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Will Bosch, Amir Esrafilian, Paavo Vartiainen, Jari Arokoski, Rami K. Korhonen, and Lauri Stenroth

Pain felt while performing rehabilitation exercises could be a reason for the low adherence of knee osteoarthritis patients to physical rehabilitation. Reducing compressive forces on the most affected knee regions may help to mitigate the pain. Knee frontal plane positioning with respect to pelvis and foot (functional knee alignment) has been shown to modify the mediolateral distribution of the tibiofemoral joint contact force in walking. Hence, different functional knee alignments could be potentially used to modify joint loading during rehabilitation exercises. The aim was to understand whether utilizing different alignments is an effective strategy to unload specific knee areas while performing rehabilitation exercises. Eight healthy volunteers performed 5 exercises with neutral, medial, and lateral knee alignment. A musculoskeletal model was modified for improved prediction of tibiofemoral contact forces and used to evaluate knee joint kinematics, moments, and contact forces. Functional knee alignment had only a small and inconsistent effect on the mediolateral distribution joint contact force. Moreover, the magnitude of tibiofemoral and patellofemoral contact forces, knee moments, and measured muscle activities was not significantly affected by the alignment. Our results suggest that altering the functional knee alignment is not an effective strategy to unload specific knee regions in physical rehabilitation.

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Leonardo Cesanelli, Sigitas Kamandulis, Nerijus Eimantas, and Danguole Satkunskiene

To describe the possible effects of chronic specific exercise training, the present study compared the anthropometric variables, muscle–tendon unit (MTU) architecture, passive stiffness, and force production capacity between a group of competitive cyclists and runners. Twenty-seven competitive male cyclists (n = 16) and runners (n = 11) participated. B-mode ultrasound evaluation of the vastus lateralis muscle and patellar tendon as well as passive stiffness of the knee extensors MTU were assessed. The athletes then performed a test of knee extensor maximal voluntary isometric contractions. Cyclists displayed greater thigh girths, vastus lateralis pennation angle and muscle thickness, patellar tendon cross-sectional area, and MTU passive stiffness than runners (P < .05). Knee extensor force production capacity also differed significantly, with cyclists showing greater values compared with runners (P < .05). Overall, the direct comparison of these 2 populations revealed specific differences in the MTU, conceivably related to the chronic requirements imposed through the training for the different disciplines.

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Javier Pérez-Tejero, Mauro Grassi-Roig, Javier Coterón, and Yeshayahu Hutzler

In Spain, wheelchair basketball competition is well developed and structured; however, reverse integration is not allowed. This study aimed to describe and synthesize the perceptions of Spanish wheelchair stakeholders (players, coaches, referees, and club managers). A mixed-method approach was used, utilizing an ad hoc survey questionnaire (n = 49) and three focus groups (n = 12). Quantitative and qualitative data were interpreted using a triangulation strategy, meaning that both sources of data were combined and analyzed. From the thematic content analysis, two main themes and several subthemes emerged: social context (audience attraction and economic impact, utility and logistics, and promoting inclusion) and sport context (grassroots and elite level). Some reservations at elite level were also reported. From the perspective of the stakeholders explored in this study, reverse integration appears to be well suited for implementation within the Spanish wheelchair basketball framework at all levels.

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Mathieu Michaud, William J. Harvey, and Gordon A. Bloom

The purpose of this scoping review was to examine how mixed methods research (MMR) has been applied in adapted physical activity (APA) research about children and adolescents age 5–18 years with a disability. Six electronic databases were searched to retrieve relevant studies published between 2003 and 2020. Sixty-four studies were identified and analyzed. The findings were organized into five categories of interest: publication information, study objectives, mixed methods research design, participants’ information, and data integration. Challenges related to the design and publication of MMR in APA were uncovered, and suggestions for improvement are provided. This study adds to the knowledge of MMR design, and it provides an understanding of the underlying processes and methodological strategies that have guided this approach in APA research. This article will encourage APA researchers to engage in MMR while also aligning future studies with contemporary MMR literature and publication standards.

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Tess M.R. Carswell, Brenton G. Hordacre, Marc D. Klimstra, and Joshua W. Giles

Research addressing lower limb amputee gait and prosthetic design often focuses on men, despite female lower limb amputees having different risk factors and lower success with their prosthetics overall. It is widely agreed that sex differences exist in able-bodied gait, but research analyzing sex differences in amputee gait is rare. This study compared male and female transtibial amputee gait to ascertain potential sex differences. Forty-five transtibial amputees were asked to walk at their self-selected speed, and spatiotemporal gait data were obtained. Both the mean and variability metric of parameters were analyzed for 10 male and 10 female participants. For all participants, amputated limbs had a shorter stance time, longer swing time, and larger step length. Females had a 10% shorter stance time and 26% larger normalized step and stride length than males. Female participants also walked over 20% faster than male participants. Finally, significant interactions were found in the mean and variability metric of stride velocity, indicating greater variability in women. These findings suggest that sex differences exist in transtibial amputee gait, offering possible explanations for the different comorbidities experienced by female lower limb amputees. These results have major implications for female amputees and for sex-specific research, rehabilitation, and prosthetic design.

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Li-Shan Chang, Xiong-Wen Ke, Weerawat Limroongreungrat, and Yong Tai Wang

The purpose of this study was to determine shoulder joint reaction forces and muscle moments during 2 speeds (1.3 and 2.2 m/s) of wheelchair propulsion and to investigate the relationship between joints reaction forces, muscle moments, and shoulder pain. The measurements were obtained from 20 manual wheelchair users. A JR3 6-channel load sensor (±1% error) and a Qualisys system were used to record 3-dimensional pushrim kinetics and kinematics. A 3-dimensional inverse dynamic model was generated to compute joint kinetics. The results demonstrated significant differences in shoulder joint forces and moments (P < .01) between the 2 speeds of wheelchair propulsion. The greatest peak shoulder joint forces during the drive phase were anterior directed (Fy, 184.69 N), and the greatest joint moment was the shoulder flexion direction (flexion moment, 35.79 N·m) at 2.2 m/s. All the shoulder joint reaction forces and flexion moment were significantly (P < .05) related to shoulder pain index. The forces combined in superior and anterior direction found at the shoulder joint may contribute to the compression of subacromial structure and predispose manual wheelchair users to potential rotator cuff impingement syndrome.

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Jessica Prebor, Brittany Samulski, Cortney Armitano-Lago, and Steven Morrison

It is widely accepted that the general process of aging can be reflected by changes in motor function. Typically, optimal performance of a given motor task is observed for healthy young adults with declines being observed for individuals at either end of the lifespan. This study was designed to examine differences in the average and variability (i.e., intraindividual variability) of chewing, simple reaction time, postural control, and walking responses. For this study, 15 healthy children, 15 young adults, and 15 older adults participated. Our results indicated the movement performance for the reaction time and postural sway followed a U shape with young adults having faster reaction times and decreased postural sway compared to the children and older adults. However, this pattern was not preserved across all motor tasks with no age differences emerging for (normalized) gait speed, while chewing rates followed a U-shaped curve with older adults and children chewing at faster rates. Taken together, these findings would indicate that the descriptive changes in motor function with aging are heavily influenced by the nature of the task being performed and are unlikely to follow a singular pattern.

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Jing Wen Pan, Pui Wah Kong, and John Komar

This study aimed to investigate individual trial-to-trial performance in three tests to define adaptive regulation as a key feature of expertise in nine-ball. Thirty-one male players were assigned into the low-skilled (n = 11), intermediate (n = 10), or high-skilled groups (n = 10). The power control, cue alignment, and angle tests were selected to assess participants’ ability to control the power applied in shots, strike the ball straight, and understand the ball paths, respectively. Error distance and correction of error distance were identified for each shot using 2D video analysis. Results of one-way analysis of variance showed that the high-skilled group performed better in two out of the three tests than the other two groups (p = .010 for the cue alignment test; p = .002 for the angle test). However, the adaptation effect represented by the decreased error distances across trials was not observed. Pearson correlation revealed only a few significant correlations between the error distance and its correction within each participant in all tests (p < .05), and hence, the hypothesis that “low correction happened after small error and vice versa” is not supported.

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Toshiaki Soga, Hiromi Saito, Kei Akiyama, and Norikazu Hirose

This crossover trial aimed to investigate whether additional loading of unilateral Nordic hamstring exercise on a sloped platform would increase the biceps femoris long head electromyographic activity. Participants were randomly allocated to unilateral Nordic hamstring exercise under three conditions: bodyweight only (BW) or BW with an added weighted ball of 3 kg (BW + 3 kg) or 6 kg (BW + 6 kg), respectively. The biceps femoris long head electromyographic activity was significantly higher for BW + 6 kg (p < .001) than for BW and BW + 3 kg (p < .01). Therefore, adding a load to unilateral Nordic hamstring exercise on a sloped platform might be effective for rehabilitation and prevention of hamstring strain injury recurrence.