Reliability of recovery heart rate variability measurements as part of the Lamberts Submaximal Cycle Test and the relationship with training status in trained to elite cyclists.

PURPOSE: To determine if post-exercise heart rate variability, in the form of logged transformed root mean square of successive differences of the R-R intervals (LnRMSSD) can be measured reliably during the recovery from a submaximal cycle test and what the relationship of LnRMSSD is with training status of the cyclists. METHODS: Fourteen male cyclists participated in the reliability part for the study, which included performing six Lamberts Submaximal Cycle Test (LSCT), during which recovery LnRMSSD was measured over 30 s (LnRMSSD30 s), 60 s LnRMSSD60 s)and 90 s LnRMSSD90 s). In addition, fifty male and twenty female cyclists completed a peak power output (PPO) test (including VO2peak) and 40 km time trial (40 km TT) before which they performed the LSCT as a standardized warm-up. Relationships between the LnRMSSD and PPO, VO2peak and 40 km TT time were studied. RESULTS: Due to the design of the LSCT, submaximal heart and breathing rate were similar at the end of stage 3 of the LSCT, as well as during the recovery periods. The highest reliability was found in LnRMSSD60 s (ICC: 0.97) with a typical error of the measurement (TEM: 5.8%). In line with this the strongest correlations were found between LnRMSSD60 s and PPO (r = 0.93[male]; 0.85[female]), VO2peak (r = 0.71[male]; 0.63[female];) and 40 km TT (r = - 0.83[male]; - 0.63[female]). CONCLUSIONS: LnRMSSD60 s can be measured reliably after the LSCT and can predict PPO, VO2peak and 40 km TT performance well in trained-to-elite cyclists. These findings suggest that recovery LnRMSSD can potentially play an important role in monitoring and fine-tuning training prescriptions in trained-to-elite cyclists.

Evaluating workforce needs: an investigation of healthcare professionals' attitudes, beliefs and preparedness towards the management of Para athlete mental health at the Tokyo 2020 and Beijing 2022 Paralympic Games.

OBJECTIVES: To examine healthcare professionals (HCPs) attitudes, beliefs and preparedness towards the management of Para athlete mental health during the Tokyo 2020 and Beijing 2022 Paralympic Games. METHODS: A cross-sectional observational study was conducted. National Paralympic Committee's HCPs (n=857) working at the Tokyo 2020 and Beijing 2022 Paralympic Games were invited to respond to an anonymous online survey regarding the management of Para athlete mental health in their team. Data were analysed using descriptive frequency statistics. RESULTS: The survey was completed by 256 HCPs (30% of respondents). Most HCPs agreed that mental health was a concern in Para athletes (n=210; 82%). However, half (n=122; 48%) agreed that they did not screen Para athletes for mental health symptoms, and half (n=130; 51%) agreed that there was increased stigma around disclosure of mental health symptoms among Para athletes, compared with athletes without disability. Most HCPs (n=221; 86%) agreed they wanted to improve their knowledge and skills surrounding athlete mental healthcare. Culturally sensitivite, non-discriminatory and contextual factors were highlighted as desired areas of education for HCPs and active information dissemination for Para athletes. CONCLUSION: HCPs working at the Paralympic Games considered Para athlete mental healthcare important and reported perceived stigma, yet indicated low rates of mental health screening. Most respondents expressed the need for mental health education. Culturally sensitive training and active education strategies should be implemented to optimally manage Para athlete mental health.

Incidence of injury and illness at the Beijing 2022 Paralympic Winter Games held in a closed-loop environment: a prospective cohort study of 7332 athlete days.

OBJECTIVE: To describe the epidemiology of injuries and illnesses sustained during the Beijing 2022 Paralympic Winter Games, organised in a closed-loop environment to adhere with COVID-19 restrictions. METHODS: Injuries and illnesses from all teams were recorded on a daily basis by team medical staff on a web-based form and by local organising committee medical (polyclinic) facilities and venue medical support. Duplicates recorded on both systems were removed. Incidence of injuries and illnesses are reported per 1000 athlete days (95% CI). RESULTS: 564 athletes (426 male and 138 female) representing 46 countries were monitored for the 13-day period of the Beijing 2022 Paralympic Winter Games (7332 athlete days). The overall incidences were 13.0 injuries (10.6-15.8) and 6.1 illnesses (4.5-8.4) per 1000 athlete days. The incidence of injury in alpine skiing (19.9; 15.2-26.1) was significantly higher compared with Nordic skiing, ice hockey and wheelchair curling (p<0.05), while the incidence of respiratory illness was significantly higher in Nordic skiing (1.6; 0.9-2.9) compared with alpine skiing, ice hockey and snowboarding (p<0.05). CONCLUSION: The incidence of both injury and illness at the Beijing 2022 Games were the lowest yet reported in the Paralympic Winter Games. The incidence of injury was highest in alpine skiing. These findings underscore the importance of ongoing vigilance and continued injury risk mitigation strategies to safeguard the well-being of athletes in these high-risk competitions. Respiratory illnesses were most commonly reported in Nordic skiing, which included the three cases of COVID-19 recorded at the games.

Evaluating workforce well-being: an investigation of healthcare professionals' mental health and burnout symptoms at the Tokyo 2020 and Beijing 2022 Paralympic Games.

OBJECTIVE: To explore the prevalence of symptoms of mental health conditions and burnout of healthcare professionals (HCPs) working during the Tokyo 2020 Paralympic Games and the Beijing 2022 Paralympic Winter Games. METHODS: In this cross-sectional, observational study, HCPs working during the Tokyo 2020 and Beijing 2022 Paralympic Games were asked to complete an online, anonymous survey, which included demographic questions and questions regarding mental health symptoms including depression (Patient Health Questionnaire 9-item depression scale) and anxiety (Generalized Anxiety Disorder 7-item scale) as well as burnout (Maslach Burnout Inventory-Human Services Survey: depersonalisation, emotional exhaustion, personal accomplishment). Correlation coefficients (r) were calculated between demographic characteristics and mental health symptoms. RESULTS: In total, 256 HCPs (of 857 HCPs; 30%) completed the surveys. Twelve and eight per cent of HCP scores fell within the moderate to severe depression and moderate to severe anxiety categories, respectively. More than 30% reported moderate to high burnout (depersonalisation: 36%; emotional exhaustion: 36%; personal accomplishment: 58%). In addition, thoughts of self-harm and/or suicidality were reported by some HCPs (8%). Weak correlations were observed between age and depression (r=-0.13, p=0.046), anxiety (r=-0.16, p=0.010) and burnout (emotional exhaustion: r=-0.14, p=0.032; personal accomplishment: r=0.27, p<0.001). CONCLUSION: Although most HCPs reported good mental health, this study suggests that a subset of HCPs experienced symptoms of depression, anxiety, burnout or thoughts of self-harm during the Tokyo 2020 and Beijing 2022 Paralympic Games. While the generalisability of these findings outside of COVID-19 restrictions should be tested, appropriate guidance and mental health support of HCPs leading up to the Paralympic Games should be prioritised.

Spinal Curvatures, Deformities, and the Level of Disability in People with Bilateral Spastic Cerebral Palsy Living in South Africa; A 6-Year Follow-Up Study During Adulthood.

OBJECTIVE: Determine if spinal curvatures, deformities, as well as level of disability (due to back pain) changes with aging in adults with bilateral spastic cerebral palsy after receiving orthopedic interval surgery approach treatment in childhood. DESIGN: Consecutive case-series SETTING: Urban South Africa PARTICIPANTS: Twenty-seven ambulatory adults with cerebral palsy MAIN OUTCOME MEASURES: Spinal curvatures (scoliosis, thoracic kyphosis and lumbar lordosis) and deformities (spondylolysis and spondylolisthesis) were determined with X-rays, while the level of disability was assessed with the Oswestry Disability Index. RESULTS: The prevalence of spinal abnormalities were: 30% scoliosis (mild: <30°), 0% thoracic hyperkyphosis, 15% lumbar hyperlordosis, 0%; spondylolysis, and 0% spondylolisthesis. No changes in scoliosis and lumbar lordosis angles were observed, while the change in thoracic kyphosis angle was smaller than the minimal clinically important difference and moved closer toward the norm-values for typically developing adults. Level of disability remained similar with 63% reporting minimal disability, 26% moderate disability and 11% severe disability. No associations with spinal curvatures were found. CONCLUSIONS: No clinically meaningful changes in spinal curvatures, deformities and level of disability due to pain were seen during the 6 years follow-up period in adults with cerebral palsy who have been treated with interval surgery approach in childhood.

Risk factors associated with acute respiratory illnesses in athletes: a systematic review by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'.

OBJECTIVE: To review risk factors associated with acute respiratory illness (ARill) in athletes, including non-infectious ARill and suspected or confirmed acute respiratory infections (ARinf). DESIGN: Systematic review. DATA SOURCES: Electronic databases: PubMed-Medline, EbscoHost and Web of Science. ELIGIBILITY CRITERIA: Original research articles published between January 1990 and July 2020 in English were searched for prospective and retrospective full text studies that reported quantitative data on risk factors associated with ARill/ARinf in athletes, at any level of performance (elite/non-elite), aged 15-65 years. RESULTS: 48 studies (n=19 390 athletes) were included in the study. Risk factors associated with ARill/ARinf were: increased training monotony, endurance training programmes, lack of tapering, training during winter or at altitude, international travel and vitamin D deficits. Low tear-(SIgA) and salivary-(IgA) were immune biomarkers associated with ARill/ARinf. CONCLUSIONS: Modifiable training and environmental risk factors could be considered by sports coaches and athletes to reduce the risk of ARill/ARinf. Clinicians working with athletes can consider assessing and treating specific nutritional deficiencies such as vitamin D. More research regarding the role and clinical application of measuring immune biomarkers in athletes at high risk of ARill/ARinf is warranted. PROSPERO REGISTRATION NUMBER: CRD42020160928.

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'.

OBJECTIVE: To determine the incidence of acute respiratory illness (ARill) in athletes and by method of diagnosis, anatomical classification, ages, levels of performance and seasons. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Electronic databases: PubMed-Medline, EbscoHost and Web of Science. ELIGIBILITY CRITERIA: Original research articles published between January 1990 and July 2020 in English reporting the incidence of ARill in athletes, at any level of performance (elite/non-elite), aged 15-65 years. RESULTS: Across all 124 studies (n=1 28 360 athletes), the incidence of ARill, estimated by dividing the number of cases by the total number of athlete days, was 4.7 (95% CI 3.9 to 5.7) per 1000 athlete days. In studies reporting acute respiratory infections (ARinf; suspected and confirmed) the incidence was 4.9 (95% CI 4.0 to 6.0), which was similar in studies reporting undiagnosed ARill (3.7; 95% CI 2.1 to 6.7). Incidences of 5.9 (95% CI 4.8 to 7.2) and 2.8 (95% CI 1.8 to 4.5) were found for studies reporting upper ARinf and general ARinf (upper or lower), respectively. The incidence of ARinf was similar across the different methods to diagnose ARinf. A higher incidence of ARinf was found in non-elite (8.7; 95% CI 6.1 to 12.5) vs elite athletes (4.2; 95% CI 3.3 to 5.3). SUMMARY/CONCLUSIONS: These findings suggest: (1) the incidence of ARill equates to approximately 4.7 per athlete per year; (2) the incidence of upper ARinf was significantly higher than general (upper/lower) ARinf; (3) elite athletes have a lower incidence of ARinf than non-elite athletes; (4) if pathogen identification is not available, physicians can confidently use validated questionnaires and checklists to screen athletes for suspected ARinf. For future studies, we recommend that a clear diagnosis of ARill is reported. PROSPERO REGISTRATION NUMBER: CRD42020160472.

Incidence and burden of injury at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days.

OBJECTIVE: To describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo. METHODS: Injury data were obtained daily via the established web-based injury and illness surveillance system (WEB-IISS; 81 countries, 3836 athletes) and local organising committee medical facilities (81 countries, 567 athletes). Univariate unadjusted incidences (injuries per 1000 athlete days with 95% CIs), injury proportion (IP, %) and injury burden (days lost per 1000 athlete days) are reported. RESULTS: A total of 4403 athletes (1853 women, 2550 men) from 162 countries were monitored prospectively during the 3-day pre-competition and 12-day competition periods (66 045 athlete days). 386 injuries were reported in 352 athletes (IP=8.0%) with an incidence of 5.8 per 1000 athlete days (95% CI 5.3 to 6.5). Football 5-a-side (17.2), taekwondo (16.0), judo (11.6) and badminton (9.6) had the highest incidence. There was a higher incidence of injuries in the pre-competition period than in the competition period (7.5 vs 5.4; p=0.0053). Acute (sudden onset) injuries and injuries to the shoulder (0.7) and hand/fingers (0.6) were most common. Injury burden was 10.9 (8.6-13.8), with 35% of injuries resulting in time loss from training and competition. CONCLUSION: Compared with previous Paralympic Games, there was a reduction in injury incidence but higher injury burden at the Tokyo 2020 Paralympic Games. The new sports of taekwondo and badminton had a high injury incidence, with the highest injury burden in taekwondo, compared with other sports. These findings provide epidemiological data to inform injury prevention measures for high-risk sports.

Incidence and burden of illness at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days.

OBJECTIVE: To describe the incidence and burden of illness at the Tokyo 2020 Paralympic Games, which was organised with strict COVID-19 countermeasures. METHODS: Daily illnesses were recorded via the web-based injury and illness surveillance system (teams with their own medical staff; n=81), and local polyclinic services (teams without their own medical staff; n=81). Illness proportion, incidence and burden were reported for all illnesses and in subgroups by sex, age, competition period, sports and physiological system. RESULTS: 4403 athletes (1853 female and 2550 male) from 162 countries were monitored for the 15-day period of the Tokyo Paralympic Games (66 045 athlete days). The overall incidence of illnesses per 1000 athlete days was 4.2 (95% CI 3.8 to 4.8; 280 illnesses). The highest incidences were in wheelchair tennis (7.1), shooting (6.1) and the new sport of badminton (5.9). A higher incidence was observed in female compared with male athletes (5.1 vs 3.6; p=0.005), as well as during the precompetition versus competition period (7.0 vs 3.5; p<0.0001). Dermatological and respiratory illnesses had the highest incidence (1.1 and 0.8, respectively). Illness burden was 4.9 days per 1000 athlete days and 23% of illnesses resulted in time loss from training/competition>1 day. CONCLUSION: The incidence of illness at the Tokyo 2020 Paralympic Games was the lowest yet to be recorded in either the summer or winter Paralympic Games. Dermatological and respiratory illnesses were the most common, with the burden of respiratory illness being the highest, largely due to time loss associated with COVID-19 cases. Infection countermeasures appeared successful in reducing respiratory and overall illness, suggesting implementation in future Paralympic Games may mitigate illness risk.

Muscular Activation Patterns During Exercise on the Treadmill, Stepper, and Elliptical Trainer.

ABSTRACT: Eken, MM, Withers, A, Flanagan, K, Burger, J, Bosch, A, and Lamberts, RP. Muscular activation patterns during exercise on the treadmill, stepper, and elliptical trainer. J Strength Cond Res 36(7): 1847-1852, 2022-Because of the low-impact, the stepper and elliptical trainer are popular alternatives to running when runners sustain running-related injuries. Muscular effort is expected to be lower during exercise on the stepper and elliptical trainer compared with running. The aim of this study was to quantify this by comparing muscular effort when exercising at similar moderate-to-high exercise intensities on a treadmill, stepper, and elliptical trainer. Seventeen well-trained runners (V̇o2max: 53.3 ml·min-1·kg-1 [male: n = 9], 44.8 ml·min-1·kg-1 [female: n = 8]; average peak treadmill running speed: 18.7 km·h-1 [male], 16.3 km·h-1 [female]) performed exercise at submaximal levels (60%-70%-80% of peak workload) on the treadmill, stepper, and elliptical trainer. Peak workload was determined during peak exercise tests on separate days. Surface electromyography was recorded from lower extremity muscles. Root-mean-squared (RMS) values were calculated and compared between exercise modalities and submaximal levels. Significance was set at p < 0.05. Root-mean-squared levels of lower extremity muscles were significantly reduced during exercise on the stepper and elliptical trainer compared with treadmill running (p < 0.05, except for quadriceps (p > 0.05). Overall, similar RMS levels were found on stepper and elliptical trainer (p > 0.05), whereas in several cases higher RMS levels were found on the stepper compared with elliptical trainer (p < 0.05). These findings support clinical expectations that exercise on the stepper and elliptical trainer reduces muscular effort up to 60% compared with (treadmill) running, and therefore can be effective training modalities during rehabilitation from running-related injuries by restricting impact on lower extremities.

Physiological and Metabolic Responses to Exercise on Treadmill, Elliptical Trainer, and Stepper: Practical Implications for Training.

Elliptical trainers and steppers are proposed as useful exercise modalities in the rehabilitation of injured runners due to the reduced stress on muscles and joints when compared to running. This study compared the physiological responses to submaximal running (treadmill) with exercise on the elliptical trainer and stepper devices at three submaximal but identical workloads. Authors had 18 trained runners (male/female: N = 9/9, age: mean ± SD = 23 ± 3 years) complete randomized maximal oxygen consumption tests on all three modalities. Submaximal tests of 3 min were performed at 60%, 70%, and 80% of peak workload individually established for each modality. Breath-by-breath oxygen consumption, heart rate, fuel utilization, and energy expenditure were determined. The value of maximal oxygen consumption was not different between treadmill, elliptical, and stepper (49.3 ± 5.3, 48.0 ± 6.6, and 46.7 ± 6.2 ml·min-1·kg-1, respectively). Both physiological measures (oxygen consumption and heart rate) as well as carbohydrate and fat oxidation differed significantly between the different exercise intensities (60%, 70%, and 80%) but did not differ between the treadmill, elliptical trainer, and stepper. Therefore, the elliptical trainer and stepper are suitable substitutes for running during periods when a reduced running load is required, such as during rehabilitation from running-induced injury.

The level of accomplishment and satisfaction in activity and participation of adults with cerebral palsy and spastic diplegia.

BACKGROUND: Orthopaedic surgery is commonly performed in children with cerebral palsy (CP) and spastic diplegia to improve functional mobility. However, no research has quantified levels of accomplishment and satisfaction in daily activities and participation long-term after surgery. Therefore, this study aimed to investigate 1) the level of accomplishment and satisfaction of life habits in adults with CP, 2) whether there were differences between Gross Motor Function Classification System (GMFCS) levels, and 3) associations with contextual factors, functional level and frequency of pain. METHODS: Levels of accomplishment and satisfaction in activity and participation were assessed using the Life-Habits 3.1 questionnaire in 30 adults with CP and spastic diplegia who received the first orthopaedic intervention more than 15 years ago (age: median [interquartile range (IQR)] = 27:8 [21:7-33:8] y:mo; GMFCS level I/II/III: n = 15/11/4). GMFCS and Functional Mobility Scale (FMS) assessed mobility over 5 m, 50 m and 500 m. Participants reported frequency of back pain and pain in the lower and upper limb. RESULTS: On average 63% of the participants were independent and faced no difficulties in the accomplishment of all life habits. Difficulties were mostly experienced for 'mobility', 'housing' and 'recreation' (all 61%). Participants were overall satisfied, with lowest scores for 'employment' (13% dissatisfied). Between the GMFCS levels, accomplishment scores of participants with level I were significantly higher than level II. In addition, negative associations were found between accomplishment of life habits and GMFCS level, FMS, and pain on spinal level. CONCLUSION: Levels of accomplishment and satisfaction were relatively high among adults with CP who underwent orthopaedic interventions during childhood. However, negative associations between accomplishment levels and level of functioning and back pain argue for rehabilitation programs specialized on these factors. This information is imperative for physicians and allied health care professionals to guide adults with CP during ageing.

Intraobserver Reliability and Construct Validity of the Squat Test in Children With Cerebral Palsy.

PURPOSE: This study evaluated intraobserver reliability and construct validity of the squat test to assess lower extremity strength in children with cerebral palsy (CP) and spastic diplegia. METHODS: Children with CP performed 2 trials of the squat test and calculated the intraclass correlation coefficient to evaluate intraobserver reliability. Correlations between outcomes of hand-held dynamometry (HHD) of knee extensor strength and an 8-repetition maximum (8RM) leg press test and the squat test were calculated to evaluate construct validity. RESULTS: Excellent intraobserver reliability was observed for the squat test. Correlations between squat test performance and HHD knee extension and 8RM leg press test demonstrated good construct validity. CONCLUSIONS: The squat test is a reliable and valid tool to assess lower extremity strength in children with CP and spastic diplegia. The squat test is inexpensive and less time-consuming, and therefore particularly suitable for clinicians.

Lower limb muscle fatigue during walking in children with cerebral palsy.

AIM: To investigate whether more prominent signs of muscle fatigue occur during self-paced walking in children with cerebral palsy (CP) compared to typically developing peers. METHOD: In this case-control study, 13 children with CP (four males, nine females; mean age [SD] 11y 4mo [3y 8mo]; nine in Gross Motor Function Classification System [GMFCS] level I, three in GMFCS level II, and one in GMFCS level III) and 14 typically developing peers (nine males, five females; mean age [SD] 9y 10mo [1y 10mo]) walked 5 minutes overground at a self-selected walking speed. Electromyography (EMG) median frequency and root mean square (RMS) were identified per gait cycle from EMG recordings of the tibialis anterior, gastrocnemius medialis, soleus, rectus femoris, and semitendinosus. Rate of change in those variables was analysed using mixed linear model analyses. RESULTS: The decrease in EMG median frequency of gastrocnemius medialis and soleus and increase in EMG-RMS of tibialis anterior, gastrocnemius medialis, and soleus were significantly larger in the most affected leg of children with CP compared with typically developing peers. INTERPRETATION: Increased selective muscle fatigue of the lower leg muscles was observed during self-paced walking in children with mild-to-moderate severe CP. This could contribute to and account for limited walking capacity. WHAT THIS PAPER ADDS: Children with cerebral palsy (CP) show more signs of lower leg muscle fatigue than typically developing peers. No signs of muscle fatigue were observed in upper leg muscles of children with CP.

Relations between muscle endurance and subjectively reported fatigue, walking capacity, and participation in mildly affected adolescents with cerebral palsy.

AIM: To investigate the relation between muscle endurance and subjectively reported fatigue, walking capacity, and participation in mildly affected adolescents with cerebral palsy (CP) and peers with typical development. METHOD: In this case-control study, knee extensor muscle endurance was estimated from individual load-endurance curves as the load corresponding to a 15-repetition maximum in 17 adolescents with spastic CP (six males, 11 females; age 12-19y) and 18 adolescents with typical development (eight males, 10 females; age 13-19y). Questionnaires were used to assess subjectively reported fatigue (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale) and participation (Life-Habits questionnaire). Walking capacity was assessed using the 6-minute walk test. Relations were determined using multiple regression analyses. RESULTS: Muscle endurance related significantly to subjectively reported fatigue and walking capacity in adolescents with CP, while no relations were found for adolescents with typical development (subjectively reported fatigue: regression coefficient ß [95% confidence intervals] for CP=23.72 [6.26 to 41.18], for controls=2.72 [-10.26 to 15.69]; walking capacity ß for CP=125m [-87 to 337], for controls=2m [-86 to 89]). The 15-repetition maximum did not relate to participation in adolescents with CP. INTERPRETATION: Subjectively reported fatigue and reduced walking capacity in adolescents with CP are partly caused by lower muscle endurance of knee extensors. Training of muscle endurance might contribute to reducing the experience of fatigue and improving walking capacity. Reduced muscle endurance seems to have no effect on participation.

Assessment of muscle endurance of the knee extensor muscles in adolescents with spastic cerebral palsy using a submaximal repetitions-to-fatigue protocol.

OBJECTIVE: To compare muscle endurance in adolescents with spastic cerebral palsy (CP) with typically developing (TD) peers using a submaximal repetitions-to-fatigue (RTF) protocol. DESIGN: Cross sectional. SETTING: Human motion laboratory. PARTICIPANTS: Adolescents with spastic CP (n=16; Gross Motor Function Classification System levels I or II) and TD adolescents (n=18) within the age range of 12 to 19 years old. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Each participant performed 3 RTF tests at different submaximal loads, ranging from 50% to 90% of their maximal voluntary knee extension torque. The relation between the number of repetitions (repetition maximum [RM]) and imposed submaximal relative (percent of maximal voluntary torque [%MVT]) and absolute (Nm/kg) torque was quantified. To compare adolescents with CP with TD adolescents, a mixed linear model was used to construct load endurance curves. Surface electromyography of quadriceps muscles was measured to assess changes in normalized amplitude and median frequency (MF) as physiological indicators of muscle fatigue. RESULTS: Adolescents with CP showed a larger decrease in %MVT per RM than TD adolescents (P<.05). TD adolescents showed substantial higher absolute (Nm/kg) load endurance curves than adolescents with CP (P<.001), but they did not show a difference in slope. Electromyographic normalized amplitude increased significantly (P<.05) in the quadriceps muscles in all tests for both groups. Electromyographic MF decreased significantly (P<.05) in tests with the low and medium loads. Electromyographic responses did not differ between groups, indicating that similar levels of muscle fatigue were reached. CONCLUSIONS: Adolescents with CP show slightly lower muscle endurance compared with TD adolescents on a submaximal RTF protocol, which is in contrast with earlier findings in a maximal voluntary fatigue protocol. Accordingly, adolescents with CP have a reduced capacity to endure activities at similar relative loads compared with TD adolescents.

Exploring the unmet needs of adults with cerebral palsy living in urban South Africa.

PURPOSE: The investigators aimed to understand the unmet needs of adults with cerebral palsy (CP) living in urban South Africa and to ascertain similarities or differences to typically developing (TD) adults in the same community. MATERIALS AND METHODS: Participants were interviewed with an adapted version of the Southampton Needs Assessment Questionnaire (SNAQ). Non-parametric statistical analysis was utilised for quantitative data and qualitative data were analysed using free coding to identify themes. RESULTS: Thirty adults with CP (median age 34.8 years; GMFCS levels I/II/III/IV/V: n = 6/6/5/7/6; socio-economic status (SES) low/average/high: n = 8/17/5) were matched for gender, age, and SES. Adults with CP reported a higher unemployment rate and lower level of satisfaction with access to health services than TD peers. Core themes identified by the participants with CP that made community participation more difficult were physical capacity, poor access to accommodation, transport and health services, lack of socialising opportunities, poor universal design, and lack of financial independence. CONCLUSIONS: Adults with CP reported experiencing many challenges in their communities. Improved access to health care services and transport, and the universal design of housing and community buildings to accommodate individuals with a disability should be made a priority.Implications for rehabilitationAdults with cerebral palsy (CP) reported that their disability had an impact on their social life, home life, and work life.Accessibility issues have been identified as a major factor affecting adults with CP in a variety of areas, including access to and use of health services, housing, transportation, and community buildings.Adults with CP reported the need for support during the transition to adulthood, especially with developing life skills that will promote living independently in the community as adults with disabilities.

The Influence of a Multistage Mountain-Bike Race on Neuromuscular Activation and Synergies: A Case Study.

INTRODUCTION: This case study aimed to describe potential changes in neuromuscular activation and synergies after an 8-day cross-country mountain-bike stage race. METHODS: A peak power output test was performed 5 days before the race. Two days before the start and after 7 days of racing, the athlete performed a power-based Lamberts Submaximal Cycling Test, including surface electromyography, and completed a Daily Analysis of Life Demands of Athletes questionnaire. Neuromuscular activation, in terms of root mean square, timing (onset-offset) of muscle activation, and synergies, was obtained from electromyography recordings. RESULTS: The athlete reported an increase in symptoms of experienced stress after the stage race on the Daily Analysis of Life Demands of Athletes questionnaire. Both biceps femoris and tibialis anterior muscles showed a reduction in normalized amplitude after the stage race. In addition, the number of synergies that was necessary to describe neuromuscular activation increased from 2 to 3. CONCLUSIONS: In this case study, the increase in synergies suggests that, after the stage race, the athlete showed a more complex muscle-recruitment pattern. This may indicate that muscle coordination can change when muscle fatigue occurs; however, further research is needed to confirm these results in a larger sample.

Epidemiology of clavicle shaft fractures in a public hospital in South Africa: differences between developing and developed countries.

PURPOSE: Describing the epidemiological profile of patients with acute clavicle shaft fractures in a developing country public state hospital where mainly low- to middle-income patients are treated. METHODS: This is a retrospective analysis of all clavicle shaft fractures between 2008 and 2018 (10 years) based on Picture Archiving and Communication System at the second largest public hospital in South Africa. RESULTS: One thousand and three patients, 729 male and 274 female, were included in the epidemiological review. Most common causes of clavicle shaft fractures, in which 23% of cases presented with other injuries, were road accidents, falls and interpersonal violence. The majority of fractures were displaced and most (72%) were treated conservatively. Only 28% of patients were treated surgically, 61% with contoured plating and a relatively high 39% with intramedullary nails. CONCLUSION: The epidemiology of clavicle shaft fractures in a public hospital in a developing country, where the majority of patients hail from low- to middle-income backgrounds, differs substantially from developed countries. Although similar types of fractures were reported, differences were noted in terms of patients' age, causes of injury, associated injuries and treatment approaches.

Pain, health-related quality of life, and mental health of adolescents and adults with cerebral palsy in urban South Africa.

PURPOSE: The aim of this study was to investigate the prevalence and level of disability due to pain, health-related quality of life (HRQoL) and mental health in adolescents and adults with cerebral palsy (CP), living in a low-to-middle income country (LMIC), compared to matched typically developing (TD) peers, and to explore associations with individual characteristics. MATERIALS AND METHODS: This case-control study included 31 adolescents and 30 adults with CP (gross motor function classification system [GMFCS] Level I-V) and matched TD peers. Assessment tools used were a pain questionnaire, the Oswestry Disability Index (ODI), Short-Form Health Survey (SF-36v2), Hospital Anxiety and Depression Scale (HADS), and General Self Efficacy (GSE) scale. RESULTS: Both CP cohorts reported more frequent pain in their lower limbs, higher level of disability due to pain (total ODI score) and lower perceived physical HRQoL compared to TD peers, while their mental health (mental HRQoL, HADS, and GSE) was not different. CONCLUSIONS: Despite the physical challenges faced by adolescents and adults with CP living in urban South Africa, the mental health scores showed no difference compared to TD peers. Care should be taken to maintain this positive mental state during ageing across their lifespan.IMPLICATIONS FOR REHABILITATIONThe prognosis of individuals with cerebral palsy (CP) has improved over the last three decades and CP should therefore be considered as a lifelong condition.Adolescents and adults with CP living in urban South Africa reported a higher level of disability due to pain and lower physical health-related quality of life compared to typically developing peers, while their level of depression, anxiety, and self-esteem was not different.These results were similar to findings of studies conducted in high-income countries, though it cannot be generalised to other low to middle-income countries with different cultural and government systems.In order to promote healthy ageing across their lifespan, intervention programmes should be considered to improve physical well-being, and care should be taken to maintain their positive mental health.