A multisite cross-sectional study of intercultural competencies in doctor of physical therapy students.

BACKGROUND: Physical therapists (PTs) work in diverse communities with individuals whose identities and beliefs may differ significantly from their own. Academic institutions must include intentional curriculum aimed at graduating PTs who can skillfully navigate intercultural encounters. Being prepared to engage with difference and demonstrate skills related to intercultural competencies (ICC) will prepare entry-level PTs to provide individualized, high-quality care. Intercultural competencies are essential skills that can reduce healthcare disparities, and promote equitable and inclusive healthcare delivery. This study examined the impact of PT curricula, student demographics, and participation in intercultural learning experiences (ILEs) on students' development of ICC. METHODS: A cross-sectional study of 8 Doctor of Physical Therapy (DPT) programs in the United States (US) compared ICC in first-year (F) and third-year students (T), and T who participated in an ILE (T + ILE) to those who did not (T-only). Subjects included 1,038 students. Outcome measures included The Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version© (IAPCC-SV), and a demographic survey. RESULTS: Independent t-tests showed that group T (mean = 64.34 ± 5.95, 95% CI: 63.78-64.90) had significantly higher IAPCC-SV total scores than group F (mean = 60.8 ± 5.54, 95% CI = 60.33-61.27, p < 0.05). Group T + ILE (mean = 65.81 ± 5.71, 95% CI = 64.91-66.71) demonstrated significantly higher IAPCC-SV total scores than group T-only (mean = 63.35 ± 5.8, 95% CI = 62.6-64.1, p = 0.039). A one-way ANOVA and post hoc comparisons showed that the 25 to 34-year age group (mean = 63.80 ± 6.04, 95% CI = 63.25-64.35, p < 0.001) and the ≥ 35-year age group (mean = 64.21 ± 5.88, 95% CI = 62.20-66.22, p < .024) had significantly higher IAPCC-SV total scores, than the 18 to 24-year age group (mean = 60.60 ± 5.41, 95% CI = 60.09-61.11). Students who identified in US census minority ethnic or racial categories (US-Mn) (mean = 63.55 ± 5.78, 95% CI = 62.75-64.35) had significantly higher IAPCC-SV total scores than students who identified in US majority ethnic or racial categories (US-Mj) (mean = 61.98 ± 5.97, 95% CI = 61.55-62.413, p = .0001). CONCLUSIONS: Results of the study support the hypothesis that DPT programs can promote the development of intercultural skills in students. The ultimate objective of this academic preparation is to improve the student's ability to deliver equitable, person-centered healthcare upon entry into practice. Specific ICC for entry-level DPT students are not clearly defined by US physical therapy professional organizations, academic institutions, or accrediting body. Students who participated in an ILE exhibited higher levels of ICC when compared to those who did not. Findings from this study can guide curriculum development, utilization of resources, and outcomes assessment. More research is needed to examine characteristics of an ILE that could inform best practice.

National biomechanics day in India - Lessons learned from a collaborative approach.

National Biomechanics Day (NBD) is an educational outreach event aimed at raising awareness of the field of biomechanics among high school students. NBD celebrations growing internationally acted as a catalyst for us to conduct the event in India, where STEM-based education is emphasized. With a truly global collaborative effort and perhaps historically for the first time, virtual and in-person NBD events were successfully conducted in India. The current article provides perspectives from different stakeholders from the collaborative team about the successes and challenges associated with conducting these events and the path forward to growing biomechanics in India and elsewhere.

Normal gait speed varies by age and sex but not by geographical region: a systematic review.

QUESTIONS: What are comfortable gait speed values for apparently healthy adults? How do these differ by age group, sex and geographical region? DESIGN: Systematic review of observational studies with meta-analysis. PARTICIPANTS: Apparently healthy, community-dwelling adults who have undergone measurement of comfortable gait speed. SEARCH METHOD: Potentially relevant studies were identified in four databases. Extracted data from studies that satisfied the eligibility criteria were added to a database containing the same information from a meta-analysis published a decade ago. OUTCOME MEASURES: The weighted mean comfortable gait speed was calculated along with the 95% confidence interval for each stratum of age/sex using a random-effects model. Mean gait speeds were further stratified by the continent where the study took place. Tests of homogeneity included I2 and prediction intervals. RESULTS: Meta-analysis of data from 51,248 apparently healthy adults was stratified by age (in decades) and sex. Male gait speed slowed beyond age 50 years whereas female gait speed slowed beyond age 30 years. The weighted mean gait speed ranged from 97 cm/s (females aged ≥ 80 years) to 140 cm/s (males aged 40 to 49 years). The I2 values ranged from 0 to 34.07; prediction interval ranges varied from a low of 30 (125 to 155 cm/s; males aged 40 to 49 years) to a high of 77 (83 to 160 cm/s; females aged 60 to 69 years). There was considerable overlap in confidence intervals between continents for each sex/age group. CONCLUSIONS: Comfortable gait speed slowed through the adult years, but males maintained a faster walking speed than females. Further stratification of comfortable gait speed by geographical region is not warranted.

Assessing cultural competence: a comparison of two measures and their utility in global learning experiences within healthcare education.

OBJECTIVES: The purpose of this study was to investigate the relationship between two measures of cultural competence (CC), one more widely used, the other designed for healthcare students. It was hypothesized that there would be strong correlations allowing educators to forgo one measure for the other based on utility, resources, and sustainability. DESIGN: Exploratory, cross sectional design SETTING: One US Doctor of Physical Therapy (DPT) academic program. PARTICIPANTS: 145 DPT students. MAIN OUTCOME MEASURES: Intercultural Development Inventory® (IDI) and Inventory for Assessing the Process of Cultural Competence-among healthcare professionals-Student Version© (IAPCC-SV). RESULTS: There were significant (negligible to low, rho = 0.16-0.28; p < 0.05) relationships between the IAPCC-SV total and three constructs with IDI Perceived Orientation scores, and the IAPCCSV total and two constructs with the IDI Developmental Orientation scores. There were significant (negligible to low, rho = 0.18-0.35; p < 0.05) relationships between IAPCC-SV total and construct scores with the IDI Acceptance and Adaptation orientation scores. Students with scores in an IDI DO of Acceptance or Adaptation were significantly more likely to have an IAPCC-SV score in the category of Culturally Competent (X2 = 3.70, p = 0.05). CONCLUSIONS: The discordance of the two measures suggests that the instruments measure unrelated constructs (worldviews, attributes or skills) of cultural competence that are exclusive to each measure and context dependent. Context specific measures may not be generalized to a greater worldview, and visa versa. Multimodal assessment that triangulates data and supports student learning outcomes may be the most effective strategy to capture the impact of curriculum and/or a global learning experience on students' development of cultural competence. CONTRIBUTION OF THE PAPER.

Learning and Study Strategies of Students in the First Year of an Entry-Level Physical Therapist Program.

INTRODUCTION: The learning and study strategies of entry-level physical therapist (PT) students may not be as effective as those needed for success in an entry-level PT education program. The Learning and Study Strategies Inventory, third edition (LASSI) is a reliable tool to assess learning and study strategies. The purpose of this study was to assess the learning and study strategies of first-year PT students and if the strategies change over the first year. REVIEW OF LITERATURE: There is little research on using the LASSI with PT students; however, the LASSI has been used with other health care professional students. SUBJECTS: The participants (n = 211) were from 5 cohorts of PT students in their first year of an entry-level PT education program. METHODS: In the first week of the curriculum the students took the LASSI in class. The results were released individually to each student. No intervention was provided. At the end of the first year, the students retook the LASSI. Paired samples t-tests were run to determine whether the 10 subtest mean percentile scores changed significantly from baseline to follow-up and how they compared to established LASSI benchmarks. RESULTS: Six subtest scores, Anxiety, Attitude, Concentration, Information Processing, Selecting Main Ideas, and Test Strategies, showed significant changes (P ≤ .005) from baseline to follow-up. However, all subtest averages fell below the 75th percentile mark, which is reported as the threshold requiring reflection to improve skills for learning and study strategies. DISCUSSION AND CONCLUSION: Students, on average, may not have adequate learning and study strategies when they start an entry-level PT education program. The LASSI may be an effective tool to focus resources in a timely and proactive manner for those students who may need them. Determining the resources needed earlier may decrease the need for later remediation, attrition, or licensure examination failures.

Clinical Measures of Adolescent Softball Players With and Without Upper-Extremity Pain: A Preliminary Study.

CONTEXT: Upper-extremity (UE) pain is a concern among softball adolescent athletes. However, research on preseason screening of demographic characteristics and clinical measures among those with and without UE pain among adolescent softball athletes is underreported. This study sought to present functional outcomes and clinical measures of shoulder and hip complex flexibility, range of motion (ROM), and strength in adolescent softball athletes with and without UE pain. DESIGN: Cross-sectional study. METHODS: Sixty-seven athletes were assessed at the start of the spring season. The Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire was administered to determine UE function. UE measurements included shoulder ROM, flexibility, and strength; lower-extremity measurements included hip ROM and strength. These variables were reported for players with and without UE pain as mean and SD. Independent samples t tests were performed to analyze differences between the groups. RESULTS: Thirteen (19.4%) athletes reported UE pain during preseason screening. Mean Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire score among athletes with UE pain was 58.0 (17.6) compared with 97.1 (6.9) for athletes reporting no UE pain (P < .001). Athletes with UE pain presented with significantly less dominant side external rotation ROM (UE pain: 106.5 [10.4], no UE pain: 114.6 [11.3]) and total ROM (UE pain: 163.7 [14.5], no UE Pain: 174.8 [14.3]). CONCLUSION: These findings inform clinicians on function and preseason clinical measures in adolescent softball athletes who present with or without UE pain. Athletes with UE pain demonstrated lower outcome scores indicating likely impact on overall UE function. These athletes also appeared to demonstrate UE ROM differences compared with athletes without UE pain. Further research is needed to investigate larger sample sizes and positional differences at baseline and throughout the season to determine if clinical measures used in the current study are risk factors for pain and injury.

Influence of wheelchair type on Wheelchair Propulsion Test performance in community-dwelling, adult wheelchair users1.

BACKGROUND: The clinimetric properties of the Wheelchair Propulsion Test (WPT) have not been developed thoroughly. OBJECTIVE: To determine inter-rater reliability and reference values for the Wheelchair Propulsion Test (WPT) for active wheelchair users and to compare WPT performance between various types of manual wheelchairs at different paces. METHODS: This was a cross-sectional, descriptive study. Participants propelled a manual wheelchair 10 m while time and the number of pushes were recorded. Trials were performed in three different manual wheelchairs (a lightweight wheelchair (LW), an ultralightweight wheelchair (ULW), and the participant's personal, customized wheelchair) at a comfortable pace and a fast pace. RESULTS: The ICC values ranged from 0.861 to 0.999 for both speed and number of pushes. Comfortable wheelchair propulsion speed ranged from 1.51 (0.31) m/s to 1.65 (0.33) m/s depending on the wheelchair utilized. Across both pace conditions, participants were significantly faster when using their personal wheelchair compared to the ULW (P < 0.001) and LW (P < 0.001). Push frequency was significantly greater during the fast pace condition compared to the comfortable pace condition (P < 0.001). CONCLUSIONS: Reference values for the WPT in active wheelchair users have been identified. Participants who utilize their personal wheelchair demonstrate faster wheelchair propulsion speeds complemented by greater push frequencies.

Quantifying national biomechanics day's impact on student perceptions toward biomechanics: A multisite pilot study.

National Biomechanics Day (NBD) is an international celebration of biomechanics that seeks to increase the awareness and appreciation of biomechanics among the high school community. Initial research supports the positive effects of NBD on students' attitudes toward the field of biomechanics; however, quantitative evidence remains scarce. The purpose of this study was to quantify changes in high school students' perceptions toward biomechanics after participating in NBD events to better understand the impact of NBD. Data were collected at two locations during the 2019 NBD season. Surveys were collected before and after NBD events for 112 high school students from Montana and North Carolina. Paired pre- versus post-NBD surveys for the aggregate sample population suggest that students perceived biomechanics as more appealing (p = 0.050), exciting (p = 0.007), and important (p = 0.018) following the NBD events. Students did not report a change in whether they could see themselves in a biomechanics-related career (p = 0.49). These findings further support the ability for NBD events to positively impact students' perceptions toward biomechanics, although opportunities persist to increase student career interest in biomechanics. This paper presents and discusses the study's results, interpretations, limitations, and implications for future research on biomechanics outreach activities.

Can Backward Walking Speed Reserve Discriminate Older Adults at High Fall Risk?

Purpose: The authors examine whether community-dwelling older adults at high fall risk have lower backward walking speed reserve (WSR) than their healthy counterparts. Method: Twenty-one healthy older adults and 20 older adults at high fall risk performed five trials of forward walking at a self-selected and maximal pace. In addition, all participants walked backward at a self-selected pace, and 15 participants from each group walked backward at a maximal pace. WSR was calculated as the difference between maximal and self-selected walking speed. Comparisons between groups were made using a one-tailed independent samples t-test or Mann-Whitney U-test with an α value of 0.025. Results: Older adults at high fall risk were significantly slower during self-selected forward walking (11.7%; p = 0.006), maximal forward walking (15.5%; p = 0.001), self-selected backward walking (25.3%; p = 0.002), and maximal backward walking (23.8%; p = 0.006). Older adults at high fall risk showed a lesser forward WSR (25.4%; p = 0.03) and backward WSR (23.7%; p = 0.03). Conclusions: Backward WSR is not useful for discriminating between healthy older adults and older adults at high fall risk. The results imply that forward or backward walking speed rather than WSR might be a useful measure.

Objectif : examiner si les adultes âgés qui vivent en communauté et qui sont très vulnérables aux chutes ont une moins bonne réserve de vitesse de marche (RVM) à reculons que leurs homologues en bonne santé. Méthodologie : au total, 21 adultes âgés en bonne santé et 20 adultes âgés très vulnérables aux chutes ont effectué cinq essais de marche vers l'avant à leur vitesse maximale. Tous les participants ont également marché à reculons à la vitesse qu'ils ont choisie et 15 participants de chaque groupe ont marché à reculons à leur vitesse maximale. La RVM correspondait à la différence entre la vitesse de marche maximale et la vitesse choisie. Les chercheurs ont comparé les groupes au moyen du test de Student unilatéral pour échantillons indépendants ou du test U de Mann-Whitney d'une valeur alpha de 0,025. Résultats : les adultes âgés très vulnérables aux chutes étaient considérablement plus lents pendant la marche vers l'avant à leur vitesse (11,7 %, p = 0,006), la marche vers l'avant à la vitesse maximale (15,5 %, p = 0,001), la marche vers l'arrière à leur vitesse (25,3 %, p = 0,002) et la marche vers l'arrière à la vitesse maximale (23,8 %, p = 0,006). Les adultes âgés très vulnérables aux chutes présentaient une RVM vers l'avant (25,4 %, p = 0,03) et à reculons (23,7 %, p = 0,03) plus faible. Conclusions : la RVM à reculons n'est pas utile pour distinguer entre les adultes âgés en santé et ceux très vulnérables aux chutes. D'après les résultats, la vitesse de marche vers l'avant ou à reculons pourrait être une mesure préférable à la RVM.

Overuse Injury, Substance Use, and Resilience in Collegiate Female Athlete.

BACKGROUND: Overuse injury is a common stressor experienced by female collegiate athletes and is often underreported. In response, athletes may develop negative coping skills such as substance use. Alternatively, resilience is a modifiable trait that may positively influence response to musculoskeletal injuries and substance use. PURPOSE: To provide an updated epidemiological profile of overuse injury and substance use and examine the relationship between resilience, overuse injury, and substance use among collegiate female athletes. DESIGN: Cross-sectional study. METHODS: Two-hundred and thirty female collegiate athletes were classified into overuse injury and resilience groups. Overuse injury, pain, and substance use incidence proportions (IP) were calculated. Kruskal-Wallis analyses were performed to investigate differences in substance use among resilience groups. Analyses of covariance were performed to evaluate differences in overuse injuries, substantial overuse injuries, and time loss injuries, among resilience groups. RESULTS: IP for pain was 45.0% (95% CI: 38.2-51.9); Overuse injury 52.0% (45.1-58.9); Alcohol use 35.1% (28.6-41.6); Electronic cigarette use 19.5% (14.6-24.9); Cigarette use 2.8% (6-5.1); and Drug use 3.3% (0.9-5.8). No significant differences were found between resilience groups for the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC) variables (Pain: p=0.102; Overuse injury: p=0.331; Substantial overuse injury: p=0.084; Not playing: p=0.058), alcohol (p=0.723), or combined substance use (p=0.069). CONCLUSIONS: Pain and overuse injury prevalence is high among female collegiate athletes. Alcohol followed by electronic cigarette use were the most commonly utilized substances. No significant differences were identified in substance use or overuse injury presentation between resilience groups, though further investigation is warranted. LEVEL OF EVIDENCE: 3.

Use of Backward Walking Speed to Screen Dynamic Balance and Mobility Deficits in Older Adults Living Independently in the Community.

BACKGROUND AND PURPOSE: Older adults who live independently in the community are higher functioning and routinely ambulate in the community. Unrestricted community ambulation increases the likelihood of encountering precarious situations challenging balance. Sufficient dynamic balance is necessary to avoid falls. Currently used balance and mobility assessments may not sufficiently challenge dynamic balance to uncover mobility deficits in independent community-dwelling older adults. The purpose of this study was to investigate whether backward walking speed (BWS) can serve as an outcome measure to screen dynamic balance and mobility deficits in independent community-dwelling older adults. METHODS: A convenience sample of 30 older adults (73.68 ± 6.54 years) participated in this cross-sectional study. Participants walked backward on an instrumented walkway to record BWS. Other outcomes included forward walking speed (FWS), Community Balance and Mobility (CB&M) Scale, Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG) test, and 7-day average step count (ASC). A multivariate analysis of variance investigated the overall group differences between older adults at fall risk and those not at risk and was followed up by univariate tests. Pearson and spearman coefficients investigated associations between study outcomes. Youden's index assessed diagnostic accuracy. RESULTS AND DISCUSSION: Backward walking speed, CB&M, FES-I, ASC discriminated older adults at fall risk from those not at risk (P < .01) whereas FWS and TUG did not. Backward walking speed strongly correlated with challenging assessments of balance and mobility (CB&M, FES-I, and ASC) but only moderately correlated with the TUG. The CB&M Scale independently explained 53% variance in the BWS performance (P < .01). Youden's index was highest (Y = 0.6, sensitivity = 93%, and specificity = 67%) for BWS (0.73 m/s) compared with other study outcomes. CONCLUSIONS: Preliminary results suggest that BWS can screen for dynamic balance and mobility deficits in independent community-dwelling older adults. Accurate screening is the first step to capture early decline in function for independent community-dwelling older adults. Longitudinal follow-up studies are warranted to validate BWS as a screening tool.

Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter?

CONTEXT: Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. OBJECTIVE: To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. DESIGN: Exploratory cross-sectional study. SETTING: Laboratory. PARTICIPANTS: In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). RESULTS: Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, -0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). CONCLUSIONS: Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete's gait upon analysis.

Functional rehabilitation of a person with transfemoral amputation through guided motor imagery: a case study.

Background: Motor imagery (MI) is a mental technique, absent of physical movement, to foster movement patterns and relieve pain via a training model enacting the brain before the body. This case study assessed MI's efficacy in decreasing phantom limb pain and attaining functional gait and balance after lower extremity amputation. Description: The participant was a 71-year-old female with a transfemoral amputation seven years prior. She required a standard walker for ambulation. The participant underwent three sessions per week for four weeks of MI intervention, with immediate, post-test, and 1-week retention testing involving subjective and functional assessments. Intervention sessions involved quiet sitting with eyes closed while listening to the MI script. The scripts focused on functional movement patterns and tasks that were relevant to the participant, such as walking, balancing, and reaching. Each session's script focused on a different task. These scripts guided her through proper action and biomechanics of the skills to imagine herself moving safely and functionally. Outcomes: Short Form Berg Balance Scale and Tinetti Performance Oriented Mobility Assessment scores demonstrated clinically important and sustained improvement. Further, the participant reported decreased phantom limb pain and could walk a short distance independently for the first time in seven years. Discussion: MI is a time- and cost-effective, low-risk treatment option that decreased phantom pain and improved balance and functional gait in an individual with an amputation. The use of MI as an intervention for the rehabilitation of persons with amputation must be further examined.

Site-specific Concurrent Validity of the ActiGraph GT9X Link in the Estimation of Activity-related Skeletal Loading.

PURPOSE: The aims of this project were twofold: 1) to assess the concurrent validity of raw accelerometer outputs with ground reaction forces (GRF) and loading rates (LR) calculated from force plate across a range of simulated habitual PA and 2) to identify the optimal wear site among the ankle, hip, and wrist with the strongest relationships between accelerometer and force plate and/or skeletal outcomes. METHODS: Thirty healthy young adults (23.0 ± 4.5 yr, 50% female) wore a triaxial accelerometer at the right ankle, hip, and wrist while performing eight trials of walking, jogging, running, low box drops, and high box drops over an in-ground force plate. Repeated-measures correlations and linear mixed models were used to assess concurrent validity of accelerometer and force plate outcomes across wear sites. RESULTS: Strong repeated-measures associations were observed between peak hip resultant acceleration and resultant LR (rrm 1169 = 0.74, P < 0.001, 95% confidence interval = 0.718, 0.769) and peak hip resultant accelerations and resultant GRF (rrm 1169 = 0.69, P < 0.001, 95% confidence interval = 0.660, 0.720) when data were combined across activities. By contrast, small to moderate associations were seen between ankle-based outcomes and corresponding GRF and LR during walking and jogging (rrm 209 = 0.17-0.34, all P < 0.001). No significant associations were seen with wrist-based outcomes during any activity. In addition, linear mixed models suggested that 24%-50% of the variability in peak GRF and LR could be attributed to measured accelerations at the hip. CONCLUSION: Peak accelerations measured at the hip were identified as the strongest proxies for skeletal loading assessed via force plate.

Shoulder Range of Motion and Strength Characteristics in Circus Acrobats.

OBJECTIVES: To begin to establish normative data for shoulder range of motion (ROM) and strength in the circus acrobats and to compare these values based on age, sex, hand dominance, and acrobatic subgroup. METHODS: Active (AROM) and passive (PROM) of the full shoulder complex and PROM of the isolated glenohumeral joint were measured in 193 circus acrobats using standardized techniques for anterior elevation (flexion), posterior elevation (extension), lateral elevation (abduction), and external and internal rotation. Shoulder strength was measured using a hand-held dynamometer in all planes of motion. Measurements were taken twice and averaged. Mixed ANOVA were performed. One-sample t-tests were used to compare with general population. RESULTS: Several significant differences were noted between dominant and non-dominant sides, but not between the sex or age groups tested. Acrobats who did both aerial and ground acrobatics had significantly greater full shoulder complex flexion AROM than the aerial group, and AROM extension than the ground group. Circus acrobats had significantly greater AROM full shoulder complex extension, abduction, internal and external rotation, and shoulder strength than the general population. CONCLUSION: Overall, results from this cross-sectional study revealed that circus acrobats had greater shoulder strength and ROM than the general population, which could affect the way these patients should be treated in a clinical setting. Age and sex seemed to have minimal effects, but there was clearly an effect of hand dominance. Acrobats who train both aerial and ground acrobatics may have greater ROM in certain planes than those who train in only one type of discipline.

Turn Characteristics During Gait Differ With and Without a Cognitive Demand Among College Athletes.

CONTEXT: Sports often involve complex movement patterns, such as turning. Although cognitive load effects on gait patterns are well known, little is known on how it affects biomechanics of turning gait among athletes. Such information could help evaluate how concussion affects turning gait required for daily living and sports. OBJECTIVE: To determine the effect of a dual task on biomechanics of turning while walking among college athletes. DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Fifty-three participants performed 5 trials of a 20-m walk under single- and dual-task conditions at self-selected speed with a 180° turn at 10-m mark. The cognitive load included subtraction, spelling words backward, or reciting the months backward. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Turn duration, turning velocity, number of steps, SD of turn duration and velocity, and coefficient of variation of turn duration and velocity. RESULTS: Participants turned significantly slower (155.99 [3.71] cm/s vs 183.52 [4.17] cm/s; P < .001) and took longer time to complete the turn (2.63 [0.05] s vs 2.33 [0.04] s; P < .001) while dual tasking, albeit taking similar number of steps to complete the turn. Participants also showed more variability in turning time under the dual-task condition (SD of turn duration = 0.39 vs 0.31 s; P = .004). CONCLUSIONS: Overall, college athletes turned slower and showed more variability during turning gait while performing a concurrent cognitive dual-task turning compared with single-task turning. The slower velocity increased variability may be representative of specific strategy of turning gait while dual tasking, which may be a result of the split attention to perform the cognitive task. The current study provides descriptive values of absolute and variability turning gait parameters for sports medicine personnel to use while they perform their concussion assessments on their college athletes.

Comparison of forward and backward gait characteristics between those with and without a history of breast cancer.

BACKGROUND: Decreased muscular strength and poorer postural stability impact the physical function of breast cancer survivors (BCS) and increases their risk of falls. Gait assessment, particularly in the backward direction, is often used as an indicator of fall risk in several populations. However this information is unknown in BCS. RESEARCH QUESTION: What are the differences in forward, backward, and accelerated forward walking in BCS in comparison to individuals without a prior cancer diagnosis? METHODS: 17 postmenopausal BCS (mean age: 58.5 (8.5) years) and 17 age-matched women without a prior cancer diagnosis (mean age: 59.11 (5.55) years) completed 5 trials each of forward, backward, and fast forward walking conditions. Absolute (Means) and variability (Coefficient of variation) estimates were obtained for spatio-temporal gait parameters. Lower body, upper body and handgrip strengths were measured. RESULTS: For absolute estimates of gait, significant group main effects indicated that BCS had 7% shorter step length (P = 0.019) and 8% slower gait speed (P = 0.048). For variability estimates of gait, there was a significant interaction for stance time (P = 0.035). BCS had greater stance time variability during forward and fast forward conditions, but lesser variability during backward condition. Averaged across all the conditions, BCS had 38% greater step length variability (P = 0.043), 50% greater gait speed variability (P = 0.028), and 28.5% greater single support time variability (P = 0.004). Averaged across both the groups, all the variables except for swing time variability were significantly different among the conditions (all P< = 0.013). BCS also had significantly reduced upper body strength (P = 0.036). SIGNIFICANCE: Slower and shorter steps while walking both forwards and backwards could be indicative of a more cautious gait strategy by BCS. Also, BCS possibly focused on controlling spatial parameters during forward walking but temporal parameters while backward walking. Whether these alterations are related to an increased fall risk within BCS needs to be determined.

Functional measures show improvements after a home exercise program following supervised balance training in older adults with elevated fall risk.

Supervised balance training shows immediate benefit for older adults at fall risk. The long-term effectiveness of such training can be enhanced by implementing a safe and simple home exercise program (HEP). We investigated the effects of a12-week unsupervised HEP following supervised clinic-based balance training on functional mobility, balance, fall risk, and gait. Six older adults with an elevated fall risk obtained an HEP and comprised the HEP group (HEPG) and five older adults who were not given an HEP comprised the no HEP group (NoHEPG). The HEP consisted of three static balance exercises: feet-together, single-leg stance, and tandem. Each exercise was to be performed twice for 30-60 s, once per day, 3 days per week for 12 weeks. Participants were educated on proper form, safety, and progression of exercises. Pre- and post-HEP testing included Berg Balance Scale (BBS), Timed Up and Go, Short Physical Performance Battery (SPPB) assessments, Activities-Balance Confidence, Late-Life Functional Disability Instrument and instrumented assessments of balance and gait (Limits of Stability, modified Clinical Test of Sensory Interaction on Balance, Gait). A healthy control group (HCG; n = 11) was also tested. For most of the measures, the HEPG improved to the level of HCG. Though task-specific improvements like BBS and SPPB components were seen, the results did not carry over to more dynamic assessments. Results provide proof of concept that a simple HEP can be independently implemented and effective for sustaining and/or improving balance in older adults at elevated fall-risk after they have undergone a clinic-based balance intervention.

Concurrent Validity of the Zeno Walkway for Measuring Spatiotemporal Gait Parameters in Older Adults.

BACKGROUND AND PURPOSE: Previous studies have shown that older adults at high fall risk exhibit altered spatiotemporal gait parameters such as lesser gait speed, shorter step length, and greater step width compared with their healthy counterparts. Measurement of these gait parameters for older adults can play a pivotal role in clinical evaluation. While the GAITRite walkway has been previously validated and used extensively for research purposes, the Zeno walkway validity has not been established. Although both walkways use pressure sensor-based technology, comparison of the spatiotemporal gait measurements between the systems for older adults is unknown. Our purpose was to determine the concurrent validity of the Zeno walkway with the gold-standard GAITRite walkway among healthy older adults and those at high fall risk using a cross-sectional study design. METHODS: Thirty healthy older adults and 17 older adults at high fall risk performed 5 walking trials barefoot on a 16´ × 4´ Zeno walkway and a 14´ × 2´ GAITRite walkway in a quasi-randomized order. Testing on the Zeno walkway was performed in a continuous manner while testing on the GAITRite walkway was performed using 5 discrete trials. Walking trials were done at self-selected comfortable and fast pace conditions. Data from the Zeno walkway were processed using the PKMAS software. Data from the GAITRite were processed using the GAITRite software. For each group and condition, spatiotemporal gait parameters common to both walkways' footfall processing software were compared using a Wilcoxon signed rank test. Concurrent validity was estimated using intraclass correlation coefficient (ICC(2,5)) and Bland-Altman plots. RESULTS AND DISCUSSION: Both groups had significantly greater stride width on the GAITRite walkway during both conditions. During the fast pace condition, both groups walked with greater gait speed, cadence, and stride velocity, lesser step time, stance time, and double-support time, greater percentage of gait cycle spent in single-support phase, and lesser percentage of gait cycle spent in double-support phase on the GAITRite walkway. Differences observed could be attributed to surface textures, software used to process the footfalls, dimensions of the walkways, or the continuous versus discrete protocols used in the current study. The ranges of ICC(2,5) values for healthy older adults and adults at high fall risk walking at a comfortable pace were 0.449 to 0.918 and 0.854 to 0.969 and at a fast pace were 0.784 to 0.964 and 0.850 to 0.976, respectively. These values imply that the concurrent validity was moderate for most temporal parameters when healthy older adults walked at comfortable pace and excellent otherwise. Overall, the concurrent validity between both walkways was acceptable. CONCLUSION: Concurrent validity for spatiotemporal parameters between the GAITRite walkway and the Zeno walkway was moderate to excellent for older adults dependent on the specific parameter (spatial vs temporal), population (healthy or fall risk), and walking pace (comfortable or fast).

Lower Quarter Y-Balance Test in healthy women 50-79 years old.

The Lower Quarter Y-Balance Test (LQ-YBT), a measure of dynamic balance used in young adults, has not been adequately studied in older women. We determined the reliability, normative values, and relationships to other balance measures for LQ-YBT in women aged 50-79 years. Interrater reliability was strong, and test-retest reliability was moderate to strong. Results by decade showed women 50-59 years had significantly better scores than both older groups. There were moderate positive correlations between single leg stance, gait speed, and LQ-YBT composite score. LQ-YBT may be used as a dynamic balance assessment in healthy older women.