Associations between running mechanics, functional lower extremity strength, and stress urinary incontinence in parous female runners.

Background: Women with stress urinary incontinence (SUI) may have altered running mechanics and reduced hip muscle strength compared to women without SUI. Little research has examined running metrics and functional lower extremity strength of parous runners. Objective: To determine if stress urinary incontinence (SUI) severity correlates with running metrics and lower extremity muscle strength among parous women. Study Design: Cross-sectional observational study of 22 parous participants (mean age 39.8 years, with a mean of 3.4 pregnancies and 8.1 years interval since last delivery). Methods: Participants completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI), Urinary Distress Inventory (UDI) 6, Colorectal-Anal Distress (CRAD) Inventory 8, and Pelvic Organ Prolapse Distress Inventory (POPDI) 6, Questionnaire for Urinary Incontinence Diagnosis (QUID), and provided demographic, relevant running, and obstetric/gynecologic history information. After a brief warm-up, participants completed 30-second single leg sit to stand tests bilaterally and a standardized 10-minute treadmill run with pod cadence assessment. Pearson-product moment correlation coefficients were calculated (alpha = 0.05). Results: Prolonged ground contact times were associated with higher ICIQ-UI SF (r = 0.523, p = 0.015), POPDI-6 (r = 0.694, p < 0.001), and UDI-6 scores (r = 0.577, p = 0.006), while lower cadences were associated with higher POPDI-6 (r = -0.550, p = 0.010) and UDI-6 scores (r = -0.444, p=0.044). Conclusion: Parous female runners with more severe SUI and prolapse symptoms demonstrate altered running mechanics characterized by prolonged ground contact times and slower cadences.

Incidence of Nonsynostotic Plagiocephaly and Developmental Disorders.

Importance: This is the first population-based study quantifying the incidence of nonsynostotic positional plagiocephaly and/or brachycephaly (PPB) in infancy and its association with developmental disorders. Objective: To report the incidence of PPB before age 1 year, the incidence of craniosynostosis, and the percentage of children with PPB diagnosed with a developmental disorder by age 7 years. Design, Setting, and Participants: This was a retrospective, population-based cohort study of children in the Rochester Epidemiology Project (REP) born in Olmsted County, Minnesota, from January 1, 2008, through December 31, 2012, with follow-up through age 7 years. Data were analyzed from March 2021 to April 2024. Exposure: Physical examination detecting cranial deformity. Main Outcomes and Measures: The primary outcome was the incidence of PPB. Secondary outcomes were the incidence of craniosynostosis and the percentage of children with PPB diagnosed with a developmental disorder by age 7 years. Results: Of 9909 infants (5084 [51.3%] male; 9205 [92.9%] born at term and 704 [7.1%] born preterm) included in the study, 575 had PPB, for a PPB incidence of 5.8% (95% CI, 5.3%-6.3%). The incidence of PPB was 5.3% (95% CI, 4.8%-5.8%) in term infants vs 11.8% (95% CI, 9.4%-14.6%) in preterm infants. The incidence of craniosynostosis was 0.16% (95% CI, 0.09%-0.26%). A developmental disorder was known or suspected in 4.2% (95% CI, 2.7%-6.2%) of infants at the time of PPB diagnosis; among 402 infants with PPB and follow-up through age 7 years, 30 (7.5%; 95% CI, 5.0%-10.7%) had a confirmed developmental disorder by 7 years of age. The prevalence of autism spectrum disorder (ASD) in children with a history of PPB who were followed up to age 7 years was 2.2% (9 of 402 children). Conclusions and Relevance: This study found that only a small percentage of the infants had positional head deformity significant enough to be documented and/or referred for subspecialty evaluation, and only a small subset of these children went on to have a developmental disorder in childhood. This information is helpful for counseling families about their child's developmental risk at time of PPB diagnosis.

Interrater reliability of the modified prone instability test for lumbar segmental instability in individuals with mechanical low back pain.

OBJECTIVE: The purpose of this study was to establish the interrater reliability of measures obtained with a novel Modified Prone Instability Test (mPIT), which, like the original Prone Instability Test (PIT), is proposed to identify lumbar segmental instability. The mPIT has clinical feasibility advantages to the PIT, but its psychometric properties are yet to be determined. DESIGN: Repeated measures (test-retest) design, methods study. METHODS: The mPIT was administered by two blinded testers, an orthopedic physical therapy resident with < 1 year experience and board-certified orthopedic specialist physical therapist with >25 years' experience. Procedures were administered at an outpatient physical therapy clinic of a tertiary Medical Center. Participants included 50 adults (≥18 years old) with mechanical low back pain and no radicular (below the knee) symptoms (mean age 50.7 years, 66% female, 76% reported previous episodes of low back pain). Interrater reliability was measured via Fleiss' kappa coefficient. RESULTS: Assessments of the mPIT had moderate interrater agreement (κ = .579 [95% CI = .302 to .856], p < .001.). CONCLUSION: Measures obtained using the mPIT demonstrated moderate interrater reliability between a new graduate and an experienced clinician, which aligns with several studies examining interrater reliability of the original PIT. Further study examining comparative validation of the mPIT with other lumbar instability measures is warranted.

Assessment of Gender Differences in Letters of Recommendation for Physical Therapy Residency Applications.

INTRODUCTION: Letters of recommendation (LOR) are an integral component of physical therapy residency applications. Identifying the influence of applicant and writer gender in LOR will help identify whether potential implicit gender bias exists in physical therapy residency application processes. REVIEW OF LITERATURE: Several medical and surgical residency education programs have reported positive, neutral, or negative LOR female gender bias among applicants and writers. Little research exists on gender differences in LOR to physical therapy education programs or physical therapy residency programs. SUBJECTS: Seven hundred sixty-eight LOR were analyzed from 256 applications to 3 physical therapy residency programs (neurologic, orthopaedic, sports) at one institution from 2014 to 2020. METHODS: Thematic categories were developed to identify themes in a sample of LOR. Associations between writer and applicant gender were analyzed using summary statistics, word counts, thematic and psycholinguistic extraction, and rule-based and deep learning Natural Language Processing . RESULTS: No significant difference in LOR word counts were found based on writer or applicant gender. Increased word counts were seen in sports residency LOR compared with the orthopaedic residency. Thematic analysis showed LOR gender differences with male applicants receiving more positive generalized recommendations and female applicants receiving more comments regarding interpersonal relationship skills. No thematic or psycholinguistic gender differences were seen by LOR writer. Male applicants were 1.9 times more likely to select all male LOR writers, whereas female applicants were 2.1 times more likely to choose all female LOR writers. DISCUSSION AND CONCLUSION: Gender differences in LORs for physical therapy residencies were found using a comprehensive Natural Language Processing approach that identified both a positive recommendation male applicant gender bias and a positive interpersonal relationship skill female applicant gender bias. Applicants were not harmed nor helped by selecting LOR writers of the opposite gender. Admissions committees and LOR writers should be mindful of potential implicit gender biases in LOR submitted to physical therapy residency programs.

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.

Effects of neuromuscular and proprioceptive training on self-reported wellness and health scores and knee sensorimotor characteristics in active seniors.

INTRODUCTION: Athletes regularly engage in comprehensive neuromuscular and proprioceptive training (NPT) to prevent musculoskeletal (MSK) injuries. NPT exercises such as movement technique, agility, balance, and posture as well as yoga-based stretching and slow/deep breathing have shown added benefits in psychological and other well-being. This study aimed to examine the effects of NPT on knee sensorimotor characteristics and multi-domain wellness and health scores in active seniors. METHODS: Twenty seniors participated in the NPT intervention (15-20min session twice a week for 10 weeks) while the control group did not receive any intervention. All participants completed surveys (general health, frailty, anxiety, stress, mindfulness, optimism, and sleep quality) and laboratory testing before and after intervention. Laboratory testing included frailty tests (grip strength, 4-m walk speed, and calcaneal ultrasound-based bone density) and knee sensorimotor characteristics (peak force, visual-motor reaction time, and force steadiness). RESULTS: There was significant increase in general mental health (Short Form 36 Mental Health; p = 0.005) and decrease in stress (Perceived Stress Scale; p = 0.010) and sleep disturbances (Pittsburgh Sleep Quality Index; p = 0.019) post-intervention while no significant changes were observed in the control group (p = 0.310-0.654). Peak knee forces in all directions and some visual-motor reaction time and force steadiness were significantly improved post-intervention only in the experimental group (p = 0.001-0.038). CONCLUSION: A simple, yet, comprehensive NPT has potential to improve MSK health as well as various domains of well-being among active seniors.

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.

Platelet-Rich Plasma Injection for Thumb Carpometacarpal Joint Osteoarthritis.

Objective: To assess the effects of platelet-rich plasma (PRP) injection among patients with thumb carpometacarpal (CMC) joint osteoarthritis (OA). Design: Retrospective chart review with follow-up questionnaires/surveys. Post-procedure, patients were sent standardized, automatically-generated follow-up questionnaires, and contacted for a survey regarding patient-reported outcomes. Setting: Single institution (tertiary care hospital) outpatient clinic from 2015 to 2020. Participants: Nineteen adult patients (9 women; average age 65.0 [±6.3 years]) who received a PRP injection for OA of 1 or both thumb CMCs (N=19). Interventions: Platelet-rich plasma injection. Main Outcome Measures: Outcome measures included symptom improvement (subjective, visual analog scale), duration of benefit, subsequent procedures, satisfaction, and side effects/adverse events. Cellular composition of whole blood and PRP injectate (platelets, erythrocytes, leukocytes, neutrophils, lymphocytes, and monocytes) were analyzed. Results: Subjects reported moderate or excellent symptom improvement in 68.8% of injected joints and were moderately or very satisfied with 68.8% of the procedures. Mean patient-reported duration of benefit was 15.6 months (±19.5) months (mean duration of follow-up: 32.4 [±18.1] months). There were no major complications attributed to the procedures, but 1 patient was diagnosed with presumed unrelated lymphoma 2 weeks post-procedure. PRP mean platelet concentration was 1787.77 (±687.14) × 109/L, resulting in a mean platelet concentration factor of 8.80 (±4.19) times baseline and mean platelet dose of 1881 × 106. Other PRP cell concentration factors were erythrocytes, 0.02; neutrophils, 0.14; lymphocytes, 3.76; and monocytes, 3.29. Conclusions: PRP injection appears to be a safe and potentially effective treatment option for pain related to first CMC OA. Further study is needed to optimize treatment protocols and better understand which patients are most likely to benefit.

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.

Passive wrist deviation to increase the ultrasound identified procedural safe zone in carpal tunnel syndrome: A retrospective cohort study.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Although prior studies have explored the anatomic changes of the median nerve and carpal arch with different wrist deviations and positionings, the change in safe zone distance between the median nerve and ulnar artery with ulnar or radial wrist deviations has not been adequately investigated. OBJECTIVE: To identify the optimal wrist positioning that increases the safe zone distance between the median nerve and ulnar artery using ultrasound in patients with CTS. DESIGN: Retrospective cohort study. SETTING: Quaternary medical center multidisciplinary outpatient hand clinic. PARTICIPANTS: Twenty five patients (41 wrists) with clinical CTS who received an electrodiagnostic study (EDX) to evaluate CTS within 1 year prior to enrollment. INTERVENTIONS: Ultrasound-identified safe zone distance measurements were obtained in each patient between the ulnar aspect of the median nerve and the radial aspect of the ulnar artery with the wrist in neutral radial-ulnar deviation as well as in passive ulnar and radial deviation. MAIN OUTCOME MEASURE: The ultrasound-identified safe zone distance with the wrist in each of the three positions. RESULTS: The interstructural safe zone distance was significantly greater when measured in the ulnarly deviated position (1.08 cm) compared with either the neutral (0.61cm, p < .001) or radially deviated positions (0.52 cm, p < .001). Interstructural safe zone distance did not differ between those with normal, mild, moderate, or severe classifications of pathology, or between dominant and nondominant limbs. CONCLUSION: This study demonstrates that the ultrasound-measured interstructural safe zone distance was significantly greater in the ulnarly deviated position than in either the neutral position or radially deviated position. These findings may lead to improvement in the safety of ultrasound-guided injections.

Physical Therapy Provider Continuity Predicts Functional Improvements in Inpatient Rehabilitation.

BACKGROUND AND PURPOSE: Health care continuity has been linked to improved patient outcomes in a variety of professions and settings. Patients in inpatient rehabilitation receive a consistent dosage of physical therapy (PT) treatment; however, the providing physical therapist may vary. Despite the potential influence of PT provider continuity on functional outcomes in the inpatient rehabilitation setting, this association has not yet been studied. METHODS: An observational retrospective chart review was conducted on 555 discharged inpatient rehabilitation patients. The relationship between the number of PT providers from whom a patient received care and Quality Indicator (QI) Mobility discharge scores was examined with Pearson product-moment correlation coefficients, initially with the entire patient group and secondarily with distinct diagnostic groups. Data from subgroups for whom a significant relationship was established were then included in a hierarchical linear regression analysis accounting for relevant covariates. RESULTS: The number of PT providers correlated negatively with QI Mobility discharge scores ( r = -0.41, P ≤ 0.001). When controlling for QI Mobility admission scores, the "Stroke" (partial r = -0.17, P = 0.02), "Spinal Cord Injury" (partial r = -0.28, P = 0.002), and "Other Neuromuscular" (partial r = -0.35, P = 0.03) groups demonstrated significant inverse relationships. A hierarchical linear regression incorporating these 3 diagnostic groups revealed that the number of PT providers remained a significant predictor of QI Mobility discharge scores ( B = -1.50, P ≤ 0.001) when accounting for covariates. DISCUSSION AND CONCLUSIONS: PT provider continuity is related to the functional improvement of neurologically impaired patients in inpatient rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A405 , which discusses the findings of this work in a narrative format).

Mixed Martial Arts: Comparing the King-Devick and Sport Concussion Assessment Tool 5 in knockouts, technical knockouts and choke holds.

Objective: To compare validity indices of the King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5) for traumatic events in MMA, and to determine if perfusion events (alterations in consciousness as the result of choke holds) cause similar changes in KD/SCAT5 scores. Design: A prospective cohort study in MMA fighters who completed KD and SCAT5 assessments before and after a match. Outcomes were categorized as non-event, traumatic event, or perfusion event. KD/SCAT5 changes were compared between all athletes. Participants: One hundred forty MMA athletes (7 women, 133 men), mean age=27.1 ± 4.9 years. Intervention: N/A. Main outcome measures: King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5). Results: Among the 140 athletes, 19 sustained traumatic and 15 perfusion events. Testing provided sensitivities/specificities of 21.05%/93.39% (KD) and 77.78%/52.99% (SCAT5) in detecting a traumatic event. KD and SCAT5 Symptom Severity scores differed between athletes with and without traumatic events (P=.041 and .014). KD and SCAT5 Symptoms Score changes were observed between athletes with and without traumatic events (P=.023 and .042). Neither KD nor SCAT5 differed significantly between athletes with and without perfusion events. Conclusions: The KD test provides high specificity and the SCAT5 demonstrates reasonable sensitivity when detecting a traumatic event. Of the SCAT5, symptoms-related scores may most effectively identify a traumatic event. A traumatic event may cause KD/SCAT5 changes similar to a concussion, while perfusion events did not.

Altered neuromuscular control in the vastus medialis following anterior cruciate ligament injury: A recurrence quantification analysis of electromyogram recruitment.

BACKGROUND: Neuromuscular deficits exist following anterior cruciate ligament (ACL) injury. To observe these deficits, we examined nonlinear characteristics of vastus medialis electromyography (EMG) signals during submaximal isometric knee extensor contractions. Our purpose was to examine if determinism and entropy in EMG signals reflected neuromuscular control deficits in individuals with ACL-deficient limbs. METHODS: 24 participants (12 male, 12 female, mean age = 18.8 ± 3.1 years) with unilaterally injured ACLs and 25 age-similar healthy controls (11 male, 14 female, mean age = 18.8 ± 3.1 years) volunteered. Isometric knee extensions were tested at 10%, 25%, 35%, and 50% maximum voluntary contractions. Surface electrodes adhered over the vastus medialis captured EMG signals. EMG data were processed with recurrence quantification analyses. Specifically, determinism (an index of system predictability) and entropy (an index of system disorder) were calculated from recurrence plots. FINDINGS: Determinism and entropy in EMG signals were lower in the injured than uninjured limb, and lower than that from healthy controls (P < .05). INTERPRETATION: Vastus medialis EMG signals from the injured limb were less predictable and less complex than those from healthy limbs. The findings reflect impaired neuromuscular control in the injured limb's quadriceps and are consistent with a 'loss of complexity' hypothesis in physiologic signals emanating from pathologic states. Determinism and entropy in EMG signals may represent biomarkers of one's neuromuscular control system.

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.

Comparing adaptive fractal and detrended fluctuation analyses of stride time variability: Tests of equivalence.

BACKGROUND: Fractal analyses quantify self-similarities in stride-to-stride fluctuations over different time scales. Fractal exponents can be measured with adaptive fractal analysis (AFA) or detrended fluctuation analysis (DFA), though measurements obtained with the algorithms have not been directly compared. RESEARCH QUESTION: Are stride time fractal exponents measured with AFA and DFA algorithms equivalent? METHODS: Data from 50 participants with Parkinson's Disease (n = 15), age-similar healthy adults (n = 15) and healthy young adults (n = 20) were analyzed in this cross-sectional, observational study. Participants completed 6-min walks at self-selected speeds overground on a straight walkway and on a treadmill. Stride times were measured with inertial measurement units. Fractal exponents in stride time data were processed using AFA and DFA algorithms and compared with two one-sided tests of equivalence. Mixed ANOVAs were used to compare exponents between groups and conditions. RESULTS: Fractal exponents computed with AFA and DFA were equivalent neither in the overground (0.796 & 0.830, respectively, p = .587) nor treadmill conditions (0.806 & 0.882, respectively, p = .122). Fractal exponents measured with DFA were higher than when measured with AFA. Standard errors were 22% lower when measured with AFA. Additionally, a group × condition interaction was statistically significant when fractal exponents were processed with the AFA algorithm (F(2,47) = 11.696, p < .001), whereas the group × condition interaction was not statistically significant when DFA exponents were compared (F(2, 47) = 2.144, p = .129). SIGNIFICANCE: AFA and DFA do not produce equivalent estimates of the fractal exponent α in stride time dynamics. Estimates of the fractal exponent α obtained with AFA or DFA algorithms therefore should not be used interchangeably. Standard errors were lower when derived with AFA. Fractal exponents calculated with AFA may be more sensitive to conditions that influence stride time fractal dynamics than are measures calculated with DFA.

Characterization of Postural Sway in Patients With Persistent Postural-Perceptual Dizziness (PPPD) Using Wearable Motion Sensors.

OBJECTIVE: To extend previous investigations of postural control in patients with persistent-postural perceptual dizziness (PPPD). STUDY DESIGN: Case-controlled, cross-sectional, observational investigation. SETTING: Tertiary care center. PATIENTS: Fifteen patients with PPPD, 15 control volunteers. INTERVENTIONS: Measurement of anterior-posterior (AP) and medial-lateral (ML) sway at the waist using wearable accelerometers during posturography; assessment of reach and gait. MAIN OUTCOME MEASURES: Peak-to-peak AP and ML sway displacement on the six conditions of the Sensory Organization Test (SOT); Scores on the SOT, Functional Reach Test (FRT), and Dynamic Gait Index (DGI). RESULTS: Compared to control volunteers, patients with PPPD had significantly greater sway displacement at the waist in the AP direction in SOT conditions 3, 5, and 6 and in the ML direction in SOT conditions 2 and 4, resulting in significantly lower median equilibrium scores on the composite index and all six SOT conditions. Patients with PPPD had significantly lower scores on the FRT and DGI that were not correlated with SOT performance. AP sway in conditions 3 and 6 differentiated patients with PPPD from controls with high sensitivity (≥0.87) and specificity (≥0.87). CONCLUSIONS: This study replicated previous work showing poor SOT performance by patients with PPPD who had greater AP sway associated with visual dependence and greater ML sway in low demand conditions than controls. Patients with PPPD also performed poorer on the FRT and DGI, but lack of correlation with SOT scores suggested different mechanisms of impairment in postural control, reach, and ambulation. AP sway demonstrated potential as a diagnostic marker.

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.

Gait synchronized neuromuscular electrical stimulation to the gluteus medius on a patient with right hemiparesis: a case report.

BACKGROUND AND PURPOSE: Although the use of neuromuscular electrical stimulation (NMES) to return gait speed and function in patients poststroke is well documented, the use of NMES to the gluteus medius in patients with hemiparesis is not well described. The purpose of this case report is to describe the use of gait synchronized NMES to the right gluteus medius of a patient with right hemiparesis who had poor hip abduction control during the stance phase of the gait cycle and impaired balance. CASE DESCRIPTION: A 72-year-old female presented to the emergency department with right-sided hemiparesis. During her fifteen day stay in in-patient rehabilitation she demonstrated a Trendelenburg gait pattern, indicating the use of functional NMES to the gluteus medius to help improve her hip abduction control during the stance phase of gait. OUTCOMES: After intervention which included traditional rehabilitation as well as functional NMES, the patient's gait speed increased from 0.22 m/s to 0.69 m/s and her Berg Balance Scale (BBS) increased from a 14/56 to 32/56 over a 14 day period indicating an improvement in dynamic balance and community ambulation. DISCUSSION: This case report outlines the novel use of NMES to the gluteus medius during the stance phase of the gait cycle in a patient with poor hip abductor control.

Diminished neuromuscular system adaptability following anterior cruciate ligament injury: Examination of knee muscle force variability and complexity.

BACKGROUND: Anterior cruciate ligament (ACL) injuries impair knee extensor and flexor force generation and may alter force variability. Fractal scaling exponents quantify signal complexity and reflect neuromuscular system adaptability. The purpose of this study was to evaluate force variability magnitudes and fractal scaling exponents in persons with ACL injuries. METHODS: Twenty-four individuals with ACL injury (time from injury: 55 ± 66 days) and 25 uninjured controls completed 10-s isometric knee extension and flexion contractions on a dynamometer at 10%, 25%, 35%, and 50% of peak force. The middle 8-s of data were used to calculate coefficients of variation and fractal exponents. Injured and non-injured limbs as well as dominant and non-dominant limbs in the control group were compared with ANOVA (P < 0.05). FINDINGS: Peak knee extensor and flexor forces were 19% and 10% lower in the injured limb of ACL-deficient participants (P = 0.014 and P = 0.036, respectively). Fractal scaling exponents of knee extensor force signals at 25% and 35% peak force in injured limbs were higher than in non-injured limbs (P = 0.008 and P = 0.027, respectively). The fractal scaling exponent of knee extensor force signals was greater in injured limbs of ACL-deficient participants than in dominant limbs of the control group at 35% peak force (P = 0.046). The magnitude of variability did not differ between limbs in ACL-deficient participants or between the injured and control groups. INTERPRETATION: Altered fractal exponents in knee extensor force signals represent sensorimotor and neuromuscular system deficits in individuals with ACL injury. Overall, fractal analysis identified both between-limb and between-group differences.

Effect of an Exercise Program That Includes Deadlifts on Low Back Pain.

Clinical Scenario: Low back pain is a common condition for the general population with 29% of adults having low back pain within the last 3 months. A deadlift is described as a free weight exercise in which a barbell is lifted from the floor in a continuous motion by extending the knees and hips. For those without low back pain, the deadlift was found to have the highest muscle activation of paraspinal musculature compared with other exercises. There are a limited number of studies that investigate the usefulness of incorporating deadlifts as part of a rehabilitation program for low back pain. Clinical Question: For those who live with low back pain, is an exercise routine that includes a deadlift a viable treatment option to improve pain and/or function? Summary of Key Findings: The literature search yielded 3 total studies meeting the inclusion and exclusion criteria: 1 randomized control trial, 1 secondary analysis of a randomized control trial, and 1 cohort study. Exercise programs that include deadlifts can yield improvements in both pain and function for those living with low back pain but were not found to be more beneficial than low load motor control exercises. Those with lower pain levels and higher baseline lumbar extension strength may be most appropriate to participate in an exercise program that includes deadlifts. Further research is needed to compare exercise programs that include deadlifts to other interventions for those living with low back pain. Clinical Bottom Line: There is minimal evidence that exercise programs that included deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures. Strength of Recommendation: Level B evidence exists that exercise programs that include deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures.