Evaluating the Vestibulo-Ocular Reflex Following Traumatic Brain Injury: A Scoping Review.

Purpose:To identify the tests and tools used to evaluate vestibulo-ocular reflex (VOR) function after traumatic brain injury (TBI) in all age groups and across TBI severity.Methods: An electronic search was conducted to include relevant peer-reviewed literature published up to November 2019. Studies included those done with humans, of all ages, and had assessments of oculomotor and/or vestibulo-ocular function in TBI.Results: Of the articles selected (N = 48), 50% were published in 2018/2019. A majority targeted mild TBI, with equal focus on non-computerized versus computerized measures of VOR. Computerized assessment tools used were videonystagmography, dynamic visual acuity/gaze stability, rotary chair, and caloric irrigation. Non-computerized tests included the head thrust, dynamic visual acuity, gaze stability, head shaking nystagmus, rotary chair tests and the vestibular/oculomotor screening tool. High variability in administration protocols were identified. Namely: testing environment, distances/positioning/equipment used, active/passive state, procedures, rotation frequencies, and variables observed.Conclusions: There is a rapid growth of literature incorporating VOR tests in mild TBI but moderate and severe TBI continues to be under-represented. Determining how to pair a clinical test with a computerized tool and developing standardized protocols when administering tests will help in developing an optimal battery assessing the VOR in TBI.

Reproducibility of 24-h heart rate variability measures in preterm infants born at 28-32 weeks of gestation.

AIMS: To determine the reproducibility and minimum detectable change (MDC) of heart rate variability (HRV) measures during two sequential 24-h periods, at week 32 of gestation, in preterm infants born between 28 and 32 weeks, hospitalized in the neonatal intensive care unit (NICU). The second aim is to assess postnatal changes in HRV measures between 32 and 35 weeks. STUDY DESIGN: 32 preterm infants born between 28 and 32 weeks of gestation were recruited. For each infant 48 h of recordings of RR interval were performed at week 32 and week 35. HRV parameters included time and frequency parameters. RESULTS: At week 32, the intra-class correlation coefficient (ICC) of all HRV values was statistically significant with high correlation coefficients (ICC = 0.83-0.97). At week 35, a significant increase was noted in the HRV parameters, characterize mainly the sympathetic tone, with over half the infants showing an increase greater than the MDC for these parameters. CONCLUSIONS: Using 24-h recording at week 32 of gestation during NICU routine is reliable, feasible, not costly and may have important implications for an early identification of premature in a state of stress such as sepsis, or as a follow-up measure.

Reproducibility of heart rate variability during rest, paced breathing and light-to-moderate intense exercise in patients one month after stroke.

AIM: To examine test-retest reliability of time and frequency domain heart rate variability (HRV) in patients 1 month after stroke during rest, paced breathing and light-to-moderate physical activity. METHODS: Fifteen patients up to 1 month after stroke underwent two measurements of HRV, with the measurements 4 days apart. Measurements took place under three conditions while sitting: (1) at rest with self-select breathing frequency, (2) paced breathing and (3) cycling while sitting. Reliability was assessed statistically by calculating intraclass correlation coefficients (ICC), standard error of measurement and coefficient of variance (CV). RESULTS: The relative reliability was found to be good-to-excellent for SDNN (ICC: 0.86-0.91), RMSSD (ICC: 0.81-0.87) and HF (ICC: 0.91-0.94) in all three conditions and poor for LF at rest and paced breathing (ICC: 0.43-0.47). The absolute reliability for all measures was found to be poor (CV >15%). CONCLUSIONS: HRV can be reliably assessed at rest, paced breathing and light-to-moderate physical activity for identifying differences between patients, while individual changes in autonomic functioning exhibited large random variations between test-retest measurements.

Prevalence of injuries among young adults in sport centers: relation to the type and pattern of activity.

The rate of injuries resulting from physical exercise in sport centers as well as related factors has not yet been described. The aims of this study were to describe the prevalence of self-reported activity-specific injuries, to identify the relations between injury profile and different types and patterns of physical activity and to assess whether gender is a modifying variable in that connection. Four hundred and fifty-seven men and women aged 20-35 years participated in this cross-sectional study. A questionnaire was used to evaluate the types and patterns of physical activity performed in the 12 months preceding the study and sports injuries sustained during that time. One hundred and ninety of the 457 subjects reported an injury as a result of exercising (41.6%). A relationship was found between weight training and injuries of the upper extremity (UE) for men and between spinning classes and knee injuries for women. Among those who participated in weight-training exercises, more frequent and longer duration exercise was associated with UE injury, and among those who participated in spinning classes more frequent exercise was associated with knee injury. Future injury prevention programs in sport centers should pay special attention to men who participate in weight training and to women who participate in spinning classes.

Physical activity participation and bleeding characteristics in young patients with severe haemophilia.

Patients with haemophilia are now widely advised to participate in sport activities. However, no extensive data are available about their actual participation. The aim of this study was to describe the type; intensity and duration of leisure time physical activity (PA) among young patients with severe hemophilia and to assess whether there are differences in bleeding profile and muscle strength in related to activity intensity. Forty-four boys (ages 12-25 years) with severe haemophilia were studied. PA was assessed by the Godin and Shephard (G&S) questionnaire. Bleeding profile was determined based on a one month diary filled by each patient. Muscle strength of the lower limbs muscles was assessed using a hand held dynamometer. Only three subjects did not perform any PA. Twenty-five of the participants performed strenuous PA at least once a week. An inverse, moderate association (r(p) =-0.45, P < 0.002) was found between the G&S score and age. There were no significant differences in bleeding frequency or pain but a significant difference in the cause of bleed was found: those who exercised strenuously showed a higher proportion of bleeds due to traumatic reasons (P < 0.01). No differences in muscle strength values were noted in related to activity intensity also no linear association was noted between muscle strength and bleeding profile. Further investigation, including prospective studies, is needed in order to assess the temporal sequencing between training and the occurrence of bleeds and bleeds cause.

Testing knee extension and flexion strength at different ranges of motion: an isokinetic and electromyographic study.

The main objective of this study was to explore the mechanical and electrical output of thigh muscles derived from a range of motion (RoM) of 90 degrees (0-90 degrees flexion, LR) and the three successive RoMs: 0-30 degrees (SR1), 30-60 degrees (SR2) and 60-90 degrees (SR3). Thirteen men took part in the study. In view of the torque-velocity relationship and in order to render the test conditions as equivalent as possible, LR was tested at 90 degrees /s while the corresponding velocity for all SRs was 30 degrees /s. The findings indicated very good agreement between LR and SR2 in terms of absolute strength (particularly the concentric), within muscle eccentric to concentric strength ratios, between muscles (agonist to antagonist) strength ratios and the normalized IEMG (expressed in muV/Nm). An agreement was also noted between the mean eccentric peak torque of the knee flexors at LR and SR1 and between the mean eccentric peak torque of the knee extensors at LR and SR3. However, in general there was a lesser agreement between LR and SR1 or SR3. It is suggested that testing thigh muscles in the middle sector of knee motion (SR2) yields strength and EMG data that are close and well correlated with those derived from testing the knee along the commonly used (0-90 degrees ) RoM.