Intramuscular Oxygenation and Muscle Activity of Extensor Carpi Radialis Brevis During Piano Performance: An Observational Study

BACKGROUND

Repetitive piano movements have been associated with playing-related musculoskeletal disorders (PRMDs) such as forearm myalgia and symptoms of lateral epicondylopathy. Despite the high prevalence of PRMDs among pianists, there is poor understanding regarding the underlying physiological mechanisms. Intramuscular oxygenation may play a role in the development of PRMDs. Therefore, this observational study aimed to explore the effect variability of playing piano repertoire on the oxygenation of the extensor carpi radialis brevis (ECRB).

METHODS

Surface electromyography (EMG) activity and intramuscular oxygenation data (using near-infrared spectroscopy, NIRS) of the left and right ECRB were recorded in 13 conservatory piano students (8 female, 5 male, mean age 23.54 ± 3.24 years) while playing piano repertoire (virtuoso piece or études) for 20 minutes. From the oxygenation data, relative changes (in the percentage of the baseline measurements at rest) were calculated.

RESULTS

For all participants, the oxygenated hemoglobin of the left ECRB over the piano play presented an averaged decline to the baseline resting value, with a sample mean for left ECRB of -7.48% and -11.88% for the right ECRB, ranging from -15.53% to -2.00% and -19.12% to -3.93%, respectively. The deoxygenated hemoglobin ranged in the left ECRB from -5.39% to 39.14% and from -9.37% to 54.01% in the right ECRB. The change in total hemoglobin ranged from -5.35% to 16.80% for the left ECRB and -12.10% to 10.37% for the right ECRB. EMG activity (in % maximal voluntary contraction) presented a mean of 16.85% (range 11.86 to 24.43) for the left ECRB and 23.65% (range 14.46 to 37.91) for the right ECRB. This pilot study presented a Pearson's r between the averaged oxygenated hemoglobin and EMG of -0.60 for the right ECRB and -0.48 for the left ECRB.

CONCLUSION

Piano performance induced an average decline in oxygenated hemoglobin in the left and right ECRB, which differed largely between the specific pieces played. The EMG activity can partially explain these differences. Further research is needed to explore the impact of a 'dynamic index' reflecting the piece's dynamic characteristics and the individual oxygenation characteristics.

Krafttraining bei Frauen mit generalisierter Hypermobilität: Machbarkeit, Beschwerden und Effekte

Hintergrund Eine generalisierte Hypermobilität liegt vor, wenn die Beweglichkeit in mehreren Gelenken das übliche Maß übersteigt. Bis zu 30 % der Frauen und 10 % der Männer sind davon betroffen. Hypermobilität ist keine Pathologie, wenn sie jedoch mit Schmerzen und weiteren Symptomen einhergeht, kann sie die Gesundheit und Alltagsfunktionen beeinträchtigen. Zur physiotherapeutischen Behandlung gibt es wenige Studien, wobei Krafttraining eine mögliche Intervention sein könnte.

Ziel Erfassung der Machbarkeit und des Effekts eines Krafttrainings für Frauen mit generalisierter Hypermobilität.

Methode Pre-post-Studie, in der hypermobile Frauen (Beighton-Score > 5) zwischen 20 und 40 Jahren während 12 Wochen ein Krafttraining an Geräten, fokussiert auf Beine und Rücken, absolvierten. Mithilfe eines Protokolls und wöchentlicher Fragebogen wurden das Training und dadurch ausgelöste Beschwerden analysiert. Vor und nach dem Training wurde die Kraft der Knieflexoren und -extensoren sowie der Muskelquerschnitt am Oberschenkel gemessen. Die Analyse erfolgte primär deskriptiv, zusätzlich erfolgte ein Vergleich von 2 Subgruppen mittels Mann-Whitney-U und Chi2-Test.

Ergebnisse 46 Teilnehmerinnen (26,3 ± 4,3 Jahre) absolvierten das Training. 6 davon brachen die Studie vorzeitig ab, davon eine wegen Rückenschmerzen aufgrund einer Diskushernie. 72,5 % der verbleibenden 40 Teilnehmerinnen absolvierten 20 oder mehr Trainings. In 34 % der Trainingswochen wurden geringe Beschwerden angegeben, mehrheitlich an Knie und Rücken. Der Einsatz der verwendeten Gewichte war oft tief, so wurde auf der Legpress mit durchschnittlich 44,8 % des Körpergewichts begonnen, nach 12 Wochen lag das Trainingsgewicht im Mittel bei 52,2 kg, was 85,7 % des Körpergewichts entspricht. Bei der Kraft und beim Muskelquerschnitt wurden keine signifikanten Verbesserungen erreicht, wobei bis zu 17 Teilnehmerinnen (42,5 %) eine Verbesserung von mehr als 10 % erreichten.

Schlussfolgerung Das Krafttraining war für die meisten Teilnehmerinnen machbar und gut verträglich. Das mehrheitlich selbstgesteuerte Training war zu wenig intensiv, um eindeutige Auswirkungen auf Kraft oder Muskelmasse zu erreichen, obwohl einzelne Teilnehmerinnen durchaus davon profitierten. In weiteren Studien sollten individuellere und enger begleitete Trainingsprogramme untersucht werden.

Continuous relative phases of walking with an articulated passive ankle-foot prosthesis in individuals with a unilateral transfemoral and transtibial amputation: an explorative case-control study

BACKGROUND

A mechanical ankle-foot prosthesis (Talaris Demonstrator) was developed to improve prosthetic gait in people with a lower-limb amputation. This study aims to evaluate the Talaris Demonstrator (TD) during level walking by mapping coordination patterns based on the sagittal continuous relative phase (CRP).

METHODS

Individuals with a unilateral transtibial amputation, transfemoral amputation and able-bodied individuals completed 6 minutes of treadmill walking in consecutive blocks of 2 minutes at self-selected (SS) speed, 75% SS speed and 125% SS speed. Lower extremity kinematics were captured and hip-knee and knee-ankle CRPs were calculated. Statistical non-parametric mapping was applied and statistical significance was set at 0.05.

RESULTS

The hip-knee CRP at 75% SS walking speed with the TD was larger in the amputated limb of participants with a transfemoral amputation compared to able-bodied individuals at the beginning and end of the gait cycle (p = 0.009). In people with a transtibial amputation, the knee-ankle CRP at SS and 125% SS walking speeds with the TD were smaller in the amputated limb at the beginning of the gait cycle compared to able-bodied individuals (p = 0.014 and p = 0.014, respectively). Additionally, no significant differences were found between both prostheses. However, visual interpretation indicates a potential advantage of the TD over the individual's current prosthesis.

CONCLUSION

This study provides lower-limb coordination patterns in people with a lower-limb amputation and reveals a possible beneficial effect of the TD over the individuals' current prosthesis. Future research should include a well-sampled investigation of the adaptation process combined with the prolonged effects of the TD.

Effects of Rehearsal Time and Repertoire Speed on Upper Trapezius Activity in Conservatory Piano Students

BACKGROUND

Repetitive piano play may overload neck and shoulder muscles and tendons, leading to playing-related musculoskeletal disorders (PRMDs).

METHODS

In this pilot study (EMG data of the extensor carpi radialis have been published separately), surface electromyography (sEMG) activity of the upper trapezius (UT) was captured in 10 conservatory piano students while playing a fast and a slow music score selected from the individual's repertoire, each 3 minutes long. Measurements were made at baseline and again after 2 hrs and 4 hrs of rehearsal time of the piano études. The amplitude of the sEMG signal was processed by a smoothing algorithm, and the frequency component with a non-orthogonal wavelets procedure. Amplitude of the sEMG was expressed in percent of maximal voluntary contraction (%MVC) at baseline, and the frequency component using median frequency based on the frequency band powers. Statistical analysis encompassed repeated measures ANOVAs for the amplitude and frequency components of the sEMG signal (set at 5%). The students also rated the intensity of rehearsals using a visual analog scale (VAS).

RESULTS

The median values for the %MVC presented a global mean for the left trapezius of 5.86 (CI90% 4.71, 6.97) and 5.83 for the right trapezius (CI90% 4.64, 7.05). The rehearsals at moderate intensity increased the amplitude of %MVC of the upper trapezius by around 50% and decreased the median frequency.

CONCLUSIONS

Playing faster presented higher magnitudes of activity of the upper trapezius. The decrease in the median frequency in response to long rehearsals may be a sign of muscle fatigue.

Correlation of muscle and bone parameters, daily function and participation in women with generalized joint hypermobility: a descriptive evaluation

OBJECTIVES

Generalized joint hypermobility (GJH) has a prevalence in women of 15% to 35%. GJH may lead to impaired movement control, frequent sprains or subluxations and pain, and can be associated with early osteoarthritis or chronic fatigue. Aim of this project was to analyse muscle strength, muscle cross-sectional area (mCSA) and daily function in women with GJH and to analyse correlations between these measurements.

METHODS

Descriptive cross-sectional study of women with GJH, defined by Beighton score ≥6/9. Assessments included muscle strength, mCSA by peripheral Quantitative Computed Tomography (pQCT), stair climbing, as well as two questionnaires. Spearman's correlations between parameters were calculated.

RESULTS

51 women with a mean age of 26.5 years participated, whereof 18 (35%) had a Beighton score of 9/9 and 17 (33%) attained 8/9. Internal correlations between strength measurements were high, whereas pQCT parameters were less correlated. Strength was moderately correlated with mCSA, while correlations with stair climbing and SF-36 were not significant.

CONCLUSIONS

This study provides insight into the muscle and bone properties of women with GJH. Only slight differences were seen compared to normative values. Correlations between various dimensions were middle or low, indicating the complex relationship between strength, muscle properties and function.

Do Sex and Pain Characteristics Influence the Effectiveness of Pain Neuroscience Education in People Scheduled for Total Knee Arthroplasty? Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

This explorative study investigates the moderating effect of sex and baseline pain characteristics on the effectiveness of preoperative pain neuroscience education (PNE) plus knee joint mobilization versus biomedical education plus knee joint mobilization in patients who have knee osteoarthritis and are scheduled to undergo total knee arthroplasty (TKA).

METHODS

After baseline assessment of self-reported questionnaires (pain intensity, disability, symptoms of central sensitization and pain cognitions) and quantitative sensory testing, 44 participants with knee osteoarthritis were randomized into the PNE plus knee joint mobilization or biomedical education plus knee joint mobilization group. The questionnaires were retaken directly after and 1 month after 4 sessions of treatment and at 3 months after surgery. Based on baseline quantitative sensory testing results, the sample was subdivided into a high (showing high experimental pain levels and low pressure pain thresholds) and low pain cluster using principal components analysis and cluster analysis. Therapy effects over time were evaluated using 3-way analysis of variance, with time as the within factor and treatment, sex, and baseline pain cluster as between factors.

RESULTS

Women benefited significantly more from the PNE intervention compared with the control intervention in terms of self-reported symptoms of central sensitization. For both pain clusters, differences in therapeutic effects concerning pain intensity and pain cognitions were found, with higher superiority of the PNE intervention in the high-pain cluster subgroup compared with the low-pain cluster.

CONCLUSION

Based on these explorative analyses, it can be concluded that sex and preoperative pain measures may influence the effectiveness of preoperative PNE for some specific outcome measures in people scheduled to undergo TKA.

IMPACT

Although further research on this topic is needed, the potential influence of sex and preoperative pain measures on the effectiveness of preoperative PNE should be considered when implementing this intervention in people undergoing TKA.

An Exploratory Meta-Analytic Review on the Empirical Evidence of Differential Learning as an Enhanced Motor Learning Method

Background: Differential learning (DL) is a motor learning method characterized by high amounts of variability during practice and is claimed to provide the learner with a higher learning rate than other methods. However, some controversy surrounds DL theory, and to date, no overview exists that compares the effects of DL to other motor learning methods.

Objective: To evaluate the effectiveness of DL in comparison to other motor learning methods in the acquisition and retention phase.

Design: Systematic review and exploratory meta-analysis.

Methods: PubMed (MEDLINE), Web of Science, and Google Scholar were searched until February 3, 2020. To be included, (1) studies had to be experiments where the DL group was compared to a control group engaged in a different motor learning method (lack of practice was not eligible), (2) studies had to describe the effects on one or more measures of performance in a skill or movement task, and (3) the study report had to be published as a full paper in a journal or as a book chapter.

Results: Twenty-seven studies encompassing 31 experiments were included. Overall heterogeneity for the acquisition phase (post-pre; I² = 77%) as well as for the retention phase (retention-pre; I² = 79%) was large, and risk of bias was high. The meta-analysis showed an overall small effect size of 0.26 [0.10, 0.42] in the acquisition phase for participants in the DL group compared to other motor learning methods. In the retention phase, an overall medium effect size of 0.61 [0.30, 0.91] was observed for participants in the DL group compared to other motor learning methods.

Discussion/Conclusion: Given the large amount of heterogeneity, limited number of studies, low sample sizes, low statistical power, possible publication bias, and high risk of bias in general, inferences about the effectiveness of DL would be premature. Even though DL shows potential to result in greater average improvements between pre- and post/retention test compared to non-variability-based motor learning methods, more high-quality research is needed before issuing such a statement. For robust comparisons on the relative effectiveness of DL to different variability-based motor learning methods, scarce and inconclusive evidence was found.

Effect of resistance training on muscle properties and function in women with generalized joint hypermobility: a single-blind pragmatic randomized controlled trial

Background

Generalized joint hypermobility is defined as an excessive range of motion in several joints. Having joint hypermobility is not a pathology, but when associated with pain and other symptoms, it might affect health and function. Evidence for physiotherapy management is sparse and resistance training might be a possible intervention. Thus, the effects of 12-week resistance-training on muscle properties and function in women with generalized joint hypermobility were evaluated.

Methods

In this single-blind randomized controlled trial women between 20 and 40 years with generalized joint hypermobility (Beighton score at least 6/9) were included. Participants were randomly allocated to 12-week resistance training twice weekly (experimental) or no lifestyle change (control). Resistance training focused on leg and trunk muscles. Primary outcome was muscle strength; additional outcomes included muscle properties, like muscle mass and density, functional activities, pain and disability. Training adherence and adverse events were recorded.

Results

Of 51 participating women 27 were randomised to training and 24 into the control group. In each group 11 women had joint hypermobility syndrome, fulfilling the Brighton criteria, while 24 (89%) in the training group and 21 (88%) in the control group mentioned any pain. The mean strength of knee extensors varied in the training group from 0.63 (sd 0.16) N/bm before training to 0.64 (sd 0.17) N/bm after training and in the control group from 0.53 (sd 0.14) N/bm to 0.54 (sd 0.15) N/bm. For this and all other outcome measures, no significant differences between the groups due to the intervention were found, with many variables showing high standard deviations. Adherence to the training was good with 63% of participants performing more than 80% of sessions. One adverse event occurred during training, which was not clearly associated to the training. Four participants had to stop the training early.

Conclusions

No improvement in strength or muscle mass by self-guided resistance training was found. Low resistance levels, as well as the choice of outcome measures were possible reasons. A more individualized and better guided training might be important. However, program adherence was good with few side effects or problems triggered by the resistance training.

Trial registration

This trial was prospectively registered in the ISRCTN registry (www.isrctn.com, BMC, Springer Nature) on July 16, 2013 as ISRCTN90224545. The first participant was enrolled at October 25, 2013.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00238-8.

Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards

Background

Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce.

Methods

In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression.

Results

On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456, p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time.

Conclusions

Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-020-01898-w.

The effects of whole-body electromyostimulation (WB-EMS) in comparison to a multimodal treatment concept in patients with non-specific chronic back pain-A prospective clinical intervention study

Background

According to present guidelines, active exercise is one key component in the comprehensive treatment of nonspecific chronic back pain (NSCBP). Whole body electromyostimulation (WB-EMS) is a safe, and time-effective training method, that may be effective in NSCBP-patients.

Methods

In this prospective and controlled nonrandomized clinical study, two therapeutic approaches were compared. One group received 20 minutes WB-EMS per week. An active control group (ACG) received a multimodal therapy program. A third group included subjects without back pain. To all groups, the following measurement instruments were applied: Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), North American Spine Society Instrument (NASS); SF 36 survey and measurements for muscular function and postural stability. In the EMS-group: T0: baseline; T1: at 6 weeks; T2: at 12 weeks and T3: at 24 weeks. In the ACG: T0 baseline and T1 after 4 weeks.

Results

In the intervention group, 128 patients with low back pain were enrolled, 85 in the WB-EMS group and 43 in the ACG. 34 subjects were allocated to the passive control group. The average age was 58.6 years (18–86 years). In the EMS group, the NRS (1–10) improved statistically and clinically significantly by 2 points. The ODI was reduced by 19.7 points. The NASS and most of the SF 36 items improved significantly. In the multimodal treatment group, only the muscular function improved slightly.

Conclusion

Our data support the hypothesis that WB-EMS is at least as effective as a multimodal treatment, which is often referred to as being the golden standard. Therefore WB-EMS may be an effective and, with 20 min./week training time, very time-efficient alternative to established multimodal treatment models.

Whole body coordination patterning in volleyball spikes under various task constraints: exploratory cluster analysis based on self-organising maps

Task and environment-related constraints can influence spike performance in volleyball players. This study was designated to investigate the impact of awareness of the presence or absence of a defensive block by the opponents on the performance and coordination pattern of spikes in elite volleyball attackers. Simulating a real-game scenario, 10 elite youth attackers (aged 15.5 ± 0.7 years) executed six spikes each with prior notification about the presence/absence of defences and six spikes without any notification. In each condition, they were blocked by two opponents in three trials. The coordination patterning of the attackers was explored using cluster analysis based on a Self-Organising Map (SOM). The SOMs and the cluster analysis showed that the coordination pattern of the spike execution was very individual-specific; however, in the third layer of the cluster analysis, it was revealed that the movement pattern of spike execution had similarities in the scenario wherein the players had prior awareness of the defences. Providing the attackers with information on the opponents' condition or performance could shift the attackers' focus from a game-oriented condition to the rivals' behaviour, which consequently resulted in deterioration of their spike performance.

Effects of Rehearsal Time and Repertoire Speed on Extensor Carpi Radialis EMG in Conservatory Piano Students

BACKGROUND

Repetitive actions while playing piano may overload forearm muscles and tendons, leading to playing-related musculoskeletal disorders (PRMDs), including lateral epicondylitis.

METHODS

In this pilot study, surface electromyography (sEMG) activity of the extensor carpi radialis (ECR) was captured in 10 conservatory piano students while playing a fast and a slow music score selected from the individual's repertoire, each 3 minutes long. Measurements were made at baseline and again after 2 hrs and 4 hrs of rehearsal time of the piano études. The amplitude of the sEMG signal was processed by a smoothing algorithm, and the frequency component with a non-orthogonal wavelets procedure. Amplitude of the sEMG was expressed in percent of maximal voluntary contraction (%MVC) at baseline. Statistical analysis encompassed 2-way repeated measures ANOVAs for the amplitude and frequency components of the sEMG signal (a set at 5%). The students also rated the intensity of rehearsals using a VAS.

RESULTS

The ECR presented with a mean amplitude of 23%MVC for the slow scores, which increased significantly to 36%MVC for the fast scores. The sEMG signal presented a significant though small decrease of 1.9%MVC in amplitude between baseline and 4 hrs of rehearsal time and no shift in frequency, which may indicate that the rehearsals were held at a physiological steady-state and suggesting optimization or complementary muscle loading.

CONCLUSIONS

These data accentuated that the loading of the ECR (as reflected in the amplitude component) was higher than that seen for computer keyboard workers. The augmented loading of the ECR and reduced blood flow to forearm muscles may be a factor in the development of PRMDs in pianists.

Short-term effects of differential learning and contextual interference in a goalkeeper-like task: Visuomotor response time and motor control

In this experiment, we compared changes in visuomotor performance and motor control after a single session of differential learning (DL) and contextual interference (CI) in a reaching task to mimic goalkeeping. Subjects (n_DL = n_CI = 16) stood in front of a wall with six LED-light targets that flashed on in a random order and subjects had to move their hand in front of it as fast as possible in order to extinguish the target. After the pre-test subjects followed a DL or CI training session, followed immediately by a post-test, followed by one hour of rest and a retention test. Performance and motor control were measured respectively by visuomotor response time (VMRT) and an Index of Motor Abundance (IMA; reflecting the strength of movement synergies) calculated with Uncontrolled Manifold analysis. A mixed-effects Bayesian ANOVA model was used to evaluate differences in changes in both parameters between both training groups. Averaged over the six targets, the decrease in VMRT was stronger for DL than CI at the post-test (interference effect) but not at retention. The IMA was on average increased at post- and retention test in both groups, indicating stronger synergies between the degrees-of-freedom. While the ANOVA for IMA was not conclusive, the changes were likely not different between both learning methods. Thus, while an interference effect was found for CI but not DL in terms of performance on the task, no such effect was observed on the behavioural level in terms of the strength of movement synergies.

Pelvic floor muscle displacement during jumps in continent and incontinent women: An exploratory study

INTRODUCTION

The prevalence of stress urinary incontinence during high-impact activities is high. Enhanced comprehension of pelvic floor muscle (PFM) displacement and activity is clinically relevant for the development of specific approaches in rehabilitation. The aim of the study is to investigate and to compare PFM displacement between the continent and incontinent women during jumps.

METHODS

A cross-sectional, exploratory design was applied to investigate PFM displacement during drop jumps (DJ) and countermovement jumps (CMJ). PFM displacement was assessed in craniocaudal translation and forward-backward rotation with an electromagnetic tracking system.

RESULTS

Twenty-eight continent and 22 incontinent women were included. During the first landing of DJ, a primary caudal, during the second landing of DJ/CMJ a primary cranial translation and during all jump a primary backward rotation was observed. No significant difference between the groups was found.

DISCUSSION

PFM displacement during running demonstrated caudal translation/forward rotation before and cranial translation/backward rotation after heel strike. During the second landing of DJ/CMJ a cranial translation/backward rotation and during the first landing of DJ a caudal translation/backward rotation has been observed after ground contact. This may be due to the longer lasting bodyweight force in the first landing of DJ. No eccentric-concentric stretch-shortening cycle could be seen.

CONCLUSION

This study indicates that during jumps two opposite reactions of involuntary PFM displacement happen, but no stretch-shortening cycle with an eccentric-concentric contraction could be found. Jumping stimuli inducing involuntary PFM displacement should be used for future investigations to consider a beneficial effect concerning continence.

Reliability and validity of pelvic floor muscle displacement measurements during voluntary contractions

INTRODUCTION AND HYPOTHESIS

Understanding the functioning of pelvic floor muscles (PFM) is crucial in female PFM rehabilitation. The aim of this study was to determine the intra-session retest reliability and validity to evaluate the quantity of PFM displacement.

METHODS

This cross-sectional observational study examined the PFM displacement of 17 young healthy nulliparous women in the midsagittal plane. Three maximal voluntary contractions (MVCs) and five fast voluntary contractions (FVCs) were simultaneously examined with an electromagnetic tracking system (ETS) and transabdominal ultrasound (TAUS) and expressed in millimeters (mean, SD). To evaluate reliability and validity, the analysis of variance, intraclass coefficient (2,1), standard error of measurement (SEM), and minimal detectable difference (MDD) were calculated.

RESULTS

Maximal voluntary contractions and FVCs in supine position measured by an ETS (TAUS) showed a displacement of MVC: 3.5 ± 1.9 mm (7.8 ± 4.5 mm), FVC: 3.5 ± 2.4 mm (7.6 ± 5.3 mm), and during standing of MVC: 5.2 ± 1.6 mm (9.4 ± 3.8 mm) and FVC: 4.8 ± 2.5 mm (9.7 ± 4.1 mm). Intraclass correlation for the ETS (TAUS) measurement varied between 0.79 and 0.89 (0.61 and 0.74), SEM 0.52 and 1.03 mm (1.54 and 3.2 mm), and MDD 1.54 and 3.2 mm (6.64 and 7.53 mm). The correlation between an ETS and TAUS varied between 0.53 and 0.67.

CONCLUSIONS

For MVC and FVC, ETS measurements are highly reliable and TAUS measurements are moderately reliable for both contraction types. The correlation between the TAUS and ETS measurements is moderate. An ETS seems to be a reliable and valid measurement tool for evaluating PFM displacement during voluntary contractions. In future studies, the reproducibility and validity of ETS measurements need to be investigated in impact activities.

Statistical parametric mapping of biomechanical one-dimensional data with Bayesian inference

Recent developments in Statistical Parametric Mapping (SPM) for continuum data (e.g. kinematic time series) have been adopted by the biomechanics research community with great interest. The Python/MATLAB package spm1d developed by T. Pataky has introduced SPM into the biomechanical literature, adapted originally from neuroimaging. The package already allows many of the statistical analyses common in biomechanics from a frequentist perspective. In this paper, we propose an application of Bayesian analogs of SPM based on Bayes factors and posterior probability with default priors using the BayesFactor package in R. Results are provided for two typical designs (two-sample and paired sample t-tests) and compared to classical SPM results, but more complex standard designs are possible in both classical and Bayesian frameworks. The advantages of Bayesian analyses in general and specifically for SPM are discussed. Scripts of the analyses are available as supplementary materials.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

Questioning the "SPIN and SNOUT" rule in clinical testing

Specificity (SP) and sensitivity (SE) answer the question ‘what is the chance of a positive or negative test in response to the presence or absence of a clinical condition?’. Related to SP and SE are the diagnostic procedures of SNOUT and SPIN. SNOUT is the acronym for ‘Sensitive test when Negative rules OUT the disease’, SPIN for, ‘Specific test when Positive rules IN the disease’. SE and SP are incomplete because for clinical diagnosis, the question of concern should actually be: ‘what is the chance that the clinical condition will be present or absent in the context of a positive or negative test result?’. The latter statement is related to the concepts of Positive and Negative Predictive Value (PPV and NPV). However, PPV and NPV are predictive values not only dependent on SE and SP but also largely dependent on the prevalence in the examined population. Consequently, predictive values from one study should not be transferred to some other setting with a different prevalence. Prevalence affects PPV and NPV differently. PPV is increasing, while NPV decreases with the increase of the prevalence. This makes prevalence the nemesis in the application of the predictive values. Therefore, another variable has been introduced to evaluate the strength of a diagnostic test, namely the likelihood ratio. Likelihood ratios determine how much more likely a particular test result is among people who have the clinical condition of interest than it is among people who do not have the condition. LIKELIHOOD RATIO (LR) is the ratio of two probabilities. This letter illustrates the limitations of the concepts of SE, SP, NPV, PPV and the LRs in context of specific shoulder tests.

Four-dimensional CT as a valid approach to detect and quantify kinematic changes after selective ankle ligament sectioning

The objective of the current study was to explore the potential of dynamic computed tomography to detect kinematic changes, induced by sequential sectioning of the lateral collateral ligaments of the ankle, during full motion sequence of the talocrural joint. A custom-made device was used to induce cyclic controlled ankle inversion movement in one fresh frozen cadaver leg. A 256-slice CT scanner was used to investigate four different scenarios. Scenario 1 with all ligaments intact was first investigated followed by sequential section of the anterior talo-fibular ligament (Scenario 2), the calcaneo-fibular ligament (Scenario 3) and posterior talo-fibular ligament (Scenario 4). Off-line image processing based on semi-automatic segmentation and bone rigid registration was performed. Motion parameters such as translation, rotational angles and orientation and position of the axis of rotation were calculated. Differences between scenarios were calculated. Progressive increase of cranio-caudal displacement up to 3.9 mm and flexion up to 10° compared to Scenario 1 were reported. Progressive changes in orientation (up to 20.6°) and position (up to 4.1 mm) of the axis of rotation were also shown. Estimated effective dose of 0.005 mSv (1.9 mGy CTDI_vol) was reported. This study demonstrated that kinematic changes due to the absence of ligament integrity can be detected with 4DCT with minimal radiation exposure. Identifying abnormal kinematic patterns could have future application in helping clinicians to choose patients’ optimal treatment. Therefore, further studies with bigger in vitro sample sizes and consequent investigations in vivo are recommended to confirm the current findings.

Wavelet analyses of electromyographic signals derived from lower extremity muscles while walking or running: A systematic review

Surface electromyography is often used to assess muscle activity and muscle function. A wavelet approach provides information about the intensity of muscle activity and motor unit recruitment strategies at every time point of the gait cycle. The aim was to review papers that employed wavelet analyses to investigate electromyograms of lower extremity muscles during walking and running. Eleven databases were searched up until June 1^st 2017. The composition was based on the PICO model and the PRISMA checklist. First author, year, subject characteristics, intervention, outcome measures & variables, results and wavelet specification were extracted. Eighteen studies included the use of wavelets to investigate electromyograms of lower extremity muscles. Three main topics were discussed: 1.) The capability of the method to correctly assign participants to a specific group (recognition rate) varied between 68.4%-100%. 2.) Patients with ankle osteoarthritis or total knee arthroplasty presented a delayed muscle activation in the early stance phase but a prolonged activation in mid stance. 3.) Atrophic muscles did not contain type II muscle fiber components but more energy in their lower frequencies. The simultaneous information of time, frequency and intensity is of high clinical relevance because it offers valuable information about pre-and reflex activation behavior on different walking and running speeds as well as spectral changes towards high or low frequencies at every time point of the gait cycle.

Evaluation of coordination hysteresis in a multidimensional movement task with continuous relative phase and Self-Organizing Maps

Hysteresis in the coordination of movement can be described in the language of coordination dynamics as an asymmetrical response of a system's order parameter with respect to opposite changes in a control parameter. For movement tasks involving a large number of active degrees-of-freedom, the order parameter can be modelled with a pattern recognition approach like Self-Organizing Maps (SOM). This study explored this method in a rope-skipping task, which involves the coordinated oscillation of several segments in the lower and upper limb and trunk and we compared the results to a classical order parameter like continuous relative phase. Five rope skippers completed a task which involved 30 s continuous forward rope-skipping during which the frequency (set by a metronome) increased linearly, immediately followed by 30 s during which the frequency decreased linearly. CRP was analyzed with statistical parametric mapping and a hysteresis measure for the SOM was calculated based on inter-trial variability. Both the CRP and the SOMs showed that the coordination patterns changed differently during the two conditions, signifying hysteresis. While the CRP captures only the relative coordination of two segments, the SOM is able to accommodate the whole-body multidimensional coordination. Hysteresis is often used as proxy for higher-order information about the movement system. While the low sample size in this study does not allow us to generalize the results, the present methodology can be used in further studies to advance our theoretical understanding of dynamical systems in complex whole-body movements.

Continuous Knee Cooling Affects Functional Hop Performance - A Randomized Controlled Trial

Cryotherapy is widely used in sports and rehabilitation to aid recovery and injury management. The purpose was to examine if a low temperature computer controlled continuous knee cooling protocol (10°C) for one hour and a moderate continuous knee cooling protocol (18°C) for one hour affected neuromuscular activity and functional performance tests. We used a randomized controlled study design. Twenty healthy male subjects (age = 24 ± 3 years) were included and randomized into 2 groups (10°C and 18°C). On day one, participants performed a maximal voluntary contraction of the quadriceps (MVC), single leg hop for distance (SLHD), and crossover hop for time (COHT) with both legs before and after cooling of their right leg. At day two, the same tests were performed with both legs before and after cooling of the left leg. Participants exposed to the 10°C-protocol showed a significant decrease in SLHD and COHT performance. For the 18°C-group, no significant changes in SLHD and COHT outcomes were noted. In both groups, EMG frequency during MVC decreased, but no significant increases were found in EMG amplitude. Continuous knee cooling at 18°C for one hour does not affect functional hop performance, though adaptations at the muscle level (EMG frequency decrease) can be observed. Applying a similar cooling protocol with 10°C results in a significant decrease in functional hop performance and EMG frequency. EMG amplitude remained unaffected. This infers that changes at muscle level due to local temperature manipulations may not always be detrimental to functional performance.

The influence of the use of ankle-foot orthoses on thorax, spine, and pelvis kinematics during walking in children with cerebral palsy

BACKGROUND

To improve gait function in children with cerebral palsy, ankle-foot orthoses are often prescribed. However, until now, little attention has been devoted to the effect of ankle-foot orthoses on the postural control during walking in children with cerebral palsy.

OBJECTIVES

The aim was to compare the differences in thorax, spine, and pelvis movements in children with cerebral palsy during walking barefoot and walking with ankle-foot orthoses.

STUDY DESIGN

Clinical study with an intra subject design.

METHODS

A total of 15 children (12 boys and 3 girls; mean age, 8 ± 2 years) with bilateral spastic cerebral palsy (12 with Gross Motor Function Classification System I and 3 with Gross Motor Function Classification System II) performed a full-body three-dimensional gait analysis. Differences in the range of motion of the thorax, spine, and pelvis during walking barefoot and walking with bilateral ankle-foot orthoses were analyzed (SPSS v20, paired-samples t-test).

RESULTS

Children with cerebral palsy showed a significantly larger range of motion of the thorax (flexion/extension, lateral bending, and rotation) and the spine (lateral bending) during walking with ankle-foot orthoses compared to walking barefoot. No significant differences were found in the range of motion of the pelvis between these two conditions.

CONCLUSION

It can be concluded that wearing ankle-foot orthoses influences the postural control during walking in children with bilateral spastic cerebral palsy. Due to the increased range of motions, the movement pattern of the trunk diverges from the typically developing children. Clinical relevance Wearing ankle-foot orthoses not only gives more stability at the pelvis and ankle joint but also influences trunk motion. In order of the level of core stability of the child, compensations can be either seen in the lower back or the upper trunk. Clinicians should be aware of these compensations and should evaluate postural control in a more detailed evaluation.

Changes in balance coordination and transfer to an unlearned balance task after slackline training: a self-organizing map analysis

How humans maintain balance and change postural control due to age, injury, immobility or training is one of the basic questions in motor control. One of the problems in understanding postural control is the large set of degrees of freedom in the human motor system. Therefore, a self-organizing map (SOM), a type of artificial neural network, was used in the present study to extract and visualize information about high-dimensional balance strategies before and after a 6-week slackline training intervention. Thirteen subjects performed a flamingo and slackline balance task before and after the training while full body kinematics were measured. Range of motion, velocity and frequency of the center of mass and joint angles from the pelvis, trunk and lower leg (45 variables) were calculated and subsequently analyzed with an SOM. Subjects increased their standing time significantly on the flamingo (average +2.93 s, Cohen's d = 1.04) and slackline (+9.55 s, d = 3.28) tasks, but the effect size was more than three times larger in the slackline. The SOM analysis, followed by a k-means clustering and marginal homogeneity test, showed that the balance coordination pattern was significantly different between pre- and post-test for the slackline task only (χ ² = 82.247; p < 0.001). The shift in balance coordination on the slackline could be characterized by an increase in range of motion and a decrease in velocity and frequency in nearly all degrees of freedom simultaneously. The observation of low transfer of coordination strategies to the flamingo task adds further evidence for the task-specificity principle of balance training, meaning that slackline training alone will be insufficient to increase postural control in other challenging situations.

Evaluation of pelvic floor kinematics in continent and incontinent women during running: An exploratory study

AIMS

Impact activity like running is associated with an increase in intra-abdominal pressure which needs to be sufficiently countered by pelvic floor muscle (PFM) activity to secure continence. The aim of this study was to investigate and compare PFM kinematics in continent and incontinent women during running.

METHOS

Three-dimensional position and orientation was measured with the electromagnetic tracking device trakSTAR™. One sensor was attached to the vaginal probe and a second one was secured to the subjects' skin at the height of the second sacral vertebrae. Cranial-caudal and forward-backward displacement of the vaginal probe was measured during 10 sec running on a treadmill at the speeds 7, 11, and 15 km/h. Displacement data from 100 ms before to 300 ms after heel-strike were analyzed.

RESULTS

Nineteen incontinent and twenty-seven continent women were included in this study. Before the foot touched the ground caudal translation and forward rotation of the vaginal probe was detected, whereas after heel-strike a cranial translation and backward rotation was measured. Cranial-caudal translation as well as backward-forward-rotation did not differ significantly between continent and incontinent subjects for the three speeds. Analysis of maximum displacements showed significantly increasing displacement with increasing speeds.

CONCLUSIONS

Kinematic measurements during impact activity of running demonstrated caudal translation before and cranial translation after heel-strike. The hypothesis of caudal translation through impact activity was not confirmed. Patterns seem similar between continent and incontinent subjects. Associations between the direction of displacement and muscle action of PFMs remain assumptions.

Non-invasive Assessments of Subjective and Objective Recovery Characteristics Following an Exhaustive Jump Protocol

Fast recovery after strenuous exercise is important in sports and is often studied via cryotherapy applications. Cryotherapy has a significant vasoconstrictive effect, which seems to be the leading factor in its effectiveness. The resulting enhanced recovery can be measured by using both objective and subjective parameters. Two commonly measured subjective characteristics of recovery are delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE). Two important objective recovery characteristics are countermovement jump (CMJ) performance and peak power output (PPO). Here, we provide a detailed protocol to induce muscular exhaustion of the frontal thighs with a self-paced, 3 x 30 countermovement jump protocol (30-s rest between each set). This randomized controlled trial protocol explains how to perform local cryotherapy cuff application (+ 8 °C for 20 min) and thermoneutral cuff application (+ 32 °C for 20 min) on both thighs as two possible post-exercise recovery modalities. Finally, we provide a non-invasive protocol to measure the effects of these two recovery modalities on subjective (i.e., DOMS of both frontal thighs and RPE) and objective recovery (i.e., CMJ and PPO) characteristics 24, 48, and 72 h post-application. The advantage of this method is that it provides a tool for researchers or coaches to induce muscular exhaustion, without using any expensive devices; to implement local cooling strategies; and to measure both subjective and objective recovery, without using invasive methods. Limitations of this protocol are that the 30 s rest period between sets is very short, and the cardiovascular demand is very high. Future studies may find the assessment of maximum voluntary contractions to be a more sensitive assessment of muscular exhaustion compared to CMJs.

The effect of local cryotherapy on subjective and objective recovery characteristics following an exhaustive jump protocol

The purpose of this controlled trial was to investigate the effects of a single local cryotherapy session on the recovery characteristics over a period of 72 hours. Twenty-two young and healthy female (n=17; mean age: 21.9±1.1 years) and male (n=5;mean age: 25.4±2.8 years) adults participated in this study. Following an exhaustive jump protocol (3×30 countermovement jumps), half of the participants received either a single local cryotherapy application (+8°C) or a single local thermoneutral application (+32°C) of 20-minute duration using two thigh cuffs. Subjective measures of recovery (delayed-onset muscle soreness and ratings of perceived exertion) and objective measures of recovery (vertical jump performance and peak power output) were assessed immediately following the postexercise applications (0 hours) and at 24 hours, 48 hours, and 72 hours after the jump protocol. Local cryotherapy failed to significantly affect any subjective recovery variable during the 72-hour recovery period (P>0.05). After 72 hours, the ratings of perceived exertion were significantly lower in the thermoneutral group compared to that in the cryotherapy group (P=0.002). No significant differences were observed between the cryotherapy and the thermoneutral groups with respect to any of the objective recovery variables. In this experimental study, a 20-minute cryotherapy cuff application failed to demonstrate a positive effect on any objective measures of recovery. The effects of local thermoneutral application on subjective recovery characteristics were superior when compared to the effects of local cryotherapy application at 72 hours postapplication.

Pelvic floor muscle reflex activity during coughing - an exploratory and reliability study

OBJECTIVES

Activities that provoke stress urinary incontinence (SUI) rapidly increase the intra-abdominal pressure and the impact loading on the pelvic floor muscles (PFMs). Coughing can cause urinary leakage and is often used to test SUI. However, PFM characteristics during coughing, including their reliability, have not been investigated. Here, we used electromyography (EMG) to describe PFM pre-activity and reflexivity during coughing and examined the reliability of the measurements.

METHODS

This was an exploratory and reliability study including 11 young healthy women to characterize EMG reflex activity in PFMs during coughing. We describe 6 variables, averaged over 3 coughs per subject, and tested their reliability (intraclass correlation coefficient 3,1 [ICC(3,1)] and ICC(3,k), related standard error of measurement (SEM) and minimal difference [MD]). The variables represented the mean EMG activity for PFMs during 30-ms time intervals of pre-activity (initial time point of coughing [T0] and minus 30ms) and reflex activity (T0-30, 30-60, 60-90, 90-120 and 120-150ms after T0) of stretch-reflex latency responses.

RESULTS

The mean %EMG (normalized to maximal voluntary PFM contraction) for EMG variables was 35.1 to 52.2 and was significantly higher during coughing than for PFM activity at rest (mean 24.9±3.7%EMG; P<0.05). ICC(3,k) ranged from 0.67 to 0.91 (SEM 6.1-13.3%EMG and MD 16.7-36.8%EMG) and was higher than ICC(3,1) (range 0.40-0.77; SEM 9.0-18.0%EMG, MD 24.9-50.0%EMG).

CONCLUSIONS

PFM activity during reflex latency response time intervals during coughing was significantly higher than at rest, which suggests PFM pre-activity and reflex activity during coughing. Although we standardized coughing, EMG variables for PFM activity showed poor reliability [good to excellent ICC(3,k) and fair to excellent ICC(3,1) but high SEM and MD]. Therefore, coughing is expected to be heterogeneous, with low reliability, in clinical test situations. Potential crosstalk from other muscles involved in coughing could limit the interpretation of our results.

The European Union Geriatric Medicine Society (EUGMS) Working Group on «Frailty in Older Persons»

The concept of frailty was introduced in literature to help atclinically depicting the transition of a robust older individualinto a different clinical phenotype of risk (1-5). Frailty isgenerally described as a multisystemic impairment responsiblefor a state of increased vulnerability to endogenous andexogenous stressors (6, 7). This syndrome may represent thefirst step towards the evident and clinically relevant functionaldisability (a cornerstone outcome for geriatric medicine)8, andhas shown to be predictive of major negative health-relatedevents, including

Test-retest Reliability in Reporting the Pain Induced by a Pain Provocation Test: Further Validation of a Novel Approach for Pain Drawing Acquisition and Analysis

BACKGROUND

Pain drawings (PD) are frequently used in research to illustrate the pain response to pain provocation tests. However, there is a lack of data on the reliability in defining the extent and location of pain. We investigated the test-retest reliability in reporting an acute painful sensation induced by a pain provocation test using a novel approach for PD acquisition and analysis in healthy volunteers.

METHODS

Forty healthy volunteers participated. Each participant underwent 2 upper limb neurodynamic tests 1 (ULNT1), once to the point of pain onset (PO) and once until the point of submaximal pain (SP). After each ULNT1, participants completed 2 consecutive PD with an interval of 1 minute. Custom software was used to quantify the pain extent and analyze the pain overlap. The test-retest reliability of pain extent was examined using Intraclass Correlation Coefficient (ICC _2,1 ) and Bland-Altman plots. Pain location reliability was examined using the Jaccard similarity coefficient (JSC).

RESULTS

The ICC values for PO and SP were 0.98 (95% CI: 0.96-0.99) and 0.97 (95% CI: 0.95-0.98), respectively. The mean difference and 95% limits of agreement (± 1.96 SD) in the Bland-Altman plots were 14 pixels (-1080;1110) for PO, and 145 (-1610;1900) for SP. The median JSCs (Q1;Q3) were 0.73 (0.64;0.80) for PO and 0.76 (0.65;0.79) for SP.

CONCLUSIONS

Pain drawings is a reliable instrument to investigate pain extent and pain location in healthy individuals experiencing an acute painful sensation induced by a pain provocation test.

Differences in ball speed and three-dimensional kinematics between male and female handball players during a standing throw with run-up

BACKGROUND

The purpose of this paper was to examine differences in ball release speed and throwing kinematics between male and female team-handball players in a standing throw with run-up. Other research has shown that this throwing type produces the highest ball release speeds and comparing groups with differences in ball release speed can suggest where this difference might come from. If throwing technique differs, perhaps gender-specific coordination- and strength-training guidelines are in order.

METHODS

Measurements of three-dimensional kinematics were performed with a seven-camera VICON motion capture system and subsequent joint angles and angular velocities calculations were executed in Mathcad. Data-analysis with Statistical Parametric Mapping allowed us to examine the entire time-series of every variable without having to reduce the data to certain scalar values such as minima/maxima extracted from the time-series.

RESULTS

Statistical Parametric Mapping enabled us to detect several differences in the throwing kinematics (12 out of 20 variables had one or more differences somewhere during the motion). The results indicated two distinct strategies in generating and transferring momentum through the kinematic chain. Male team-handball players showed more activity in the transverse plane (pelvis and trunk rotation and shoulder horizontal abduction) whereas female team-handball players showed more activity in the sagital plane (trunk flexion). Also the arm cocking maneuver was quite different.

CONCLUSIONS

The observed differences between male and female team handball players in the motions of pelvis, trunk and throwing arm can be important information for coaches to give feedback to athletes. Whether these differences contribute to the observed difference in ball release speed is at the present unclear and more research on the relation with anthropometric profile needs to be done. Kinematic differences might suggest gender-specific training guidelines in team-handball.

Involuntary reflexive pelvic floor muscle training in addition to standard training versus standard training alone for women with stress urinary incontinence: study protocol for a randomized controlled trial

BACKGROUND

Pelvic floor muscle training is effective and recommended as first-line therapy for female patients with stress urinary incontinence. However, standard pelvic floor physiotherapy concentrates on voluntary contractions even though the situations provoking stress urinary incontinence (for example, sneezing, coughing, running) require involuntary fast reflexive pelvic floor muscle contractions. Training procedures for involuntary reflexive muscle contractions are widely implemented in rehabilitation and sports but not yet in pelvic floor rehabilitation. Therefore, the research group developed a training protocol including standard physiotherapy and in addition focused on involuntary reflexive pelvic floor muscle contractions.

METHODS/DESIGN

The aim of the planned study is to compare this newly developed physiotherapy program (experimental group) and the standard physiotherapy program (control group) regarding their effect on stress urinary incontinence. The working hypothesis is that the experimental group focusing on involuntary reflexive muscle contractions will have a higher improvement of continence measured by the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence (short form), and - regarding secondary and tertiary outcomes - higher pelvic floor muscle activity during stress urinary incontinence provoking activities, better pad-test results, higher quality of life scores (International Consultation on Incontinence Modular Questionnaire) and higher intravaginal muscle strength (digitally tested) from before to after the intervention phase. This study is designed as a prospective, triple-blinded (participant, investigator, outcome assessor), randomized controlled trial with two physiotherapy intervention groups with a 6-month follow-up including 48 stress urinary incontinent women per group. For both groups the intervention will last 16 weeks and will include 9 personal physiotherapy consultations and 78 short home training sessions (weeks 1-5 3x/week, 3x/day; weeks 6-16 3x/week, 1x/day). Thereafter both groups will continue with home training sessions (3x/week, 1x/day) until the 6-month follow-up. To compare the primary outcome, International Consultation on Incontinence Modular Questionnaire (short form) between and within the two groups at ten time points (before intervention, physiotherapy sessions 2-9, after intervention) ANOVA models for longitudinal data will be applied.

DISCUSSION

This study closes a gap, as involuntary reflexive pelvic floor muscle training has not yet been included in stress urinary incontinence physiotherapy, and if shown successful could be implemented in clinical practice immediately.

TRIAL REGISTRATION

NCT02318251 ; 4 December 2014 First patient randomized: 11 March 2015.

The Effect of Post-Exercise Cryotherapy on Recovery Characteristics: A Systematic Review and Meta-Analysis

The aim of this review and meta-analysis was to critically determine the possible effects of different cooling applications, compared to non-cooling, passive post-exercise strategies, on recovery characteristics after various, exhaustive exercise protocols up to 96 hours (hrs). A total of n = 36 articles were processed in this study. To establish the research question, the PICO-model, according to the PRISMA guidelines was used. The Cochrane’s risk of bias tool, which was used for the quality assessment, demonstrated a high risk of performance bias and detection bias. Meta-analyses of subjective characteristics, such as delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE) and objective characteristics like blood plasma markers and blood plasma cytokines, were performed. Pooled data from 27 articles revealed, that cooling and especially cold water immersions affected the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery, with a standardized mean difference (Hedges’ g) of -0.75 with a 95% confidence interval (CI) of -1.20 to -0.30. This effect remained significant after 48 hrs (Hedges’ g: -0.73, 95% CI: -1.20 to -0.26) and 96 hrs (Hedges’ g: -0.71, 95% CI: -1.10 to -0.33). A significant difference in lowering the symptoms of RPE could only be observed after 24 hrs of recovery, favouring cooling compared to the control conditions (Hedges’ g: -0.95, 95% CI: -1.89 to -0.00). There was no evidence, that cooling affects any objective recovery variable in a significant way during a 96 hrs recovery period.

Prognostic factors for recovery after arthroscopic rotator cuff repair: a prognostic study

BACKGROUND

Studies concerning prognostic factors of recovery after arthroscopic rotator cuff repair mostly focus on tendon integrity or functional recovery as an outcome. Little is known about how they influence quality of life after surgery. We therefore tried to identify prognostic factors having an impact on quality of life after arthroscopic rotator cuff repair.

METHODS

This study included 30 patients who underwent arthroscopic rotator cuff repair. We assessed Western Ontario Rotator Cuff Index as primary outcome and RAND-36, Constant-Murley score, and a shoulder hindrance score as secondary outcomes. Patients were repeatedly measured: once preoperatively and 4 times postoperatively. Preoperative range of motion, obesity, fatty infiltration, and cuff retraction were preselected as prognostic factors.

RESULTS

Patients were significantly improved at 3 months and 6 months after arthroscopic rotator cuff repair. In multiple regression analysis, none of the preselected factors could be identified as a prognostic factor influencing quality of life after arthroscopic rotator cuff repair (measured with the Western Ontario Rotator Cuff Index). For the outcome variables RAND-36 (6 months, 1 year) and shoulder hindrance score (1 year), fatty infiltration Goutallier stages 1 and 2 and retraction grades II, III, and IV were significant predictors.

CONCLUSION

Although fatty infiltration and retraction grade predict the RAND-36 and shoulder hindrance score, this study could not support preoperative range of motion, obesity, fatty infiltration, or retraction of the cuff as a prognostic factor for quality of life after arthroscopic rotator cuff repair. This study shows that if selection of patients is done properly, these factors do not influence a successful outcome.

Pelvic floor muscle electromyography during different running speeds: an exploratory and reliability study

PURPOSE

Stress urinary incontinence (SUI) affects women of all ages including young athletes, especially those involved in high-impact sports. To date, hardly any studies are available testing pelvic floor muscles (PFM) during sports activities. The aim of this study was the description and reliability test of six PFM electromyography (EMG) variables during three different running speeds. The secondary objective was to evaluate whether there was a speed-dependent difference between the PFM activity variables.

METHODS

This trial was designed as an exploratory and reliability study including ten young healthy female subjects to characterize PFM pre-activity and reflex activity during running at 7, 9 and 11 km/h. Six variables for each running speed, averaged over ten steps per subject, were presented descriptively, tested regarding their reliability (Friedman, ICC, SEM, MD) and speed difference (Friedman).

RESULTS

PFM EMG variables varied between 67.6 and 106.1 %EMG, showed no systematic error and were low for SEM and MD using the single value model. Applying the average model over ten steps, ICC (3,k) were >0.75 and SEM and MD about 50 % lower than for the single value model. Activity was found to be highest in 11 km/h.

CONCLUSION

EMG variables showed excellent ICC and very low SEM and MD. Further studies should investigate inter-session reliability and PFM reactivity patterns of SUI patients using the average over ten steps for each variable as it showed very high ICC and very low SEM and MD. Subsequently, longer running distances and other high-impact sports disciplines could be studied.

Robot-assisted walking with the Lokomat: the influence of different levels of guidance force on thorax and pelvis kinematics

BACKGROUND

Little attention has been devoted to the thorax and pelvis movements during gait. The aim of this study is to compare differences in the thorax and pelvis kinematics during unassisted walking on a treadmill and during walking with robot assistance (Lokomat-system (Hocoma, Volketswil, Switzerland)).

METHODS

18 healthy persons walked on a treadmill with and without the Lokomat system at 2kmph. Three different conditions of guidance force (30%, 60% and 100%) were used during robot-assisted treadmill walking (30% body weight support). The maximal movement amplitudes of the thorax and pelvis were measured (Polhemus Liberty™ (Polhemus, Colchester, Vermont, USA) (240/16)). A repeated measurement ANOVA was conducted.

FINDINGS

Robot-assisted treadmill walking with different levels of guidance force showed significantly smaller maximal movement amplitudes for thorax and pelvis, compared to treadmill walking. Only the antero-posterior tilting of the pelvis was significantly increased during robot-assisted treadmill walking compared to treadmill walking. No significant changes of kinematic parameters were found between the different levels of guidance force.

INTERPRETATION

With regard to the thorax and pelvis movements, robot-assisted treadmill walking is significantly different compared to treadmill walking. It can be concluded that when using robot assistance, the thorax is stimulated in a different way than during walking without robot assistance, influencing the balance training during gait.

Body weight support during robot-assisted walking: influence on the trunk and pelvis kinematics

BACKGROUND

Efficacy studies concerning robot assisted gait rehabilitation showed limited clinical benefits. A changed kinematic pattern might be responsible for this. Little is known about the kinematics of the trunk and pelvis during robot assisted treadmill walking (RATW).

OBJECTIVE

The aim of this study was to assess the trunk and pelvis kinematics of healthy subjects during RATW, with different amounts of body weight support (BWS) compared to regular treadmill walking (TW).

METHOD

Eighteen healthy participants walked on a treadmill, while kinematics were registered by an electromagnetic tracking device. Hereafter, the kinematics of pelvis and trunk were registered during RATW (guidance force 30%) with 0%, 30% and 50% BWS.

RESULTS

Compared to TW, RATW showed a decrease in the following trunk movements: axial rotation, anteroposterior flexion, lateral and anteroposterior translation. Besides, a decrease in lateral tilting and all translation of the pelvis was found when comparing RATW with TW. Furthermore, the anteroposterior tilting of the pelvis increased during RATW.

CONCLUSION

In general, there was a decrease in trunk and pelvis movement amplitude during RATW compared with regular TW. Though, it is not known if these changes are responsible for the limited efficacy of robot assisted gait rehabilitation. Further research is indicated.

Effects of core strength training using stable versus unstable surfaces on physical fitness in adolescents: a randomized controlled trial

Background

It has been demonstrated that core strength training is an effective means to enhance trunk muscle strength (TMS) and proxies of physical fitness in youth. Of note, cross-sectional studies revealed that the inclusion of unstable elements in core strengthening exercises produced increases in trunk muscle activity and thus provide potential extra training stimuli for performance enhancement. Thus, utilizing unstable surfaces during core strength training may even produce larger performance gains. However, the effects of core strength training using unstable surfaces are unresolved in youth. This randomized controlled study specifically investigated the effects of core strength training performed on stable surfaces (CSTS) compared to unstable surfaces (CSTU) on physical fitness in school-aged children.

Methods

Twenty-seven (14 girls, 13 boys) healthy subjects (mean age: 14 ± 1 years, age range: 13–15 years) were randomly assigned to a CSTS (n = 13) or a CSTU (n = 14) group. Both training programs lasted 6 weeks (2 sessions/week) and included frontal, dorsal, and lateral core exercises. During CSTU, these exercises were conducted on unstable surfaces (e.g., TOGU© DYNAIR CUSSIONS, THERA-BAND© STABILITY TRAINER).

Results

Significant main effects of Time (pre vs. post) were observed for the TMS tests (8-22%, f = 0.47-0.76), the jumping sideways test (4-5%, f = 1.07), and the Y balance test (2-3%, f = 0.46-0.49). Trends towards significance were found for the standing long jump test (1-3%, f = 0.39) and the stand-and-reach test (0-2%, f = 0.39). We could not detect any significant main effects of Group. Significant Time x Group interactions were detected for the stand-and-reach test in favour of the CSTU group (2%, f = 0.54).

Conclusions

Core strength training resulted in significant increases in proxies of physical fitness in adolescents. However, CSTU as compared to CSTS had only limited additional effects (i.e., stand-and-reach test). Consequently, if the goal of training is to enhance physical fitness, then CSTU has limited advantages over CSTS.

Trial registration

ClinicalTrials.gov Identifier: NCT02290457 Registered 13 November 2014.

Trunk kinematics during walking in persons with multiple sclerosis: the influence of body weight support

BACKGROUND

Although body weight supported (BWS) treadmill training (TT) leads to some improvements in walking ability, it has not been proven that it is more effective than other walking therapies in persons with multiple sclerosis (PwMS). One possible explanation could be that BWSTT focuses on the cyclic movement of the lower extremities while the trunk is passively suspended in the harness.

OBJECTIVE

This study aimed to assess the 3 dimensional trunk and pelvis movements during BWS treadmill walking.

METHODS

14 PwMS and 14 healthy persons (8 male/20 female; age 23 to 59 years) walked with 0%, 10%, 20%, 30%, 50% and 70% BWS. After a familiarization period, kinematic electromagnetic tracking (Polhemus Liberty™ 240/16) of the trunk and pelvis movements was applied. Statistical analysis consisted of a repeated measures ANOVA with simple contrasts (SPSS 20).

RESULTS

This study shows that BWS walking leads in general to smaller maximum trunk and pelvis movement amplitudes compared with walking without BWS, this with exception of the pelvis anterior-posterior movement in healthy subjects.

CONCLUSION

These data help to identify and isolate the effect of different BWS levels in PwMS and in healthy persons and suggest to use BWS lower than 30% for treadmill training.

Pelvic floor muscle activation and strength components influencing female urinary continence and stress incontinence: a systematic review

AIMS

A better understanding of pelvic floor muscle (PFM) activation and strength components is a prerequisite to get better insight in PFM contraction mechanisms and develop more specific PFM-training regimens for female stress urinary incontinence (SUI) patients. The aim of this systematic review (2012:CRD42012002547) was to evaluate and summarize existing studies investigating PFM activation and strength components influencing female continence and SUI.

METHODS

PubMed, EMBASE, and Cochrane databases were systematically searched for literature from January 1980 to November 2013 for cross-sectional studies comparing female SUI patients with healthy controls and intervention studies with SUI patients reporting on the association between PFM activation and strength components and urine loss. Trial characteristics, evaluated PFM components, their definitions, measurement methods, study outcomes, as well as quality measures, based on the Cochrane risk of bias tool, were independently extracted. The high heterogeneity of the retrieved data made pooling of results impossible and therefore restricted the analysis to a systematic review.

RESULTS

Cross-sectional studies showed group differences in favor of the continent women compared to SUI patients for PFM activation or PFM maximal strength, mean strength or sustained contraction. All intervention studies showed an improvement of PFM strength and decrease in urine loss in SUI patients after physical therapy.

CONCLUSIONS

Higher PFM activation and strength components influence female continence positively. This systematic review underscored the need for a standardized PFM components' terminology (similar to rehabilitation and training science), standardized test procedures and well matched diagnostic instruments.

Walking with robot assistance: the influence of body weight support on the trunk and pelvis kinematics

PURPOSE

The goal was to assess in healthy participants the three-dimensional kinematics of the pelvis and the trunk during robot-assisted treadmill walking (RATW) at 0%, 30% and 50% body weight support (BWS), compared with treadmill walking (TW).

METHODS

18 healthy participants walked (2 kmph) on a treadmill with and without robot assistance (Lokomat; 60% guidance force; 0%, 30% and 50% BWS). After an acclimatisation period (four minutes), trunk and pelvis kinematics were registered in each condition (Polhemus Liberty [240 Hz]). The results were analysed using a repeated measures analysis of variance with Bonferroni correction, with the level of suspension as within-subject factor.

RESULTS

During RATW with BWS, there were significantly (1) smaller antero-posterior and lateral translations of the trunk and the pelvis; (2) smaller antero-posterior flexion and axial rotation of the trunk; (3) larger lateral flexion of the trunk; and (4) larger antero-posterior tilting of the pelvis compared with TW.

CONCLUSIONS

There are significant differences in trunk and pelvis kinematics in healthy persons during TW with and without robot assistance. These data are relevant in gait rehabilitation, relating to normal balance regulation. Additional research is recommended to further assess the influence of robot assistance on human gait.

IMPLICATIONS FOR REHABILITATION

The trunk and pelvis moves in a different way during walking with robot assistance. The data suggest that the change in movement is due to the robot device and the harness of the suspension system more than due to the level of suspension itself.

Guidance synthesis. Medical research for and with older people in Europe: proposed ethical guidance for good clinical practice: ethical considerations

INTRODUCTION

In Europe the population is ageing rapidly. Older people are taking many medicinal products daily and these may not necessarily be suitable for them. Publications show that older patients are underrepresented in clinical trials, especially those over 75 years, with multiple co-morbidities, concomitant treatments and/or frailty. This document provides a summary of recommendations on ethical aspects of clinical trials with older people, who may in some cases be considered a vulnerable patient population. The EFGCP's Geriatric Medicine Working Party (GMWP) has developed this guidance to promote such research and to support health care professionals in their efforts. ETHICAL, SCOPE AND CONTEXT: The definition of a geriatric patient is reviewed. Frail and vulnerable patients, who are a minority of geriatric patients, should be included whenever it is relevant. The legal context is described. THE PROCESS OF INFORMED CONSENT: All adults should be presumed capable of consent, unless proven otherwise; informed consent must be sought for all older people who are able to consent. A simple, short and easy-to-understand information sheet and consent form will contribute to improving the readability and understanding of the older participant. A participant guide and the use of a simple tool to ensure decision making capacity, are recommended. Whenever older people are unable to consent, their assent should be sought systematically using adequate information, in addition to seeking the consent of their legal or authorised representative as appropriate. ETHICS COMMITTEES: Research ethics committees need internal and/or external geriatric expertise to balance the benefits and risks of research in older people and to appreciate and recognise their autonomy. DESIGN AND ANALYSES: Design and Analyses should be adapted to the objectives with appropriate outcomes and are not different from other clinical trials.

CONCLUSIONS

The absence of proper recruitment or insufficient presence of older patients in clinical development plans for new medicinal products is detrimental; there is a need to improve evidence-based knowledge, understanding and management of their conditions and treatment. The aim of this guidance is to facilitate clinical research for and with the older patient population. The long version of the guidance will be available on the EFGCP's website: www.efgcp.be/.

The effect of exercise on visceral adipose tissue in overweight adults: a systematic review and meta-analysis

Excessive visceral adipose tissue appears to trigger a cascade of metabolic disturbances that seem to coexist with ectopic fat storage in muscle, liver, heart and the ß-cell. Therefore, the reduction of visceral adipose tissue potentially plays a pivotal role in the treatment of the metabolic syndrome. The purpose of this systematic review and meta-analysis is to describe the overall effect of exercise on visceral adipose tissue and to provide an overview of the effect of different exercise regimes, without caloric restriction, on visceral adipose tissue in obese persons. A systematic literature search was performed according to the PRISMA statement for reporting systematic reviews and meta-analyses. The initial search resulted in 87 articles after removing duplicates. After screening on title, abstract and full-text 15 articles (totalling 852 subjects) fulfilled the a priori inclusion criteria. The quality of each eligible study was assessed in duplicate with “The Critical Review Form for Quantitative Studies”. Using random-effects weights, the standardized mean difference (Hedge's g) of the change in visceral adipose tissue was −0.497 with a 95% confidence interval of −0.655 to −0.340. The Z-value was −6.183 and the p-value (two tailed) was <0.001. A subgroup analysis was performed based on gender, type of training and intensity. Aerobic training of moderate or high intensity has the highest potential to reduce visceral adipose tissue in overweight males and females. These results suggest that an aerobic exercise program, without hypocaloric diet, can show beneficial effects to reduce visceral adipose tissue with more than 30 cm² (on CT analysis) in women and more than 40 cm² in men, even after 12 weeks.