Influence of Different Dual-Task Conditions During Straight or Curved Walking on Gait Performance of Physically Active Older Women With Cognitive Decline.

Real-world walking requires shifting attention from different cognitive demands to adapt gait. This study aims to evaluate the effect of dual tasking on spatiotemporal gait parameters of older adults. Participants were asked to perform a primary complex single-walking task, consisting of a fast-paced linear and a curved gait. Primary task was performed separately and simultaneously with different motor and cognitive secondary tasks. Spatiotemporal gait parameters, walk ratio, and walk stability ratio were measured. Apart from stride length, which stood relatively unchanged, gait speed and cadence were strongly affected by cognitive dual tasking. Cadence seems to be the most impacted by dual tasking during curved gait as it combines challenges of both primary and secondary tasks. Also, during curved phase, walking ratio was significantly lower and stability ratio was greater demonstrating that participants adopted a cautious gait where maintenance of stability took preference over efficiency.

A systematic review of the morphology and function of the sacrotuberous ligament.

The sacrotuberous ligament (STL) has been linked to conditions such as pelvic girdle pain and pudendal nerve entrapment, yet its contribution to pelvic stability is debated. The purpose of this review was to explore the current understanding of the STL and highlight any gaps in knowledge regarding its anatomy and function. A systematic search of the literature was conducted, focussing on the morphology and attachments of the STL, the relationship of the STL with surrounding structures, and its neurovascular supply and function. A total of 67 papers and four textbooks were obtained. The attachment sites of the STL are largely consistent; however, the extent of its connections with the long head of biceps femoris, gluteus maximus, piriformis, the posterior layer of the thoracolumbar fascia, and sacrospinous ligament are unclear. Morphometric parameters, such as mean STL length (6.4-9.4 cm), depth (0.3-0.4 cm), and width (1.8-3.5 cm, at its mid-point) are variable within and between studies, and little is known about potential side-, age-, or sex-related differences. The STL is pierced in several sites by the inferior and superior gluteal arteries, but information on its innervation pattern is sparse. Functionally, the STL may limit sacral nutation but it appears to have a limited contribution to pelvic stability. Some morphological aspects of the STL warrant further investigation, particularly its connections with surrounding structures, innervation pattern and function. Knowledge of the detailed anatomy and function of this ligament is important to better understanding its role in clinical conditions. Clin. Anat. 32:396-407, 2019. © 2018 Wiley Periodicals, Inc.

Shoulder kinematics is not influenced by external load during elevation in the scapular plane.

The current study aimed to compare the shoulder kinematics (3D scapular orientation, scapular angular displacement and scapulohumeral rhythm) of asymptomatic participants under unloaded and loaded conditions during unilateral shoulder elevation in the scapular plane. We used a repeated-measures design with a convenience sample. Eleven male participants with an age range of 21-28 years with no recent history of shoulder injury participated in the study. The participants performed isometric shoulder elevation from a neutral position to approximately 150 degrees of elevation in the scapular plane in intervals of approximately 30 degrees during unloaded and loaded conditions. Shoulder kinematic data were obtained with videogrammetry. During shoulder elevation, the scapula rotated upwardly and externally, and tilted posteriorly. The addition of an external load did not affect 3D scapular orientation, scapular angular displacement, or scapulohumeral rhythm throughout shoulder elevation (P > .05). In clinical practice, clinicians should expect to observe upward and external rotation and posterior tilt of the scapula during their assessments of shoulder elevation. Such behavior was not influenced by an external load normalized to 5% of body weight when performed in an asymptomatic population.

Exploring challenges affecting resilience in carers of stroke survivors: a qualitative descriptive study.

PURPOSE: To develop an intervention to build resilience in carers of stroke survivors this study aimed to understand these carers' (1) Challenges that adversely affect their resilience, and (2) suggestions for a relevant intervention to build resilience. METHODS: Individual semi-structured interviews were used. Participants included carers of stroke survivors (stroke duration > six months). Transcripts were analysed using the General Inductive Approach. This study followed guidelines of Consolidated criteria for Reporting Qualitative research (COREQ). RESULTS: Four themes were identified that affected resilience: (1) carer psychosocial outcomes, (2) stroke's sudden and unexpected impact, (3) financial stressors, and (4) carer exclusion in care planning. Carers suggested an intervention comprising information sharing and training in coping skills, positive communication, problem-solving, and connection with "people who have gone through this" to improve resilience. Most supported a group, monthly delivery of the intervention. CONCLUSION: These findings provide direction for a suitable intervention. Further, they suggest that stroke rehabilitation could be improved by adopting a family-centered model of care so that carers can be included as active partners in care process. Protecting carers from the negative impact of caring role on their resilience may sustain their ability to provide long-term care for the stroke survivor.IMPLICATIONS FOR REHABILITATIONThe provision of informal care to stroke survivors can be associated with significant emotional consequences, withdrawal from social activities, and poor quality of life for the carers.The abruptness of stroke presentation along with its long-term nature can negatively affect the resilience of informal carers.Exploration of challenges affecting carer resilience is important to develop interventions to build resilience in carers of stroke survivors.Integrating interventions focusing on carers' resilience as part of the stroke rehabilitation process is imperative to ensure well-being of carers and sustainability of the care provided to the stroke survivor.

Psychosocial interventions for building resilience of informal carers of people living with stroke: a systematic review.

PURPOSE: To identify and synthesise the evidence of interventions purported to build resilience among informal carers of stroke survivors. METHODS: A systematic review of randomised controlled trials of psychosocial interventions to build resilience for carers of people post-stroke was planned. A systematic search was conducted in seven online databases from inception to March 2021. Outcomes measured were resilience and its proxy constructs including copying, adaptation, adjustment, problem-solving, self-efficacy, locus of control, competence and strength. RESULTS: Twelve studies were included in the review and were grouped into four intervention categories (i) Education and social support, (ii) problem-solving skills, (iii) problem-solving skills, and psychoeducation and (iv) information provision, problem-solving skills and psychoeducation. Level of evidence A exists for interventions that combine information provision, problem-solving skills and psychoeducation over the interventions that only use problem-solving skills intervention or problem-solving skills with psychoeducation strategies. All interventions apart from one reported significant within and/or between group changes in outcomes. CONCLUSION: Interventions comprising of information provision, problem-solving skills and psychoeducation appear to be beneficial to improve resilience of carers. However, because of the heterogeneity of the interventions and outcome measures reported across the twelve studies no particular intervention could be definitively supported. CLINICAL TRIAL REGISTRATION: Systematic review registration: CRD 42020172824 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172824 IMPLICATIONS FOR REHABILITATIONProviding care for stroke survivors is particularly demanding due to the lack of preparation for managing the unexpected and complex nature of stroke, resulting in negative physical, social, behavioral, emotional, and financial outcomes.The long-term nature of stroke and its many residual problems can negatively affect the physical and psychological well-being of the individual and their carers, which may subsequently affect the recovery of the stroke survivor.Evidence suggests that resilience is the protective shield for carers' stress and burnout.Integrating interventions focusing on carers' resilience as part of the stroke rehabilitation process is imperative to ensure the well-being of carers and the sustainability of the care provided to the stroke survivor.

Dose-response relationship between work-related cumulative postural exposure and low back pain: a systematic review.

OBJECTIVES: To assess the evidence for a dose-response relationship between ROM, duration, and frequency of trunk flexion, and risk of occupational LBP. METHODS: An electronic systematic search was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Scopus databases focusing on cohort and case-control studies. Studies were included if they focused on non-specific LBP and postural exposure, considering ROM, duration, or frequency of trunk flexion as independent variables. No language restriction was imposed. Included studies were assessed for risk of bias using the Newcastle-Ottawa Scale for observational studies and a summary of evidence is presented. RESULTS: Eight studies were included and all were methodologically rated as high quality. The included studies yielded a total of 7023 subjects who were considered for risk analysis. Different outcome measures for postural exposure were adopted making meta-analysis difficult to perform. CONCLUSIONS: We could not find a clear dose-response relationship for work posture exposures and LBP. Limited evidence was found for ROM and duration of sustained flexed posture as risk factor for LBP. We found no evidence for frequency of trunk flexion as a risk factor for LBP.

Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review.

PURPOSE: To determine the level of evidence for altered mechanical and motor control of the pelvis being associated with pregnancy-related pelvic girdle pain (PPGP). METHODS: This systematic review was undertaken by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six different databases were used for the electronic search. Observational cohorts, cross sectional or case-control studies focused on the association between altered kinematic/kinetic and motor control of the pelvis and PPGP during pregnancy were included. Study selection was conducted by two reviewers who firstly screened for titles, then for abstracts and finally for full articles. The Newcastle-Ottawa scale and the guidelines proposed by the Cochrane back review group were used to assess risk of bias and quality of evidence, respectively. RESULTS: 354 references were identified, and after excluding unwanted articles, 10 studies met the final inclusion criteria. Studies not related to motor control or pelvic mobility were the main reason for exclusion. Seven studies were case-control and three were prospective cohort studies. Seven studies were ranked as high while three were ranked as low quality. Among the high quality studies, six found association between PPGP and altered motor control and mobility of the pelvis. CONCLUSIONS: The level of evidence for an association between PPGP and altered motor control and kinematic or kinetic parameters of the pelvis was found to be moderate.

Pregnancy-related pelvic girdle pain and its relationship with relaxin levels during pregnancy: a systematic review.

PURPOSE: The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy. METHODS: PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using six different databases. Observational cohorts, cross-sectional or case-control studies focused on the association between relaxin levels and PPGP during pregnancy were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Newcastle-Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group. RESULTS: 731 references were identified. Six articles met the inclusion criteria and were considered for this systematic review. The main reason for the studies exclusion was PPGP related to gynaecological reasons. Five studies were case-control and one study was a prospective cohort. Four studies were ranked as high while two were ranked as low quality. Among the high quality studies, three found no association between PPGP and relaxin levels. CONCLUSIONS: Based on these findings, the level of evidence for the association between PPGP and relaxin levels was found to be low. PPGP assessment and controlling for risk factors were found to increase bias leaving uncertainty in interpretation of these findings and a need for further research.

Changes in static balance during pregnancy and postpartum: A systematic review.

BACKGROUND: Because pregnant women show a high risk of falling, some researchers examined their balance during static standing. This systematic review summarized the findings from all studies evaluating static balance in women during pregnancy and postpartum. RESEARCH QUESTION: Do pregnant and postpartum women show differences in static balance compared to non-pregnant women, and does static balance change during pregnancy and postpartum? METHODS: Pubmed, Embase, CINAHL, and Web of Science databases were searched systematically from inception until Feb 23, 2022. Studies were eligible for inclusion if they measured COP sway with a force plate during bipedal static standing, and compared COP outcomes between healthy pregnant or postpartum women and non-pregnant women, and/or during different stages of pregnancy and the postpartum period. Methodological quality was assessed overall with a modified version of the Downs and Black checklist, and specifically related to COP measurement by using recommendations of Ruhe et al. (2010). The protocol was registered in PROSPERO (CRD42020166302). RESULTS: Thirteen studies were included. Because methodological approaches varied greatly between studies, results were summarized descriptively. Studies reported either greater overall and anteroposterior COP sway magnitude, velocity and variability in women from the second half of pregnancy until six months postpartum compared to non-pregnant controls, or no differences in static balance. Changes in static balance throughout pregnancy were generally not found. Finally, there was no clear consensus on the influence of pregnancy on the reliance on visual inputs for balance control, and on whether differences in balance in pregnant and postpartum women reflect poorer balance or positive adaptations to the physical changes experienced during pregnancy. SIGNIFICANCE: Methodological heterogeneity between studies prevented us from drawing strong conclusions regarding the effect of pregnancy on static balance. Assessing the methodological quality of the studies revealed weaknesses that should be taken into account in future studies.

Management of women with pregnancy-related pelvic girdle pain: an international Delphi study.

OBJECTIVES: Pregnancy-related pelvic girdle pain (PPGP) contributes to significant prenatal and postpartum impairments; however, various clinical practices exist around the conservative treatment of this condition. This study sought to reach a consensus on the essential components of PPGP management through an international Delphi survey of experts in women's health. DESIGN AND PARTICIPANTS: Eighty-seven international experts in the field of PPGP were invited to participate and surveyed over three rounds. Round 1 of the survey utilised open-ended questions to gain feedback on 16 components of PPGP management previously identified by a focus group. Feedback from panel members guided modification and refinement of questions for Rounds 2 and 3. A 5-point Likert scale was used to rate level of agreement, with a minimum threshold for consensus of ≥75% agreement set across all survey rounds. RESULTS: Forty-four of the 87 (50%) invited professionals agreed to participate in the panel, with 77% (34/44) of panellists contributing to all three rounds. Of the 16 initial components, 15 were included in Round 2. The final consensus was reached on 10 important components of assessment and management after Round 3: pain education, postural and ergonomic advice, social and lifestyle factors, psychological factors, cultural considerations, strengthening exercise, other exercise, exercise precautions, manual therapy and the use of crutches. CONCLUSION: This study identified 10 key components that should be considered in the management of PPGP. In addition, these components provide a potential framework for future research around the conservative management of PPGP.