Determining fall risk change throughout pregnancy: the accuracy of postpartum survey and relationship to fall efficacy.

All epidemiological studies on pregnancy fall risk to date have relied on postpartum recall. This study investigated the accuracy of postpartum recall of falls that were reported during pregnancy, including assessment of fall efficacy as a possible reason for recall inaccuracy. Twenty participants reported fall experiences weekly during pregnancy, but one participant was excluded as an outlier. A fall efficacy questionnaire was completed every six weeks during pregnancy. A postpartum survey to mimic previous studies (Dunning, Lemasters, and Bhattacharya 2010; Dunning et al. 2003) was delivered to determine recall accuracy. Postpartum recall of fall events each gestational month matches the previous study (Dunning, Lemasters, and Bhattacharya 2010). However, recall of falls is 16% underestimated and recall of all fall events is 30% overestimated in postpartum survey. There is a slight relationship between fall efficacy and true falls, but not between fall efficacy and fall recall. Our study suggests fall risk needs to be intermittently surveyed throughout pregnancy rather than assessed via postpartum survey.Practitioner summary: This study investigated the accuracy of postpartum survey of fall risk during pregnancy and the possibility of fall efficacy as a covariate. We used three corresponding surveys. We found inaccuracies in postpartum survey, not explain by fall efficacy.

Weighted Vest Loads Do Not Elicit Changes in Spatial-Temporal Gait Parameters in Children and Adolescents With Autism.

Weighted vests have been used primarily as behavioral interventions for children and adolescents with autism. Contemporary research has begun to examine weighted vest effects on movement. Previous research in children with neurotypical development revealed 15% body mass loads modified spatial-temporal gait characteristics; however, a value applicable to children and adolescents with autism has not been established. The purpose of this study was to establish an appropriate mass value by examining spatial-temporal gait parameters in children and adolescents with autism with various loads in a weighted vest. Nine children and adolescents with autism, aged 8-17, walked without a weighted vest, with 5%, 10%, 15%, and 20% body mass while spatial-temporal data were captured. Repeated-measures analysis of variance (α = .05) were conducted among conditions for each variable, with a Holm-Bonferroni method correction. Analysis revealed significant decreases in right step length, but no differences in stride width, left step length, double-limb support time, or stride velocity were observed. Due to insignificant findings, an appropriate mass value could not be determined for weighted vests for children with autism. However, unchanged spatial-temporal gait parameters with increasing loads could be clinically relevant as weighted vest loads of 10% are typically used for behavioral interventions.

Common Vertical Jump and Reactive Strength Index Measuring Devices: A Validity and Reliability Analysis.

ABSTRACT: Montalvo, S, Gonzalez, MP, Dietze-Hermosa, M, Eggleston, JD, and Dorgo, S. Common vertical jump and reactive strength index measuring devices: A validity and reliability analysis. J Strength Cond Res 35(5): 1234-1243, 2021-Several field-test devices exist to assess vertical jump, but they either lack proper validation or have been validated for the countermovement jump (CMJ) only. This study aimed to quantify the validity and reliability of metrics, including jump height and the calculated reactive strength index (RSI), obtained using the flight-time method from 4 different assessment devices with 3 different vertical jump modalities in comparison to a force platform (criterion assessment). The Optojump, Push-Band 2.0, MyJump2 mobile application, and What'sMyVert mobile application were used synchronously and together with the force platforms. Thirty subjects (17 males and 13 females; age ± SD: 23.37 ± 1.87 years) performed 5 repetitions of CMJ, squat jump (SQJ), and drop jump (DJ) with a standardized 90° knee flexion for all jumps. Relative reliability was determined by intraclass correlation (ICC) and absolute reliability by coefficient of variation (CV) analyses. Excellent reliability was considered as ICC > 0.9 and CV < 10%. Validity was obtained through an ordinary least products regression, ICC, and CV. Significance was set at p < 0.05. Reliability was excellent on jump height for the CMJ (ICC ≥ 0.98; CV ≤ 8.14%) for all instruments. With the exception of the Optojump, all instruments also had excellent reliability for the SQJ (ICC ≥ 0.98; CV ≤ 6.62) and DJ (ICC ≥ 0.94; CV ≤ 8.19). For the RSI metric, all instruments had excellent relative reliability (ICC ≥ 0.92), but none had excellent absolute reliability (CV ≥ 12.5%). The MyJump2 and What'sMyVert apps showed excellent validity on all jump modalities and RSI. The Optojump and Push-Band 2.0 devices both showed system and proportional bias for several jump modalities and RSI. Overall, both mobile applications may provide coaches with a cost-effective and reliable measurement of various vertical jumps.

Evaluating Performance During Maximum Effort Vertical Jump Landings.

The ability to rapidly complete a jump landing has received little attention in the literature despite the need for rapid performance in a number of sports. As such, our purpose was to investigate differences between groups of individuals who land quickly (FAST) and slowly (SLOW) relative to peak vertical ground reaction forces (vGRFs), loading rates, rates of vGRF attenuation, contributions to lower extremity mechanical energy absorption at the involved joints, and the onsets of preparatory joint flexion/dorsiflexion. Twenty-four healthy adults (26.1 [3.3] y, 75.7 [18.9] kg, 1.7 [0.1] m) were stratified into FAST and SLOW groups based on landing time across 8 jump-landing trials. Independent t tests (α = .05) and effect sizes (ESs; large ≥ 0.8) compared differences between groups. A greater rate of vGRF attenuation (P = .02; ES = 0.95) was detected in the FAST group. The FAST group also exhibited greater contributions to lower extremity energy absorption at the ankle (P = .03; ES = 0.98) and knee (P = .03; ES = 0.99) during loading and attenuation, respectively. The SLOW group exhibited greater contributions to energy absorption at the hip during loading (P = .02; ES = 1.10). Results suggest that individuals who land quickly utilize different energy absorption strategies than individuals who land slowly. Ultimately, the FAST group's strategy resulted in superior landing performance (more rapid landing time).

The use of preferred footwear versus barefoot conditions in gait analysis: A methodological investigation.

Laboratory-based gait analyses traditionally analyze baseline characteristics in individuals while they are barefoot. However, there is limited evidence on whether individuals' preferred walking shoes alter lower extremity kinematics during over-ground walking. We present novel evidence regarding the effects of shoes on lower extremity kinematics in healthy, young adults. Fifteen volunteers participated in this study which obtained lower extremity kinematic data on two over-ground walking conditions (barefoot and preferred shoes). Gait velocity, stance width, and stride length, along with sagittal plane hip, knee, and ankle angular positions were computed; hip, knee, and ankle positions were normalized to 100% of the stride. Dependent t-tests were used to compare baseline and shoe conditions for gait velocity and stance width; a two-way analysis of variance was used for stride length. A point-by-point Model Statistic analysis was used to identify significant differences in angular joint positions between conditions. Our results indicate that shoes affected the ankle angular joint position for more than half of the gait cycle, and affected the knee angular joint position, but only for approximately 20% of the cycle. The hip was unaffected by shoes. Gait velocity and stance width were statistically significant, with gait velocity being greater for shoes, and stance width being greater while barefoot. Stride length was not statistically significant between conditions. These outcomes suggest that researchers should use caution if they are considering a barefoot condition as a 'baseline' for healthy, young adults, as there are marked changes in the ankle, and in traditional gait metrics.

Children with autism display altered ankle strategies when changing speed during over-ground gait.

BACKGROUND: Examining gait mechanics when altering speed has been used in various clinical populations to understand the pervasiveness of neurological impairments. Few studies have examined whether different gait mechanics exist when altering speed in children with Autism Spectrum Disorder, although autism may present as a movement disorder due to abnormalities in the central nervous system. Most autism gait-related research has used preferred walking speed, while different speeds may yield discernible patterns that can be used for future interventions. The purpose of this study was to examine kinematic strategies used by children with autism in preferred, fast, and slow walking speeds. METHODS: Three-dimensional kinematic data were obtained on 14 children (aged 8-17 years) during preferred, fast, and slow walking. Hip, knee, and ankle angular joint positions were examined at loading response, pre-swing, and terminal swing sub-phases due to their importance on forward propulsion and weight transfer. Repeated measures analyses of variance (α = 0.05) were used to test for statistical differences and effect sizes were interpreted with Cohen's d. FINDINGS: Although significant differences were observed for each joint and sub-phase, the left and right ankle joints during pre-swing displayed the most consistent differences among conditions (p < 0.001, and p < 0.001), respectively. Additionally, the left ankle displayed a moderate effect size (η2 = 0.71) and the right ankle displayed a large effect size (η2 = 0.80). INTERPRETATIONS: These findings reveal that the ankle joint, during pre-swing, is the primary kinematic strategy used by children with autism when altering gait speed, whereas previous evidence suggests that the hip joint was the primary strategy.

Children With Autism Exhibit More Individualized Responses to Live Animation Biofeedback Than Do Typically Developing Children.

Children with autism have displayed imbalances in responding to feedback and feedforward learning information and they have shown difficulty imitating movements. Previous research has focused on motor learning and coordination problems for these children, but little is known about their motoric responses to visual live animation feedback. Thus, we compared motor output responses to live animation biofeedback training in both 15 children with autism and 15 age- and sex-matched typically developing children (age range: 8-17 years). We collected kinematic data via Inertial Measurement Unit devices while participants performed a series of body weight squats at a pre-test, during live animation biofeedback training, and at post-test. Dependent t-tests (α = 0.05), were used to test for statistical significance between pre- and post-test values within groups, and repeated measures analyses of variance (α = 0.05) were used to test for differences among the training blocks, within each group. The Model Statistic technique (α = 0.05) was used to test for pre- and post-test differences on a single-subject level for every participant. Grouped data revealed little to no significant findings in the children with autism, as these participants showed highly individualized responses. However, typically developing children, when grouped, exhibited significant differences in their left hip position (p = 0.03) and ascent velocity (p = 0.004). Single-subject analyses showed more individualistic live animation responses of children with autism than typically developing children on every variable of interest except descent velocity. Thus, to teach children with autism new movements in optimal fashion, it is particularly important to understand their individualistic motor learning characteristics.

Lesser magnitudes of lower extremity variability during terminal swing characterizes walking patterns in children with autism.

BACKGROUND: Anecdotally, children with Autism Spectrum Disorder have highly variable lower extremity walking patterns, yet, this has not been sufficiently quantified. As such, the purpose of this study was to examine walking pattern variability by way of lower extremity coordination and spatio-temporal characteristics in children with autism compared with individuals with typical development during over-ground walking. METHODS: Bilateral continuous relative phase variability was computed for the thigh-leg, leg-foot, and thigh-foot segment couples for 11 children with autism and 9 children with typical development at each gait sub-phase. Furthermore, left and right stride lengths and stride width were computed and compared. The Model Statistic was utilized to test for statistical differences in variability between each child with autism to an aggregate group with typical development. Effect sizes were computed to determine the meaningfulness between responses for children with autism and typical development. Coefficient of variation and effect sizes were computed for stride lengths and stride width. FINDINGS: Analysis revealed that children with autism exhibited differences in variability in each gait sub-phase. Notably, all but two children with autism exhibited lesser variability in all segment couples during terminal swing. Differences in stride lengths were relatively minimal, however, greater coefficient of variation magnitudes in stride width were observed in children with autism. INTERPRETATION: This finding reveals that children with autism may have limited or a preferred movement strategy when preparing the foot for ground contact. The findings from this study suggest variability may be an identifiable characteristic during movement in children with autism.

Computer interactions during walking workstation use moderately affects spatial-temporal gait characteristics.

BACKGROUND: Due to increased sedentary workstyles, active workstations have shown the ability to increase activity while only moderately affecting work ability. However, previous examinations have not examine fine motor mousing tasks on tripping descriptors. RESEARCH QUESTION: What affect do mousing tasks of varying target size have on tripping descriptors during walking workstation use? METHODS: Three-dimensional kinematic data were collected while participants used a walking workstation completing one baseline and three mousing conditions of varying target sizes. RESULTS: Target size main effects (p < 0.001) detected decreased stride length in all experimental conditions, which were supported by moderate effect sizes, and decreased stance width and time in double limb support (p < 0.001 for both comparisons). Stance width differences resulted in large effect sizes between baseline and all conditions, while only moderate effect sizes were observed between time in double limb support in baseline compared to all conditions. No changes in knee flexion range of motion were observed in response to target size (p = 0.278). SIGNIFICANCE: These results indicate that walking workstation users shorten their stride length and decrease their base of support while completing mousing tasks. The placement of the upper extremities on the workstation desk likely acted as the primary mechanism to increase stability. It is concluded that performing mousing tasks of varying target size using a walking workstation does not pose greater risk for adverse gait events.

Lower extremity joint stiffness during walking distinguishes children with and without autism.

How children with Autism Spectrum Disorder (ASD) and peers with typical development (TD) modulate lower extremity stiffness during walking could identify a mechanism for gait differences between groups. We quantified differences in lower extremity joint stiffness and linear impulses, along the vertical and anterior/posterior axes during over-ground walking in children with ASD compared to age- and gender-matched children with TD. Nine age- and gender-matched pairs of children, aged 5-12 years, completed the current study. Joint stiffness and linear impulses were computed in four sub-phases of stance: loading response, mid-stance, terminal stance, and pre-swing. The Model Statistic technique (α = 0.05) was used to test for statistical significance between the matched-pairs for each variable and sub-phase. Furthermore, dependent t-tests (α = 0.05) were utilized, at the group level, to determine whether significant differences existed between sub-phases. Results indicate that children with ASD may exhibit greater stiffness in pre-swing, and thus, produce inefficient propulsive forces during walking. We attribute these differences to sensory processing dysfunction previously observed in children with ASD.

A Novel Approach to Assessing Head Injury Severity in Pediatric Patient Falls.

INTRODUCTION: Pediatric patient falls with head-to-floor impact have the greatest potential for injury. METHODS: An objective measure of head injury severity, the Head Injury Criterion (HIC15), was calculated from anthropometric and biomechanical components of patient falls. A secondary aim was to compare HIC15 levels with the hospital's subjective assignment of level of harm (1-9 scale) used for regulatory reports. RESULTS: Adverse event reports yielded a sample of 49 falls from heights of 72.5 to 1793.0 cm by children ages 11 months through 17 years. Contact velocity from beginning to end was 2.81 to 6.16 ms. Mean acceleration was 19.5 to 95.3g. HIC15 levels of impact ranged from 26.4 to 1,330.0, and mean force upon contact was 2.0 to 9.8 N/kg body mass. Seven (14.3%) children's HIC15 levels exceeded age-specific thresholds, with no follow-up scheduled. Hospital-assigned levels of harm were not correlated with HIC15 levels (r = .23, R2 = .05, p = .12). DISCUSSION: A point-of-care computerized HIC15 algorithm would be useful for diagnostic and follow-up decisions.

Weighted Walking Influences Lower Extremity Coordination in Children on the Autism Spectrum.

There is sparse quantitative research regarding gait coordination patterns of children on the autism spectrum, though previous studies, relying only upon observational data, have alluded to characteristically poor movement coordination. This study compared walking with a weighted vest, a backpack carriage, and an unloaded walking condition on lower extremity coordination among 10 male children (aged 8-17 years) on the autism spectrum. All participants completed 15 gait trials in the following three conditions: (a) unloaded, (b) wearing a backpack weighted with 15% body mass, and (c) wearing a vest weighted with 15% body mass. We used continuous relative phase analysis to quantify lower extremity coordination and analyzed data through both group and single-subject comparisons. We used the Model Statistic to test for statistical significance at each of the normalized data points for each segment couple (thigh-leg, leg-foot, and thigh-foot). The first 10 and last 10 stride blocks were tested for possible accommodation strategies. Group comparisons revealed no coordination changes among the three conditions (likely due to insufficient statistical power), while single-subject comparisons exposed significant decreased variability in gait coordination patterns ( p < .05) in both loaded conditions, relative to the unloaded condition. These participants exhibited variable coordination patterns during the unloaded gait. When walking with loads, coordination pattern variability of the lower extremities was decreased. This finding suggests that walking while carrying or wearing heavy objects may reduce the number of potential motor pattern choices and thus decrease the overall variability of lower extremity movement patterns. Additional research with a larger and more diverse participant sample is required to confirm this conclusion.

Examination of gait parameters during perturbed over-ground walking in children with autism spectrum disorder.

BACKGROUND: Many children with Autism Spectrum Disorder (ASD) are school-aged and typically carry a backpack. It is important to understand how this task affects walking. Weighted vests (WVs) often prescribed to mitigate behavioral effects of ASD. The effects of backpack and WV walking have not been examined in children with ASD. AIMS: To quantify differences in lower extremity mechanics in children with ASD during WV and backpack walking. METHODS: Eight male participants completed 15 trials in three conditions: body mass, and carrying or wearing a backpack or WV with 15% added body mass. Three-dimensional kinematic data were collected and normalized to 100% of the gait cycle. The Model Statistic was utilized to test for bilateral asymmetries between the lower extremity joints at all points along the gait cycle. RESULTS: Analysis revealed similar numbers of significant asymmetries in hip (71.0, 70.4, 60.6), knee (68.4, 71.5, 74.6), and ankle (64.1, 68.9, 68.4) for unloaded, backpack, and WV, respectively. CONCLUSION: Participants exhibited individualized kinematic symmetry-responses to the loaded conditions compared to the unloaded condition. These findings suggest that 15% body mass backpack or WV does not affect gait symmetry in children with ASD.

A Comparative Evaluation of Gait between Children with Autism and Typically Developing Matched Controls.

Anecdotal reports suggest children with autism spectrum disorder (ASD) ambulate differently than peers with typical development (TD). Little empirical evidence supports these reports. Children with ASD exhibit delayed motor skills, and it is important to determine whether or not motor movement deficits exist during walking. The purpose of the study was to perform a comprehensive lower-extremity gait analysis between children (aged 5-12 years) with ASD and age- and gender-matched-samples with TD. Gait parameters were normalized to 101 data points and the gait cycle was divided into seven sub-phases. The Model Statistic procedure was used to test for statistical significance between matched-pairs throughout the entire gait cycle for each parameter. When collapsed across all participants, children with ASD exhibited large numbers of significant differences (p < 0.05) throughout the gait cycle in hip, knee, and ankle joint positions as well as vertical and anterior/posterior ground reaction forces. Children with ASD exhibited unique differences throughout the gait cycle, which supports current literature on the heterogeneity of the disorder. The present work supports recent findings that motor movement differences may be a core symptom of ASD. Thus, individuals may benefit from therapeutic movement interventions that follow precision medicine guidelines by accounting for individual characteristics, given the unique movement differences observed.

Analysis of gait symmetry during over-ground walking in children with autism spectrum disorder.

Gait symmetry is utilized as an indicator of neurologic function. Healthy gait often exhibits minimal asymmetries, while pathological gait exhibits exaggerated asymmetries. The purpose of this study was to examine symmetry of mechanical gait parameters during over-ground walking in children with Autism Spectrum Disorder (ASD). Kinematic and kinetic data were obtained from 10 children (aged 5-12 years) with ASD. The Model Statistic procedure (α=0.05) was used to compare gait related parameters between limbs. Analysis revealed children with ASD exhibit significant lower extremity joint position and ground reaction force asymmetries throughout the gait cycle. The observed asymmetries were unique for each subject. These data do not support previous research relative to gait symmetry in children with ASD. Many individuals with ASD do not receive physical therapy interventions, however, precision medicine based interventions emphasizing lower extremity asymmetries may improve gait function and improve performance during activities of daily living.