RESUMEN
Surgical reconstruction of the anterior cruciate ligament (ACL) and subsequent physical therapy can help athletes return to competition; however, re-injury rates remain disproportionately high due, in part, to lingering biomechanical and neurological factors that are not fully addressed during rehabilitation. Prior reports indicate that individuals exhibit altered electrical activity in both brain and muscle after ACL reconstruction (ACLR). In this investigation, we aimed to extend existing approaches by introducing a novel non-linear analysis of corticomuscular dynamics, which does not assume oscillatory coupling between brain and muscle: Corticomuscular cross-recurrence analysis (CM-cRQA). Our findings indicate that corticomuscular dynamics vary significantly between involved (injured) and uninvolved legs of participants with ACLR during voluntary isometric contractions between the brain and both the vastus medialis and lateralis. This finding points to a potential lingering neural deficit underlying re-injury for athletes after surgical reconstruction, namely the dynamical structure of neuromuscular (brain to quad muscle) coordination, which is significantly asymmetric, between limbs, in those who have ACLR.
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Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Lesiones de Repetición , Humanos , Lesiones del Ligamento Cruzado Anterior/cirugía , Lesiones de Repetición/cirugía , Músculo Cuádriceps/fisiología , Extremidades , Fuerza Muscular/fisiologíaRESUMEN
BACKGROUND: Young athletes who specialize early in a single sport may subsequently be at increased risk of injury. While heightened injury risk has been theorized to be related to volume or length of exposure to a single sport, the development of unhealthy, homogenous movement patterns, and rigid neuromuscular control strategies may also be indicted. Unfortunately, traditional laboratory assessments have limited capability to expose such deficits due to the simplistic and constrained nature of laboratory measurement techniques and analyses. METHODS: To overcome limitations of prior studies, the authors proposed a soccer-specific virtual reality header assessment to characterize the generalized movement regularity of 44 young female athletes relative to their degree of sport specialization (high vs low). Participants also completed a traditional drop vertical jump assessment. RESULTS: During the virtual reality header assessment, significant differences in center of gravity sample entropy (a measure of movement regularity) were present between specialized (center of gravity sample entropy: mean = 0.08, SD = 0.02) and nonspecialized center of gravity sample entropy: mean = 0.10, SD = 0.03) groups. Specifically, specialized athletes exhibited more regular movement patterns during the soccer header than the nonspecialized athletes. However, no significant between-group differences were observed when comparing participants' center of gravity time series data from the drop vertical jump assessment. CONCLUSIONS: This pattern of altered movement strategy indicates that realistic, sport-specific virtual reality assessments may be uniquely beneficial in exposing overly rigid movement patterns of individuals who engage in repeated sport specialized practice.
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Traumatismos en Atletas , Fútbol , Deportes , Realidad Virtual , Humanos , Femenino , Fútbol/lesiones , Atletas , MovimientoRESUMEN
The purpose of this clinical trial was to examine whether internal jugular vein compression (JVC)-using an externally worn neck collar-modulated the relationships between differential head impact exposure levels and pre- to postseason changes in diffusion tensor imaging (DTI)-derived diffusivity and anisotropy metrics of white matter following a season of American tackle football. Male high-school athletes (n = 284) were prospectively assigned to a non-collar group or a collar group. Magnetic resonance imaging data were collected from participants pre- and postseason and head impact exposure was monitored by accelerometers during every practice and game throughout the competitive season. Athletes' accumulated head impact exposure was systematically thresholded based on the frequency of impacts of progressively higher magnitudes (10 g intervals between 20 to 150 g) and modeled with pre- to postseason changes in DTI measures of white matter as a function of JVC neck collar wear. The findings revealed that the JVC neck collar modulated the relationships between greater high-magnitude head impact exposure (110 to 140 g) and longitudinal changes to white matter, with each group showing associations that varied in directionality. Results also revealed that the JVC neck collar group partially preserved longitudinal changes in DTI metrics. Collectively, these data indicate that a JVC neck collar can provide a mechanistic response to the diffusion and anisotropic properties of brain white matter following the highly diverse exposure to repetitive head impacts in American tackle football. Clinicaltrials.gov: NCT# 04068883.
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Lesiones Traumáticas del Encéfalo/prevención & control , Vendajes de Compresión , Fútbol Americano/lesiones , Traumatismos Cerrados de la Cabeza/complicaciones , Venas Yugulares , Equipos de Seguridad , Sustancia Blanca/lesiones , Deportes Juveniles/lesiones , Acelerometría , Adolescente , Lesiones Traumáticas del Encéfalo/diagnóstico por imagen , Lesiones Traumáticas del Encéfalo/etiología , Imagen de Difusión Tensora , Diseño de Equipo , Traumatismos Cerrados de la Cabeza/epidemiología , Humanos , Venas Yugulares/fisiopatología , Masculino , Modelos Neurológicos , Cooperación del Paciente , Estudios Prospectivos , Recurrencia , Estados Unidos , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patologíaRESUMEN
Navigation can be haptically guided. In specific, tissue deformations arising from both limb motions during locomotion (i.e., gait patterns) and mechanical interactions between the limbs and the environment can convey information, detected by the haptic perceptual system, about how the body is moving relative to the environment. Here, we test hypotheses concerning the properties of mechanically contacted environments relevant to navigation of this kind. We studied blindfolded participants implicitly learning to perceive their location within environments that were physically encountered via walking on, stepping on, and probing ground surfaces with a cane. Environments were straight-line paths with elevated sections where the path either narrowed or remained the same width. We formed hypotheses concerning how these two environments would affect spatial updating and reorientation processes. In the constant pathwidth environment, homing task accuracy was higher and a manipulation of the elevated surface, to be either unchanged or (unbeknown to participants) shortened, biased the performance. This was consistent with our hypothesis of a metric recalibration scaled to elevated surface extent. In the narrowing pathwidth environment, elevated surface shortening did not bias performance. This supported our hypothesis of positional recalibration resulting from contact with the leading edge of the elevated surface. We discuss why certain environmental properties, such as path-narrowing, have significance for how one becomes implicitly oriented the surrounding environment.
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Actividad Motora/fisiología , Desempeño Psicomotor/fisiología , Percepción Espacial/fisiología , Navegación Espacial/fisiología , Percepción del Tacto/fisiología , Adulto , Femenino , Humanos , Masculino , Caminata/fisiología , Adulto JovenRESUMEN
Persistent gait alterations can occur after concussion and may underlie future musculoskeletal injury risk. We compared dual-task gait stability measures among adolescents who did/did not sustain a subsequent injury post-concussion, and uninjured controls. Forty-seven athletes completed a dual-task gait evaluation. One year later, they reported sport-related injuries and sport participation volumes. There were three groups: concussion participants who sustained a sport-related injury (n = 8; age =15.4 ± 3.5 years; 63% female), concussion participants who did not sustain a sport-related injury (n = 24; 14.0 ± 2.6 years; 46% female), and controls (n = 15; 14.2 ± 1.9 years; 53% female). Using cross-recurrence quantification, we quantified dual-task gait stability using diagonal line length, trapping time, percent determinism, and laminarity. The three groups reported similar levels of sports participation (11.8 ± 5.8 vs. 8.6 ± 4.4 vs. 10.9 ± 4.3 hours/week; p = 0.37). The concussion/subsequent injury group walked slower (0.76 ± 0.14 vs. 0.65 ± 0.13 m/s; p = 0.008) and demonstrated higher diagonal line length (0.67 ± 0.08 vs. 0.58 ± 0.05; p = 0.02) and trapping time (5.3 ± 1.5 vs. 3.8 ± 0.6; p = 0.006) than uninjured controls. Dual-task diagonal line length (hazard ratio =1.95, 95% CI = 1.05-3.60), trapping time (hazard ratio = 1.66, 95% CI = 1.09-2.52), and walking speed (hazard ratio = 0.01, 95% CI = 0.00-0.51) were associated with subsequent injury. Dual-task gait stability measures can identify altered movement that persists despite clinical concussion recovery and is associated with future injury risk.
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Traumatismos en Atletas , Conmoción Encefálica , Análisis de la Marcha , Lesiones de Repetición , Adolescente , Atletas , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/diagnóstico , Conmoción Encefálica/complicaciones , Conmoción Encefálica/diagnóstico , Niño , Femenino , Humanos , Masculino , Lesiones de Repetición/complicaciones , Lesiones de Repetición/diagnóstico , CaminataRESUMEN
CONTEXT: Laboratory-based biomechanical analyses of sport-relevant movements such as landing and cutting have classically been used to quantify kinematic and kinetic factors in the context of injury risk, which are then used to inform targeted interventions designed to improve risky movement patterns during sport. However, the noncontextual nature of standard assessments presents challenges for assessing sport-relevant skill transfer. OBJECTIVE: To examine injury-risk biomechanical differences exhibited by athletes during a jump-landing task performed as part of both a standard biomechanical assessment and a simulated, sport-specific virtual reality (VR)-based assessment. DESIGN: Observational study. SETTING: Medical center laboratory. PARTICIPANTS: Twenty-two female adolescent soccer athletes (age = 16.0 [1.4] y, height = 165.6 [4.9] cm, and weight = 60.2 [11.4] kg). INTERVENTIONS: The landing performance was analyzed for a drop vertical jump task and a VR-based, soccer-specific corner-kick scenario in which the athletes were required to jump to head a virtual soccer ball and land. MAIN OUTCOME MEASURES: Hip, knee, and ankle joint kinematic differences in the frontal and sagittal planes. RESULTS: Athletes exhibited reduced hip and ankle flexion, hip abduction, and frontal plane ankle excursion during landing in realistic sport scenario compared with the standard drop vertical jump task. CONCLUSION: VR-based assessments can provide a sport-specific context in which to assess biomechanical deficits that predispose athletes for lower-extremity injury and offer a promising approach to better evaluate skill transfer to sport that can guide future injury prevention efforts.
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Extremidad Inferior/fisiología , Movimiento/fisiología , Fútbol/fisiología , Realidad Virtual , Adolescente , Traumatismos en Atletas/prevención & control , Fenómenos Biomecánicos , Femenino , Voluntarios Sanos , Humanos , Medición de Riesgo , Análisis y Desempeño de TareasRESUMEN
STUDY DESIGN: Cross-over study. CONTEXT: The squat, single-leg squat, forward lunge, and reverse lunge are fundamental movements often performed in activities of daily living, sports competitions, and sport-specific training. OBJECTIVE: The purpose of this study was to investigate the effect of visual feedback with a laser sensor (VFLS) versus a control condition on the myoelectric activity (surface electromyography [sEMG]) of the vastus medialis oblique (VMO), vastus lateralis, gluteus medius (Gmed), and erector spinae muscles during the performance of several squat variations with bodyweight. METHODS: Nineteen female college students (20 [2.5] y, 165.3 [10.2] cm, 66.4 [4.1] kg, 2 [1.2] y of resistance training experience) with a background in strength or sports training volunteered to participate in this study. Over 4 separate visits, subjects performed 2 sets of 10 repetitions of a squat variation exercise in random order (ie, squat, single-leg squat, forward lunge, and reverse lunge). The first set of a given squat variation condition was considered a control set, and then after 3-minute rest, a second set was performed with VFLS. RESULTS: Significant decreases in VMO and Gmed myoelectric activity were observed during the VFLS set versus the control set for the forward lunge exercise (P = .03). No differences were observed between the control set and VFLS set in the sEMG normalized signal for all muscles analyzed for the squat and single-leg squat, respectively. However, the sample entropy of the sEMG signal for the erector spinae became more irregular during the VFLS set versus the control set for the squat exercise (P = .01), whereas the Gmed presented a more irregular sEMG signal during the VFLS set versus the control set for the single-leg squat (P = .08). CONCLUSION: Laser sensor biofeedback may induce significant decreases in VMO and Gmed activation performing forward lunge exercise. Therefore, laser sensor biofeedback may induce a reduction in muscle activity of neutralizers muscles during a few squat bodyweight variations (bilateral, single-leg, forward, and reverse lunge).
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Ejercicio Físico/fisiología , Retroalimentación Sensorial/fisiología , Rayos Láser , Movimiento/fisiología , Músculo Esquelético/fisiología , Adolescente , Adulto , Atletas , Fenómenos Biomecánicos , Estudios Cruzados , Electromiografía , Femenino , Humanos , Contracción Isométrica/fisiología , Adulto JovenRESUMEN
This technical report describes the design and implementation of a novel biofeedback system to reduce biomechanical risk factors associated with anterior cruciate ligament (ACL) injuries. The system provided objective real-time biofeedback driven by biomechanical variables associated with increased ACL injury risk without the need of a present expert. Eleven adolescent female athletes (age = 16.7 ± 1.34 yrs; height = 1.70 ± 0.05 m; weight = 62.20 ± 5.63 kg) from the same varsity high school volleyball team were enrolled in the experiment. Participants first completed 10 bodyweight squats in the absence of the biofeedback (pretest), 40 bodyweight squats while interacting with the biofeedback, and a final 10 bodyweight squats in the absence of the biofeedback (posttest). Participants also completed three pretest drop vertical jumps and three posttest drop vertical jumps. Results revealed significant improvements in squat performance, as quantified by a novel heat map analysis, from the pretest to the posttest. Additionally, participants displayed improvements in landing mechanics during the drop vertical jump. This study demonstrates that participants were able to interact effectively with the real-time biofeedback and that biomechanical improvements observed during squatting translated to a separate task.
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Lesiones del Ligamento Cruzado Anterior/prevención & control , Retroalimentación Sensorial/fisiología , Voleibol/lesiones , Adolescente , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Fenómenos Biomecánicos , Estudios de Factibilidad , Femenino , Articulación de la Cadera/fisiología , Calor , Humanos , Articulación de la Rodilla/fisiología , Movimiento/fisiología , Acondicionamiento Físico Humano/métodos , Postura/fisiología , Factores de Riesgo , Programas Informáticos , Estudios de Tiempo y Movimiento , Torso/fisiologíaRESUMEN
CONTEXT: Existing anterior cruciate ligament (ACL) injury prevention programs have failed to reverse the high rate of ACL injuries in adolescent female athletes. OBJECTIVE: This investigation attempts to overcome factors that limit efficacy with existing injury prevention programs through the use of a novel, objective, and real-time interactive visual feedback system designed to reduce the biomechanical risk factors associated with ACL injuries. DESIGN: Cross-over study. SETTING: Medical center laboratory. PARTICIPANTS: A total of 20 females (age = 19.7 [1.34] y; height = 1.74 [0.09] m; weight = 72.16 [12.45] kg) participated in this study. METHODS: Participants performed sets of 10 bodyweight squats in each of 8 training blocks (ie, 4 real-time and 4 control blocks) and 3 testing blocks for a total of 110 squats. Feedback conditions were blocked and counterbalanced with half of participants randomly assigned to receive the real-time feedback block first and half receiving the control (sham) feedback first. RESULTS: Heat map analysis revealed that during interaction with the real-time feedback, squat performance measured in terms of key biomechanical parameters was improved compared with performance when participants squatted with the sham stimulus. CONCLUSIONS: This study demonstrates that the interactive feedback system guided participants to significantly improve movement biomechanics during performance of a body weight squat, which is a fundamental exercise for a longer term ACL injury risk reduction intervention. A longer training and testing period is necessary to investigate the efficacy of this feedback approach to effect long-term adaptations in the biomechanical risk profile of athletes.
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Traumatismos en Atletas/prevención & control , Técnicas de Ejercicio con Movimientos/métodos , Retroalimentación Sensorial , Adolescente , Adulto , Lesiones del Ligamento Cruzado Anterior/prevención & control , Fenómenos Biomecánicos , Estudios Cruzados , Femenino , Humanos , Cinética , Factores de Riesgo , Adulto JovenRESUMEN
Tightly coordinated grip force adaptations in response to changing load forces have been reported as continuous, stable, and proportional to the load force changes. Considering the existence of inherent sensorimotor feedback delays, current accounts of grip force-load force coupling invoke explicit predictive mechanisms in the form of internal models for feedforward control to account for anticipatory grip force modulations. However, recent findings suggest that the stability and regularity of grip force-load force coupling is less persistent than previously thought. Thus, the objective of the current study was to comprehensively quantify the time-varying characteristics of grip force-load force coupling. Investigations into the coupling's dynamics during continuous 30 s bouts of load force oscillation revealed intermittent phases of coordination, as well as phases that varied in stability, rather than a persistent and continuously stable pattern of coordination. These findings have important implications for accounts of grip force-load force coupling and of anticipation in motor control, more broadly.
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Adaptación Fisiológica/fisiología , Fuerza de la Mano/fisiología , Mano/fisiología , Movimiento/fisiología , Adulto , Femenino , Humanos , Masculino , Desempeño Psicomotor/fisiología , Análisis y Desempeño de Tareas , Soporte de Peso/fisiología , Adulto JovenRESUMEN
Exposure to explosive blasts places one at risk for traumatic brain injury, especially for special weapons and tactics (SWAT) and military personnel, who may be repeatedly exposed to blasts. In the current study, the effectiveness of a jugular vein compression collar to prevent alterations in resting-state electrocortical activity following a single-SWAT breacher training session was investigated. SWAT team personnel were randomly assigned to wear a compression collar during breacher training and resting state electroencephalography (EEG) was measured within 2 days prior to and two after breacher training. It was hypothesized that significant changes in brain dynamics-indicative of possible underlying neurodegenerative processes-would follow blast exposure for those who did not wear the collar, with ameliorated changes for the collar-wearing group. Using recurrence quantification analysis (RQA) it was found that participants who did not wear the collar displayed longer periods of laminar electrocortical behavior (as indexed by RQA's vertical max line measure) after breacher training. It is proposed that the blast wave exposure for the no-collar group may have reduced the number of pathways, via axonal disruption-for electrical transmission-resulting in the EEG signals becoming trapped in laminar states for longer periods of time. Longer laminar states have been associated with other electrocortical pathologies, such as seizure, and may be important for understanding head trauma and recovery.
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Lesiones Encefálicas/cirugía , Traumatismos Craneocerebrales/prevención & control , Venas Yugulares/cirugía , Presión , Armas , Adulto , Anciano , Encéfalo/patología , Lesiones Encefálicas/prevención & control , Lesiones Traumáticas del Encéfalo/patología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
CONTEXT: A limiting factor for reducing anterior cruciate ligament injury risk is ensuring that the movement adaptions made during the prevention program transfer to sport-specific activity. Virtual reality provides a mechanism to assess transferability, and neuroimaging provides a means to assay the neural processes allowing for such skill transfer. OBJECTIVE: To determine the neural mechanisms for injury risk-reducing biomechanics transfer to sport after anterior cruciate ligament injury prevention training. DESIGN: Cohort study. SETTING: Research laboratory. PARTICIPANTS: Four healthy high school soccer athletes. INTERVENTIONS: Participants completed augmented neuromuscular training utilizing real-time visual feedback. An unloaded knee extension task and a loaded leg press task were completed with neuroimaging before and after training. A virtual reality soccer-specific landing task was also competed following training to assess transfer of movement mechanics. MAIN OUTCOME MEASURES: Landing mechanics during the virtual reality soccer task and blood oxygen level-dependent signal change during neuroimaging. RESULTS: Increased motor planning, sensory and visual region activity during unloaded knee extension and decreased motor cortex activity during loaded leg press were highly correlated with improvements in landing mechanics (decreased hip adduction and knee rotation). CONCLUSION: Changes in brain activity may underlie adaptation and transfer of injury risk-reducing movement mechanics to sport activity. Clinicians may be able to target these specific brain processes with adjunctive therapy to facilitate intervention improvements transferring to sport.
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Adaptación Fisiológica , Encéfalo/fisiología , Movimiento , Lesiones del Ligamento Cruzado Anterior/prevención & control , Atletas , Fenómenos Biomecánicos , Estudios de Cohortes , Femenino , Humanos , Corteza Motora/fisiología , Neuroimagen , Plasticidad Neuronal , Oxígeno/sangre , Acondicionamiento Físico Humano , Fútbol , Deportes , Realidad VirtualRESUMEN
PURPOSE: The purpose of this study was to evaluate the utility of postural sway variability as a potential assessment to detect altered postural sway in youth with symptoms related to a concussion. METHODS: Forty participants (20 who were healthy and 20 who were injured) aged 10 to 16 years were assessed using the Balance Error Scoring System (BESS) and postural sway variability analyses applied to center-of-pressure data captured using a force plate. RESULTS: Significant differences were observed between the 2 groups for postural sway variability metrics but not for the BESS. Specifically, path length was shorter and Sample and Renyi Entropies were more regular for the participants who were injured compared with the participants who were healthy (P < .05). CONCLUSION: The results of this study indicate that postural sway variability may be a more valid measure than the BESS to detect postconcussion alterations in postural control in young athletes.
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Conmoción Encefálica/rehabilitación , Modalidades de Fisioterapia , Equilibrio Postural , Adolescente , Atletas , Niño , Femenino , Humanos , MasculinoRESUMEN
Previous work suggests that synergistic activity among motor elements implicated in force production tasks underlies enhanced performance stability associated with visual feedback. A hallmark of synergistic activity is reciprocal compensation, that is, covariation in the states of motor elements that stabilizes critical performance variables. The present study examined if characteristics of reciprocal compensation are indicators of individuals' capacity to respond adaptively to variations in the resolution of visual feedback about criterion performance. Twenty healthy adults (19.25 ± 1.25 years; 15 females and five males) pressed two sensors with their index fingers to produce a total target force equivalent to 20% of their maximal voluntary contraction under nine conditions that differed in the spatial resolution of real-time feedback about their performance. By combining within-trial uncontrolled manifold and sample entropy analyses, we quantified the amount and degree of irregularity (i.e., non-repetitiveness) of reciprocal compensations over time. We found a U-shaped relationship between performance stability and gain. Importantly, this relationship was moderated by the degree of irregularity of reciprocal compensation. Lower irregularity in reciprocal compensation patterns was related to individuals' capacity to maintain (or minimize losses in) performance under changes in feedback resolution. Results invite future investigation into how interindividual variations in reciprocal compensation patterns relate to differences in control strategies supporting adaptive responses in complex, visually guided motor tasks.
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Physical activity avoidance and fear of movement (FOM) is often observed in individuals with chronic musculoskeletal pain, along with difficulties coping with pain. There is little research regarding how FOM may also relate to reduced physical strength and altered movement patterns that may perpetuate a cycle of pain, FOM, and disability. The objective of this observational study was to compare how adolescents with juvenile fibromyalgia (JFM) exhibiting high versus low FOM (Tampa Scale of Kinesiophobia-11) differed on patient-reported measures of pain, fatigue, catastrophizing and pain interference, and performance-based measures of strength, postural control, and biomechanical function. Participants were youth with JFM (N = 135, Meanage = 15.6 years, 88.9% female) enrolled in an ongoing clinical trial who completed self-report questionnaires and standardized tests, including knee and hip strength, the Star Excursion Balance Test, and the Drop Vertical Jump (with 3 dimensional motion capture). Participants were categorized into Low, Medium, and High FOM groups based on Tampa Scale of Kinesiophobia-11 tertile scores. Relative to the Low FOM group, the High FOM group reported significantly greater fatigue, pain interference and catastrophizing, as well as reduced dominant leg knee strength. Additionally, those with high FOM showed altered lower-extremity movement patterns. This preliminary study highlights the importance of combining self-reported measures of symptoms and functioning with physical assessments to gain a more comprehensive view of the impact of FOM in patients with chronic musculoskeletal pain. The results could inform the development of more precise interventions to reduce FOM using a combination of behavioral and exercise-based interventions. PERSPECTIVE: The results of this study demonstrate the association between FOM, fatigue and pain interference in adolescents with JFM, as well as preliminary evidence for altered movement patterns in that may predispose them to further pain/injury and activity avoidance. GOV REGISTRATION: NCT03268421.
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Catastrofización , Miedo , Fibromialgia , Movimiento , Humanos , Femenino , Adolescente , Fibromialgia/fisiopatología , Fibromialgia/psicología , Masculino , Miedo/fisiología , Movimiento/fisiología , Catastrofización/fisiopatología , Catastrofización/psicología , Fuerza Muscular/fisiología , Dimensión del Dolor , Fatiga/fisiopatología , Fatiga/etiología , KinesiofobiaRESUMEN
ABSTRACT: Juvenile fibromyalgia (JFM) is a chronic condition characterized by symptoms of pain and fatigue and is associated with sedentary behavior and functional disability. Adults with fibromyalgia exhibit deficits in physical fitness as evidenced by lower aerobic capacity and physical endurance, but it is unknown whether these impairments are apparent in adolescents with JFM. Furthermore, the extent to which functional disability and pain interference relate to measures of physical fitness has not been investigated in a pediatric pain population. During a baseline assessment for a clinical trial, 321 adolescents with juvenile fibromyalgia (M age = 15.14, 85.2% female) completed measures of pain intensity, fatigue, JFM symptom severity, functional disability, and pain interference. They also completed 2 validated fitness tasks: (1) the Harvard step test, which assesses aerobic fitness, and (2) the 6-minute walk test, a simple submaximal test of endurance. We examined associations among self-report measures and fitness assessments using bivariate correlations. We then employed hierarchical regression analyses to determine the unique contributions of physical fitness assessments to self-reported functional disability and pain interference. Results indicated that youth with JFM exhibited deficits in aerobic capacity and physical endurance. However, physical fitness explained negligible variance in functional disability and pain interference beyond that accounted for by pain, fatigue, and JFM symptom severity. Scores on available functional disability measures may reflect perceived difficulties in coping with symptoms during physical tasks rather than actual physical capability. Rigorous and sensitive assessments of physical fitness and endurance are needed to determine whether rehabilitation interventions for pediatric pain improve physical functioning.
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Fibromialgia , Adolescente , Femenino , Humanos , Masculino , Fatiga/complicaciones , Dolor/complicaciones , Dimensión del Dolor , Medición de Resultados Informados por el PacienteRESUMEN
CONTEXT: Visual biofeedback has been shown to facilitate injury-resistant movement acquisition in adolescent athletes. Visual biofeedback is typically thought to foster implicit learning by stimulating athletes to focus attention externally (on movement outcome). However, biofeedback may also induce explicit learning if the athlete uses the visual information to consciously guide movement execution (via an internal focus). OBJECTIVE: To determine the degree to which athletes reported statements indicating implicit or explicit motor learning after engaging in a visual biofeedback intervention. DESIGN: Prospective cohort study. SETTING: Three-dimensional motion-analysis laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-five adolescent female soccer athletes (age = 15.0 ± 1.5 years, height = 165.7 ± 5.9 cm, mass = 59.4 ± 10.6 kg). INTERVENTIONS: Standard 6-week neuromuscular training intervention (three 90-minute sessions/wk), with added visual biofeedback sessions (2 sessions/wk). For the biofeedback training, participants performed squatting and jumping movements while interacting with a visual rectangular stimulus that mapped key parameters associated with injury risk. After the last biofeedback session in each week, participants answered open-ended questions to probe learning strategies. MAIN OUTCOME MEASURE(S): Responses to the open-ended questions were categorized as externally focused (ie, on movement outcome, suggestive of implicit learning), internally focused (ie, on movement itself, suggestive of explicit learning), mixed focus, or other. RESULTS: A total of 171 open-ended responses were collected. Most of the responses that could be categorized (39.2%) were externally focused (41.8%), followed by mixed (38.8%) and internally focused (19.4%). The frequency of externally focused statements increased from week 1 (18%) to week 6 (50%). CONCLUSIONS: Although most statements were externally focused (suggesting implicit learning), the relatively large proportion of internal- and mixed-focus statements suggested that many athletes also engaged in explicit motor learning, especially in early practice sessions. Therefore, biofeedback may affect motor learning through a mixture of implicit and explicit learning.
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Biorretroalimentación Psicológica , Movimiento , Adolescente , Humanos , Femenino , Estudios Prospectivos , Biorretroalimentación Psicológica/métodos , Postura , Aprendizaje/fisiologíaRESUMEN
Optically pumped magnetometers (OPMs) can capture brain activity but are susceptible to magnetic noise. The objective of this study was to evaluate a novel methodology used to reduce magnetic noise in OPM measurements. A portable magnetoencephalography (MEG) prototype was developed with OPMs. The OPMs were divided into primary sensors and reference sensors. For each primary sensor, a synthetic gradiometer (SG) was constructed by computing a secondary sensor that simulated noise with signals from the reference sensors. MEG data from a phantom with known source signals and six human participants were used to assess the efficacy of the SGs. Magnetic noise in the OPM data appeared predominantly in a low frequency range (<4 Hz) and varied among OPMs. The SGs significantly reduced magnetic noise (p < 0.01), enhanced the signal-to-noise ratio (SNR) (p < 0.001) and improved the accuracy of source localization (p < 0.02). The SGs precisely revealed movement-evoked magnetic fields in MEG data recorded from human participants. SGs provided an effective method to enhance SNR and improve the accuracy of source localization by suppressing noise. Software-simulated SGs may provide new opportunities regarding the use of OPM measurements in various clinical and research applications, especially those in which movement is relevant.
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The practice of early sport specialization, defined as intense year-round training in a single sport at the exclusion of others, is increasing in youth athletics. Despite potential benefits, sport specialization may be detrimental to the health of young athletes, as specialization may increase the risk of musculoskeletal injuries-particularly overuse injuries. However, there remains limited knowledge about how sports specialization uniquely alters underlying sports-related motor behavior. The purpose of this study was to compare the variability of movement patterns exhibited by highly sports specialized youth athletes to that of nonspecialized athletes during performance of a sport-specific, virtual reality based cutting task. It was hypothesized that highly specialized athletes would display different patterns of movement coordination compared to nonspecialized athletes during both the run-up phase and cut-and-decelerate phase. In support of the hypothesis, specialized athletes exhibited both intra- and inter-limb coordination that were significantly different than unspecialized athletes. Overall, the results indicate that the highly specialized athletes tended to exhibit greater degrees of coordination but also the ability to break the coordinated patterns of joint angle changes to execute a cutting maneuver, which requires asymmetric demands on the lower extremities while planting on one leg and changing direction.
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Traumatismos en Atletas , Deportes , Adolescente , Humanos , Factores de Riesgo , Extremidad Inferior , AtletasRESUMEN
The uncontrolled manifold (UCM) approach quantifies the presence of compensatory variability between musculoskeletal elements involved in a motor task. This approach has proved useful for identifying synergistic control strategies for a variety of everyday motor tasks and for investigating how control strategies are affected by motor pathology. However, the UCM approach is limited in its ability to relate compensatory motor variance directly to task performance because variability along the UCM is mathematically agnostic to performance. We present a new approach to UCM analysis that quantifies patterns of irregularity in the compensatory variability between motor elements over time. In a bimanual isometric force stabilization task, irregular patterns of compensation between index fingers predicted greater performance error associated with difficult task conditions, in particular for individuals who exploited a larger set of compensatory strategies (i.e., a larger subspace of the UCM). This relationship between the amount and structure of compensatory motor variance might be an expression of underlying processes supporting performance resilience.