Repetitive strain injuries in youth

Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments

INTRODUCTION

Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology.

METHODS AND ANALYSIS

In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

NCT05998239; pre-results.

The structure of occupational diseases in first-third-year piano students

BACKGROUND

The aim is to analyze the structure of occupational diseases in first-third year piano students studying.

METHODS

A total sample of 300 individuals participating in the research process underwent a complete medical examination at the end of each academic year.

RESULTS

Among piano students, number of those distributed to special medical groups for health reasons grew from 14 to 38% (p ≤ 0.02). The incidence of diseases of the muscular system increased from 58 to 71% (p ≤ 0.05), with the sharpest rise during the transition from the second to the third year of study. Similar tendencies were obtained for the incidence of hand-related diseases-their overall frequency advanced from 17 to 23% (p ≤ 0.05). The surge of morbidity in the transition from the second to the third year of study can be attributed to the increased educational load experienced by students during this period, as they begin to practice music intensively after theoretical classes. Сorresponding measures directed at preventing occupational diseases, bettering physical education, expanding the rest intervals between piano lessons are to be taken.

CONCLUSIONS

The research results indicate that the main occupational diseases of piano students are those related to hands and muscular system.

IMPACT

The obtained data suggest that the range of diseases is likely to progress throughout the musical training. The main diseases of piano students are those related to hands and muscular system. The sharpest rise was during the transition from the 2nd to the 3rd year of study.

Compliant Prosthetic Wrists Entail More Natural Use Than Stiff Wrists During Reaching, Not (Necessarily) During Manipulation

Developing an artificial arm with functions equivalent to those of the human arm is one of the challenging goals of bioengineering. State-of-the-artprostheses lack several degrees of freedom and force the individuals to compensate for them by means of compensatory movements, which often result in residual limb pain and overuse syndromes. Passive wristsmay reduce such compensatory actions, nonethelessto date their actual efficacy, associated to conventional myoelectric hands is a matter of debate. We hypothesized that a transradial prosthesiswould allow a simpler operation if its wrist behaved compliant during the reaching and grasping phase, and stiff during the holding andmanipulation phase. To assess this, we compared a stiff and a compliant wrist and evaluating the extent of compensatory movements in the trunk and shoulder, with unimpaired subjects wearing orthoses, while performing nine activities of daily living taken from the southampton hand assessment procedure. Our findings show indeed that the optimal compliance for a prosthetic wrist is specific to the phase of the motor task: the compliant wrist outperforms the stiff wrist during the reaching phase, whereas the stiff wrist exhibits more natural movements during the manipulation phase of heavy objects. Hence, this paper invites rehabilitation engineers to develop wrists with switchable compliance.

A passive wrist with switchable stiffness for a body-powered hydraulically actuated hand prosthesis

State of art upper limb prostheses lack several degrees of freedom (DoF) and force the individuals to compensate for them by changing the motions of their arms and body. Such movements often yield to articulation injuries, nonetheless these could be prevented by adding DoFs, for instance, an articulated passive wrist. Available stiff or compliant wrists with passive flexion/extension and/or radial/ulnar deviation are sub-optimal solutions. Indeed, stiff wrists induce the individuals wearing them to perform exaggerated compensatory movements during the reaching phase while compliant wrists proved to be unpractical while manipulating heavy objects. Here we present a wrist capable of combining the benefits of stiff and compliant wrists. It is provided with two switchable levels of passive compliance that are automatically selected. The prototype was integrated in a body-powered hydraulic hand prosthesis and actuated using the same hydraulic circuit of the hand. Detailed analysis of the parameters that affect the compliance, the critical load and the performance of the prosthesis are presented.

Refined clothespin relocation test and assessment of motion

BACKGROUND

Advancements in upper limb prosthesis design have focused on providing increased degrees of freedom for the end effector through multiple articulations of a prosthetic hand, wrist and elbow. Measuring improvement in patient function with these devices requires development of appropriate assessment tools.

OBJECTIVES

This study presents a refined clothespin relocation test for measuring performance and assessing compensatory motion between able-bodied subjects and subjects with upper limb impairments.

STUDY DESIGN

Comparative analysis.

METHODS

Trunk and head motions of 13 able-bodied subjects who performed the refined clothespin relocation test were compared to the motion of a transradial prosthesis user with a single degree of freedom hand.

RESULTS

There were observable differences between the prosthesis user and the able-bodied group. The assessment used provided a clear indication of the differences in motion through analysis of compensatory motion.

CONCLUSION

The refined clothespin relocation test provides additional benefits over the standard clothespin assessment and makes identification of compensatory motions easily identifiable to the researcher. While this article establishes the method for the new assessment, further validation will need to be performed with more users. Clinical relevance The refined test provides a more defined structure for the trajectory of the hand/terminal device than the standard protocol for the clothespin relocation test. This will help researchers interested in motion studies of limb segments to efficiently compare and analyse motion between able-bodied and prosthesis user groups.

Categorization of compensatory motions in transradial myoelectric prosthesis users

BACKGROUND

Prosthesis users perform various compensatory motions to accommodate for the loss of the hand and wrist as well as the reduced functionality of a prosthetic hand.

OBJECTIVES

Investigate different compensation strategies that are performed by prosthesis users.

STUDY DESIGN

Comparative analysis.

METHODS

A total of 20 able-bodied subjects and 4 prosthesis users performed a set of bimanual activities. Movements of the trunk and head were recorded using a motion capture system and a digital video recorder. Clinical motion angles were calculated to assess the compensatory motions made by the prosthesis users. The video recording also assisted in visually identifying the compensations.

RESULTS

Compensatory motions by the prosthesis users were evident in the tasks performed (slicing and stirring activities) as compared to the benchmark of able-bodied subjects. Compensations took the form of a measured increase in range of motion, an observed adoption of a new posture during task execution, and prepositioning of items in the workspace prior to initiating a given task.

CONCLUSION

Compensatory motions were performed by prosthesis users during the selected tasks. These can be categorized into three different types of compensations. Clinical relevance Proper identification and classification of compensatory motions performed by prosthesis users into three distinct forms allows clinicians and researchers to accurately identify and quantify movement. It will assist in evaluating new prosthetic interventions by providing distinct terminology that is easily understood and can be shared between research institutions.

Anterior cruciate ligament prevention strategies: are they effective in young athletes - current concepts and review of literature

PURPOSE OF REVIEW

Participation in sports is on the rise, with young athletes training year round and specializing at earlier ages, predisposing them to sports-related injuries. Once thought to be rare, injuries of the anterior cruciate ligament (ACL) are being seen with a greater frequency in the paediatric population. Numerous preventive training programmes have been developed. The purpose of this review is to discuss risk factors and the effectiveness of preventive programmes in the young athlete.

RECENT FINDINGS

Most ACL prevention programmes take a multifaceted approach, targeting dynamic neuromuscular and proprioceptive deficits. Focus often lies on noncontact mechanisms of injury, jump and landing techniques, and improving movement patterns during pivoting, cutting and change in direction. However, the effectiveness of these programmes in skeletally immature athletes needs to be evaluated.

SUMMARY

Early specialization and increased demand for peak performance at a time of major physiological change, lack of physical fitness and neuromuscular deficits have contributed to an increase in ACL injuries in young athletes. Various preventive training programmes have been developed, but their effectiveness is debatable. We encourage young athletes to partake in preseason training programmes focused on strengthening, neuromuscular and proprioceptive training units under the appropriate supervision of qualified personnel.

Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector

INTRODUCTION

Farming is a very large industry in the United States. Understanding the risks for injuries and more specifically musculoskeletal disorders in this industry poses a challenge for health officials.

METHODS

A review was conducted of the existing peer-reviewed publications prior to December 2006 about injuries and musculoskeletal disorders for farmers and farm workers. The aim was to review existing knowledge concerning: (1) the prevalence, types, and causes of farm-related injuries, paying particular attention to musculoskeletal disorders and the special populations within the agricultural sector, and (2) interventions that have been developed to reduce risk factors associated with farm-related injuries.

RESULTS

Farmers and farm workers experience high rates of low back, shoulder, and upper extremity disorders. Musculoskeletal disorders may disproportionately affect farm youth and migrant workers due to the types of farm tasks performed. There is an urgent need for improved and validated interventions to reduce exposures and to improve the health of farmers and farm workers.

DISCUSSION

Future farm-related musculoskeletal disorder research should emphasize: (1) better identification of exposures for special populations, (2) development of interventions for diverse farm populations, and (3) identification of additional exposures for musculoskeletal disorders. Inadequate understanding of musculoskeletal disorders in farming impedes efforts to prevent this common and important type of occupational injuries on farms.

Prevalence of Preseason Conditioning among High School Athletes in Two Spring Sports

PURPOSE

To determine the prevalence and predictors of preseason conditioning among high school athletes.

METHODS

Cross-sectional survey of 451 high school athletes participating on girls and boys track and boys soccer teams in five public high schools in Seattle, WA, spring 2005. Questions were modified from validated surveys of physical activity for adolescents. The main outcome measure was meeting criteria for adequate preseason conditioning, which specify a combination of aerobic conditioning (vigorous exercise for at least 300 min x wk(-1)) and stretching and strengthening exercises (at least three times a week for any duration). Log-binomial regression was performed to examine factors associated with preseason conditioning.

RESULTS

The majority of athletes met the criteria for each of the components (59% for aerobic conditioning, 62% for stretching, 63% for strengthening). As defined by meeting the criteria for all three components, 33% of the athletes had adequate preseason conditioning. Of those athletes meeting criteria for all three components, the majority reported at least 1 month of conditioning to prepare for the season. Varsity athletes were more likely to meet the preseason conditioning criteria compared with junior varsity athletes (38 vs 25%, prevalence ratio 1.5, 95% CI 1.0-2.1). Athletes who reported help with conditioning from a coach were twice as likely to have adequate preseason conditioning compared with those who did not receive help from a coach (45 vs 23%, prevalence ratio 1.8, 95% CI 1.3-2.4).

CONCLUSION

The majority of athletes in this study did meet criteria for each individual conditioning component (aerobic, stretching, strengthening), but only a minority met all three criteria. These findings highlight the need for school- or coach-sponsored involvement to ensure that all athletes engage in comprehensive preseason conditioning programs.

Severe back pain among farmworker high school students from Starr County, Texas: baseline results

PURPOSE

This cohort study is among the first to estimate the prevalence of and examine potential risk factors for severe back pain (resulting in medical care, 4+ hours of time lost, or pain lasting 1+ weeks) among adolescent farmworkers. These youth often perform tasks requiring bent/stooped postures and heavy lifting.

METHODS

Of 2536 students who participated (response rate across the three public high schools, 61.2% to 83.9%), 410 students were farmworkers (largely Hispanic and migrant). Students completed a self-administered Web-based survey including farm work/nonfarm work and back-pain items relating to a 9-month period.

RESULTS

The prevalence of severe back pain was 15.7% among farmworkers and 12.4% among nonworkers. The prevalence increased to 19.1% among farm workers (n = 131) who also did nonfarm work. A multiple logistic regression for farmworkers showed that significantly increased adjusted odds ratios for severe back pain were female sex (4.59); prior accident/back injury (9.04); feeling tense, stressed, or anxious sometimes/often (4.11); lifting/carrying heavy objects not at work (2.98); current tobacco use (2.79); 6+ years involved in migrant farm work (5.02); working with/around knives (3.87); and working on corn crops (3.40).

CONCLUSIONS

Areas for further research include ergonomic exposure assessments and examining the effects of doing farm work and nonfarm work simultaneously.

Trauma prevention in children

Play and sports activities are important to the healthy development of children worldwide. Many accidents are the result of the normal desire of children for excitement and adventure. Injury prevention has been difficult to evaluate and manage because of many variables. The frequency of injuries can be reduced with parental input and adult supervision, as well as proper equipment design and installation, followed by regular inspection and maintenance. Current initiatives hold promise, especially with equipment designs and manufacture, but injuries continue to be a significant and costly health problem. By identifying where and how children are injured, recommendations can be made to increase the safety of play areas, gyms, and equipment.