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Erdman A, Loewen A, Dressing M, Wyatt C, Oliver G, Butler L, Sugimoto D, Black AM, Tulchin-Francis K, Bazett-Jones DM, Janosky J, Ulman S. A 2D video-based assessment is associated with 3D biomechanical contributors to dynamic knee valgus in the coronal plane. Front Sports Act Living 2024; 6:1352286. [PMID: 38558858 PMCID: PMC10978775 DOI: 10.3389/fspor.2024.1352286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Adolescent athletes involved in sports that involve cutting and landing maneuvers have an increased risk of anterior cruciate ligament (ACL) tears, highlighting the importance of identifying risky movement patterns such as dynamic knee valgus (DKV). Qualitative movement screenings have explored two-dimensional (2D) scoring criteria for DKV, however, there remains limited data on the validity of these screening tools. Determining a 2D scoring criterion for DKV that closely aligns with three-dimensional (3D) biomechanical measures will allow for the identification of poor knee position in adolescent athletes on a broad scale. The purpose of this study was to establish a 2D scoring criterion that corresponds to 3D biomechanical measures of DKV. Methods A total of 41 adolescent female club volleyball athletes performed a three-task movement screen consisting of a single-leg squat (SLS), single-leg drop landing (SLDL), and double-leg vertical jump (DLVJ). A single rater scored 2D videos of each task using four criteria for poor knee position. A motion capture system was used to calculate 3D joint angles, including pelvic obliquity, hip adduction, knee abduction, ankle eversion, and foot progression angle. Receiver operating characteristic curves were created for each 2D scoring criterion to determine cut points for the presence of movement faults, and areas under the curve (AUC) were computed to describe the accuracy of each 2D criterion compared to 3D biomechanical data. Results 3D measures indicated knee abduction angles between 2.4°-4.6° (SD 4.1°-4.3°) at the time point when the center of the knee joint was most medial during the three tasks. AUCs were between 0.62 and 0.93 across scoring items. The MEDIAL scoring item, defined as the knee joint positioned inside the medial border of the shoe, demonstrated the greatest association to components of DKV, with AUCs ranging from 0.67 to 0.93. Conclusion The MEDIAL scoring criterion demonstrated the best performance in distinguishing components of DKV, specifically pelvic obliquity, hip adduction, ankle eversion, and foot progression. Along with the previously published scoring definitions for trunk-specific risk factors, the authors suggest that the MEDIAL criterion may be the most indicative of DKV, given an association with 3D biomechanical risk factors.
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Affiliation(s)
- Ashley Erdman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Alex Loewen
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Michael Dressing
- Department of Orthopedics, Joe DiMaggio Children’s Hospital, Hollywood, FL, United States
| | - Charles Wyatt
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gretchen Oliver
- Sports Medicine & Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Lauren Butler
- Department of Rehabilitation, Nicklaus Children’s Hospital, Miami, FL, United States
| | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Sports Medicine Division, The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
| | - Amanda M. Black
- Centre for Healthy Youth Development Through Sport, Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Kirsten Tulchin-Francis
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, United States
| | - David M. Bazett-Jones
- Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, The University of Toledo, Toledo, OH, United States
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, United States
| | - Sophia Ulman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Morris WZ, Loewen A, Ulman S, Johnson B, Sucato DJ, Podeszwa DA, Ellis HB. Comparison of Gait and Functional Outcomes Between Open and Arthroscopic Treatment of Adolescent and Young Adult Femoroacetabular Impingement. J Pediatr Orthop 2024; 44:22-27. [PMID: 37791636 DOI: 10.1097/bpo.0000000000002532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Management of femoroacetabular impingement (FAI) through an arthroscopic or surgical hip dislocation (SHD) approach has been shown to have similar clinical success and patient-reported outcomes. However, there are limited data comparing functional outcomes. The purpose of this study was to compare gait and functional outcomes of adolescent/young adult patients with FAI treated by either an arthroscopic or open SHD approach. METHODS We identified prospectively enrolled adolescent/young adult patients (≤20 years old) who underwent surgical treatment for FAI through an SHD or arthroscopic approach. Participants were evaluated in a movement science lab preoperatively and postoperatively (minimum 8 months postoperatively) with barefoot walking and a 30-second single-limb balance trial on the affected side. Participants also completed the Harris Hip Score at the same timepoints. Differences from preoperative to postoperative were determined using a paired-samples t test for each surgical technique, and differences between the SHD and arthroscopic groups were determined using an independent samples t test (α=0.05). RESULTS Fifty-five participants (42F, 16.2±1.4 y) were tested and grouped by surgical intervention. The SHD and arthroscopy groups consisted of 28 and 27 participants, respectively, with no significant difference between the SHD and arthroscopic cohorts in age (16.4±1.2 vs. 15.9±1.5 y, respectively, P =0.218) or sex distribution (78.6% vs. 74.1% females, respectively, P =0.75). Each group demonstrated significant postoperative improvement in Harris Hip Score (SHD: 64.8±16.4 to 81.8±17.8; arthroscopy: 57.0±16.7 to 84.7±19.7; preoperatively to postoperatively, respectively, both P <0.001). During gait, increased maximum hip flexion was observed following surgical intervention for the SHD group (32.3±5.7 vs. 36.1±5.2, P =0.003). No other clinically significant changes were detected in the SHD or arthroscopic groups preoperatively to postoperatively in trunk, pelvis, or hip kinematics in the coronal plane. During the balance task, neither cohort demonstrated markers of clinically significant abductor dysfunction. However, post operatively, the arthroscopy group was able to balance longer than the SHD group (18.8±7.8 vs. 14.2±2.7 s, respectively, P =0.008), although no differences were detected in trunk or pelvis position in the coronal plane during balance. CONCLUSIONS Both open SHD and arthroscopic treatment of FAI resulted in improved clinical outcomes with no clinically significant abductor dysfunction 1 year post operatively. However, further study is needed to determine whether more dynamic tasks can potentially elicit subtle differences between the groups. LEVELS OF EVIDENCE Level II-prospective study.
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Affiliation(s)
- William Z Morris
- Department of Orthopedics, Scottish Rite for Children, Dallas, TX
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Butler L, Martinez A, Erdman A, Sugimoto D, Loewen A, Milian E, Wyatt C, Hayden K, DeVerna A, Tulchin-Francis K, Ulman S. Concurrent Validity of The Expanded Cutting Alignment Scoring Tool (E-CAST). Int J Sports Phys Ther 2023; 18:1147-1155. [PMID: 37795331 PMCID: PMC10547067 DOI: 10.26603/001c.87633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023] Open
Abstract
Background The Expanded Cutting Alignment Scoring Tool (E-CAST) has been previously shown to be reliable when assessing lower extremity alignment during a 45-degree sidestep cut, however, the validity of this tool remains unknown. The purpose of this study was to assess the concurrent validity of the E-CAST by comparing visually identified movement errors from two-dimensional (2D) video with three-dimensional (3D) biomechanical variables collected using motion capture. Study Design Cross Sectional. Methods Sixty female athletes (age 14.1 ± 1.5 years) who regularly participated in cutting/pivoting sports performed a sidestep cut with 2D video and 3D motion capture simultaneously recording. One clinician scored the 2D videos for each limb using the E-CAST criteria. Joint angles and moments captured in 3D were computed for the trunk and knee. Receiver operating characteristic (ROC) curve analyses were performed to determine the accuracy of each E-CAST item and to provide cut-off points for risk factor identification. Results ROC analyses identified a cut-off point for all biomechanical variables with sensitivity and specificity ranging from 70-85% and 55-89%, respectively. Across items, the area under the curve ranged from 0.67 to 0.91. Conclusion The E-CAST performed with acceptable to outstanding area under the curve values for all variables except static knee valgus. Level of evidence 3b.
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Affiliation(s)
- Lauren Butler
- Physical Therapy Florida International University
- Rehabilitation, Nicklaus Children's Hospital
| | | | | | - Dai Sugimoto
- Waseda University
- The Micheli Center for Sports Injury Prevention
| | | | | | - Charles Wyatt
- Scottish Rite for Children
- University of Texas Southwestern Medical Center
| | | | | | | | - Sophia Ulman
- Scottish Rite for Children
- University of Texas Southwestern Medical Center
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Ekdahl M, Loewen A, Erdman A, Sahin S, Ulman S. Inertial Measurement Unit Sensor-to-Segment Calibration Comparison for Sport-Specific Motion Analysis. Sensors (Basel) 2023; 23:7987. [PMID: 37766040 PMCID: PMC10534374 DOI: 10.3390/s23187987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Wearable inertial measurement units (IMUs) can be utilized as an alternative to optical motion capture as a method of measuring joint angles. These sensors require functional calibration prior to data collection, known as sensor-to-segment calibration. This study aims to evaluate previously described sensor-to-segment calibration methods to measure joint angle range of motion (ROM) during highly dynamic sports-related movements. Seven calibration methods were selected to compare lower extremity ROM measured using IMUs to an optical motion capture system. The accuracy of ROM measurements for each calibration method varied across joints and sport-specific tasks, with absolute mean differences between IMU measurement and motion capture measurement ranging from <0.1° to 24.1°. Fewer significant differences were observed at the pelvis than at the hip, knee, or ankle across all tasks. For each task, one or more calibration movements demonstrated non-significant differences in ROM for at least nine out of the twelve ROM variables. These results suggest that IMUs may be a viable alternative to optical motion capture for sport-specific lower-extremity ROM measurement, although the sensor-to-segment calibration methods used should be selected based on the specific tasks and variables of interest for a given application.
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Affiliation(s)
- Mitchell Ekdahl
- Scottish Rite for Children, Frisco, TX 75034, USA; (A.L.); (A.E.); (S.S.); (S.U.)
| | - Alex Loewen
- Scottish Rite for Children, Frisco, TX 75034, USA; (A.L.); (A.E.); (S.S.); (S.U.)
| | - Ashley Erdman
- Scottish Rite for Children, Frisco, TX 75034, USA; (A.L.); (A.E.); (S.S.); (S.U.)
| | - Sarp Sahin
- Scottish Rite for Children, Frisco, TX 75034, USA; (A.L.); (A.E.); (S.S.); (S.U.)
| | - Sophia Ulman
- Scottish Rite for Children, Frisco, TX 75034, USA; (A.L.); (A.E.); (S.S.); (S.U.)
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Butler LS, Sugimoto D, Erdman A, Yoder J, Greiner K, Larroque C, Latz K, Loewen A, Wyatt CW, DeVerna A, Ulman S. Highly Active Middle School Athletes Demonstrate Poor Motor Skill Proficiency. Sports Health 2023:19417381231178822. [PMID: 37329118 DOI: 10.1177/19417381231178822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Fundamental movement skills (FMS) are critical components to lifelong participation in sports and physical activity. With the rise in early sports specialization, mastery of motor skills may be limited in youth athletes. The purpose of this study was to assess FMS proficiency in highly active middle school athletes and determine whether proficiency differed between specialization levels and sex. HYPOTHESIS (1) Most athletes would fail to achieve proficiency in all domains of the Test of Gross Motor Development (TGMD-2), (2) highly specialized athletes would demonstrate lower proficiency in all domains of the TGMD-2, and (3) male athletes would demonstrate higher proficiency than female athletes. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 4. METHODS A total of 91 athletes were recruited (44 male, 12.6 ± 0.9 years). Activity level was quantified using the Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (Pedi-FABS), specialization level was determined using the Jayanthi Specialization Scale, and the TGMD-2 was used to assess FMS proficiency. Descriptive statistics were used to describe gross motor, locomotor, and object control percentile rank. A 1-way analysis of variance (ANOVA) was used to assess differences in percentile rank between low, moderate, and high specialization groups and independent samples t tests were used to compare sexes (α < 0.05). RESULTS Mean Pedi-FABS score was 23.6 ± 4.9. In total, 24.2%, 38.5%, and 37.4% of athletes classified as low, moderate, and highly specialized, respectively. Mean percentile ranks were 56.2%, 64.7%, and 62.6% for locomotor, object control, and gross motor domains, respectively. No athlete achieved a percentile rank >99% in any domain of the TGMD-2, and there was no significant difference between specialization groups or sex. CONCLUSION Despite high activity levels, no athlete demonstrated proficiency in any domain of the TGMD-2, and there was no difference in proficiency between specialization levels or by sex. CLINICAL RELEVANCE Sport participation, regardless of level, does not ensure adequate mastery of FMS.
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Affiliation(s)
| | - Dai Sugimoto
- Waseda University, Tokyo, Japan; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | | | - Jason Yoder
- Children's Mercy Hospital, Kansas City, Missouri
| | | | | | - Kevin Latz
- Children's Mercy Hospital, Kansas City, Missouri
| | | | - Charles W Wyatt
- Scottish Rite Hospital, Dallas, Texas, and University of Texas Southwestern, Dallas, Texas
| | | | - Sophia Ulman
- Scottish Rite Hospital, Dallas, Texas, and University of Texas Southwestern, Dallas, Texas
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Butler L, Wyatt C, Martinez A, Erdman A, Milian E, Sugimoto D, Loewen A, Fernandez J, Hayden K, DeVerna A, Tulchin-Francis K, Ulman S. No Difference in Two-Dimensional Kinematic Assessment of a 45-Degree Sidestep Cut Compared to Qualitative Assessment. Int J Sports Phys Ther 2023; V18:587-595. [PMID: 37425108 PMCID: PMC10324343 DOI: 10.26603/001c.74366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Purpose The Expanded Cutting Alignment Scoring Tool (E-CAST) is a two-dimensional qualitative scoring system that has demonstrated moderate inter-rater and good intra-rater reliability for the assessment of trunk and lower extremity alignment during a 45-degree sidestep cut. The primary purpose of this study was to examine the reliability of the quantitative version of the E-CAST among physical therapists and to compare the reliability of the quantitative E-CAST to the original qualitative E-CAST. The hypothesis was that the quantitative version of the E-CAST would demonstrate greater inter-rater and intra-rater reliability compared to the qualitative E-CAST. Study Design Observational cohort, repeated measures reliability study. Methods Twenty-five healthy female athletes (age 13.8±1.4 years) performed three sidestep cuts with two-dimensional video capturing frontal and sagittal views. Two physical therapist raters independently scored a single trial using both views on two separate occasions. Based on the E-CAST criteria, select kinematic measurements were extracted using a motion analysis phone application. Intraclass correlation coefficients and 95% confident intervals were calculated for the total score, and kappa coefficients were calculated per kinematic variable. Correlations were converted to z-scores and compared to the six original criteria for significance (α<0.05). Results Cumulative intra- and inter-rater reliability were both good (ICC=0.821, 95% CI 0.687-0.898 and ICC=0.752, 95% CI 0.565-0.859). Cumulative intra-rater kappa coefficients ranged from moderate to almost perfect, and cumulative inter-rater kappa coefficients ranged from slight to good. No significant differences were observed between the quantitative and qualitative criteria for either inter- or intra-rater reliability (Zobs(intra)= -0.38, p=0.352 and Zobs(inter)= -0.30, p=0.382). Conclusion The quantitative E-CAST is a reliable tool to assess trunk and lower extremity alignment during a 45-degree sidestep cut. No significant differences were observed in reliability of the quantitative versus qualitative assessment. Level of evidence 3b.
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Affiliation(s)
| | - Charles Wyatt
- Scottish Rite Hospital
- University of Texas Southwestern
| | | | | | - Eryn Milian
- Faculty of Sport Sciences University of Miami
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Stevens W, Loewen A, Jeans K, Tulchin-Francis K, Ulman S. Advancing biomechanics laboratories capabilities: A proposed framework for in-house technology development. Clin Biomech (Bristol, Avon) 2023; 103:105908. [PMID: 36822064 DOI: 10.1016/j.clinbiomech.2023.105908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Technological advancements have generated more opportunities to develop/distribute custom data analysis codes (e.g., automated events, biomechanical models, etc.). Industry standards for the code development process is regularly modeled to ensure product quality and usability. Procedural project management improves efficiency of the code development process by monitoring project planning, duration, analysis, success, and maintenance. The purpose of this study was to outline in the form of guidance to research labs, a framework that standardizes the development, management, testing, and documentation of various types of data analysis codes, utilized in the motion analysis laboratory setting. METHODS This brief report outlines the workflow, briefly highlights its success a year after implementation, and provides a framework that can be adopted across laboratories of different sizes and those involved in multi-center collaborative studies. Specifically, the workflow outlined is initiated when a requestor has identified the need for a custom data analysis code. The workflow is complete and the code is released once the results of testing performed by a non-affiliated user, verifies that the code project workflow was followed appropriately, confirms a standard operating procedure has been finalized, and ensures the requestor and additional end-users are satisfied with the final product. FINDINGS Guidance documents and optimization of workflows are imperative for motion analysis laboratories managing numerous coding projects. INTERPRETATION Implementation of the proposed framework is an effective approach to reduce workload, by minimizing redundancies, maximizing on the research team's expertise and promotes collaborative input which in turn allows for feedback along the process.
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Affiliation(s)
| | - Alex Loewen
- Movement Science Lab, Scottish Rite for Children, TX, USA
| | - Kelly Jeans
- Movement Science Lab, Scottish Rite for Children, TX, USA
| | | | - Sophia Ulman
- Movement Science Lab, Scottish Rite for Children, TX, USA
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8
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Ulman S, Erdman AL, Loewen A, Õunpuu S, Chafetz R, Wren TAL, Tulchin-Francis K. Trunk and lower-extremity kinematics differ based on step-down tap variation: An assessment of methodology for a return-to-play protocol using motion analysis. Gait Posture 2022; 98:180-186. [PMID: 36155000 DOI: 10.1016/j.gaitpost.2022.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 08/22/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The step-down tap (SDT) is a commonly used task to assess unilateral neuromuscular control and to identify deficient movement patterns of the trunk and lower extremities. However, instruction of the SDT varies greatly in recent reports, which may alter the clinical interpretation of potential movement deficiencies. RESEARCH QUESTION The purpose of this study was to identify differences in trunk and lower extremity kinematics between variations of a step-down tap that differ based on step direction, fixing the arms or stance foot, and trial collection methods. METHODS This study followed a single-group repeated measures design in a laboratory setting. Three-dimensional angles of the trunk, hip, and knee of 18 participants were evaluated at 60 degrees of knee flexion and at maximum squat depth during six SDT variations. Wilcoxon signed rank tests were performed to determine the effects of an anterior verse lateral step direction, a fixed arm or stance foot position, and an individual verse continuous trial collection method. RESULTS Knee flexion, external pelvic rotation, and external trunk rotation were greater in the anterior SDT, while the lateral SDT elicited greater pelvic tilt and hip flexion. Additionally, overall squat depth was greater across participants during the anterior SDT. Few clinically significant differences (≥3°) were observed due to fixing arm or stance foot position, and no differences were identified based on trial collection methods. SIGNIFICANCE The standardization of task instructions for motion analysis protocols utilized for research purposes and/or clinical decision-making is crucial. Specifically, for the SDT, the authors recommend using the anterior step direction. A fixed arm and stance foot position is not necessary, and trials may be collected individually or continuously based on convenience for a small number of repetitions.
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Affiliation(s)
| | | | | | - Sylvia Õunpuu
- Connecticut Children's Medical Center, Farmington, CT, USA
| | - Ross Chafetz
- Shriners Hospitals for Children - Philadelphia, Philadelphia, PA, USA
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9
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Ulman S, Erdman AL, Loewen A, Worrall HM, Tulchin-Francis K, Jones JC, Chung JS, Ellis HB, Cullum CM, Miller SM. Improvement in balance from diagnosis to return-to-play initiation following a sport-related concussion: BESS scores vs center-of-pressure measures. Brain Inj 2022; 36:921-930. [PMID: 35957571 DOI: 10.1080/02699052.2022.2109736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Accurate assessment of balance recovery throughout treatment of a sport-related concussion is imperative. This study examined differences in balance from diagnosis to return-to-play initiation in adolescent patients post-concussion. Second, this study investigated the extent to which the Balance Error Scoring System (BESS) correlated with center-of-pressure (COP) measures. METHODS Forty participants performed the BESS while standing on a force platform such that COP data were obtained simultaneously. Spatial and velocity COP-based measures were computed for the double-stance conditions. RESULTS BESS scores and COP-based measures indicated improved balance performance between visits. Specifically, 62.5/65.0% of participants exhibited improved firm/foam BESS final scores, respectively, and 56.4-71.8% exhibited improved COP-based measures. However, once normative ranges were referenced to identify maintained performance, the percentage of participants who substantially improved differed from initial findings (BESS: 2.5/7.5%, COP: 48.7-69.2%). Additionally, positive correlations between balance measures were primarily found at diagnosis (r=0.33-0.53), while only three correlations were maintained at return-to-play initiation (r=0.34-0.39). CONCLUSIONS BESS scores successfully identified poor balance performance at diagnosis when symptoms were most pronounced, but failed to accurately depict performance once balance impairment, indicated by COP-based measures, became less apparent. Further work is needed to implement more advanced balance assessments into clinical environments.
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Affiliation(s)
- Sophia Ulman
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley L Erdman
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA
| | - Alex Loewen
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA
| | - Hannah M Worrall
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA
| | - Kirsten Tulchin-Francis
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jacob C Jones
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jane S Chung
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Munro Cullum
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shane M Miller
- Scottish Rite for Children, Division Director of Movement Science Lab, Frisco, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
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10
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Ulman S, Erdman A, Loewen A, Dressing M, Wyatt C, Oliver G, Butler L, Sugimoto D, Black AM, Janosky J. Concurrent Validity of Movement Screening Criteria Designed to Identify Injury Risk Factors in Adolescent Female Volleyball Players. Front Sports Act Living 2022; 4:915230. [PMID: 35813049 PMCID: PMC9263117 DOI: 10.3389/fspor.2022.915230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Anterior cruciate ligament (ACL) injuries in female adolescent athletes occur at disproportionately high levels compared to their male counterparts. However, limited prospective data exist on the validity of low-cost screening tools that can proactively identify ACL injury risk, specifically for female athletes. The purpose of this study was to assess the concurrent validity of a three-task injury risk factor assessment by comparing visually derived outcome scores from two-dimensional (2D) video data with dichotomized three-dimensional (3D) biomechanical variables collected using motion capture technology. A total of 41 female club volleyball athletes (14.7 ± 1.4 years) were tested and asked to perform three tasks: double-leg vertical jump (DLVJ), single-leg squat (SLS), and single-leg drop landing (SLDL). One rater was trained on the scoring criteria for the 2D data and independently scored one forward-facing and one side-facing video for each task. Risk factors identified included poor knee position, lateral trunk lean, and excessive trunk flexion/extension. In addition, 3D joint angles were calculated for the trunk and knee in the sagittal and frontal planes and converted to dichotomous variables based on biomechanical thresholds of injury risk. For comparison of 2D and 3D outcomes, percent agreement and Cohen's kappa were calculated for each risk factor individually. Overall, 2D scores were found to exhibit moderate to excellent percent agreement with 3D outcomes for trunk position (69.1–97.1%). Specifically, ipsilateral trunk lean during single-leg tasks exhibited the highest agreement (85.3–88.2%) with moderate reliability (κ = 0.452–0.465). In addition, moderate to substantial reliability was found for trunk flexion during double-leg tasks (κ = 0.521–0.653); however, an evaluation of single-leg tasks resulted in only fair reliability (κ = 0.354). Furthermore, 2D scores were not successful in identifying poor knee position as percent agreement fell below 50% for both the single-leg tasks and averaged 60% agreement across both the phases of the DLVJ. Kappa coefficients further emphasized these trends indicating no to slight concurrent validity (κ = −0.047–0.167) across tasks. Overall, these findings emphasize the potential for valid, low-cost screening tools that can identify high-risk movement patterns. Further study is needed to develop improved assessment guidelines that may be employed through visual assessment in sports environments.
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Affiliation(s)
- Sophia Ulman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
- *Correspondence: Sophia Ulman
| | - Ashley Erdman
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Alex Loewen
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
| | - Michael Dressing
- Department of Orthopedics, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Charles Wyatt
- Movement Science Lab, Division of Sports Medicine, Scottish Rite for Children, Frisco, TX, United States
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Gretchen Oliver
- Sports Medicine and Movement Laboratory, School of Kinesiology, Auburn University, Auburn, AL, United States
| | - Lauren Butler
- Department of Rehabilitation, Nicklaus Children's Hospital, Miami, FL, United States
| | - Dai Sugimoto
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, United States
| | - Amanda M. Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Joseph Janosky
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, United States
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Butler LS, Martinez AR, Sugimoto D, Wyatt CW, Milian EK, Ulman S, Erdman A, Loewen A, Hayden K, DeVerna A, Tulchin-Francis K, Research Interest Group PRIP. Reliability of the Expanded Cutting Alignment Scoring Tool (E-CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut. Int J Sports Phys Ther 2022; 17:456-465. [PMID: 35391867 PMCID: PMC8975584 DOI: 10.26603/001c.33045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/23/2022] [Indexed: 12/05/2022] Open
Abstract
Background Current clinical screening tools assessing risky movements during cutting maneuvers do not adequately address sagittal plane foot and ankle evaluations. The Cutting Alignment Scoring Tool (CAST) is reliable in evaluating frontal plane trunk and lower extremity alignment during a 45-degree side-step cut. The Expanded Cutting Alignment Scoring Tool (E-CAST) includes two new sagittal plane variables, knee flexion and ankle plantarflexion angle. Hypothesis/Purpose To assess the inter-and intra-rater reliability of the E-CAST to evaluate trunk and lower extremity alignment during a 45-degree side-step cut. Study Design Repeated Measures. Methods Participants included 25 healthy females (13.8 ± 1.4 years) regularly participating in cutting or pivoting sports. Participants were recorded performing a side-step cut in frontal and sagittal planes. One trial was randomly selected for analysis. Two physical therapists independently scored each video using the E-CAST on two separate occasions, with randomization and a two-week wash-out between rounds. Observed movement variables were awarded a score of "1", with higher scores representing poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the total score, and a kappa coefficient (k) was calculated for each variable. Results The cumulative intra-rater reliability was good (ICC=0.78, 95% CI 0.59-0.96) and the cumulative inter-rater reliability was moderate (ICC=0.71, 95% CI 0.50-0.91). Intra-rater kappa coefficients ranged from moderate to excellent for all variables (k= 0.50-0.84) and inter-rater kappa coefficients ranged from slight to excellent for all variables (k=0.20-0.90). Conclusion The addition of two sagittal plane variables resulted in lower inter-rater ICC compared to the CAST (ICC= 0.81, 95% CI 0.64-0.91). The E-CAST is a reliable tool to evaluate trunk and LE alignment during a 45-degree side-step cut, with good intra-rater and moderate inter-rater reliability. Level of Evidence Level 2, Diagnosis.
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Affiliation(s)
| | | | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Faculty of Sport Sciences, Waseda University, Tokyo, Japan
| | - Charles W Wyatt
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | | | | | | | - PRiSM Injury Prevention Research Interest Group
- Nicklaus Children's Hospital, Miami, FL, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Faculty of Sport Sciences, Waseda University, Tokyo, Japan
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
- University of Miami, Miami, FL, USA
- Scottish Rite for Children, Dallas, TX, USA
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Ocay DD, Loewen A, Premachandran S, Ingelmo PM, Saran N, Ouellet JA, Ferland CE. Psychosocial and psychophysical assessment in pediatric patients and young adults with chronic back pain: a cluster analysis. Eur J Pain 2022; 26:855-872. [PMID: 35090183 PMCID: PMC9304192 DOI: 10.1002/ejp.1912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Identifying subgroups with different clinical profiles may inform tailored management and improve outcomes. The objective of this study was to identify psychosocial and psychophysical profiles of children and adolescents with chronic back pain. Methods One hundred and ninety‐eight patients with chronic back pain were recruited for the study. Pain assessment was mainly conducted in the form of an interview and with the use of validated pain‐related questionnaires assessing their psychosocial factors and disability. All patients underwent mechanical and thermal quantitative sensory tests assessing detection and pain thresholds, and conditioned pain modulation efficacy. Results Hierarchal clustering partitioned our patients into three clusters accounting for 34.73% of the total variation of the data. The adaptive cluster represented 45.5% of the patients and was characterized to display high thermal and pressure pain thresholds. The high somatic symptoms cluster, representing 19.2% of patients, was characterized to use more sensory, affective, evaluative and temporal descriptors of pain, more likely to report their pain as neuropathic of nature, report a more functional disability, report symptoms of anxiety and depression and report poor sleep quality. The pain‐sensitive cluster, representing 35.4% of the cohort, displayed deep tissue sensitivity and thermal hyperalgesia. Conclusions This study identified clinical profiles of children and adolescents experiencing chronic back pain based on specific psychophysical and psychosocial characteristics highlighting that chronic pain treatment should address underlying nociceptive and non‐nociceptive mechanisms. Significance To our current knowledge, this study is the first to conduct cluster analysis with youth experiencing chronic back pain and displays clinical profiles based on specific physical and psychosocial characteristics. This study highlights that in a clinical context, chronic pain assessment should include multiple elements contributing to pain which can be assessed in a clinical context and addressed when pathoanatomical symptoms are unidentifiable.
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Affiliation(s)
- D D Ocay
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada
| | - A Loewen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - S Premachandran
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada
| | - P M Ingelmo
- Chronic Pain Services, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - N Saran
- Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - J A Ouellet
- Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - C E Ferland
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
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Schmidt T, Kronborg M, Huo Y, Sitzy J, Richter U, Loewen A, Piorkowski C, Gaspar T. P823Effect of cardiac resynchronization therapy in RV-stimulation-induced cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Schmidt
- Dresden University of Technology, Heart Center, Dept. of Electrophysiology, Heart Center, Dresden, Germany
| | - M Kronborg
- Aarhus University Hospital, Dept. of Cardiology, Aarhus, Denmark
| | - Y Huo
- Dresden University of Technology, Heart Center, Dept. of Electrophysiology, Heart Center, Dresden, Germany
| | - J Sitzy
- Dresden University of Technology, Heart Center, Dept. of Electrophysiology, Heart Center, Dresden, Germany
| | - U Richter
- Dresden University of Technology, Heart Center, Dept. of Electrophysiology, Heart Center, Dresden, Germany
| | - A Loewen
- Steinbeis Research Institute “Electrophysiology and Cardiac Devices”, Dresden, Germany
| | - C Piorkowski
- Dresden University of Technology, Heart Center, Dept. of Electrophysiology, Heart Center, Dresden, Germany
| | - T Gaspar
- Dresden University of Technology, Heart Center, Dept. of Electrophysiology, Heart Center, Dresden, Germany
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Loewen A, Kossel KM, Gesché V, Gries T, Jockenhoevel S. Combining material and structural elasticity – An approach to enhanced compliance of small-calibre vascular grafts. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1757-899x/254/6/062007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Loewen A. A dog's life. Can Fam Physician 2001; 47:2215-6. [PMID: 11768916 PMCID: PMC2018465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Loewen A. You should get over to see that exhibit. Can Fam Physician 2000; 46:1969-72. [PMID: 11072576 PMCID: PMC2145091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Nelson D, Azari M, Brown R, Burhop K, Bush S, Catarello J, Chuang H, Downing C, Estep T, Loewen A. Preparation and characterization of diaspirin cross-linked hemoglobin solutions for preclinical studies. Biomater Artif Cells Immobilization Biotechnol 1992; 20:423-7. [PMID: 1391458 DOI: 10.3109/10731199209119662] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
During 1990 and 1991 the capability for repetitive, consecutive production of DCLHb solution to meet a rigorous and complete set of product criteria was demonstrated. In addition, through periodic monitoring of product stored under controlled conditions, the stability of all lots of DCLHb solution during frozen storage was demonstrated for more than a year. In this way, assurance was provided that the DCLHb solution used in preclinical testing met all product criteria throughout the biological testing period.
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Affiliation(s)
- D Nelson
- Blood Substitutes Program, Baxter Healthcare Corporation, Los Angeles, CA
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Abstract
Contagious ecthyma (CE) is reported in bighorn sheep (Ovis c. canadensis) from several national parks in western Canada and in moutain goat (Oreamnos americanus) from Kootenay National Park, British Columbia. (This is the first report of CE in mountain goat.) Diagnosis was based on clinical signs, histopathology, transmission experiments and the demonstration of a proxvirus with the electron microscope. The infection was transmitted from wild to domestic goat, but not to domestic sheep. Most infections, some of them severe, were found in lambs and kids. Clinical signs of disease were similar to those seen in domestic sheep and goats. General body condition was poor and animals had difficulty feeding normally. All infected herds had prolonged contact with areas where salt was provided artificially (i.e., salt blocks, highways and campgrounds). Fewer infected sheep were observed annually when salt blocks were removed from Jasper National Park.
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