Ultrasound-guided dry needling versus traditional dry needling for patients with knee osteoarthritis: A double-blind randomized controlled trial.

OBJECTIVE: To compare the effect of ultrasound (US)-guided dry needling (DN) with traditional DN in the treatment of pain and dysfunction for patients with knee osteoarthritis (KOA). DESIGN: A double-blind, randomized controlled trial. METHODS: Patients (25 male and 65 female), age 50-80 years diagnosed with KOA were recruited and randomly assigned to one of three groups in a 1:1:1 ratio for intervention: real US-guided DN with exercise therapy (G1), placebo US-guided DN with exercise therapy (G2), and exercise therapy solely (G3). G1 and G2 were blinded to the application of real or placebo US guidance by turning the monitor of US imaging out-of-view from participants' vantage points. The effectiveness of blinding was evaluated by asking the participants whether they had received real-US guided DN. The responses were assessed by Chi-square test. Visual Analogue Scale (VAS), Knee injury, and Osteoarthritis Outcome Score (KOOS) subscales (KOOS-pain, KOOS-symptoms, KOOS-quality-of-life (QoL)) were collected at baseline, 4 weeks, and 8 weeks by a blinded assessor. Data were analyzed by mixed model analysis of variance (ANOVA) with Bonferroni correction. RESULTS: Eighty-four participants (61.26±5.57 years) completed the study. G1 achieved significant improvement in VAS at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = -15.61, 95% CI [-25.49, -5.51], p = 0.001; G1 vs. G3: MD = -19.90, 95% CI [-29.71, -10.08], p< 0.001). G1 achieved significant improvement in KOOS-pain at 8 weeks compared to G2 and G3 (G1 vs. G2: MD = 9.76, 95% CI [2.38, 17.14], p = 0.006; G1 vs. G3: MD = 9.48, 95% CI [2.31, 16.66], p = 0.010). KOOS-symptoms and KOOS-QoL were not statistically significant between groups. G2 had no significant difference of the perceptions as G1 with p = 0.128. G2 were successfully blinded to placebo US-guided DN. CONCLUSION: US-guided DN with exercise therapy may be more effective than traditional DN with exercise therapy or exercise therapy alone in reduce pain of KOA.

Muscular Morphomechanical Characteristics After an Achilles Repair.

BACKGROUND: The purpose of the study was to compare the morphomechanical and functional characteristics during maximal isometric, concentric, and eccentric contractions in the legs of patients that underwent unilateral Achilles tendon repair with those in their noninjured control legs. METHODS: Twenty participants (median age = 38.2 years; range, 21.1-57.3 years) who underwent Achilles repair between 3 and 12 months ago were recruited with the following measures: (1) mechanical stiffness of the aponeurosis and (2) electromyography and medial gastrocnemius fascicle angle and length, standing muscle and tendon length, and height of heel rise with isometric contraction. RESULTS: Compared to the noninjured legs, the repaired legs showed less resting fascicle length, standing muscle length, isometric plantarflexion torque, and heel raise distance ( Ps ranged between .044 and <.001). During the concentric and eccentric phases of the raising and lowering test, the repaired legs demonstrated less fascicle length ( P ≤ .028) but greater tendinous tissue length ( Ps ranged between .084 and <.001) and fascicle angle ( Ps ranged between .247 and .008) and fewer change magnitudes of the fascicle length and tendinous tissue length ( P ≤ .003). The change magnitudes of the morphological characteristics showed correlations with the torque or distance. CONCLUSION: Selecting the appropriate surgical repair and rehabilitation for Achilles tendon ruptures is recommended for restoring the length and mechanical strength of the muscle-tendon unit of plantar-flexion muscles. LEVEL OF EVIDENCE: Level III, comparative study.

Motor skill experience modulates executive control for task switching.

This study aimed to investigate the effect of types of motor skills, including open and closed skills on enhancing proactive and reactive controls for task switching. Thirty-six athletes in open (n=18) or closed (n=18) sports and a control group (n=18) completed the task-switching paradigm and the simple reaction task. The task-switching paradigm drew on the proactive and reactive control of executive functions, whereas the simple reaction task assessed the processing speed. Significant Validity×Group effect revealed that the participants with open skills had a lower switch cost of response time compared to the other two groups when the task cue was 100% valid; whereas the participants regardless of motor skills had a lower switch cost of response time compared to the control group when the task cue was 50% valid. Hierarchical stepwise regression analysis further confirmed these findings. For the simple reaction task, there were no differences found among the three groups. These findings suggest that experience in open skills has benefits of promoting both proactive and reactive controls for task switching, which corresponds to the activity context exposed by the participants. In contrast, experience in closed skills appears to only benefit development of reactive control for task switching. The neural mechanisms for the proactive and reactive controls of executive functions between experts with open and closed skills call for future study.

Imagery perspective among young athletes: Differentiation between external and internal visual imagery.

PURPOSE: This study aimed to investigate the construct of external visual imagery (EVI) vs. internal visual imagery (IVI) by comparing the athletes' imagery ability with their levels of skill and types of sports. METHODS: Seventy-two young athletes in open (n = 45) or closed (n = 27) sports and with different skill levels completed 2 custom-designed tasks. The EVI task involved the subject generating and visualizing the rotated images of different body parts, whereas the IVI task involved the subject visualizing himself or herself performing specific movements. RESULTS: The significant Skill-Level × Sport Type interactions for the EVI task revealed that participants who specialized in open sports and had higher skill-levels had a higher accuracy rate as compared to the other subgroups. For the IVI task, the differences between the groups were less clear: those with higher skill-levels or open sports had a higher accuracy rate than those with lower skill-levels or closed sports. CONCLUSION: EVI involves the visualization of others and the environment, and would be relevant to higher skill-level athletes who engage in open sports. IVI, in contrast, tends to be more self-oriented and would be relevant for utilization by higher skill-level athletes regardless of sport type.

The effects of Tai Chi on the balance control of elderly persons with visual impairment: a randomised clinical trial.

BACKGROUND: balance control is a major problem for older individuals with poor vision. There are limitations, however, for visually impaired elderly persons wishing to participate in exercise programmes. The benefits of Tai Chi for balance control, muscle strength and preventing falls have been demonstrated with sighted elderly subjects. This study was designed to extend those findings to elderly persons with visual impairment. OBJECTIVE: to investigate the effects of Tai Chi on the balance control of elderly persons with visual impairment. DESIGN: randomised clinical trial. SETTING: residential care homes. SUBJECTS: forty visually impaired persons aged 70 or over. METHODS: the participants were randomly divided into Tai Chi and control groups and assessed pre- and post-intervention using three tests: (i) passive knee joint repositioning to test knee proprioception; (ii) concentric isokinetic strength of the knee extensors and flexors and (iii) a sensory organisation test to quantify an individual's ability to maintain balance in a variety of complex sensory conditions. RESULTS: after intervention, the Tai Chi participants showed significant improvements in knee proprioception and in their visual and vestibular ratios compared with the control group. CONCLUSION: practicing Tai Chi can improve the balance control of visually impaired elderly persons.

Balance control in very old adults with and without visual impairment.

Good balance, an important ability in controlling body movement, declines with age. Also, balance appears to decrease when visual input is restricted, while this has been poorly investigated among visually impaired very old adults. The objective of this study is thus to explore whether the balance control of the very old differs with varying degrees of visual impairment. This cross-sectional study was conducted in community centers and residential care homes. Thirty-three visually impaired (17 = low vision; 16 = blind) and 15 sighted elderly aged ≥ 70 years participated in the study. All participants were assessed: (1) concentric isokinetic strength of the knee extensors and flexors; (2) a sensory organization test to measure their ability to use somatosensory, visual, and vestibular information to control standing balance; (3) a perturbed double-leg stance test to assess the ability of the automatic motor system to quickly recover following an unexpected external disturbance; (4) the five times sit-to-stand test. Compared with low-vision subjects, the sighted elderly achieved higher peak torque-to-body weight ratios in concentric knee extension. The sighted elderly showed less body sway than the low vision and blind subjects in sensory conditions where they benefited from visual inputs to help them maintain standing balance. The sighted and low-vision subjects achieved smaller average body sway angles during forward and backward platform translations compared to the blind subjects. Low vision and blindness decrease balance control in elderly.

Effects of concurrent cognitive task on pre-landing muscle response latency during stepping down activity in older adults with and without a history of falls.

PURPOSE: To investigate the co-contraction of ankle muscles in older subjects with and without a history of falls during a stepping down activity, and whether the co-contraction was disrupted by a concurrent cognitive task. METHOD: Ten fallers and 9 non-fallers (mean age = 72.0 +/- 5.0 and 72.1 +/- 7.3 years, respectively) were recruited. Electromyography (EMG) of the tibialis anterior (TA) and medial gastrocnemius (MG) was recorded during stepping down with and without a concurrent cognitive task. Co-contraction was investigated using the time between the EMG onset and the foot touching a force-platform, termed the pre-landing muscle response latency. RESULTS: The fallers showed longer pre-landing muscle response latencies in the TA compared with non-fallers (141.1 +/- 58.1 ms and 110.9 +/- 68.2 ms, respectively). With a concurrent cognitive task, the pre-landing muscle response latencies in the TA were shortened in fallers significantly more than in non-fallers (44.4% and 15.5%, respectively). No significant difference in MG activation was found between 2 groups in the stepping down activity with and without cognitive task. CONCLUSIONS: Subjects with history of falls exhibit a greater shortening in the pre-landing muscle response latency than non-fallers when distracted during stepping down. Disruption of their co-contraction in ankle joint might precipitate such older adults to fall.

Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains.

BACKGROUND: Deficiencies in ankle proprioception and standing balance in basketball players with multiple ankle sprains have been reported in separate studies. However, the question of how ankle proprioceptive inputs and postural control in stance are related is still unclear. HYPOTHESIS: Ankle repositioning errors and the amount of postural sway in stance are increased in basketball players with multiple ankle sprains. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty healthy male basketball players and 19 male basketball players who had suffered bilateral ankle sprains within the past 2 years were examined. Both groups were similar in age. Passive ankle joint repositioning errors at 5 degrees of plantar flexion were used to test for ankle joint proprioception. The Sensory Organization Test was applied with dynamic posturography to assess postural sway angle under 6 sensory conditions. RESULTS: A significant increase in ankle repositioning errors was demonstrated in basketball players with bilateral ankle sprains (P < .05). The mean errors in the right and left ankles were increased from 1.0 degrees (standard deviation, 0.4 degrees ) and 0.8 degrees (standard deviation, 0.2 degrees ), respectively, in the healthy players to 1.4 degrees (standard deviation, 0.7 degrees ) and 1.1 degrees (standard deviation, 0.5 degrees ) in the injured group. A significant increase in the amount of postural sway in the injured subjects was also found in conditions 1, 2, and 5 of the Sensory Organization Test (P < .05). Furthermore, there were positive associations between averaged errors in repositioning both ankles and postural sway angles in conditions 1, 2, and 3 of the Sensory Organization Test (r = 0.39-0.54, P < .05). CONCLUSIONS: Ankle repositioning errors and postural sway in stance increased in basketball players with multiple ankle sprains. A positive relationship was found between these 2 variables. CLINICAL RELEVANCE: Such findings highlight the need for the rehabilitation of patients with multiple ankle sprains to include proprioceptive and balance training.