the first (F1) and second (F2) peak vertical ground reaction force magnitudes (tF1 and tF2) and the end of impact. Two-way analyses of variance (α = 0.05) compared limb and task differences in F1, F2, hip, knee, and ankle joint angles at ground contact, F1, F2, and the end of impact, and hip, knee, and ankle joint displacements between contact and F1, F1 and F2, and F2 and the end of impact. Impact velocity was not different between STL and VJL, although STL produced a greater F1 and a more rapid tF2. Greater hip, knee, and ankle flexion/dorsiflexion occurred during STL throughout the majority of impact regardless of limb. Lesser hip, knee, and ankle joint displacements occurred during STL regardless of limb between F1 and F2, whereas greater joint displacement occurred between F2 and the end of impact. Lastly, knee joint angles at ground contact differed between limbs during STL only. Strength and conditioning professionals aiming to improve an athlete's performance during sport-specific jump landings should consider the likely impact attenuation outcomes before selecting STL or VJL in training.

Evaluating Performance During Maximum Effort Vertical Jump Landings.

The ability to rapidly complete a jump landing has received little attention in the literature despite the need for rapid performance in a number of sports. As such, our purpose was to investigate differences between groups of individuals who land quickly (FAST) and slowly (SLOW) relative to peak vertical ground reaction forces (vGRFs), loading rates, rates of vGRF attenuation, contributions to lower extremity mechanical energy absorption at the involved joints, and the onsets of preparatory joint flexion/dorsiflexion. Twenty-four healthy adults (26.1 [3.3] y, 75.7 [18.9] kg, 1.7 [0.1] m) were stratified into FAST and SLOW groups based on landing time across 8 jump-landing trials. Independent t tests (α = .05) and effect sizes (ESs; large ≥ 0.8) compared differences between groups. A greater rate of vGRF attenuation (P = .02; ES = 0.95) was detected in the FAST group. The FAST group also exhibited greater contributions to lower extremity energy absorption at the ankle (P = .03; ES = 0.98) and knee (P = .03; ES = 0.99) during loading and attenuation, respectively. The SLOW group exhibited greater contributions to energy absorption at the hip during loading (P = .02; ES = 1.10). Results suggest that individuals who land quickly utilize different energy absorption strategies than individuals who land slowly. Ultimately, the FAST group's strategy resulted in superior landing performance (more rapid landing time).

Kinetic and Electromyographic Subphase Characteristics With Relation to Countermovement Vertical Jump Performance.

This study sought to identify kinetic and electromyographic subphase characteristics distinguishing good from poor jumpers during countermovement vertical jumps (CMVJs), as defined by the reactive strength index (RSI, CMVJ displacement divided by jump time; cutoff = 0.46 m·s-1). A total of 15 men (1.8 [0.6] m, 84.5 [8.5] kg, 24 [2] y) were stratified by RSI into good (n = 6; RSI = 0.57 [0.07] m·s-1) and poor (n = 9; RSI = 0.39 [0.06] m·s-1) performance groups. The following variables were compared between groups using independent t tests (α = .05) and Cohen's d effect sizes (d ≥ 0.8, large): jump height, propulsive impulse, eccentric rate of force development, and jump time, unloading, eccentric, and concentric subphase times, and average electromyographic amplitudes of 8 lower extremity muscles. Compared with the poor RSI group, the good RSI group exhibited a greater, though not statistically different CMVJ displacement (d = 1.07, P = .06). In addition, the good RSI group exhibited a significantly greater propulsive impulse (P = .04, d = 1.27) and a significantly more rapid unloading subphase (P = .04, d = 1.08). No other significant or noteworthy differences were detected. Enhanced RSI appears related to a quicker unloading phase, allowing a greater portion of the total jumping phase to be utilized generating positive net force. Poor jumpers should aim to use unloading strategies that emphasize quickness to enhance RSI during CMVJ.

Use of active video gaming in children with neuromotor dysfunction: a systematic review.

AIM: To examine current evidence on use of active video gaming (AVG) to improve motor function in children with movement disorders including cerebral palsy, developmental coordination disorder, and Down syndrome. METHOD: Scopus, MEDLINE, Cochrane Library, EMBASE, and CINAHL were searched. Included papers studied the use of AVG for improving movement-related outcomes in these populations. Parameters studied included health condition, strength of evidence, AVG delivery methods, capacity for individualizing play, outcomes addressed, effectiveness for achieving outcomes, and challenges/limitations. RESULTS: The 20 extracted articles varied in quality. Studies involved children with six different conditions using AVG in clinical, home, or school settings for 49 different motor outcomes. Dosage varied in frequency and duration. Choice of games played and difficulty level were therapist determined (n=6) or child controlled (n=14). The most common study limitations were small sample sizes and difficulty individualizing treatment. All articles showed improvement in outcomes with AVG, although differences were not consistently significant compared with conventional therapy. INTERPRETATION: Heterogeneity of measurement tools and target outcomes prevented meta-analysis or development of formal recommendations. However, AVG is feasible and shows potential for improving outcomes in this population. Additional investigations of dosing variables, utility as a home supplement to clinical care, and outcomes with larger sample sizes are merited.

Gait Retraining From Rearfoot Strike to Forefoot Strike does not change Running Economy.

Gait retraining is a method for management of patellofemoral pain, which is a common ailment among recreational runners. The present study investigated the effects of gait retraining from rearfoot strike to forefoot strike on running economy, heart rate, and respiratory exchange ratio immediately post-retraining and one-month post-retraining in recreational runners with patellofemoral pain. Knee pain was also measured. Sixteen participants (n=16) were randomly placed in the control (n=8) or experimental (n=8) group. A 10-minute treadmill RE test was performed by all subjects. The experimental group performed eight gait retraining running sessions where foot strike pattern was switched from rearfoot strike to forefoot strike, while the control group received no intervention. There were no significant differences for running economy (p=0.26), respiratory exchange ratio (p=0.258), or heart rate (p=0.248) between the groups. Knee pain reported on a visual analog scale was also significantly reduced (p<0.05) as a result of retraining. The present study demonstrates that retraining from rearfoot strike to forefoot strike did not affect running economy up to one-month post-retraining while reducing running-related patellofemoral pain.

Classifying performer strategies in drop landing activities.

Our purpose was to use group and single-case methods to examine inter-individual variability in the context of factors related to landing injuries. We tested the load accommodation strategies model (An exploration of load accommodation strategies during walking with extremity-carried weights. Human Movement Science, 35, 17-29) using landing impulse, revealing pre-landing strategies following height and external load manipulations. Ten healthy volunteers (8 male, 2 female, 24.0 ± 1.4 years, 1.72 ± 0.06 m, 73.5 ± 8.7 kg) were analysed across 12 trials in each of three load conditions (100% body weight [BW], 110% BW, 120% BW) from two landing heights (30 cm, 60 cm). Landing impulse (BW ∙ s) was computed for each participant-condition-trial, using impulse ratios (unit-less; BW ∙ s/BW ∙ s) to evaluate load accommodation strategies between adjacent load conditions (110%/100%, 120%/110%) at each landing height. Load accommodation strategy classifications were based on 95% confidence intervals (CIs) containing mechanically predicted impulse ratios (1.10 and 1.09 for 110/100% BW and 120/110% BW, respectively; α = 0.05). Mean group impulse ratios matched and exceeded predicted impulse ratios. Single-case analyses revealed a range of individual landing strategies that might be overlooked during group analyses, possibly uncovering individuals at greater risk of injury during landing activities.

Aerial Rotation Effects on Vertical Jump Performance Among Highly Skilled Collegiate Soccer Players.

Barker, LA, Harry, JR, Dufek, JS, and Mercer, JA. Aerial rotation effects on vertical jump performance among highly skilled collegiate soccer players. J Strength Cond Res 31(4): 932-938, 2017-In soccer matches, jumps involving rotations occur when attempting to head the ball for a shot or pass from set pieces, such as corner kicks, goal kicks, and lob passes. However, the 3-dimensional ground reaction forces used to perform rotational jumping tasks are currently unknown. Therefore, the purpose of this study was to compare bilateral, 3-dimensional, and ground reaction forces of a standard countermovement jump (CMJ0) with those of a countermovement jump with a 180° rotation (CMJ180) among Division-1 soccer players. Twenty-four participants from the soccer team of the University of Nevada performed 3 trials of CMJ0 and CMJ180. Dependent variables included jump height, downward and upward phase times, vertical (Fz) peak force and net impulse relative to mass, and medial-lateral and anterior-posterior force couple values. Statistical significance was set a priori at α = 0.05. CMJ180 reduced jump height, increased the anterior-posterior force couple in the downward and upward phases, and increased upward peak Fz (p ≤ 0.05). All other variables were not significantly different between groups (p > 0.05). However, we did recognize that downward peak Fz trended lower in the CMJ0 condition (p = 0.059), and upward net impulse trended higher in the CMJ0 condition (p = 0.071). It was concluded that jump height was reduced during the rotational jumping task, and rotation occurred primarily via AP ground reaction forces through the entire countermovement jump. Coaches and athletes may consider additional rotational jumping in their training programs to mediate performance decrements during rotational jump tasks.

Vertical and Horizontal Impact Force Comparison During Jump Landings With and Without Rotation in NCAA Division I Male Soccer Players.

Harry, JR, Barker, LA, Mercer, JA, and Dufek, JS. Vertical and horizontal impact force comparison during jump landings with and without rotation in NCAA Division I male soccer players. J Strength Cond Res 31(7): 1780-1786, 2017-There is a wealth of research on impact force characteristics when landing from a jump. However, there are no data on impact forces during landing from a jump with an airborne rotation about the vertical axis. We examined impact force parameters in the vertical and horizontal axes during vertical jump (VJ) landings and VJ landings with a 180° rotation (VJR). Twenty-four Division I male soccer players performed 3 VJ and VJR landings on a dual-force platform system. Paired-samples t-tests (α = 0.05) compared differences in the first (F1) and second (F2) peak vertical ground reaction forces, times to F1 (tF1), F2 (tF2), and the end of the impact phase, vertical impulse, and anterior-posterior and medial-lateral force couples. Effect sizes (ES; large >0.8) were computed to determine the magnitude of the differences. Lower jump height (41.60 ± 4.03 cm, VJ landings; 39.40 ± 4.05 cm, VJR landings; p = 0.002; ES = 0.39), greater F2 (55.71 ± 11.95 N·kg, VJ; 68.16 ± 14.82 N·kg; p < 0.001; ES = 0.94), faster tF2 (0.057 ± 0.012 seconds, VJ; 0.047 ± 0.011 seconds, VJR; p = 0.001; ES = 0.89), greater anterior-posterior (0.06 ± 0.03 N·s·kg, VJ; 0.56 ± 0.15 N·s·kg, VJR; p < 0.001; ES = 1.83) and medial-lateral force couples (0.29 ± 0.11 N·s·kg, VJ; 0.56 ± 0.14 N·s·kg, VJR; p < 0.001; ES = 1.46) occurred during VJR landings. No other differences were identified. This kinetic analysis determined that landing from a jump with 180° airborne rotation is different than landing from a jump without an airborne rotation. Male Division I soccer players could benefit from increasing the volume of VJR landings during training to address the differences in jump height and force parameters compared with VJ landings.

Load Accommodation Strategies and Movement Variability in Single-Leg Landing.

Our purpose was to examine changes in participant-specific single-leg landing strategies and intra-individual movement variability following alterations in mechanical task demands via external load and landing height. Nineteen healthy volunteers (15M, 4 F, age: 24.3 ± 4.9 y, mass: 78.5 ± 14.7 kg, height: 1.73 ± 0.08 m) were analyzed among 9 single-leg drop landing trials in each of 6 experimental conditions (3 load and 2 landing height) computed as percentages of participant bodyweight (BW, BW + 12.5%, BW + 25%) and height (H12.5% & H25%). Lower-extremity sagittal joint angles and moments (hip, knee, and ankle), vertical ground reaction forces (GRFz), and electrical muscle activities (gluteus maximus, biceps femoris, vastus medialis, medial gastrocnemius, and tibialis anterior muscles) were analyzed. Individual single-leg drop landing strategies were identified using landing impulse predictions and the Load Accommodation Strategies Model (James et al., 2014). Intra-individual movement variability was assessed from neuromechanical synergies extracted using single-case principal component analyses (PCA). Fewer contrasting single-leg landing strategies were identified among participants under greater mechanical task demands (p < .001) alongside lesser intra-individual movement variability (p < .001). These results reveal changes in movement control under greater mechanical task demands, which may have implications for understanding overuse injury mechanisms in landing.

Lower extremity variability changes with drop-landing height manipulations.

Landing is a common lower extremity injury mechanism in sport, with potential connections to movement control accessed through variability measures. We investigated intra-subject lower extremity variability changes following drop-landing height manipulations using standard deviation (SD) and coefficient of variation (CV) among lower extremity peak sagittal joint angles and moments. Fourteen healthy participants completed five drop-landing trials from five heights 20%, 60%, 100%, 140% and 180% maximum vertical jump height (MVJH). Peak joint angles and moments increased with greater landing height (p < 0.001), highlighting inter-joint differences (Flexion: Knee > Hip > Ankle, p < 0.001; Extensor Moment: Hip > Knee > Ankle, in excess of 60% MVJH, p < 0.05). Kinematic and kinetic SD increased with variable magnitudes, while CV decreased at greater landing heights (p ≤ 0.016). Decreased relative variability under greater task demands may underscore non-contact injury mechanisms from repetitive loading of identical structures.

Automated plantar contact area estimation in a dynamic state using K-Means clustering.

BACKGROUND: Estimation of plantar contact area (PCA) can be used for a variety of purposes such as classification of foot types and diagnosis of foot abnormalities. While some techniques have been developed for assessing static PCA, understanding dynamic PCA may improve understanding of gait biomechanics. This study aims (1) to develop an approach to estimate PCA from video images of footprints during walking and (2) to assess the accuracy and generalizability of this method. METHODS: A sample of 41 ambulatory, young adults (age = 24.3 ± 3.2 years, mass = 67.2 ± 16.9 kg, height = 1.63 ± 0.08 m) completed 10 trials walking on a raised transparent plexiglass platform. Foot contact during walking was recorded using a video camera placed under the platform. An image processing algorithm, Clustering Segmentation, was developed based on identifying color intensity between the PCA and the rest of the foot and plantar contact morphology. RESULTS: The proposed approach was compared to manual hand tracing, which is widely accepted as the Gold Standard, as well as with an earlier automated approach (Lidstone et al., 2019). Results showed that Clustering Segmentation followed the Gold Standard closely in all phases of gait. The maximum PCA and the maximum PCA length and width generally increased with foot size, indicating that the algorithm could successfully estimate the PCA across a wide range of foot sizes. Results also showed that the proposed approach for obtaining the PCA may be used to characterize various foot types in a dynamic state. CONCLUSION: Clustering Segmentation algorithm eliminates the need for subjective interpretation of the PCA. The results showed that the algorithm was considerably faster and more accurate than the earlier automated method. The proposed algorithm will be appropriate for assessment of foot abnormalities and provides complementary information to gait analysis.

Cerebellar Transcranial Direct Current Stimulation Applied over Multiple Days Does Not Enhance Motor Learning of a Complex Overhand Throwing Task in Young Adults.

Cerebellar transcranial direct current stimulation (tDCS) enhances motor skill and learning in relatively simple motor tasks, but it is unclear if c-tDCS can improve motor performance in complex motor tasks. The purpose of this study was to determine the influence of c-tDCS applied over multiple days on motor learning in a complex overhand throwing task. In a double-blind, randomized, between-subjects, SHAM-controlled, experimental design, 30 young adults were assigned to either a c-tDCS or a SHAM group. Participants completed three identical experiments on consecutive days that involved overhand throwing in a pre-test block, five practice blocks with concurrent c-tDCS, and a post-test block. Overhand throwing endpoint accuracy was quantified as the endpoint error. The first dorsal interosseous muscle motor evoked potential (MEP) amplitude elicited by transcranial magnetic stimulation was used to quantify primary motor cortex (M1) excitability modulations via c-tDCS. Endpoint error significantly decreased over the 3 days of practice, but the magnitude of decrease was not significantly different between the c-tDCS and SHAM group. Similarly, MEP amplitude slightly increased from the pre-tests to the post-tests, but these increases did not differ between groups. These results indicate that multi-day c-tDCS does not improve motor learning in an overhand throwing task or increase M1 excitability.