Ultrasonographic measurement indicated patients with chronic neck pain had reduced diaphragm thickness and mobility along with declined respiratory functions.

BACKGROUND: Chronic neck pain (CNP) is a prevalent musculoskeletal condition including notable impairments in respiratory function. The diaphragm, serving dual roles in respiration and spinal stability, is intricately linked to the cervical spine through fascial, neurophysiological, and biomechanical connections. However, to date, none has investigated the diaphragm function in patients with CNP. OBJECTIVES: To investigate the diaphragm function, respiratory muscle strength, and pulmonary function in patients with CNP. In addition, their associations were also examined. DESIGN: A case-control study. METHODS: A total of 54 participants were recruited including 25 patients with CNP (CNP group) and 29 healthy adults (CON group). Pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), and respiratory muscle strength represented by maximal inspiratory (MIP) and maximal expiratory pressure (MEP), as well as diaphragm function including ultrasonographic measures of mobility and thickness changes during maximal inspiration and expiration were assessed in all participants. Additionally, the intensity of pain and disability were evaluated using a Visual Analog Scale and Neck Disability Index only in patients with CNP. RESULTS: Significant reductions of the FVC, FEV1, MIP, and MEP were found in the CNP group compared to the CON group (p < 0.05). The diaphragm mobility and thickness changes were also significantly decreased in the CNP group than the CON group with medium effect sizes (p < 0.05). Only diaphragm thickness change was positively correlated with FVC, FEV1, and MEP in patients with CNP. Furthermore, MEP showed the strongest contribution to diaphragm thickness change based on the regression analysis. CONCLUSIONS: Impaired diaphragm function, respiratory muscle strength, and pulmonary function were observed in patients with CNP. Patients with smaller diaphragm thickness change had poorer pulmonary function and reduced maximal expiratory muscle strength. Diaphragm assessment and intervention may be considered in CNP management.

The fully engaged inspiratory muscle training reduces postoperative pulmonary complications rate and increased respiratory muscle function in patients with upper abdominal surgery: a randomized controlled trial.

BACKGROUND: Upper abdominal surgical treatment may reduce respiratory muscle function and mucociliary clearance, which might be a cause of postoperative pulmonary complications (PPCs). Threshold inspiratory muscle training (IMT) may serve as an effective modality to improve respiratory muscle strength and endurance in patients. However, whether this training could help patients with upper abdominal surgery remains to be determined. The aim of the present investigation was to determine the effect of a fully engaged IMT on PPCs and respiratory function in patients undergoing upper abdominal surgery. We hypothesized that the fully engaged IMT could reduce PPCs and improve respiratory muscle function in patients with upper abdominal surgery. METHODS: This is a randomized controlled trial (RCT) with 28 patients who underwent upper abdominal surgery. Patients were randomly assigned to the control (CLT) group or the IMT group. The CTL group received regular health care. The IMT group received 3 weeks of IMT with 50% of MIP as the initial intensity before the operation. The intensity of MIP increased by 5-10% per week. The IMT was continued for 4 weeks after the operation. The study investigated the outcomes including PPCs, respiratory muscle strength, diaphragmatic function, cardiopulmonary function, and quality of life (QoL). RESULTS: We found that IMT improved respiratory muscle strength and diaphragmatic excursion. IMT also had a beneficial effect on the incidence of postoperative pulmonary complications (PPCs) compared to CLT care. CONCLUSION: The results from this study revealed that IMT provided positive effects on parameters associated with the respiratory muscle function and reduced the incidence of PPCs. We propose that fully engaged IMT should be a part of clinical management in patients with upper abdominal surgery.KEY MESSAGESThe fully engaged inspiratory muscle training reduces postoperative pulmonary complications rate in patients with upper abdominal surgery.The fully engaged inspiratory muscle training increases maximal inspiratory pressure in patients with upper abdominal surgery.The fully engaged inspiratory muscle training increases diaphragm function in patients with upper abdominal surgery.The fully engaged inspiratory muscle training increases the quality of life in patients with upper abdominal surgery.

The Influence of Nordic Walking on Spinal Posture, Physical Function, and Back Pain in Community-Dwelling Older Adults: A Pilot Study.

Nordic walking is an increasingly popular form of exercise among the elderly. Using poles is thought to facilitate a more upright posture; however, previous studies primarily investigated the effects of Nordic walking on respiratory function and physical fitness. The aims of this study were to investigate the influence of Nordic walking on spinal posture, physical functions, and back pain in community-dwelling older adults. Thirty-one community-dwelling older adults aged ≥ 60 years participated in a twice weekly Nordic walking training program for 12 weeks. The outcome measures, including spinal posture, physical functions, back pain, and the strength and endurance of back extensor muscles were assessed before and after a 12-week program. After training, spinal posture, back pain, and the strength and endurance of back extensor muscles did not show any statistically significant changes. Among the seven clinical tests of physical function, only the 30 s arm curl test, the 30 s chair stand test, and the single leg stance test showed significant improvements. Nordic walking has limited influence on age-related hyperkyphosis and back pain, but may be effective for physical function. The results of this study can provide useful information for people involved in the prevention and treatment of physical dysfunction in community-dwelling older adults.

Sitting Posture during Prolonged Computer Typing with and without a Wearable Biofeedback Sensor.

Prolonged sitting combined with an awkward posture might contribute to the increased risks of developing spinal pain. Maintaining an upright sitting posture is thus often suggested, especially nowadays when people spend longer periods in the sitting posture for occupational or leisure activities. Many types of assistive devices are commercially available to help computer users maintain an upright sitting posture. As the technology advances, wearable sensors that use microelectromechanical technology are designed to provide real-time biofeedback and promote adjusting posture actively. However, whether such wearable biofeedback sensors could assist adjusting sitting posture in computer users during prolonged typing remains unknown. This study aimed to investigate the effects of a wearable biofeedback sensor on maintaining an upright sitting posture. Twenty-one healthy young adults were recruited and performed a 1-h computer typing task twice, with and without using the active biofeedback device. The sagittal spinal posture during computer typing was measured using a three-dimensional motion analysis system. Using the wearable biofeedback sensor significantly decreased the neck flexion (p < 0.001), thoracic kyphotic (p = 0.033), and pelvic plane (p = 0.021) angles compared with not using the sensor. Computer users and sedentary workers may benefit from using wearable biofeedback sensors to actively maintain an upright sitting posture during prolonged deskwork.

Effects of Sling Exercise for Neck Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. METHODS: The Cochrane Central Register of Controlled Trials, EMBASE, Physiotherapy Evidence Database (PEDro), and 6 other databases were searched from inception to July 2020. The reference lists of relevant articles to identify additional trials were also screened. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain, including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. The random-effects model was used to perform meta-analyses. RESULTS: Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD = 1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD = -1.23; 95% CI = -1.88 to -0.58) immediately postintervention compared with the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion and sustained effects on disability at intermediate-term follow-up. CONCLUSION: Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. IMPACT: This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain.

Abdominal Expansion versus Abdominal Drawing-In Strategy on Thickness and Electromyography of Lumbar Stabilizers in People with Nonspecific Low Back Pain: A Cross-Sectional Study.

The abdominal expansion (AE) strategy, involving eccentric contraction of the abdominal muscles, has been increasingly used in clinical practices; however, its effects have not been rigorously investigated. This study aimed to investigate the immediate effects of the AE versus abdominal drawing-in (AD) strategy on lumbar stabilization muscles in people with nonspecific low back pain (LBP). Thirty adults with nonspecific LBP performed the AE, AD, and natural breathing (NB) strategies in three different body positions. Ultrasonography and surface electromyography (EMG) were, respectively, used to measure the thickness and activity of the lumbar multifidus and lateral abdominal wall muscles. The AE and AD strategies showed similar effects, producing higher EMG activity in the lumbar multifidus and lateral abdominal wall muscles when compared with the NB strategy. All muscles showed higher EMG activity in the quiet and single leg standing positions than in the lying position. Although the AE and AD strategies had similar effects on the thickness change of the lumbar multifidus muscle, the results of thickness changes of the lateral abdominal muscles were relatively inconsistent. The AE strategy may be used as an alternative method to facilitate co-contraction of lumbar stabilization muscles and improve spinal stability in people with nonspecific LBP.

Evaluation of a Cervical Stabilization Exercise Program for Pain, Disability, and Physical Impairments in University Violinists with Nonspecific Neck Pain.

Cervical stabilization exercises are frequently used to reduce pain, maximize function, and improve physical impairments for people with nonspecific neck pain. We conducted a single arm study to evaluate the effects of a home-based cervical stabilization exercise program for university violin players with nonspecific neck pain who frequently assume an asymmetrical neck posture and activate their superficial cervical flexors to stabilize the violin. Twenty violin players with nonspecific neck pain from university symphony orchestras participated in this study. All participants received assessments twice before the intervention and once immediately after a 6-week cervical stabilization exercise program. No significant differences were found between the two pretests before the intervention. After the intervention, the Numeric Rating Scale, the Neck Disability Index, the craniocervical flexion test, muscle endurance tests, cervical range of motion (all directions except flexion) tests, and cervicocephalic relocation tests (flexion and left rotation) showed improvements. The forward head posture indicated by the craniovertebral angle also slightly improved. The results of this single arm study suggest that cervical stabilization exercise is feasible and has the potential to improve physical health for collegiate violin players with nonspecific neck pain.

A Pilot Study of Hip Corrective Taping Using Kinesio Tape for Pain and Lower Extremity Joint Kinematics in Basketball Players with Patellofemoral Pain.

PURPOSE: This pilot study aimed to determine the feasibility of hip corrective taping to improve self-reported knee pain and lower extremity joint kinematics in basketball players with patellofemoral pain. PATIENTS AND METHODS: A single group pre-test and post-test design. Collegiate basketball players with patellofemoral pain were recruited. Three-dimensional hip and knee joint kinematics were measured during two tasks, single-leg squat (SLS) and lay-up jump (LUJ), and each task was conducted under no-taping and taping conditions. Subjective report of pain was compared between no-taping and taping conditions only during SLS. RESULTS: Twelve collegiate basketball players with patellofemoral pain (median age, 22.7 [2.5] years; mean height, 173.8 ± 7.4 cm; mean weight, 72.5 ± 12.8 kg) participated in this study. Compared with no-taping, the use of hip corrective taping significantly increased the hip abduction angle at the instant of the maximal vertical ground reaction force during LUJ (no-taping vs taping: 0.6° ± 6.3° vs 3.3° ± 5.1°, p = 0.029), and also caused a trend of decreased maximal hip internal rotation angle during SLS (no-taping vs taping: 8.0° ± 6.6° vs 4.7° ± 6.9°, p = 0.050). Hip corrective taping also improved self-reported knee pain during SLS (no-taping vs taping: 3.4 ± 1.7 vs 2.6 ± 1.0, p = 0.046). CONCLUSION: Hip corrective taping may be used as an effective intervention for athletes with patellofemoral pain during basketball-related tasks.

Landing Kinematics, Sports Performance, and Isokinetic Strength in Adolescent Male Volleyball Athletes: Influence of Core Training.

CONTEXT: Core control and strength are important for reducing the risk of lower-extremity injury. Current evidence on the effect of core training in male adolescent athletes is limited, and other investigations into the effects of core training often emphasized core strength only. OBJECTIVE: To examine whether core training emphasizing both control and strength of the trunk and hip would improve joint kinematics during landing, sports performance, and lower-extremity muscle strength in adolescent male volleyball athletes. DESIGN: Single group pretest and posttest design. SETTING: University laboratory. PARTICIPANTS: Sixteen male participants (age: 13.4 [1] y, height: 167.8 [8.6] cm, mass: 58.6 [13.9] kg, and volleyball experience: 3.8 [1.5] y) from a Division I volleyball team at a junior high school. MAIN OUTCOME MEASUREMENTS: Kinematics of the trunk and lower-extremity during box landing and spike jump landing tasks, volleyball-related sports performance, and isokinetic strength of hip and knee muscles were assessed before and after a 6-week core training program. RESULTS: After training, the participants demonstrated decreased trunk flexion angle (P = .01, Cohen's d = 0.78) during the box landing task and reduced the maximum knee internal rotation angle (P = .04, Cohen's d = 0.56) during the spike jump landing task. The average isokinetic strength of hip flexors and external rotators, and knee flexors and extensors also significantly increased (P = .001, Cohen's d = 0.98; P = .04, Cohen's d = 0.57; P = .02, Cohen's d = 0.66; P = .003, Cohen's d = 0.87, respectively); however, sports performance did not show significant changes. CONCLUSIONS: A more erect landing posture following training suggests that the core training program may be beneficial for improving core stability. The long-term effect of core training for knee injury prevention needs further investigation.

Collegiate baseball players with more optimal functional movement patterns demonstrate better athletic performance in speed and agility.

Sports injuries are common among baseball players and may result in abnormal movement patterns, increased risks of future injury, and unsatisfactory performance. The Functional Movement Screen (FMS™) has been developed to detect abnormal functional movement patterns and can be used for predicting risks of sports injury. However, whether FMS™ scores are associated with athletic performance remains unclear. The goal of this study was to determine the association between functional movements and athletic performance in elite baseball players. Core stability, muscular strength and flexibility of the lower extremities, and FMS™, as well as athletic performance in sprinting, agility, and balance tests were assessed in 52 male collegiate Division I baseball players placed into two groups based on FMS™ scores. The high-scoring group demonstrated better athletic performance than the low-scoring group, with a shorter duration of the agility test. No group differences were found in core stability, muscular strength, or muscle flexibility, except for rectus femoris flexibility. Thus, the FMS™ score is associated with sprinting and agility performance in elite baseball players. These findings indicate that the FMS™ may have a role in predicting athletic performance and thereby help determine the goals of training regimens or return-to-play strategies.

Immediate effects of real-time postural biofeedback on spinal posture, muscle activity, and perceived pain severity in adults with neck pain.

BACKGROUND: Previous studies have investigated various types of postural biofeedback devices on different body regions to improve posture; however, they focused only on healthy adults without a history of chronic musculoskeletal disorders. In addition, those postural biofeedback devices used in previous studies are often designed for experimental research. The designs are usually bulky with many wires, which is not practical for everyday use. RESEARCH QUESTION: The aim of this study was to determine the immediate effect of a commercially available real-time postural biofeedback device on spinal posture, muscle activity, and perceived pain severity in adults with neck pain. METHODS: 21 adults who had chronic or recurrent nonspecific neck pain for more than 3 months and whose pain was induced or aggravated by prolonged computer work were enrolled in this study. Spinal posture (head tilt, neck flexion, cervical and thoracic angles), muscle activity (cervical erector spinae, upper trapezius, and thoracic erector spinae), and self-reported neck and shoulder pain were measured during computer typing tasks, with and without biofeedback. RESULTS: Compared with the non-biofeedback condition, the biofeedback condition significantly decreased neck flexion, upper cervical, and lower thoracic angles and lowered the activity of the cervical erector spinae. Self-reported neck pain was not influenced by the application of biofeedback, but significantly increased over the 1-hour typing task. SIGNIFICANCE: The application of a commercially available wearable real-time biofeedback device improves sitting posture and reduces muscular activity in adults with nonspecific neck pain during computer work. Future studies should examine the long-term effects of wearable real-time postural biofeedback devices for prevention and management of neck pain.

The Association Between Built Environment Attributes and Physical Activity in East Asian Adolescents: A Systematic Review.

Asian adolescents living in Australia and England were found to be less active than their Western peers. We aimed to systematically examine evidence of the associations between attributes of the built environment and physical activity in adolescents dwelling in East Asian countries. A total of 10 electronic databases for relevant observational studies without time limit were searched. Five studies met the eligibility criteria, which involved a total of 43 817 schoolchildren aged 11 to 17 years. The majority of the built environment attributes measured was significantly associated with reported physical activity. Difficult access to public facilities was associated with physical inactivity. Inconsistent finding of the association between residential density and physical activity was found. Further studies comparing participants from different Asian countries using a longitudinal design with an appropriate period of follow-up and both objective and reported measures of built environment attributes and physical activity are needed.

Steadiness of Spinal Regions during Single-Leg Standing in Older Adults with and without Chronic Low Back Pain.

The aims of this study were to compare the steadiness index of spinal regions during single-leg standing in older adults with and without chronic low back pain (LBP) and to correlate measurements of steadiness index with the performance of clinical balance tests. Thirteen community-dwelling older adults (aged 55 years or above) with chronic LBP and 13 age- and gender-matched asymptomatic volunteers participated in this study. Data collection was conducted in a university research laboratory. Measurements were steadiness index of spinal regions (trunk, thoracic spine, lumbar spine, and pelvis) during single-leg standing including relative holding time (RHT) and relative standstill time (RST), and clinical balance tests (timed up and go test and 5-repetition sit to stand test). The LBP group had a statistically significantly smaller RHT than the control group, regardless of one leg stance on the painful or non-painful sides. The RSTs on the painful side leg in the LBP group were not statistically significantly different from the average RSTs of both legs in the control group; however, the RSTs on the non-painful side leg in the LBP group were statistically significantly smaller than those in the control group for the trunk, thoracic spine, and lumbar spine. No statistically significant intra-group differences were found in the RHTs and RSTs between the painful and non-painful side legs in the LBP group. Measurements of clinical balance tests also showed insignificant weak to moderate correlations with steadiness index. In conclusion, older adults with chronic LBP demonstrated decreased spinal steadiness not only in the symptomatic lumbar spine but also in the other spinal regions within the kinetic chain of the spine. When treating older adults with chronic LBP, clinicians may also need to examine their balance performance and spinal steadiness during balance challenging tests.

Does pilates-based exercise improve postural alignment in adult women?

A randomized, controlled trial was conducted to determine the effect of Pilates-based exercise on postural alignment. Seventy-four adult women (mean age ± SD, 34.9 ± 16.4 years) were randomized to a Pilates-based mat class (n = 40) or a control group (n = 34). Pilates-based exercise participants were taught the Initial Mat of Body Control Pilates for 6 months, twice a week, for 60 minutes per session; the control group received no exercise intervention. Repeated measurements were performed at baseline, 3 months, and 6 months of the frontal alignment of the thoracolumbar spine, shoulder, and pelvis, and sagittal alignment of the head and pelvis. No differences were found in either group, over time, on frontal alignment of the thoracolumbar spine and pelvis. The experimental group showed significant improvements in frontal alignment of the shoulder and sagittal alignment of the head and pelvis at 6 months. The Pilates-based exercise enhanced some parameters of the postural alignment of women, as measured by frontal alignment of the shoulder and sagittal alignment of the head and pelvis. The significant improvement in sagittal alignment of the head may imply that 6 months of Pilates-based exercise enhances sagittal alignment of the cervical or thoracic spine.

The influence of chair seat height on the performance of community-dwelling older adults' 30-second chair stand test.

BACKGROUND AND AIMS: Although chair seat height affects the performance of sit-to-stand movement, no previous study has examined the influence of chair seat height on the 30-second chair stand test (CST). METHODS: Fifty-five community-dwelling older adults (age 70.0 ± 6.3 years) performed the test from the standard height of 43 cm and then from five randomly ordered seat heights from 80 to 120 % of each participant's lower leg length. RESULTS: Chair seat height significantly influences the performance of community-dwelling older adults' 30-s CST (F = 57.50, p < 0.001). The mean score for standard conditions was significantly lower from those at 120, 110, and 100 % conditions (p < 0.05). No significant difference was observed between the standard and 80 % conditions (p > 0.95) and between the standard and 90 % conditions (p = 0.353). When comparing the scores between the randomly ordered chair seat heights, all comparisons were significantly different (p < 0.001) except for the difference between the 120 and 110 % conditions (p = 0.104). CONCLUSION: Chair seat height's relation to the lower leg length should be considered when interpreting 30-s CST scores. Additionally, it is necessary to optimize the chair seat height when using the 30-s CST as an outcome measure for exercise intervention or to screen for people with weaker lower extremities.

Bird species migration ratio in East Asia, Australia, and surrounding islands.

Bird migration and its relationship with the contemporary environment have attracted long-term discussion. We calculated the avian migration ratio (the proportion of breeding species that migrate) in the areas from 70°E to 180°E and examined its relationship with the annual ranges of ambient temperature, primary productivity (estimated by the Enhanced Vegetation Index), and precipitation, along with island isolation and elevational range. The avian migration ratio increased with increasing latitude in general but varied greatly between the two hemispheres. Additionally, it showed minimal differences between continents and islands. Our analyses revealed that the seasonality of ambient temperature, which represents the energy expenditure of birds, is the dominant factor in determining bird species migration. Seasonality in primary productivity and other environmental factors play an indirect or limited role in bird species migration. The lower avian migration ratio in the Southern Hemisphere can be attributed to its paleogeographical isolation, stable paleoclimate, and warm contemporary environment. Under current trends of global warming, our findings should lead to further studies of the impact of warming on bird migration.

Prevalence and risk factors associated with spinal pain in adolescent computer users: a systematic review.

BACKGROUND: Increased computer use has been suggested as a contributing factor for a rapid increase in the prevalence of neck and back pain in adolescents in the late 1990s and the beginning of 2000. OBJECTIVE: The overall objective of this review was to synthesise the best available evidence on the estimates of prevalence of, and risk factors associated with, spinal discomfort in adolescent computer users. INCLUSION CRITERIA: This review considered cross-sectional, case-control, or cohort studies. Studies were considered for inclusion if they reported either prevalence or risk factors associated with spinal pain in adolescents aged between 13 and 18 years using computer in school or at home. SEARCH STRATEGY: The search included The Cochrane Library, JBI Library of Systematic Reviews, PEDro, MEDLINE, CINAHL, Web of Science, ERIC, PsycINFO, EMBASE, and CEPS. The grey literature was also searched. The search was limited to English and Chinese language papers, and spanned from the inception of each database to May 2011. METHODOLOGICAL QUALITY: Two review authors independently evaluated the methodological quality of the included studies using the standardised Joanna Briggs Institute instruments. DATA EXTRACTION: Data was extracted using the standardised Joanna Briggs Institute data extraction form. DATA SYNTHESIS: Meta-analysis was not appropriate because there was considerable heterogeneity between studies. The findings were summarised in tables and in narrative form. RESULTS: Seven studies were included in this review: three studies were carried out in Finland, two in the USA, one in Sweden, and one in South Africa. There was marked variability in the period prevalence data across different studies: 15-60% for cervical pain and 12-53% for lumbar pain. None of the reviewed studies reported the confidence intervals for prevalence estimate. Four studies investigated the association between the duration of computer use and cervical pain, two studies for lumbar pain and none for thoracic pain. Positive associations between the duration of computer use and cervical pain were found in three out of four studies, with the odds ratio ranged from 1.3 (95% CI 1.1 to 1.6) to 2.3 (95% CI 1.5 to 3.6). One study found that weekly internet use greater than 42 hours predicted the occurrence of lumbar pain, and the odds ratio was 1.9 with 95% CI of 1.1 to 3.4. The other study reported non-significant association without providing statistical evidence. CONCLUSION: This systematic review suggests a relatively high prevalence of spinal pain in adolescents. The cervical spine region appears to be more prone to musculoskeletal pain than the lumbar or thoracic regions. Cervical spine pain was statistically significantly associated with duration of computer use, however the odds ratio may be too small to be considered clinical significant. There is conflicting evidence on the association with duration of computer use and lumbar pain and no evidence for thoracic spine. IMPLICATIONS FOR PRACTICE: The relatively high prevalence of spinal pain in adolescents highlights the need for preventative and treatment strategies. IMPLICATIONS FOR RESEARCH: Further research, preferably prospective cohort studies utilising physical examination, is required to more rigorously investigate the issue of computer use and spinal pain among adolescents. There is a need to conduct more research in Asian or developing countries to reflect any cultural or socioeconomic differences that may influence the amount of computer exposure and its potential impact on musculoskeletal health in adolescent computer users.

The effects of verbal instructions on gait in people with Parkinson's disease: a systematic review of randomized and non-randomized trials.

OBJECTIVE: To collate and appraise empirical evidence relating to the effects of verbal instructions (verbal commands given by another person) on stride length, gait velocity and stride variability in people with Parkinson's disease. DATA SOURCES: Cinahl, Cochrane, Embase, Medline, PEDro, PsycINFO and Web of Science. REVIEW METHODS: Independent reviewers extracted data from eligible studies and assessed methodological quality. The level of evidence was determined by best evidence synthesis based upon the experimental design, methodological quality and statistical findings of individual studies. RESULTS: One randomized controlled study and 12 non-controlled studies fulfilled the selection criteria and involved 149 participants. Five types of verbal instructions were examined which included 'take big steps', 'walk fast', 'swing arms when walking', 'count rhythm when walking' and 'walk fast with big steps'. Best evidence synthesis found indicative evidence in support of the use of the instruction to take big steps in walking training for stride length improvement in people with mild to moderate Parkinson's disease who are without cognitive impairment. There was insufficient evidence in support of effects on gait velocity and stride variability. There was also insufficient evidence in support of effects of other instructions on any of the gait variables. CONCLUSION: The empirical evidence in support of the benefits from verbal instructions is weak. The evidence is limited to short-term stride length improvement from the use of the instruction to take big steps in walking training.

Kinematics of sagittal spine and lower limb movement in healthy older adults during sit-to-stand from two seat heights.

STUDY DESIGN: A cross-sectional study to examine the sagittal kinematics of spine and lower limb movement during sit-to-stand (STS). OBJECTIVE: To describe the sagittal kinematics of the spine and lower limb in healthy older adults during STS from 2 seat heights. SUMMARY OF BACKGROUND DATA: Older adults with age-related changes in the neuromusculoskeletal system are likely to have difficulty in STS. However, little is known about movement of the spinal regions and their interaction with the lower limb during STS, and the effect of seat height. METHODS: Thirty-two healthy older adults aged over 60 years were videotaped performing STS from 2 seat heights. A 2-dimensional video motion analysis system with a revised sagittal model was used to measure angular displacement and velocity for the cervical, thoracic, lumbar spine, and the lower limb joints. RESULTS: Concurrent flexion in the hip joint and lumbar spine was accompanied by extension in the thoracic, lower, and upper cervical spine as the trunk leaned forward. After the buttocks lifted off (LO) the chair, the movement interaction in the spine and hip joint was reversed. Some significant age-related changes during STS included downward head tilt at LO, decreased lumbar range of motion, and a large between-participant variation in the movement ratios. Statistically significant differences in the temporal parameters, angular displacement, and velocity were also found when standing from a lower chair. CONCLUSION: This study provides a detailed description of STS in healthy older adults, which has implications for rehabilitation of elderly patients who have difficulty with this activity. Clinicians need to be aware of the concurrent contribution of the hip joint and lumbar spine to trunk forward lean, the importance of thoracic extension during the pre-LO phase and the downward gaze at LO in healthy older adults.

Lumbofemoral rhythm during active hip flexion in standing in healthy older adults.

The 2D PEAK Motus motion analysis system was used to measure the sagittal lumbofemoral rhythm during active hip (knee) flexion in standing in 34 healthy older adults whose movement may be influenced by age-related changes in the neuromusculoskeletal system. When the thigh was raised, the lumbar spine moved concurrently with the hip joint throughout the movement. Approximately 5 degrees of initial hip flexion occurred before 1 degrees of lumbar flexion. Overall, the lumbar spine contributed 26.6% (29.3 degrees ) of the total thigh movement (pelvis+hip joint) during the upward (110.2 degrees ) movement phase. Compared to children and young adults, older adults demonstrated some age-related differences in sagittal lumbofemoral rhythm, including decreased hip flexion and a large variation in the hip-to-lumbar movement ratio. Clinicians and exercise instructors need to be aware of the concurrent movement interaction between the hip joint and lumbar spine when measuring hip flexion range or when instructing abdominal, hip, or lumbar exercises. The potential influence of limited range of motion of either hip or lumbar component on the movement should also be addressed.