Phase I trial of the MuSic to CONnect (MuSiCON) protocol: feasibility and effect of choir participation for individuals with cognitive impairment

BACKGROUND

Individuals living in residential aged care facilities with cognitive decline are at risk of social isolation and decreased wellbeing. These risks may be exacerbated by decline in communication skills. There is growing awareness that group singing may improve sense of wellbeing for individuals with dementia. However, to date few studies have examined broader rehabilitative effects on skills such as communication of individuals with dementia.

AIMS

To determine the feasibility and acceptability of the MuSic to Connect (MuSiCON) choir and language/communication assessment protocol in people with cognitive impairment living in non-high-care wards of a residential facility.

METHODS

Six individuals with mild-moderate cognitive impairment participated (age range 55-91 years, five female, one male). A mixed method approach was used. Quantitative outcomes included attendance rates, quality of life and communication measures. The qualitative measure was a brief survey of experience completed by participants and carers post-intervention.

RESULTS

Overall, MuSiCON was perceived as positive and beneficial, with high attendance, perception of improved daily functioning and high therapeutic benefit without harmful effects. While there was no reliable change in communication skills over the course of the six-week intervention, most participants successfully engaged in the conversational task, suggesting it is a suitable and ecologically valid method for data collection.

CONCLUSIONS

The MuSiCON protocol demonstrated feasibility and was well received by participants and staff at the residential facility. A co-design approach is recommended to improve upon feasibility, acceptability and validity of the assessment protocol prior to Phase II testing.

Quantifying demands on the hamstrings during high-speed running: A systematic review and meta-analysis

INTRODUCTION

Hamstring strain injury (HSI) remains a performance, economic, and player availability burden in sport. High-speed running (HSR) is cited as a common mechanism for HSI. While evidence exists regarding the high physical demands on the hamstring muscles in HSR, meta-analytical synthesis of related activation and kinetic variables is lacking.

METHODS

A systematic search of Medline, Embase, Scopus, CINAHL, SportDiscus, and Cochrane library databases was conducted in accordance with the PRISMA 2020 guidelines. Studies reporting hamstring activation (electromyographic [EMG]) or hamstring muscle/related joint kinetics were included where healthy adult participants ran at or beyond 60% of maximum speed (activation studies) or 4 m per second (m/s) (kinetic studies).

RESULTS

A total of 96 studies met the inclusion criteria. Run intensities were categorized as "slow," "moderate," or "fast" in both activation and kinetic based studies with appropriate relative, and raw measures, respectively. Meta-analysis revealed pooled mean lateral hamstring muscle activation levels of 108.1% (95% CI: 84.4%-131.7%) of maximal voluntary isometric contraction (MVIC) during "fast" running. Meta-analysis found swing phase peak knee flexion internal moment and power at 2.2 Newton meters/kilogram (Nm/kg) (95% CI: 1.9-2.5) and 40.3 Watts/kilogram (W/kg) (95% CI: 31.4-49.2), respectively. Hip extension peak moment and power was estimated as 4.8 Nm/kg (95% CI: 3.9-5.7) and 33.1 W/kg (95% CI: 17.4-48.9), respectively.

CONCLUSIONS

As run intensity/speed increases, so do the activation and kinetic demands on the hamstrings. The presented data will enable clinicians to incorporate more objective measures into the design of injury prevention and return-to-play decision-making strategies.

Comparison of image quality assessments between interventional radiographers and interventional radiologists using digital subtraction angiography

Purpose

The aim of our study was to compare the image quality assessments of vascular anatomy between interventional radiographers and interventional radiologists using digital subtraction angiography (DSA) runs acquired during an interventional radiology procedure.

Approach

Visual grading characteristics (VGC) analysis was used to assess image quality by comparing two groups of images, where one group consisted of procedures in which radiation dose was optimized (group A, n = 10 ) and one group where dose optimization was not performed (group B, n = 10 ). The radiation dose parameters were optimized based on theoretical and empirical evidence to achieve radiation dose reductions during uterine artery embolization procedures. The two observer groups comprised of interventional radiologists ( n = 4 ) and interventional radiographers ( n = 4 ). Each observer rated the image quality of 20 DSA runs using a five-point rating scale.

Results

The VGC analysis produced an area under the VGC curve (AUC VGC ) of 0.55 for interventional radiographers ( P = 0.61 ) and AUCVGC of 0.52 for interventional radiologists ( P = 0.83 ). The optimization of radiation dose parameters demonstrated a reduction in kerma-area product by 35% ( P = 0.026 , d = 0.5 ) and reference air kerma (Ka, r ) by 43% ( P = 0.042 , d = 0.5 ) between group A and group B.

Conclusions

VGC analysis indicated that the image quality assessments of interventional radiographers were comparable with interventional radiologists, where a reduction in radiation dose revealed no effect on both observer groups regarding their image quality assessment of vascular anatomy.

Longitudinal changing relationships between growth tempo and vertical stiffness in movement across maturation

PURPOSE

To determine whether average growth tempo influenced longitudinal relationships between maturity status and coordination capability using a 15-s hopping task (Aim 1). To investigate how differences in absolute growth tempo were associated with change in coordination capability within and across peak growth (Aim 2).

METHODS

Participants were N₁ = 110 (Aim 1) and N₂ = 71 (Aim 2) Australian male competitive swimmers, aged 10-15 years, exposed to repeated-measures tracking (2-years, and 12-months respectively) of maturity status, growth tempo and movement coordination capability. Coordination capability was estimated via vertical stiffness (K_V) in a hopping task, reflected by participant mean K_V and between-jump coefficient of variation (CV).

RESULTS

For Aim 1, log-linear mixed model trends identified maturity status and growth tempo were significantly associated with K_V mean and K_V CV. For a given maturity status, mean K_V was 9% lower in the 'High' average growth tempo group than the 'Low' average tempo group. For Aim 2, mixed repeated-measures analyses of variance identified how time points of increased growth tempo were significantly associated with 7-11% reductions in mean K_V, with similar mean K_V decrements irrespective of growth tempo group. Meanwhile, K_VCV only illustrated progressive longitudinal reductions.

CONCLUSIONS

Within maturational progression, short-term accelerations in growth tempo corresponded with short-term decreases in K_V mean, suggesting temporary disruptions to movement coordination capability. Measuring growth tempo and applying hopping tasks in specific movement contexts could help consistently identify disturbances in motor coordination.

Limited evidence of altered gait parameters in people with chronic nonspecific low back pain

BACKGROUND

Differences in gait parameters have been shown between people with and without low back pain (LBP). However, previous studies did not well control factors such as sex, age, height and walking speed known to influence gait parameters.

RESEARCH QUESTION

Is gait altered in people with LBP when sex, age, height and walking speed are controlled?

METHODS

A series of gait parameters were measured in 16 participants with LBP and 16 age, sex and height matched healthy controls while walking on an instrumented treadmill. LBP group walked at a comfortable speed whilst control group walked at their own comfortable speed and at the comfortable speed of their matched participants with LBP. Pain and disability were measured for the LBP group. The between-group differences in mean, standard deviation (SD) and coefficient of variation (CV) of gait parameters were tested using paired samples t-test, Wilcoxon signed-rank test or two-factor repeated measures analyses of variance.

RESULTS

The median (interquartile range) of pain intensity was 2 (1, 3.5). From 102 tests of between-group difference in mean, SD and CV of 17 gait parameters at both comfortable speed and matched speed walking, only the mean of stride length (p = 0.037) during matched speed walking and SD of single support phase (p = 0.040) during comfortable speed walking showed significant between-group differences. There was no significant between-group difference in the rest means (comfortable walking: p ≥ 0.116; matched speed walking: p ≥ 0.069), SDs (comfortable walking: p ≥ 0.066; matched speed walking: p ≥ 0.098) and CVs of gait parameters (comfortable walking: p ≥ 0.110; matched speed walking: p ≥ 0.121).

SIGNIFICANCE

The lack of significant between-group difference in gait parameters may suggest that the gait of people with low level of LBP were not altered when sex, age and height were controlled.

Maturation-based Corrective Adjustment Procedures (Mat-CAPs) in youth swimming: Evidence for restricted age-group application in females

Inter-individual differences in maturation-associated development can lead to variations in physical performance, resulting in performance (dis)advantages and maturation selection bias within youth sport systems. To address such bias and account for maturational differences, Maturation-based Corrective Adjustment Procedures (Mat-CAPs) could be beneficial. The present study aimed to: (1) determine maturity timing distributions in youth female swimming; (2) quantify the relationship between maturation status and 100-m front-crawl (FC) performance; (3) implement Mat-CAPs to remove maturational influences upon swimming performance. For Aim 1 and 2, participants were 663 female (10–15 years) swimmers who participated in 100-m FC events at Australian regional, state, and national-level competitions between 2016–2020 and underwent anthropometric assessment (mass, height and sitting height) to estimate maturity timing and offset. For Aim 3, participants aged 10–13 years were categorised into maturity timing categories. Maturity timing distributions for Raw (‘All’, ‘Top 50%’ and ‘Top 25%’) and Correctively Adjusted swim times were examined. Chi-square, Cramer’s V and Odds Ratios determined the presence of maturation biases, while Mat-CAPs identified whether such biases were removed in targeted age and selection-groups. Results identified that between 10–13 years, a significantly higher frequency of ‘early’ maturers was apparent, although tapered toward higher frequencies of ‘Late-normative’ maturers by 14–15 years. A curvilinear relationship between maturity-offset and swim performance was identified (R²= 0.51, p<0.001) and utilised for Mat-CAPs. Following Mat-CAPs application, maturity timing biases evident in affected age-groups (10–13 years), and which were magnified at higher selection levels (‘Top 50%’ & ‘25%’ of swim performances) were predominantly removed. Findings highlight how maturation advantages in females occurred until approximately 13 years old, warranting restricted Mat-CAPs application. Mat-CAPS has the potential to improve female swimmer participation experiences and evaluation.

Effect of Set-Structure on Upper-Body Muscular Hypertrophy and Performance in Recreationally-Trained Male and Female

ABSTRACT

Davies, TB, Halaki, M, Orr, R, Mitchell, L, Helms, ER, Clarke, J, and Hackett, DA. Effect of set structure on upper-body muscular hypertrophy and performance in recreationally trained men and women. J Strength Cond Res 36(8): 2176-2185, 2022-This study explored the effect of volume-equated traditional-set and cluster-set structures on muscular hypertrophy and performance after high-load resistance training manipulating the bench press exercise. Twenty-one recreationally trained subjects (12 men and 9 women) performed a 3-week familiarization phase and were then randomized into one of two 8-week upper-body and lower-body split programs occurring over 3 and then progressing to 4 sessions per week. Subjects performed 4 sets of 5 repetitions at 85% one repetition maximum (1RM) using a traditional-set structure (TRAD, n = 10), which involved 5 minutes of interset rest only, or a cluster-set structure, which included 30-second inter-repetition rest and 3 minutes of interset rest (CLUS, n = 11). A 1RM bench press, repetitions to failure at 70% 1RM, regional muscle thickness, and dual-energy x-ray absorptiometry were used to estimate changes in muscular strength, local muscular endurance, regional muscular hypertrophy, and body composition, respectively. Velocity loss was assessed using a linear position transducer at the intervention midpoint. TRAD demonstrated a significantly greater velocity loss magnitude (g = 1.50) and muscle thickness of the proximal pectoralis major (g = -0.34) compared with CLUS. There were no significant differences between groups for the remaining outcomes, although a small effect size favoring TRAD was observed for the middle region of the pectoralis major (g = -0.25). It seems that the greater velocity losses during sets observed in traditional-set compared with cluster-set structures may promote superior muscular hypertrophy within specific regions of the pectoralis major in recreationally trained subjects.

Risk factors of paternal postnatal depression in Pakistan: Findings from an urban sample

Paternal postnatal depression is an emerging public health concern, with negative outcomes for men, their partners, and the newborn. There is a dearth of data on paternal postnatal depression in lower‐middle‐income countries like Pakistan. This study aimed to identify risk factors of postnatal depression in Pakistani men. Men who consented to this cross‐sectional study completed a questionnaire that included sociodemographic information and Urdu translated versions of the Edinburgh Postnatal Depression Scale (EPDS) and the Pittsburgh Sleep Quality Index, 10–12 weeks postpartum. Descriptive analyses for the sociodemographic variables were calculated. Univariate analyses were conducted to calculate the relative risk and 95% confidence interval of the independent variables with an EPDS score of >10. Multivariate binary logistic regression models were performed for risk factors of paternal postnatal depression. Fifty‐one questionnaires were analyzed and 23.5% of the participants scored more than 10 on the EPDS. Spouse's EPDS score > 12, and own sleep disturbance were risk factors of paternal postnatal depression in Pakistani men. There is an imminent need to incorporate fathers in the existing and future perinatal mental health programs in Pakistan.

Effect of high-volume cluster sets versus lower-volume traditional sets on muscular performance

BACKGROUND

Similar muscle performance adaptations have been shown following volume-equated resistance training using cluster (CLUS) versus traditional (TRAD) set structures. This study aimed to examine the effects of higher-volume CLUS compared to lower-volume TRAD set structures on muscle performance.

METHODS

Twenty resistance-trained males (age 20.9 ± 4.3 y) were randomized into one of two bench press training routines performed for six weeks. Subjects in CLUS (n = 10), performed six sets of five repetitions at 85% 1RM with 30 seconds inter-repetition rest and three minutes of inter-set rest. In contrast, subjects in TRAD (n = 10) performed three sets of five repetitions at 85% 1RM with five minutes of inter-set rest. Muscular strength (one repetition maximum - 1RM), concentric velocity, power, local muscular endurance and maintenance muscle performance (in training sessions) were assessed.

RESULTS

For 1RM there was a significant time effect (p < 0.001) with moderate effect sizes (ES) within each group (CLUS: ES = 0.48; TRAD: ES = 0.67). A trend towards significance was found for concentric velocity (p = 0.05; CLUS: ES =-0.36; TRAD (ES = -0.96). There were no other significant time or group effects nor group × time interactions. Greater maintenance of concentric velocity and power (sets 1-3) was found for CLUS compared to TRAD at week one (p <0.05) but not at week six.

CONCLUSIONS

High load resistance training in the bench press exercise, utilizing intra-set rest periods to increase the training volume, does not yield any muscular performance benefits compared to traditional set structures.

Conversational speech of school-age children after syllable-timed speech treatment for stuttering

Purpose: The purpose of this laboratory study was to investigate whether rhythmic speech was primarily responsible for stuttering reductions in four school-aged children after the instatement stage of the Westmead Program of syllable-timed speech (STS) intervention. The study was designed to inform further development of the program. Reduction in variability of vowel duration is a marker of STS, and it was predicted that this would be present in the children's conversational speech after Stage 1 of the program if they were using STS. To strengthen such a finding, it was also predicted that there would be no reduction in articulation rate, sentence complexity, and utterance length after treatment, as there is evidence that reductions in these can reduce stuttering. Perceptual judgments of speech quality after treatment were also made by independent listeners.Method: Participants were four children, ages 8-11 years, who completed Stage 1 of an STS program and whose stuttering had reduced significantly. Pre-treatment (PRE) and post-treatment (POST) within-clinic audio-visual recordings of conversational speech were analysed for percentage of syllables stuttered, variability of vowel duration, articulation rate, and length and complexity of utterance. Four blinded listeners made perceptual judgments of speech quality in the POST recordings.Result: Recordings of all children showed that variability of vowel duration clearly reduced from the PRE to POST speech samples. Importantly, articulation rate and language use were not compromised. Some possible indicators of rhythmicity were identified in one child in the perceptual study.Conclusion: The findings suggest that STS was primarily responsible for the clinically significant reductions in stuttering after Stage 1 of the program. There is an urgent need for more evidence-based interventions for stuttering in this age group and further development of STS interventions is warranted.

Predictors of radiation dose for uterine artery embolisation are angiography system-dependent

This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre's practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura,n= 95) and Group II (Azurion,n= 95) demonstrated a significant reduction in kerma-area product (KAP) and Ka, r (reference air kerma) by 63% (143.2 Gy cm²vs 52.9 Gy cm²;P< 0.001,d= 0.8) and 67% (0.6 Gy vs 0.2 Gy;P< 0.001,d= 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy cm²and the limits of agreement were +28.49 and -27.71 Gy cm², and thus illustrated no proportional bias. The resultant MLR model was considered system-dependent and validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose. Interventional radiologist and interventional radiographer familiarisation of the system's features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.

A standard enteral formula versus an iso-caloric lower carbohydrate/high fat enteral formula in the hospital management of adolescent and young adults admitted with anorexia nervosa: a randomised controlled trial

BACKGROUND

The nutritional rehabilitation of malnourished patients hospitalised with anorexia nervosa is essential. The provision of adequate nutrition must occur, while simultaneously, minimising the risk of refeeding complications, such as electrolyte, metabolic, and organ dysfunction. The aim of this study was to compare the efficacy and safety of an iso-caloric lower carbohydrate/high fat enteral formula (28% carbohydrate, 56% fat) against a standard enteral formula (54% carbohydrate, 29% fat).

METHODS

Patients (aged 15-25 years) hospitalised with anorexia nervosa were recruited into this double blinded randomised controlled trial. An interim analysis was completed at midpoint, when 24 participants, mean age 17.5 years (± 1.1), had been randomly allocated to lower carbohydrate/high fat (n = 14) or standard (n = 10) feeds.

RESULTS

At baseline, there was no significant difference in degree of malnutrition, medical instability, history of purging or serum phosphate levels between the two treatment arms. A significantly lower rate of hypophosphatemia developed in patients who received the lower carbohydrate/high fat formula compared to standard formula (5/14 vs 9/10, p = 0.013). The serum phosphate level decreased in both feeds, however it decreased to a larger extent in the standard feed compared to the lower carbohydrate/high fat feed (standard feed 1.11 ± 0.13 mmol/L at baseline vs 0.88 ± 0.12 mmol/L at week 1; lower carbohydrate/high fat feed 1.18 ± 0.19 mmol/L at baseline vs 1.06 ± 0.15 mmol/L at week 1). Overall, serum phosphate levels were significantly higher in the lower carbohydrate/high fat feed compared with standard feed treatment arm at Week 1 (1.06 ± 0.15 mmol/L vs 0.88 ± 0.12 mmol/L, p < 0.001). There was no significant difference in weight gain, number of days to reach medical stability, incidence of hypoglycaemia, or hospital length of stay.

CONCLUSIONS

The results of this study indicate that enteral nutrition provided to hospitalised malnourished young people with anorexia nervosa using a lower carbohydrate/high fat formula (28% carbohydrate, 56% fat) seems to provide protection from hypophosphatemia in the first week compared to when using a standard enteral formula. Further research may be required to confirm this finding in other malnourished populations.

TRIAL REGISTRATION

ANZCTR, ACTRN12617000342314. Registered 3 March 2017, http://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617000342314.

The effectiveness of EMG-driven neuromusculoskeletal model calibration is task dependent

Calibration of neuromusculoskeletal models using functional tasks is performed to calculate subject-specific musculotendon parameters, as well as coefficients describing the shape of muscle excitation and activation functions. The objective of the present study was to employ a neuromusculoskeletal model of the shoulder driven entirely from muscle electromyography (EMG) to quantify the influence of different model calibration strategies on muscle and joint force predictions. Three healthy adults performed dynamic shoulder abduction and flexion, followed by calibration tasks that included reaching, head touching as well as active and passive abduction, flexion and axial rotation, and submaximal isometric abduction, flexion and axial rotation contractions. EMG data were simultaneously measured from 16 shoulder muscles using surface and intramuscular electrodes, and joint motion evaluated using video motion analysis. Muscle and joint forces were calculated using subject-specific EMG-driven neuromusculoskeletal models that were uncalibrated and calibrated using (i) all calibration tasks (ii) sagittal plane calibration tasks, and (iii) scapular plane calibration tasks. Joint forces were compared to published instrumented implant data. Calibrating models across all tasks resulted in glenohumeral joint force magnitudes that were more similar to instrumented implant data than those derived from any other model calibration strategy. Muscles that generated greater torque were more sensitive to calibration than those that contributed less. This study demonstrates that extensive model calibration over a broad range of contrasting tasks produces the most accurate and physiologically relevant musculotendon and EMG-to-activation parameters. This study will assist in development and deployment of subject-specific neuromusculoskeletal models.

Analysis of phase detects altered timing of muscle activation in subjects with chronic shoulder pain

Optimal exercise therapy for shoulder pain is unknown due to limited information regarding specific changes in muscle function associated with pain. Timing of muscle activity with respect to movement (phase) can provide information about muscle activation patterns without requiring electromyography data normalization which is problematic in the presence of pain. The aim of this study was to determine if a phase measure is able to detect differences in the timing of shoulder muscle activation in subjects with chronic shoulder pain. Fourteen subjects with pain and 14 without pain were recruited. Electromyography from eight shoulder muscles was recorded. Approximately 20 cycles of small amplitude (∼30°) rapid shoulder flexion/extension was performed. A cross-correlation and spectrographic analysis provided a measure of phase. Welch's t-tests were used to compare mean phase angles between groups. Subjects with chronic shoulder pain had greater variability in the relative timing of muscle activation with significant differences found in the phase angles for pectoralis major, infraspinatus, supraspinatus, upper and lower trapezius and serratus anterior. This preliminary study indicates that the examination of the timing of muscle activation using a phase measure can identify significant differences in muscle function between normal subjects and those with chronic shoulder pain.

UTERINE ARTERY EMBOLISATION: CONTINUOUS QUALITY IMPROVEMENT REDUCES RADIATION DOSE WHILE MAINTAINING IMAGE QUALITY

The purpose of this study was to introduce a continuous quality improvement (CQI) program for radiation dose optimisation during uterine artery embolisation (UAE) and assess its impact on dose reduction and image quality. The CQI program investigated the effects of optimising radiation dose parameters on the kerma-area product (KAP) and image quality when comparing a 'CQI intervention' group (n = 50) and 'Control' group (n = 50). Visual grading characteristics (VGC) analysis was used to assess image quality, using the 'Control' group as a reference. A significant reduction in KAP by 17% (P = 0.041, d = 0.2) and reference air kerma (Ka, r) by 20% (P = 0.027, d = 0.2) was shown between the two groups. The VGC analysis resulted in an area under the VGC curve (AUCVGC) of 0.54, indicating no significant difference in image quality between the two groups (P = 0.670). The implementation of the CQI program and optimisation of radiation dose parameters improved the UAE radiation dose practices at our centre. The dose reduction demonstrated no detrimental effects on image quality.

Interaction between hand span and different sizes of keyboards on EMG activity in pianists: An observational study

The availability of keyboards with reduced key width has been recently promoted as an ergonomic aid for small-handed pianists to overcome any potential physical disadvantages that may restrict their piano repertoire. However, a lack of biomechanical data exists to support whether reduced piano key size is effective in achieving this outcome. This research investigates the effect of playing on three different key width size pianos (5.5-inch octave, 6.0-inch octave and conventional size with 6.5-inch octave) on hand, arm and shoulder muscle activity levels according to the hand size of the pianists. Results indicate that piano key size affects the muscle activity levels of selected muscles. Furthermore, this effect of different key sizes changed according to the players' hand spans. Small-handed pianists may benefit from using smaller-sized keyboards to reduce muscular exertion during performance. This investigation provides preliminary EMG data supporting the use of different size keyboards to improve the ergonomic fit according to the dimensions of individual pianists.

P079 Effect of sleepwear fibre type on menopausal sleep quality – Study protocol and preliminary data

Introduction

Vasomotor symptoms and sleep disturbances are common in menopausal women. Different fabric types affect thermal comfort through moisture absorption and thermal insulation. This study examined the impact of cotton and wool sleepwear on menopausal women’s sleep quality.

Methods

This is a randomized, crossover, repeated-measures and triple-blinded trial comparing the sleep quality and vasomotor symptoms of healthy menopausal women between cotton and wool sleepwear at 30°C, 50% relative humidity. Participants undergo 6 laboratory visits. After a screening visit and a familiarization night, participants are randomized to 4 nights (2 nights in cotton and 2 nights in wool sleepwear) during which polysomnography and actigraphy recordings are taken including objective hot flush events, room temperature and relative humidity measurements, as well as subjective questionnaires on clothing comfort, mood and vasomotor symptoms.

Results

Eleven participants (age 51.2±4.7 years, BMI 26.8±2.9 kg.m-2, Insomnia Severity Index 11.1±5.5) completed all six visits so far. Reasons for exclusion: 3 didn’t have vasomotor symptoms; 1 on HRT, 5 had severe sleep disturbances, 3 on medications, 4 had diabetes, 1 asthma, and 1 had BMI>30. All sleep-related outcomes are pending analysis (blinding).

Discussion

Recruitment is a major study challenge. Many participants found it hard to arrange a time to attend overnight studies due to family/work commitments. The COVID-19 pandemic changed people’s attitude as some were hesitant to attend the laboratory. Menopause transition status is an important time during women’s lifespan. Effective management, e.g., through appropriate sleepwear, would be helpful to improve menopausal women’s symptom and quality of life.

Is there an association between high-speed running biomechanics and hamstring strain injury? A systematic review

Despite increased awareness of the multifactorial nature of Hamstring Strain Injury (HSI), the role of running biomechanics remains unclear. The aim of this systematic review was to investigate whether an association exists between running biomechanics and HSI. Five databases were searched from inception to January 2021. Eligibility criteria included epidemiological studies that provide data on running biomechanics in athletes who have sustained a HSI (retrospectively or prospectively) and compared to control data. Searches yielded 4,798 articles. Twelve met the selection criteria. Biomechanical analysis differed considerably across studies, thus meta-analyses was not possible. Studies largely found either no differences or contradicting findings between running biomechanics of athletes who have sustained a HSI (retrospectively or prospectively) and controls, with the exception of lateral trunk kinematics and horizontal propulsive forces. It is important to note some concern regarding the quality of included studies, particularly sample size, increasing the risk of bias associated with results. Further research utilising validated methods of biomechanical analysis, is needed to determine if an association exists between running biomechanics and HSI. Until then, definitive conclusions cannot be drawn as to whether specific biomechanical interventions should be included in injury prevention and/or rehabilitation programmes.

High intensity power training in middle-aged women with Charcot–Marie–Tooth disease: a case series

Background/aims

High-intensity power training has been shown to be effective in improving muscular capabilities, functional performance and health-related quality of life in populations with physical impairments. However, the effectiveness of high-intensity power training in people with Charcot–Marie–Tooth disease remains uncertain. This case series investigated the effects of high-intensity power training on muscle performance, function and health-related quality of life in middle-aged women with Charcot-Marie-Tooth disease.

Methods

Four women (age 51–58 years) with Charcot–Marie–Tooth disease type 1A participated in 8 weeks of supervised high-intensity power training.

Results

All participants improved strength of the right hip abductors (46.7–109.7%) and left hip abductors (27.3–128.6%), maximal gait speed (2.3–9.1%), static balance (0.7–4.9%), tandem walk (−3.3 to −58.5%), and mental component scores on the Short Form 36 Health Status Survey (0.8–27.6%). Adherence to high-intensity power training was 100% and only one minor adverse event related to the intervention was reported.

Conclusions

Although promising, larger controlled studies are indicated to confirm the safety and efficacy of high-intensity progressive resistance and power training in this cohort.

Identifying predictors of patient radiation dose during uterine artery embolisation

INTRODUCTION

Uterine artery embolisation (UAE) is regarded as a safe and effective treatment for symptomatic uterine fibroids and/or adenomyosis. Dose reduction during UAE is critical for this reproductive-age patient population to minimise the risks of radiation-induced effects. The aim of this study was to identify the predictors of radiation dose which can be controlled and optimised for patients during UAE.

METHODS

A total of 150 patients between June 2018 and August 2019 were included in this study. Demographic and clinical information such as age, body mass index (BMI), total number of fibroids, total fibroid volume, total uterus volume and dosimetric measurements on Dose Area Product (DAP), Air Kerma (AK) and fluoroscopy time were recorded. Total digital subtraction angiography (DSA), total conventional roadmap (CRM), total last-image hold (LIH) and total fluoroscopy were calculated from the dose report. Multiple linear regression analysis was used to identify the independent predictor variables of total dose (DAP) using a regression model.

RESULTS

Total DSA, total CRM and total LIH were identified as the determinants of dose for UAE (P < 0.05) and together accounted for 95.2% of the variance.

CONCLUSIONS

This study identified the key imaging predictors of dose for UAE. Total DSA, total CRM and total LIH were shown to have a greater impact on the outcome DAP compared to other demographic or dosimetric measurements. Optimisation of these predictors during future UAE procedures can facilitate radiation dose reduction to the pelvis and reproductive organs.

Perinatal depression in Pakistan: A systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence and associated risk factors of perinatal depression in Pakistan.

METHODS

We conducted a systematic search of Medline, PsycINFO, CINAHL, EMBASE, and Global health, up through May 31, 2019. Studies reporting on the prevalence of perinatal depression in Pakistan with or without associated risks factors were included.

RESULTS

Forty-three studies reporting data from 17 544 women met the eligibility criteria and were included. Overall, the pooled prevalence of antenatal depression was 37% (95% CI: 30-44), while that of postnatal depression was 30% (95% CI: 25-36). The prevalence of perinatal depression in women residing in urban areas and those living in rural settings was not significantly different. The most frequently reported risk factors for antenatal depression were intimate partner violence and poor relationship with spouse, and that reported for postnatal depression was low-income level. An unintended pregnancy was significantly associated with perinatal depression in Pakistan.

CONCLUSIONS

We identified variability in prevalence rate of perinatal depression in Pakistan. It is difficult to gauge the true magnitude of this problem potentially due to differing risk factors between the antenatal and postnatal periods and the lack of uniformity of data collection protocols and procedures. The high prevalence rates of 30%-37% compared to global estimates suggest policy makers and stakeholders should direct additional resources toward improving perinatal mental health in Pakistan.

Effect of Set-Structure on Upper-Body Muscular Hypertrophy and Performance in Recreationally-Trained Male and Female

ABSTRACT

Davies, TB, Halaki, M, Orr, R, Mitchell, L, Helms, ER, Clarke, J, and Hackett, DA. Effect of set structure on upper-body muscular hypertrophy and performance in recreationally trained men and women. J Strength Cond Res XX(X): 000-000, 2021-This study explored the effect of volume-equated traditional-set and cluster-set structures on muscular hypertrophy and performance after high-load resistance training manipulating the bench press exercise. Twenty-one recreationally trained subjects (12 men and 9 women) performed a 3-week familiarization phase and were then randomized into one of two 8-week upper-body and lower-body split programs occurring over 3 and then progressing to 4 sessions per week. Subjects performed 4 sets of 5 repetitions at 85% one repetition maximum (1RM) using a traditional-set structure (TRAD, n = 10), which involved 5 minutes of interset rest only, or a cluster-set structure, which included 30-second inter-repetition rest and 3 minutes of interset rest (CLUS, n = 11). A 1RM bench press, repetitions to failure at 70% 1RM, regional muscle thickness, and dual-energy x-ray absorptiometry were used to estimate changes in muscular strength, local muscular endurance, regional muscular hypertrophy, and body composition, respectively. Velocity loss was assessed using a linear position transducer at the intervention midpoint. TRAD demonstrated a significantly greater velocity loss magnitude (g = 1.50) and muscle thickness of the proximal pectoralis major (g = -0.34) compared with CLUS. There were no significant differences between groups for the remaining outcomes, although a small effect size favoring TRAD was observed for the middle region of the pectoralis major (g = -0.25). It seems that the greater velocity losses during sets observed in traditional-set compared with cluster-set structures may promote superior muscular hypertrophy within specific regions of the pectoralis major in recreationally trained subjects.

Understanding training needs in eating disorders of graduating and new graduate dietitians in Australia: an online survey

BACKGROUND

Following recent reforms by the Australian Government to the Medicare Benefits Schedule, people living with a diagnosed eating disorder (ED) in Australia have greater access to dietetic services. However, new graduate dietitians anecdotally lack confidence to provide appropriate interventions to support patients with an ED. Therefore, this cross-sectional study aims to explore the perceived confidence, and educational and professional development needs of student dietitians and new graduate dietitians in the area of EDs.

METHODS

An online survey with 17 questions was designed, consisting of a combination of discrete (yes/no) questions, free text, ordered scales and 5-point Likert scales. Student dietitians, and first- and second- year graduates (n = 1456) were approached via email as potential participants, from the professional organisation Dietitians Australia member list. Survey data was analysed using descriptive statistics and odds ratios.

RESULTS

In total, 150 surveys were completed, with a response rate of 10.3%. Respondents reported a lack of confidence in managing patients with an ED and implementing ED treatment approaches (81 and 95%, respectively). However, participants previously exposed to patients with an ED, such as anorexia nervosa, were 4.7 times (95% CI 1.72, 12.97) more likely to be confident compared to those not exposed to patients with an ED. The majority of respondents (37%) stated they would seek assistance from other dietitians, and develop their skills via online webinars (27%) and workshops (25%).

CONCLUSIONS

This survey identified that final year dietetics students and new graduate dietitians perceive lower levels of confidence to practice in the area of EDs. The desire for further ED-specific training and education was reported.

Changes in Bench Press Velocity and Power After 8 Weeks of High-Load Cluster- or Traditional-Set Structures

Davies, TB, Halaki, M, Orr, R, Helms, ER, and Hackett, DA. Changes in bench press velocity and power after 8 weeks of high-load cluster- or traditional-set structures. J Strength Cond Res 34(10): 2734-2742, 2020-This study investigated the effects of high-load cluster- vs. traditional-set structures using the bench press on velocity and power. Twenty-one resistance-trained individuals (male = 12, female = 9) performed a 3-week familiarization block followed by randomization into 1 of 2 upper- and lower-body split training routines performed for 8 weeks. The bench press was the only exercise manipulated with subjects using either cluster-set (CLUS, n = 11) or traditional-set (TRAD, n = 10) structures during training sessions. Subjects performed 4 sets of 5 repetitions at 85% 1 repetition maximum (1RM) with CLUS having a 30-second inter-repetition, and 3-minute interset rest while TRAD had a 5-minute interset rest. A load-velocity profile of relative loads derived from a 1RM test was used to assess velocity and power (absolute and relative to body mass) on the bench press. Significant improvements over time were found across various loads ranging from 45 to 75% 1RM for absolute and relative peak power (p = 0.006-0.041), and mean power (p = 0.001-0.032). Significant decreases over time were found at 55% 1RM and 65% 1RM for peak velocity (p = 0.027 and p = 0.012, respectively) and mean velocity (p = 0.047 and p = 0.022, respectively). There were no significant group or group by time interactions found for all outcomes. Within the context of high-load resistance training, set structure seems to be of less importance for changes in bench press velocity and power provided there is an intention to lift with maximal concentric velocity.

Acute experimentally-induced pain replicates the distribution but not the quality or behaviour of clinical appendicular musculoskeletal pain. A systematic review

OBJECTIVES

Experimental pain is a commonly used method to draw conclusions about the motor response to clinical musculoskeletal pain. A systematic review was performed to determine if current models of acute experimental pain validly replicate the clinical experience of appendicular musculoskeletal pain with respect to the distribution and quality of pain and the pain response to provocation testing.

METHODS

A structured search of Medline, Scopus and Embase databases was conducted from database inception to August 2020 using the following key terms: "experimental muscle pain" OR "experimental pain" OR "pain induced" OR "induced pain" OR "muscle hyperalgesia" OR ("Pain model" AND "muscle"). Studies in English were included if investigators induced experimental musculoskeletal pain into a limb (including the sacroiliac joint) in humans, and if they measured and reported the distribution of pain, quality of pain or response to a provocation manoeuvre performed passively or actively. Studies were excluded if they involved prolonged or delayed experimental pain, if temporomandibular, orofacial, lumbar, thoracic or cervical spine pain were investigated, if a full text of the study was not available or if they were systematic reviews. Two investigators independently screened each title and abstract and each full text paper to determine inclusion in the review. Disagreements were resolved by consensus with a third investigator.

RESULTS

Data from 57 experimental pain studies were included in this review. Forty-six of these studies reported pain distribution, 41 reported pain quality and six detailed the pain response to provocation testing. Hypertonic saline injection was the most common mechanism used to induce pain with 43 studies employing this method. The next most common methods were capsaicin injection (5 studies) and electrical stimulation, injection of acidic solution and ischaemia with three studies each. The distribution of experimental pain was similar to the area of pain reported in clinical appendicular musculoskeletal conditions. The quality of appendicular musculoskeletal pain was not replicated with the affective component of the McGill Pain Questionnaire consistently lower than that typically reported by musculoskeletal pain patients. The response to provocation testing was rarely investigated following experimental pain induction. Based on the limited available data, the increase in pain experienced in clinical populations during provocative maneuvers was not consistently replicated.

CONCLUSIONS

Current acute experimental pain models replicate the distribution but not the quality of chronic clinical appendicular musculoskeletal pain. Limited evidence also indicates that experimentally induced acute pain does not consistently increase with tests known to provoke pain in patients with appendicular musculoskeletal pain. The results of this review question the validity of conclusions drawn from acute experimental pain studies regarding changes in muscle behaviour in response to pain in the clinical setting.

Tracking Preschoolers' Lifestyle Behaviors and Testing Maternal Sociodemographics and BMI in Predicting Child Obesity Risk

BACKGROUND

Longitudinal data investigating tracking of children's lifestyle behaviors and predictors of childhood obesity are limited.

OBJECTIVES

We examined changes in children's lifestyle behaviors (dietary, physical activity, and screen time) from ages 2-5 y to determine if maternal sociodemographic factors and BMI predict child obesity at 3.5 y and 5 y.

METHODS

Data were obtained from 667 first-time mothers who were recruited into the Healthy Beginnings Trial at 24-34 weeks of gestation in Sydney, Australia. Child lifestyle behaviors were assessed using face-to-face questionnaire interviews with mothers. To measure child and maternal anthropometry, BMI (in kg/m2) was calculated using measured height and weight. Children were categorized as overweight or obese based on the International Obesity Task Force criteria. We used 1-factor repeated-measures ANOVA to track preschoolers' lifestyle behaviors and multiple logistic regression to determine obesity predictors.

RESULTS

In children aged 2-5 y, consumption of vegetables (ηp2 = 0.06; P < 0.005) and milk (ηp2 = 0.02; P < 0.001) decreased, whereas physical activity (ηp2 = 0.07; P < 0.001) increased. Discretionary foods (sweet snacks, fast foods, salty snacks, processed meats, confectionary) (ηp2 = 0.03-0.25; P ≤ 0.01) and screen time (ηp2 = 0.39; P < 0.001) increased. Maternal BMI (in kg/m2) (Exp β: 1.06; 95% CI:1.01, 1.12 ; P=0.02), marital status (married/de facto compared with single) (Exp β: 0.06; 95% CI:0.01, 0.26; P < 0.001), and child BMI at 2 y (Exp β: 1.82; 95% CI: 1.46, 2.27; P < 0.001) predicted overweight/obesity at 3.5 y. Child BMI at 3.5 y (Exp β: 3.51; 95% CI: 2.50, 4.93; P < 0.001) predicted obesity at 5 y.

CONCLUSIONS

Poor dietary and lifestyle behaviours track in early childhood, with maternal single-parent status and high maternal and child BMI at 2 y predicting earlier obesity onset.

Study protocol for a randomised controlled trial investigating two different refeeding formulations to improve safety and efficacy of hospital management of adolescent and young adults admitted with anorexia nervosa

INTRODUCTION

Providing effective nutritional rehabilitation to patients hospitalised with anorexia nervosa (AN) is challenging, partly due to conservative recommendations that advocate feeding patients at low energy intakes. An 'underfeeding syndrome' can develop when patients are not provided with adequate nutrition during treatment, whereby malnourished patients fail to restore weight in a timely matter, and even lose weight. Of particular concern, the reintroduction of carbohydrate in a starved patient can increase the risk of developing electrolyte, metabolic and organ dysfunction. The proposed trial assesses the efficacy and safety of a lower carbohydrate enteral formula (28% carbohydrate) against a standard enteral formula (54% carbohydrate), in adolescent and young adult patients (aged 15-25 years), hospitalised with AN.

METHODS AND ANALYSIS

The study employs a double-blind randomised controlled trial design. At admission to hospital, malnourished adolescent and young adults with AN will be randomly allocated to commence feeding on a standard enteral feeding formula (1.5 kcal/mL, 54% carbohydrate) or a lower carbohydrate isocaloric enteral feeding formula (1.5 kcal/mL, 28% carbohydrate). Assessments of nutritional intake, weight and biochemistry (phosphate, magnesium, potassium) will be conducted at baseline and during the first 3 weeks of hospital admission. The primary outcome measure will be incidence of hypophosphatemia. Secondary outcomes include weight gain, oedema, other electrolyte distortion, length of hospital admission, admission to the Intensive Care Unit (ICU) and number of days to reach medical stability, using defined parameters.

ETHICS AND DISSEMINATION

The protocol was approved by the Western Sydney Local Health District Human Research Ethics Committee and institutional research governance approvals were granted. Written informed consent will be sought prior to study enrolment. Study findings will be widely disseminated through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12617000342314); Pre-results.

Ergonomics in violin and piano playing: A systematic review

This systematic review aimed to evaluate whether muscle activity and playing-related musculoskeletal disorders are associated with musicians' anthropometrics and their instrument size or set-up during violin and piano performance. Studies were retrieved systematically from six databases on 1 April 2019 combined with hand searching results. The Appraisal tool for Cross-Sectional Studies (AXIS tool) was used to evaluate the methodological quality of the included papers. A total of twenty articles were identified. Most included studies focussed on either the adjustment of the shoulder rest in violinists, or the hand size in pianists. However, methodological quality was inconsistent. The electromyography data reported by the included studies were not appropriately processed and interpreted. Studies generally reported the use of a shoulder rest changes muscle activity and smaller hand size is correlated to increased playing-related musculoskeletal disorders incidence. However, no conclusions can be drawn due to heterogeneity and low quality of methodology in the available literature.

Epidemiology of injuries in Australian junior rugby league players

OBJECTIVES

Conduct a large-scale epidemiological study of injury characteristics (location, type, mechanism, severity, burden) and incidence in community junior rugby league.

DESIGN

Prospective cohort epidemiology study.

METHODS

Injury surveillance was conducted in three district leagues (Penrith, Canberra, Melbourne) in under 6 (U6) to under 18 years (U18) age groups across the 2016 season. Club sports trainers recorded all match/training medical-attention injuries using a commercial electronic application which recorded injury circumstances and characteristics.

RESULTS

A total of 13,169 players from 897 teams participated and 408 (89% male) players sustained 485 injuries, 94% of which were match related. The overall injury incidence was 5.9 injuries/1000 player hours and highest in U13-U18 female players (22.2 injuries/1000 player hours). The mean injury severity of 16±31 days missed training/match-play caused an overall injury burden of 94.2 days missed/1000 player hours). Tackles accounted for 84% of injuries. Joint and contusion injuries were the most prevalent injury type and the head (35% total injuries, primarily bruising and bleeding) was the most injured body site.

CONCLUSIONS

This is the first study to report injuries across a large cohort of all-age Australian community junior rugby league players over one season. Injury prevalence was lower than previously reported in junior rugby league suggesting the sport has not become more dangerous for junior players. These findings provide an evidence-base to inform or revise policy, training and injury prevention programs and athlete development pathways in relation to game-wide safety and develop best-practice protocols in injury management for rugby league athlete support personnel.

Cognitive effects of video games in older adults and their moderators: a systematic review with meta-analysis and meta-regression

The growing interest in preserving cognition through video games in the ageing population is evidenced by its wealth of literature. However, there has been a lack of consensus on video games efficacy and even limited understanding on the factors moderating its effectiveness. The present review sought to evaluate video game effects, relative to no-game control condition, on cognitive functions in older adults. The functions included processing speed, attention, delayed memory, reasoning, and executive functions (inhibition, shifting and updating memory). Personal and methodological moderators were explored to explain the variability in cognitive effects using meta-regression. Through a systematic literature search of online databases, 27 intervention studies were eligible, with a total of 1126 participants, for analysis. Using random-effect models, small but significant training effects were found on updating memory but none were detected in other cognitive functions. The heterogeneity across studies was in general high for all cognitive functions and was partially accounted for, in all cognitive functions except for inhibition and updating, by different moderators such as the proportion of females, outcome measure parameters, training intensity, and game type. The findings highlight limited effects of video games on cognitive functions that were largely influenced by factors related to study design.

The effects of choral singing on communication impairments in acquired brain injury: A systematic review

BACKGROUND

Acquired brain injury (ABI), such as Parkinson's disease, dementia or stroke, can result in communication difficulties that lead to an impoverished ability to connect meaningfully with others. Choral singing is a complex task that uses multiple brain regions which are also responsible for language and communication skills. The potential therapeutic effects of group singing on communication-related outcomes across ABI aetiologies have not been systematically reviewed.

AIMS

To examine whether participation in group singing over multiple sessions improves speech, voice, language and/or communication skills in individuals with ABI-related communication disorders.

METHODS & PROCEDURES

A database search was undertaken according to the PRISMA guidelines. Search terms included: stroke OR Parkinson^* OR dementia OR 'acquired brain injury' AND choir OR choral OR singing OR sing OR 'choral sing^* ' OR group adj3 singing OR community adj3 singing AND speech OR language OR communication.

MAIN CONTRIBUTION

A total of 11 studies were included. Nine were quantitative, including one randomized and one non-randomized control trial, and two were mixed method. Nine studies were scored as level IV (uncontrolled) on the American Academy of Neurology (AAN) Classification of Evidence Matrix and two as level III (e.g., lack of blinded assessors). Eight examined speech and voice skills in Parkinson's disease, two functional communication skills in post-stroke aphasia and one communication between individuals with dementia and a significant other. One level III control trials provided evidence for a therapeutic effect of group singing on communication in individuals with Parkinson's disease.

CONCLUSIONS & IMPLICATIONS

Currently, there is only one study providing support for using group singing to improve speech and voice skills in people with Parkinson's disease, and no studies of adequate quality indicating positive effects on language and functional communication abilities in ABI. Further research using more rigorous experimental designs is required to determine whether group singing can influence communication skills in ABI. What this paper adds What is already known on the subject Music activates widespread, bilateral cortical and subcortical brain regions. Group singing is increasingly understood to have positive benefits on quality of life and health-related well-being in both healthy and clinical populations. Given the crossover in neural networks between singing, speech and language, singing activities are also thought to have positive effect of communication impairments secondary to ABI. However, to date, the research evidence supporting the application of group singing for communication impairments in ABI has not been summarized. What this paper adds to existing knowledge A total of 11 studies have looked at communication outcomes after group singing in ABI. For most of these, the quality of evidence was low (AAN level IV). It also highlights that there is a bias in the literature towards the studying individuals with Parkinson's disease (i.e., nine of the 11 studies). What are the potential or actual clinical implications of this work? This review concludes that, currently, there is emerging evidence to support positive effects of a group singing for speech and voice symptoms in individuals with Parkinson's disease, when provided using the Tamplin protocol. However, there is not yet any evidence for communication benefits for individuals with aphasia or dementia.

Role of the kinetic chain in shoulder rehabilitation: does incorporating the trunk and lower limb into shoulder exercise regimes influence shoulder muscle recruitment patterns? Systematic review of electromyography studies

OBJECTIVE

To investigate the influence of trunk and lower limb motion on electromyography (EMG) muscle activity and recruitment patterns around the shoulder.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, CINAHL, PEDro, AMED, PubMed, Cochrane Central Register of Controlled trials, Cochrane Database of Systematic reviews, SportsDiscuss and PROSPERO.

ELIGIBILITY CRITERIA

Studies investigating both multiregional kinetic chain (KC) shoulder exercises and localised non-kinetic chain (nKC) shoulder exercises in healthy subjects under the same experimental conditions were included in this review.

RESULTS

KC exercises produced greater EMG activation levels in 5 of 11 studies for the lower trapezius. Of the remaining studies, five found no difference between the exercise types and one favoured nKC exercises. KC exercises produced greater EMG activation levels in 5 of 11 studies for the serratus anterior. Of the remaining studies, three reported the opposite and three found no significant difference between the exercise types. nKC exercises produced greater EMG activation in infraspinatus in three of four studies. KC exercises produced the lowest trapezius muscle ratios in all studies. Studies investigating the upper trapezius, middle trapezius, supraspinatus, subscapularis, biceps brachii, latifissimus dorsi, pectoralis major, deltoid, and trapezius and serratus anterior ratios showed inconsistency.

CONCLUSION

This review found evidence that integrating the KC during shoulder rehabilitation may increase axioscapular muscle recruitment, produce lower trapezius muscle ratios and reduce the demands on the rotator cuff. Stepping appears preferable to squatting.

PROSPERO REGISTRATION NUMBER

CRD42015032557, 2015.

Movement Demands and Injury Characteristics in Under-20-Years University Rugby Union Players

CONTEXT

Rugby union is a field-based collision sport with high injury rates. Associations between injury characteristics and global positioning system-derived movement demands in rugby union athletes are yet to be investigated.

OBJECTIVE

To investigate associations between match injuries and movement demands, anthropometrics, and physical performance in under-20-years university-level rugby union players.

DESIGN

Descriptive epidemiology study.

SETTING

Competition season.

PATIENTS OR OTHER PARTICIPANTS

Rugby union players (n = 34, age = 19.3 ± 0.6 years) from a university club were recruited.

MAIN OUTCOME MEASURE(S)

Acute medical attention non-time-loss (NTL), medical-attention time-loss (TL), and total medical-attention (MA) injuries sustained were recorded. Principal component (PC) analysis was performed on player-movement demand variables to identify independent-movement demand components. Pearson correlation and bivariate linear regression were used to test associations between match injuries and PCs. Anthropometric and physical performance measures were tested as predictors of match injuries using a forward stepwise multiple regression analysis.

RESULTS

Backs had lower anthropometric and performance measures than forwards (P < .05), whereas forwards performed fewer weekly movement demands than backs (P < .05). Increases in body mass and skinfold thickness were associated with more injuries (P < .05). Principal component analysis revealed 3 PCs representing overall performance, high-intensity running (HIR) performance, and impacts. Increases in HIR were associated with decreases in NTL upper limb and trunk (r = -0.32, P = .03), NTL musculoskeletal (r = -0.36, P = .05), NTL total (r = -0.46, P < .01), TL musculoskeletal (r = -0.30, P = .05), MA musculoskeletal (r = -0.41, P < .01), and MA total (r = -0.48, P < .01) injuries. Increases in impacts were associated with increased TL (r = 0.32, P = .03) and MA (r = 0.33, P = .03) head or neck injuries.

CONCLUSIONS

Backs experienced greater weekly movement demands than forwards. Increases in HIR demands were associated with decreased acute injuries in university rugby players. Increases in impacts were associated with more acute head or neck injuries. Positional differences in movement demands, anthropometrics, and physical performance highlight the need for position-specific training.

Is the Normal Shoulder Rotation Strength Ratio Altered in Elite Swimmers?

INTRODUCTION

It is commonly believed that the shoulder external rotation (ER) to internal rotation (IR) strength ratio is decreased in swimmers due to predominant IR loading during the pull-through (propulsive) phase which predisposes to shoulder pain. However, the evidence supporting this hypothesis is inconclusive. Therefore, the aim of this study was to examine shoulder rotation strength parameters in elite swimmers and investigate potential associations with shoulder pain.

METHODS

Sixty-eight (40 men; age, 19.9 ± 3.2 yr) elite swimmers provided demographic and shoulder pain history data before measurement of shoulder rotation strength. Mixed model analyses were used to examine differences in shoulder IR and ER strength normalized to body weight (BW) and the shoulder rotation strength ratio. A multinomial logistic regression model was utilized to examine associations between shoulder rotation strength parameters and shoulder pain.

RESULTS

Mean shoulder IR strength (BW) was approximately 0.29 for male swimmers and 0.26 for female swimmers. Mean shoulder ER strength (BW) was approximately 0.19 for male swimmers and 0.18 for female swimmer. The shoulder ER/IR strength ratio was approximately 0.70 bilaterally for all swimmers. There were no significant differences between dominant and nondominant shoulders in IR or ER strength normalized to BW (P ≥ 0.547). There were no associations between any shoulder strength parameters and shoulder pain (r = 0.032, P = 0.107).

CONCLUSIONS

Despite the high IR loading, optimal swimming technique does not alter the normal ER/IR strength ratio at the shoulder. Elite swimmers who report current or a history of shoulder pain demonstrate normal shoulder rotation strength ratios. The finding of symmetrical shoulder rotation strength points to side-to-side strength comparisons as a valuable clinical tool in managing swimmers with unilateral shoulder pain.

Whole-body kinematics and coordination in a complex dance sequence: Differences across skill levels

This study examined differences across skill levels in the kinematics of a complex, whole-body, asymmetrical, cyclical dance sequence, the 'Alternate Basic' in Cha-Cha-Cha, to determine whether observed differences were consistent with Bernstein's (1967) model of development of coordination. Bernstein proposed that with novel motor skills, beginners move their bodies rigidly and spastically, freezing kinematic degrees of freedom (DOF) to constrain the motor system. As the skill becomes practised, the DOF unfreeze and movements become more dynamic, allowing the integration of reactional elements (passive forces, moments, etc.) and organisation of more complex coordinative structures. Twenty-nine dancers - beginners (n = 10), intermediates (n = 10), experts (n = 9) - performed 12 cycles of the dance sequence (total duration ~60 s). Three-dimensional kinematic data from 36 joint angles were collected using a 14-camera infrared motion capture system. Most joints displayed increased amplitude and speed of movement, especially early in skill progression (beginner-intermediate stage), with no evidence of any decreases, showing that unfreezing occurred around the general movement pattern early. Speed of movement continued to increase later (intermediate-expert stage), as well as further unfreezing of the upper limbs. Changes to intra-limb couplings were limited, comprising some early reductions in coupling strength. Principal component analyses (PCA) showed that the structure of movement became more organised with increased skill. There was an early reduction in the number of coordinative structures, while later, movement was integrated more into the first coordinative structure. As predicted by Bernstein's coordination development model, therefore, the kinematic DOF unfroze as skill level progressed, leading to increased organisation of coordinative structures. The results of this study support the importance of a whole-body perspective in studies of coordination, with incorporation of kinetic variables in future research in order to examine the role that reactional elements play in motor skill development.

Experimental shoulder pain models do not validly replicate the clinical experience of shoulder pain

Background and aims

People with shoulder pain often present with abnormal shoulder muscle function. It is not known whether shoulder pain causes or is the result of muscle dysfunction. If pain leads to muscle dysfunction, therapeutic interventions that produce shoulder pain may be contraindicated. Experimentally induced nociception can be used to investigate a causal relationship between shoulder pain and muscle dysfunction. However, the validity of current experimental shoulder pain protocols has not been established. The aim of this study was to determine whether current experimental shoulder pain protocols validly replicate the clinical experience of shoulder pain with respect to pain distribution, quality and behaviour.

Methods

Nine pain free participants received two injections of hypertonic saline, one into the subacromial space and one into supraspinatus, in random order, at least 1 week apart. Investigators blind to the injection site assessed pain distribution, pain response to clinical tests which provoke shoulder pain and pain quality assessed using the McGill Pain Questionnaire.

Results

Following hypertonic saline injection into both the subacromial space and supraspinatus: pain was most commonly reported in the deltoid region and did not extend beyond the elbow; the most common response to clinical tests which provoke shoulder pain was a decrease in pain; and the highest rating of pain quality was in the sensory domain with very few responses in the affective domain.

Conclusions

Experimental shoulder pain induced by injection of hypertonic saline into either the subacromial space or supraspinatus produced a pain distribution similar to that observed in clinical shoulder pain, but neither experimental pain protocol could reproduce the increases in pain intensity following shoulder provocation tests or the emotional distress commonly observed in people with clinical shoulder pain.

Implications

Pain induced by local shoulder nociception produced by hypertonic saline injection into shoulder structures has significant limitations as a model of clinical shoulder pain. While it is perhaps unsurprising that short duration, chemically-induced experimental pain does not replicate the quality of the clinical experience of shoulder pain, the validity of experimental shoulder pain models which produce the opposite response to provocation testing to clinical shoulder pain must be questioned.

Balance impairment in pediatric charcot-marie-tooth disease

INTRODUCTION

Balance impairment contributes to gait dysfunction, falls, and reduced quality of life in adults with Charcot-Marie-Tooth disease (CMT) but has been minimally examined in pediatric CMT.

METHODS

The CMT Pediatric Scale (CMTPedS) was administered to 520 children with CMT. Associations between balance function (Bruininks-Oseretsky Test of Motor Proficiency [BOT-2]) and sensorimotor and gait impairments were investigated.

RESULTS

Daily trips/falls were reported by 42.3% of participants. Balance (BOT-2) varied by CMT subtype, was impaired in 42% of 4-year-olds, and declined with age (P < 0.001). Vibration (P < 0.001), pinprick (P < 0.004), ankle dorsiflexion strength (P < 0.001), and foot alignment (P < 0.004) were associated with BOT-2 balance (adjusted R² = 0.28). The visual dependence of balance increased with age.

DISCUSSION

Balance impairment occurs from a young age in children with CMT. Balance intervention studies are required in pediatric CMT and should consider the degree of sensorimotor impairment, foot malalignment, and visual dependence. Muscle Nerve, 2019.

Acute Effect of Kettlebell Swings on Sprint Performance

Previous research has shown that kettlebell swings (KBS), utilizing the hip-hinge technique, exhibit similar lower-limb muscle activation patterns to sprint running. This study investigated whether the inclusion of KBS in the warm-up enhances sprint performance. Moderately trained males (n = 12) and females (n = 8) performed KBS and a control (CON) condition (passive rest) in random order before performing three 20-m sprint trials separated by 4 minutes. No condition (KBS versus CON) effects, time effects or condition by time interactions were found for sprint times at 5-m and 10-m. A significant time effect was found for sprint time at 20-m with faster sprint time at 12 minutes compared to 4 minutes (p = 0.022). No condition effect or condition by time interaction was found for sprint time at 20-m. Small to moderate correlations were found for change in sprint time (CON minus KBS) and KBS load at 4, 8, and 12 minutes. It appears the KBS is not effective for potentiating 20-m sprint performance; however, any potential benefit from the inclusion of KBS as a preconditioning exercise for sprinting may be influenced by individual strength capabilities with KBS.

Energetic Demands of Interchange and Full-Match Rugby League Players

Cummins, CJ, Gray, AJ, Shorter, KA, Halaki, M, and Orr, R. Energetic demands of interchange and full-match rugby league players. J Strength Cond Res 32(12): 3456-3464, 2018-The purpose of this study was to describe and compare the metabolic demands of rugby league for interchange and full-match players in relation to positional groups. Eighteen elite rugby league players were recruited. A time-motion model was used to estimate the energy expenditure and metabolic demands of rugby league match-play using Global Positioning System (GPS) technology. This approach uses players' GPS velocity-time curves to examine running velocity. Players were categorized into positional groups (outside backs, adjustables, wide-running, and hit-up forwards) and then further categorized into full-match or interchange players. Compared with their full-match counterparts, interchange wide-running forwards expended greater energy (43.1 ± 6.1 vs. 28.6 ± 7.5 kJ·kg, p ≤ 0.001, effect size [ES] = -2.38) and produced a higher anaerobic index (p = 0.016, ES = 0.56) and mean power (7.4%, p = 0.003, ES = 0.66) per match. Full-match adjustables expended 94.8% more energy (p ≤ 0.001, ES = -2.3) and performed more moderate accelerations (10.1%, p = 0.014, ES = -0.57) and decelerations (7.6%, p = 0.017, ES = -0.8), than their interchange counterparts. Outside backs did not interchange and hit-up forwards rarely (n = 2) played an entire match. Differing metabolic demands were identified for interchange and full-match players across positional groups, suggesting position-specific conditioning drills are required to model the energetic demands of match-play.

Malaysian adaptation of the physical activity scale for individuals with physical disabilities in individuals with spinal cord injury

Purpose: The Physical Activity Scale for Individuals with Physical Disabilities questionnaire provides an assessment of physical activity after spinal cord injury. This study sought to adapt, with cultural competence, the English questionnaire and translate it into Bahasa Malaysia, including evaluation of content and face validity, internal consistency and test-retest reliability, and completion of a factor analysis in order to validate the Malaysian version.Materials and methods: A total of 250 participants completed the questionnaire that was distributed via email, postal mail, the internet, physically and by word of mouth. Sixty-eight respondents were re-contacted to complete the questionnaire again.Results: The adapted PASIPD demonstrated adequate internal consistency Cronbach's α = 0.68 and acceptable test-retest reliability, intraclass correlation = 0.87. Factor analysis extracted four main dimensions for physical activity; factor 1 (heavy housework, home repair, lawn work and gardening), factor 2 (sports and recreation), factor 3 (light housework and caring for another person) and factor 4 (leisure and occupational activities) that accounted for 64% of the physical activities' total variance.Conclusion: The Malaysian-adapted English and translated Bahasa Malaysia versions of the questionnaires intended to measure physical activity levels in individuals with spinal cord injury, demonstrated good to acceptable validity and reliability. However, some individual items revealed weak reliability measures. Further work is needed to validate the questionnaire's criterion validity against other physical activity measures.Implications for rehabilitationThe Malaysian adaptation of the Physical Activity Scale for Individuals with Physical Disabilities questionnaire provided preliminary support for its use since it has demonstrated adequate construct validity and reliability.The Malaysian adaptation of the Physical Activity Scale for Individuals with Physical Disabilities questionnaire can quantify the physical activity level of community-dwelling individuals with spinal cord injury, whilst deriving descriptive information on their physical activities.Deploying the Physical Activity Scale for Individuals with Physical Disabilities questionnaire to a spinal cord injury population in Malaysia may provide the first data on activities of daily living in an Asian developing country.

The impact of sleepwear fiber type on sleep quality under warm ambient conditions

BACKGROUND

Sleep disturbance in adults with no health concerns is often linked to the thermal environment. This study assesses the impact on sleep quality of sleepwear made from fibers with different thermal insulation and hygral properties. This randomized cross-over study investigated the effects on sleep quality of sleepwear made from cotton, polyester and Merino wool in adults aged 50-70 years, at an ambient temperature of 30 °C and a relative humidity of 50%.

METHODS

Thirty-six healthy participants completed four nights of sleep study with polysomnography. Participants were categorized by body mass index as <25 kg·m^-2 or ≥25 kg·m^-2, age as <65 years or ≥65 years, and by Pittsburgh Sleep Quality Index (PSQI) as poor sleepers (PSQI≥5) or good sleepers (PSQI<5).

RESULTS

Small, but statistically significant sleep benefits were observed for wool over cotton and polyester sleepwear for multiple sleep parameters, while neither cotton nor polyester was responsible for any statistically significant sleep benefit over the 11 sleep parameters examined. The key findings were: 1) A significant sleepwear effect was observed for sleep onset latency (SOL), p=0.04. 2) For older participants, sleeping in wool significantly reduced SOL (12.4 mins) compared with cotton (26.7 mins, p=0.001) or polyester (21.6 mins, p=0.001). 3) A statistically significant effect was found for sleep fragmentation index (p=0.01) in which wool sleepwear (12.1 no·h^{- 1}) was lower than polyester (13.7 no·h^{- 1}) (p=0.005), but not different to cotton (13.3 no·h^{- 1}). 4) Poor sleepers had less wakefulness when sleeping in wool compared to cotton (p=0.047). 5) And Poor sleepers had higher rapid eye movement sleep latency in polyester than in cotton (p=0.037) or in wool (p=0.036).

CONCLUSION

Statistically significant benefits for wool sleepwear were observed on average for all participants and, in particular, for the older and poorer sleepers. There were no significant differences in any sleep variables between sleepwear types for the BMI sub-group.

An Investigation of Compensation and Adaptation to Auditory Perturbations in Individuals With Acquired Apraxia of Speech

Two auditory perturbation experiments were used to investigate the integrity of neural circuits responsible for speech sensorimotor adaptation in acquired apraxia of speech (AOS). This has implications for understanding the nature of AOS as well as normal speech motor control. Two experiments were conducted. In Experiment 1, compensatory responses to unpredictable fundamental frequency (F0) perturbations during vocalization were investigated in healthy older adults and adults with acquired AOS plus aphasia. F0 perturbation involved upward and downward 100-cent shifts versus no shift, in equal proportion, during 2 s vocalizations of the vowel /a/. In Experiment 2, adaptive responses to sustained first formant (F1) perturbations during speech were investigated in healthy older adults, adults with AOS and adults with aphasia only (APH). The F1 protocol involved production of the vowel /ε/ in four consonant-vowel words of Australian English (pear, bear, care, dare), and one control word with a different vowel (paw). An unperturbed Baseline phase was followed by a gradual Ramp to a 30% upward F1 shift stimulating a compensatory response, a Hold phase where the perturbation was repeatedly presented with alternating blocks of masking trials to probe adaptation, and an End phase with masking trials only to measure persistence of any adaptation. AOS participants showed normal compensation to unexpected F0 perturbations, indicating that auditory feedback control of low-level, non-segmental parameters is intact. Furthermore, individuals with AOS displayed an adaptive response to sustained F1 perturbations, but age-matched controls and APH participants did not. These findings suggest that older healthy adults may have less plastic motor programs that resist modification based on sensory feedback, whereas individuals with AOS have less well-established and more malleable motor programs due to damage from stroke.

Magnetic resonance imaging of the anterior compartment of the lower leg is a biomarker for weakness, disability, and impaired gait in childhood Charcot-Marie-Tooth disease

INTRODUCTION

Biomarkers of disease severity in Charcot-Marie-Tooth disease (CMT) are required to evaluate early responses to treatment. In this study we used magnetic resonance imaging (MRI) to evaluate the relationship between muscle volume and intramuscular fat accumulation with weakness, disability, and impaired gait in affected children and adolescents.

METHODS

Fifty-five participants underwent MRI of the anterior compartment of the lower leg. Muscle and fat volumes were calculated. Strength was measured using hand-held dynamometry, disability using the CMT Pediatric Scale, and 3-dimensional gait analysis using an 8-camera Vicon Nexus motion capture system.

RESULTS

Lower muscle volume was significantly associated with reduced dorsiflexion strength, increased disability, impaired gait profile score, and foot drop. Intramuscular fat accumulation was associated with reduced dorsiflexion strength and impaired gait profile score.

DISCUSSION

The MRI protocol described was feasible, reliable, and sensitive to the magnitude of weakness, disability, and walking difficulties in children with CMT. Muscle Nerve 59:213-217, 2019.

Does muscle guarding play a role in range of motion loss in patients with frozen shoulder?

STUDY DESIGN

Observational: cross-sectional study.

BACKGROUND

Idiopathic frozen shoulder is a common cause of severe and prolonged disability characterised by spontaneous onset of pain with progressive shoulder movement restriction. Although spontaneous recovery can be expected the average length of symptoms is 30 months. Chronic inflammation and various patterns of fibrosis and contracture of capsuloligamentous structures around the glenohumeral joint are considered to be responsible for the signs and symptoms associated with frozen shoulder, however, the pathoanatomy of this debilitating condition is not fully understood.

OBJECTIVES

To investigate the feasibility of a muscle guarding component to movement restriction in patients with idiopathic frozen shoulder.

METHODS

Passive shoulder abduction and external rotation range of motion (ROM) were measured in patients scheduled for capsular release surgery for frozen shoulder before and after the administration of general anaesthesia.

RESULTS

Five patients with painful, global restriction of passive shoulder movement volunteered for this study. Passive abduction ROM increased following anaesthesia in all participants, with increases ranging from approximately 55°-110° of pre-anaesthetic ROM. Three of these participants also demonstrated substantial increases in passive external rotation ROM following anaesthesia ranging from approximately 15°-40° of pre-anaesthetic ROM.

CONCLUSION

This case series of five patients with frozen shoulder demonstrates that active muscle guarding, and not capsular contracture, may be a major contributing factor to movement restriction in some patients who exhibit the classical clinical features of idiopathic frozen shoulder. These findings highlight the need to reconsider our understanding of the pathoanatomy of frozen shoulder.

LEVEL OF EVIDENCE

Level 4.

The effects of multi-stage exercise with and without concurrent cognitive performance on cardiorespiratory and cerebral haemodynamic responses

INTRODUCTION

Studies of cerebral haemodynamics have shown changes with increased exercise intensity, but the patterns have been highly variable and reliable associations with cognitive performance have not been identified. The aim of this study was to examine whether exercise-induced changes in oxygenated haemoglobin (O₂Hb) led to changes in concomitant cognitive performance.

METHODS

This study examined cardiorespiratory and cerebral haemodynamics during multi-stage exercise from rest to exhaustion, with (Ex + C) and without (Ex) concurrent cognitive performance (Go/No-go task).

RESULTS

The presence of the cognitive task affected both cardiorespiratory and cerebral haemodynamics. The patterns in the cerebral haemodynamics during Ex and Ex + C diverged above the respiratory compensation threshold (RCT), but differences were significant only at 100% [Formula: see text], displaying increased deoxygenated haemoglobin (HHb), decreased difference between oxygenated and deoxygenated haemoglobin (HbDiff), and decreased cerebral oxygenation (COx) during Ex + C. More complex haemodynamic trends against intensity during Ex + C suggested that the presence of a cognitive task increases cerebral metabolic demand at high exercise intensities. The levels of O₂Hb, HHb, HbDiff and total haemoglobin increased most steeply at intensities around the RCT during both Ex and Ex + C, but these changes were not accompanied by improved cognitive performance.

CONCLUSION

The primary hypothesis, that cognitive performance would match changes in O₂Hb, was not supported. Small variations in reaction time and response accuracy across exercise intensities were not significant, suggesting that cognitive performance is unaffected by intense short-duration exercise. Our results add further evidence that exercise-induced changes in cerebral haemodynamics do not affect cognitive performance.