Association between Self-Reported Prior Night's Sleep and Single-Task Gait in Healthy, Young Adults: A Study Using Machine Learning.

Failure to obtain the recommended 7−9 h of sleep has been associated with injuries in youth and adults. However, most research on the influence of prior night's sleep and gait has been conducted on older adults and clinical populations. Therefore, the objective of this study was to identify individuals who experience partial sleep deprivation and/or sleep extension the prior night using single task gait. Participants (n = 123, age 24.3 ± 4.0 years; 65% female) agreed to participate in this study. Self-reported sleep duration of the night prior to testing was collected. Gait data was collected with inertial sensors during a 2 min walk test. Group differences (<7 h and >9 h, poor sleepers; 7−9 h, good sleepers) in gait characteristics were assessed using machine learning and a post-hoc ANCOVA. Results indicated a correlation (r = 0.79) between gait parameters and prior night's sleep. The most accurate machine learning model was a Random Forest Classifier using the top 9 features, which had a mean accuracy of 65.03%. Our findings suggest that good sleepers had more asymmetrical gait patterns and were better at maintaining gait speed than poor sleepers. Further research with larger subject sizes is needed to develop more accurate machine learning models to identify prior night's sleep using single-task gait.

Relationship Between Age and Running Kinematics in Female Recreational Runners.

Sex-based analyses are important when studying running kinematics. Females experience a unique aging process and demonstrate differences in running biomechanics from males. The purpose was to determine the relationship between age and running kinematics in female runners. Forty-six female runners (18-65 y) ran at self-selected jogging and maximal speed on a treadmill. Lower-extremity joint kinematics were calculated, and 2 principal component analyses (jogging speed and maximal speed) were performed from kinematic variables. Regression was used to examine the relationship between age and identified components, and between age and the variables with the highest loadings within these components. For jogging speed, there was a positive relationship between age and ankle varus at initial contact and a negative relationship between age and peak eversion, hip adduction, knee flexion, dorsiflexion, and hip adduction at initial contact (Ps < .05). For maximal speed, initial contact ankle frontal plane angle became more positive with age, and there was a negative relationship with age and peak eversion, dorsiflexion and knee flexion, and knee flexion and hip adduction at initial contact (Ps < .05). Primarily distal joint angles decreased with increasing age in female recreational runners at self-selected running speeds.

Machine learning for lumbar and pelvis kinematics clustering.

Clustering algorithms such as k-means and agglomerative hierarchical clustering (HCA) may provide a unique opportunity to analyze time-series kinematic data. Here we present an approach for determining number of clusters and which clustering algorithm to use on time-series lumbar and pelvis kinematic data. Cluster evaluation measures such as silhouette coefficient, elbow method, Dunn Index, and gap statistic were used to evaluate the quality of decision making. The result show that multiple clustering evaluation methods should be used to determine the ideal number of clusters and algorithm suitable for clustering time-series data for each dataset being analyzed.

The effectiveness of 3D multiple object tracking training on decision-making in soccer.

BACKGROUND: Soccer requires athletes to make quick decisions in dynamic environments. Several off-court technology-based interventions have been developed to train these perceptual cognitive skills. However, the evidence for training transfer using technologies to athletic performance has been sparse. Previous research found 3-dimensional multiple object tracking (3D MOT) training to cause a significant increase in quality of passing decision-making. Limitations to the research warrant further investigation of this association. PURPOSE: To re-examine the effectiveness of 3D MOT on training decision-making. METHODS: Thirty-one NCAA Division III soccer players (female n = 16) were randomized to 3D MOT training or a control task. The experimental group received 10 training sessions over a span of 4 weeks. RESULTS: The manipulation check indicated a significant training effect in 3D MOT performance for the intervention but not the control group (F(1,29) = 21.46, p < .001, np2 = .43). Non-significant changes with small effect sizes (np2 = .01-.03) in decision-making and measures of near-transfer were found. CONCLUSION: The findings challenge the association between 3D MOT training and increased quality of decision-making in soccer.

The Effects of Vision-Deprived Progressive Resistance Training on One-Repetition Maximum Bench Press Performance: An Exploratory Study.

The objective of this study was to determine whether vision-occluded progressive resistance training would increase upper-extremity movement performance using the one-repetition maximum (1-RM) bench press. Participants (n = 57) were recruited from a historically black college and university (HBCU), cross-matched by sex, age (±1 year), 1-RM (±2.27 kg), 1-RM/weight (±0.1), and 1-RM/lean mass ratio (±0.1), and randomly assigned to either the experimental group (vision occluded) or the control group. Participants performed resistance training for 6 weeks prior to beginning the study, and 1-RM was assessed the week prior to the beginning of the study. Weight and body composition were measured using a BOD POD. Of the 57 participants who started the study, 34 completed the study (Experimental = 16, Control = 18) and were reassessed the week after completing the 6-week-long training protocol. Using a combination of Mann−Whitney U and Wilcoxon signed-rank tests, we found that when accounting for changes in lean muscle mass, individuals who trained with their vision occluded reported significantly greater improvements in 1-RM strength compared to those who did not (p < 0.05). The findings from our study suggest that vision-occluded progressive resistance training increases upper-extremity performance when assessed using the bench press. These findings may have significant practical implications in both sports and rehabilitation, as these techniques may be used to enhance performance in athletes and/or improve rehabilitation effectiveness.

Effectiveness of Three-Dimensional Multiple-Object Tracking in Patients with Multiple Sclerosis: A Pilot Trial.

BACKGROUND: Computerized cognitive training remains an attractive supplemental modality to enhance rehabilitation in multiple sclerosis (MS). The objective of the present study was to assess the usability of three-dimensional multiple-object tracking (3D-MOT) in patients with MS. METHODS: In this pilot study, 16 patients with relapsing-remitting MS and nine age-matched controls participated in four 30-minute training sessions of 3D-MOT. Computerized neuropsychological tests, including driving readiness (ie, Useful Field of View) and cognitive function (ie, Stroop Color and Word Test, Paced Visual Serial Addition Test, Symbol Digit Modalities Test) were conducted at baseline and at the conclusion of training. RESULTS: Although scoring lower in 3D-MOT, the MS group improved their 3D-MOT scores in similar magnitude as the control group. The 3D-MOT training led to significant improvements in driving readiness in the MS group. Taken together, 3D-MOT training showed similar effectiveness in patients with MS as in age-matched controls. CONCLUSIONS: Training with 3D-MOT may be an accessible and remotely administrable supplement to cognitive rehabilitation protocols for patients with MS.

Lower limb kinematics of unicompartmental knee arthroplasty individuals during stair ascent.

OBJECTIVE: Purpose of the study was to compare lower-limb kinematics and interlimb asymmetry during stair ascent in individuals post-medial or lateral unicompartmental knee arthroplasty (UKA). METHODS: 60 patients (20 medial; 10 lateral) post-UKA and 30 matched healthy controls performed stair ascent. Spatio-temporal, lower-limb kinematics and interlimb asymmetries during stair ascent were compared. RESULTS: Medial-UKA group displayed 5° less knee extension of the UKA limb than controls (p = 0.005) and 2° less than the contralateral limb during stance phase. No interlimb asymmetries were found for lateral-UKA. CONCLUSION: Patients post-UKA demonstrate satisfactory lower-limb kinematics and minimal interlimb asymmetry during stair ascent compared to healthy individuals.

Evaluating the effectiveness of implementation intentions in a pedometer worksite intervention.

BACKGROUND: Pedometer-based worksite interventions have been found to be successful in increasing physical activity (PA) but adherence is challenging. OBJECTIVE: To examine the use of Implementation Intentions (II), a self-regulatory skill, with self-monitoring with a pedometer to initiate behavior change as well as post-intervention adherence in a worksite wellness intervention. METHODS: University employees (N = 54) participated in an 8-week pedometer-based intervention. A 2-arm randomized trial was used to compare the effectiveness of 1) only pedometers (PED) (n = 28) and 2) pedometers and II (PED+II) (n = 26) on PA. RESULTS: Significant differences were observed between time points (p < .0001) but not between groups. Post-hoc pairwise comparisons between the time points revealed difference between Baseline and Week 4 (mean difference: 2446.9 steps/ day; p < 0.001), Week 4 and 12 (mean difference: 2956.3 steps/ day; p < 0.001), and Week 8 and 12 (mean difference: 2228.8 steps/ day; p = 0.005). CONCLUSION: The PED+II group had higher step increases during the intervention indicating that the behavioral strategy was effective. However, participants in both groups had a significant decrease in steps from the end of the intervention to the delayed-post assessment highlighting the challenge to maintain behavioral changes post-intervention.

A Comparison of Muscular Activity During Gait Between Walking Sticks and a Walker in Patients With Adult Degenerative Scoliosis.

STUDY DESIGN: A repeated measurement, single-center, prospective study. OBJECTIVE: The purpose of this study is to compare and contrast the benefits of walking sticks versus a walker on the trunk and lower extremity muscular control in patients with adult degenerative scoliosis (ADS). SUMMARY OF BACKGROUND DATA: ADS patients demonstrate an altered gait pattern. Walking aids help maintain mobility in those patients. Whereas a walker forces patients into kyphosis, the higher grips of walking sticks allows for more upright posture, arm swing, and improved sagittal alignment. METHODS: Twenty ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed under 3 testing conditions: 1) with walking sticks (WS); 2) with walker (WR); and 3) without any device (ND). Trunk and lower extremity peak muscle activation, time to peak muscle activity, muscle duration, muscle onset, and integrated electromyography (iEMG) were measured and compared. RESULTS: The use of WS produced increases in muscle activity in the external oblique (WS: 44.3% vs. WR: 7.4% of submaximum voluntary contraction [sMVC], p = .007) and medial gastrocnemius (WS: 78.8% vs ND: 43.7% of sMVC, p = .027) in comparison to the walker and no device, respectively. When using WS, shorter muscle activity time was observed for rectus femoris (WS: 62.9% vs. WR: 88.8% of gait cycle, p = .001), semitendinosus (WS: 64.3% vs. WR: 93.0% of gait cycle, p = .003), tibialis anterius (WS: 59.4% vs. WR: 85.1% of gait cycle, p = .001), and medial gastrocnemius (WS: 67.3% vs. WR: 98.0% of gait cycle, p = .006) in comparison to the walker. CONCLUSIONS: The use of walking sticks can potentially promote trunk and lower extremity neuromuscular control and gait mechanics comparable to gait without any assistive devices. Although the differences in magnitudes between comparisons were small and should be cautiously interpreted on a case-by-case basis, based on this study's results and our anecdotal experience treating patients with ADS, we recommend the use of walking sticks to assist with their gait prior to and after surgical intervention. LEVEL OF EVIDENCE: Level III.

Spine and Lower Extremity Kinematics Exhibited During Running by Adolescent Idiopathic Scoliosis Patients With Spinal Fusion.

STUDY DESIGN: Case-controlled design; biomechanics laboratory setting. OBJECTIVE: To compare the spine and lower extremity kinematics displayed during high-effort running between individuals with spinal fusion surgery for adolescent idiopathic scoliosis (SF-AIS) and healthy controls (CON). SUMMARY OF BACKGROUND DATA: Individuals with SF-AIS often return to exercise and sports that include running. However, how these individuals produce the spinal rotations needed during high-effort running and thus compensate for the loss of spinal flexibility is not known. METHODS: Ten SF-AIS (posterior-approach spinal fusion; postoperative time: 2.0 ± 0.6 years; physically active) and 10 CON individuals, pair-matched for gender, age, mass, height, and level of physical activity participated. SF-AIS individuals ran on a treadmill at a self-selected submaximal speed perceived as "hard" (15/20 on Borg perceived-effort scale), and CON ran at the SF-AIS pair-matched speed. 3D motion capture system was used to generate trunk and pelvis segmental angles (trunk segments = upper trunk [C7-T8], middle trunk [T9-T12], lower trunk [L1-L5]), relative angles (relative angles between the two consecutive trunk segments), and lower extremity joint angles. The group differences between the SF-AIS and CON were assessed using one-way analysis of covariance (with running speed as the covariate) for trunk, lower extremity, and step kinematics. RESULTS: SF-AIS participants exhibited a significantly greater (6.1° greater) lower trunk and (6.3° greater) pelvis segmental axial rotation compared with CON during running. In addition, SF-AIS participants displayed a 9.2° less ankle plantarflexion during the support phase. There were no significant differences detected for step kinematics. CONCLUSION: Possibly because of relearned compensatory mechanism, individuals with SF-AIS displayed similar patterns of spine, lower extremity, and step kinematics as healthy controls during high-effort running with some exceptions. LEVEL OF EVIDENCE: Level III.

Postural control of individuals with spinal fusion for adolescent idiopathic scoliosis.

BACKGROUND: The purpose of the study was to assess the postural stability and complexity of postural control for moderately physically active individuals with spinal fusion for adolescent idiopathic scoliosis at two years post-operation. METHODS: Limit of stability test and sensory organization test were conducted for 10 moderately physically-active participants with spinal fusion and 10 controls pair-matched for mass, height and physical activity level. During the limit of stability test, participants were instructed to lean the center of gravity as far as possible toward 8 predetermined directions and the maximum excursion and direction control were analyzed. During the sensory organization test, participants were instructed to maintain as still as possible in six test conditions and equilibrium scores and sway area of center of pressure were analyzed. Multi-scale entropy of center of pressure was calculated to quantify sway complexity. FINDINGS: Most postural stability outcomes of spinal fusion participants were comparable to controls except for significantly reduced equilibrium scores (p = 0.039, partial η2 = 0.217). Moreover, spinal fusion participants exhibited tendencies of reduced direction control (p = 0.053) during the limit of stability test and greater sway area (p = 0.052) during the sensory organization test. INTERPRETATION: Although the center of gravity control might be affected, spinal fusion individuals who were moderately physically active likely progressively learned to adapt postoperatively to their fused spine to meet the postural demands required when performing physical movements. We suggest that spinal fusion is a satisfactory treatment in regard to the recovery of postural stability.

Spine kinematics exhibited during the stop-jump by physically active individuals with adolescent idiopathic scoliosis and spinal fusion.

BACKGROUND CONTEXT: Individuals with adolescent idiopathic scoliosis post spinal fusion often return to exercise and sport. However, the movements that individuals with spinal fusion for adolescent idiopathic scoliosis (SF-AIS) use to compensate for the loss of spinal flexibility during high-effort tasks are not known. PURPOSE: The objective of this study was to compare the spinal kinematics of the trunk segments displayed during the stop-jump, a maximal effort task, between SF-AIS and healthy control groups. STUDY DESIGN: The study used a case-controlled design. MATERIALS AND METHODS: Ten SF-AIS (physically active, posterior-approach spinal fusion: 11.2±1.9 fused segments, postop time: 2±.6 years) and nine control individuals, pair matched for gender, age (17.4±1.3 years and 20.6±1.5 years, respectively), mass (63.50±12.2 kg and 66. 40±10.9 kg), height (1.69±.09 m and 1.72±.08 m), and level of physical activity, participated in the study. Individuals with spinal fusion for adolescent idiopathic scoliosis and controls (CON) performed five acceptable trials of the stop-jump task. Spatial locations of 21 retroreflective trunk and pelvis markers were recorded via high-speed motion capture methodology. Mean differences and analysis of covariance (jump height=covariate, p<.05) were used to compare the groups' relative angle (RelAng) and segmental angle (SegAng) of the three trunk segments (trunk segments=upper trunk [C7-T8], middle trunk [MT: T9-T12], lower trunk [LT: L1-L5]) for each rotation plane in the three phases of interest (flight, stance, and the vertical flight phases). RESULTS: No significant group differences for jump height and RelAng were detected in the three phases of stop-jump. Individuals with spinal fusion for adolescent idiopathic scoliosis displayed 3.2° greater transverse plane RelAng of LT compared with CON (p=.059) in the stance phase. Group differences for RelAng ranged from 0° to 15.3°. For SegAng in the stance phase, LT demonstrated greater SegAng in the sagittal and frontal planes (mean difference: 3.2°-6.2°), whereas SegAng for MT was 5.1° greater in the sagittal plane and had a tendency of 2° greater displacement in the frontal plane (p=.070). In the vertical flight phase, greater LT displacement in the frontal plane was observed for SF-AIS than CON. In the flight phase, LT had a tendency for greater SegAng for SF-AIS than for CON in the transverse plane (p=.089). CONCLUSIONS: Overall, SF-AIS who participate in physical activity on a regular basis are able to demonstrate similar trunk kinematics during a high-intensity stop-jump task as their matched healthy peers. Fewer group differences for relative angular displacements of the spine were observed than anticipated. This finding suggests that the fused MT appeared to be moving synchronously with the LT, thereby suggesting a compensatory adaptation of SF-AIS to achieve sufficient trunk movements during this high-effort movement.

SHORT-TERM EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON PAIN FREE RANGE OF MOTION IN A WEIGHTLIFTER WITH SUBACROMIAL PAIN SYNDROME.

BACKGROUND AND PURPOSE: While there is limited evidence supporting the use of soft tissue mobilization techniques for Subacromial Pain Syndrome (SAPS), synonymous with subacromial impingement syndrome, previous studies have reported successful outcomes using soft tissue mobilization as a treatment technique. The purpose of this case report is to document the results of Instrument-Assisted Soft Tissue Mobilization (IASTM) for the treatment of SAPS. CASE DESCRIPTION: Diagnosis was reached based on the subject's history, tenderness to palpation, and four out of five positive tests in the diagnostic cluster. Treatment consisted of three visits where the IASTM technique was applied to the pectoral muscles as well as periscapular musculature followed by retesting pain-free shoulder flexion active range of motion (AROM) and Numerical Pain Rating Scale (NPRS) during active shoulder flexion. Scapulothoracic mobilization and stretching were performed after AROM measurement. OUTCOMES: The subject reported an NPRS of 0/10 and demonstrated improvements in pain free flexion AROM in each of the three treatment sessions post-IASTM: 85 ° to 181 °, 110 ° to 171 °, and 163 ° to 174 ° with some carryover in pain reduction and pain free AROM to the next treatment. Through three treatments, DASH score improved by 17.34%, Penn Shoulder Score improved 29%, worst NPRS decreased from 4/10 to 0/10, and a GROC score of 6. DISCUSSION: IASTM may have a beneficial acute effect on pain free shoulder flexion. In conjunction with scapulothoracic mobilizations and stretching, IASTM may improve function, decrease pain, and improve patient satisfaction. While this technique will not ameliorate the underlying pathomechanics contributing to SAPS, it may serve as a valuable tool to restore ROM and decrease pain allowing the patient to reap the full benefits of a multi-modal treatment approach. LEVEL OF EVIDENCE: 5.

Review of Physical Activity Benefits and Potential Considerations for Individuals with Surgical Fusion of Spine for Scoliosis.

Evidence-based recommendations for physical activity following spinal fusion surgeries for idiopathic scoliosis are limited, specifically in the adolescent population. Individuals with scoliosis treated operatively or non-operatively have been reported to participate in less than 1-3 days/week of even mildly strenuous physical exercises. Over 40% of individuals with scoliosis returned to sports at a level lower than pre-operative participation levels or did not return at all post spinal fusion. It is particularly important for human movement specialists, such as physical therapists, occupational therapists, athletic trainers and kinesiologists to assist these individuals effectively transition to and maintain engagement in physical activity. This review provides a snapshot of common considerations and potential factors influencing individuals with spinal-fusion for scoliosis to participate in safe physical activity.

Impact of cognitive fatigue on gait and sway among older adults: A literature review.

Cognitive fatigue is an alteration in central nervous system (CNS) processing due to prolonged performance of mentally demanding tasks. Decreased gait speed and increased stride length variability have been noted in cognitively fatigued older adults (≥ 65 years). Further, cognitive fatigue may weaken the visual, vestibular, and proprioceptive systems of the CNS, contributing to increased postural sway. Detriments in gait and sway caused by cognitive fatigue could increase fall risk. The objective of this literature review was to evaluate the impact of cognitive fatigue on changes in gait and postural sway and its role in fall risk.

Opportunities for Regenerative Rehabilitation and Advanced Technologies in Physical Therapy: Perspective From Academia.

As rehabilitation specialists, physical therapists must continue to stay current with advances in technologies to provide appropriate rehabilitation protocols, improve patient outcomes, and be the preferred clinician of choice. To accomplish this vision, the physical therapy profession must begin to develop a culture of lifelong learning at the early stages of education and clinical training in order to embrace cutting-edge advancements such as stem cell therapies, tissue engineering, and robotics, to name a few. The purposes of this article are: (1) to provide a current perspective on faculty and graduate student awareness of regenerative rehabilitation concepts and (2) to advocate for increased integration of these emerging technologies within the doctor of physical therapy (DPT) curriculum. An online survey was designed to gauge awareness of principles in regenerative rehabilitation and to determine whether the topic was included and assessed in doctoral curricula. The survey yielded 1,006 responses from 82 DPT programs nationwide and indicated a disconnect in familiarity with the term "regenerative rehabilitation" and awareness of the inclusion of this material in the curriculum. To resolve this disconnect, the framework of the curriculum can be used to integrate new material via guest lecturers, interdisciplinary partnerships, and research opportunities. Successfully mentoring a generation of clinicians and rehabilitation scientists who incorporate new medical knowledge and technology into their own clinical and research practice depends greatly on sharing the responsibility among graduate students, professors, the American Physical Therapy Association (APTA), and DPT programs. Creating an interdisciplinary culture and integrating regenerative medicine and rehabilitation concepts into the curriculum will cultivate individuals who will be advocates for interprofessional behaviors and will ensure that the profession meets the goals stated in APTA Vision 2020.