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Amanda Young, Seán Healy, Lisa Silliman-French, and Ali Brian

To inform the development of scalable and sustainable fundamental motor skill interventions for children with Down syndrome, this study examined the feasibility and preliminary effectiveness of Project Skill Intervention Implemented by Parents (Project SKIP), a web-based, parent-mediated intervention intended to improve ball skills among children with Down syndrome. Twenty-four families enrolled in the study (including 13 boys and 11 girls; M age = 4.92). Fourteen children were assigned to an experimental group and participated in the 6-week intervention, and 10 children served as the inactive comparison group. The Test of Gross Motor Development-3 was administered preintervention and postintervention. In addition, parents of children in the experimental group completed a postintervention survey to assess their perceptions of Project SKIP. Following the intervention, there was a significant improvement in ball skills (p = .023, d = 0.86) for children in the experimental group, whereas the comparison group did not show significant improvement. Moreover, parents perceived Project SKIP to be feasible and effective; all parents reported being satisfied with their overall experience in the program, and 11 parents indicated that their child’s fundamental motor skills were positively influenced by the intervention. Engagement was high, with the majority of parents (n = 8, 57%) interacting with Project SKIP content three to four times a week.

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Kerri A. Graber, Kari L. Loverro, Mark Baldwin, Erika Nelson-Wong, Joshua Tanor, and Cara L. Lewis

Pelvic drop is caused by decreased hip abductor muscle activity and is associated with lower-extremity injury. Hip abductor strengthening exercises are well established; however, no standard method exists to increase hip abductor activity during functional activities. The purpose of this research was to study the effects of walking with a unilateral weight. A total of 26 healthy adults walked on an instrumented treadmill with and without handheld weight (15%–20% body weight). Muscle activity, kinematic, and kinetic data were collected using surface electromyography, motion capture, and force plates, respectively. Average hip and trunk muscle activity, hip, pelvic, and trunk angles, and peak internal hip moments during stance were compared for each side (contralateral/ipsilateral to the weight) between conditions (unweighted/weighted) using a generalized linear model with generalized estimating equation correction. Interactions between condition and side were observed for muscle activity, frontal plane pelvic and trunk angles, and frontal plane hip moments (P ≤ .003). Compared with the unweighted condition, the weighted condition had higher hip abductor activity contralateral to the weight (P < .001), while no change was found ipsilateral to the weight (P ≥ .790). Similar changes were found for kinematic and kinetic variables. Walking with a unilateral weight may be a therapeutic option to increase functional hip abductor activity.

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Dennis E. Dever, Kellen T. Krajewski, Camille C. Johnson, Katelyn F. Allison, Nizam U. Ahamed, Mita Lovalekar, Qi Mi, Shawn D. Flanagan, William J. Anderst, and Chris Connaboy

The objective was to examine the interactive effects of load magnitude and locomotion pattern on lower-extremity joint angles and intralimb coordination in recruit-aged women. Twelve women walked, ran, and forced marched at body weight and with loads of +25%, and +45% of body weight on an instrumented treadmill with infrared cameras. Joint angles were assessed in the sagittal plane. Intralimb coordination of the thigh–shank and shank–foot couple was assessed with continuous relative phase. Mean absolute relative phase (entire stride) and deviation phase (stance phase) were calculated from continuous relative phase. At heel strike, forced marching exhibited greater (P < .001) hip flexion, knee extension, and ankle plantar flexion compared with running. At mid-stance, knee flexion (P = .007) and ankle dorsiflexion (P = .04) increased with increased load magnitude for all locomotion patterns. Forced marching (P = .009) demonstrated a “stiff-legged” locomotion pattern compared with running, evidenced by the more in-phase mean absolute relative phase values. Running (P = .03) and walking (P = .003) had greater deviation phase than forced marching. Deviation phase increased for running (P = .03) and walking (P < .001) with increased load magnitude but not for forced marching. With loads of >25% of body weight, forced marching may increase risk of injury due to inhibited energy attenuation up the kinetic chain and lack of variability to disperse force across different supportive structures.

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Kevin Alan Valenzuela, Songning Zhang, Lauren Elizabeth Schroeder, Joshua Trueblood Weinhandl, Jeffrey Reinbolt, Rebecca Zakrajsek, and Harold Earl Cates

Patient dissatisfaction following total knee replacement (TKR) procedures is likely influenced by both subjective and objective aspects. Increased pain and reduced performance on clinical tests have been shown in persons who are dissatisfied with the outcome of their surgery. However, it is unknown how overground walking kinematics and kinetics might differ in the dissatisfied versus satisfied patients following TKR surgery. This study compared the lower-extremity walking kinematics and kinetics of patients dissatisfied with their TKR to that of satisfied patients and healthy controls. Thirty nine subjects completed walking trials, including nine dissatisfied and 15 satisfied TKR patients and 15 healthy controls. A 2 × 3 repeated -measures analysis of variance was used to assess differences between groups and limbs (P < .05). Dissatisfied persons showed significantly reduced loading-response and push-off peak vertical ground reaction forces, flexion range of motion, loading-response extension moments, and loading-response abduction moments compared to the controls. Peak loading-response and push-off vertical ground reaction forces and flexion range of motion were reduced in the replaced limb of dissatisfied patients compared with their nonreplaced limb. Push-off plantar flexion moments were reduced in the dissatisfied patients compared with the satisfied and healthy controls. Dissatisfied patients also reported increased knee joint pain and reduced preferred gait speed. Moreover, dissatisfied patients experienced mechanical limb asymmetries not present in those satisfied with their surgery result. Thus, patients dissatisfied with their total knee replacement outcome were found to be experiencing significant negative physiological changes.

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Frederico Ribeiro Neto, Irineu Loturco, Guilherme Henrique Lopes, Jefferson Rodrigues Dorneles, José Irineu Gorla, and Rodrigo Rodrigues Gomes Costa

Context: A detailed analysis of wheelchair basketball skills in beginner wheelchair basketball players (WBP) can provide practitioners with important indications regarding the selection and prospective development of potential sports talents. A comprehensive WBP evaluation can be very time consuming, mainly during the initial phases of the training processes, which could be a barrier in clinical and practical settings. Moreover, the large number and the turnover of beginner WBP attending rehabilitation centers make the applicability of field and strength tests unfeasible. Objective: To verify the relationships between the medicine ball throw (MBT) and wheelchair basketball mobility performance field tests and the shoulder and trunk peak torque in male and female beginner WBP. Design: Cross-sectional study. Setting: Rehabilitation Hospital Network, Paralympic Program. Participants: Thirty-seven female and male beginner WBP. Main Outcomes Measures: Participants performed wheelchair basketball field tests (speed, agility, strength, and power tests) and the maximum strength test in the isokinetic dynamometer. The outcomes were correlated with the MBT results. Results: The MBT presented significantly very high and perfect correlations with all wheelchair basketball field tests assessed (5-m sprint, 20-m sprint, and zig-zag agility test with and without a ball), and peak torque (R 2 ranging from .810 to .995; P ≤ .05) for male and female athletes. Conclusions: The MBT, a simple and feasible test, can be used for estimating and determining the wheelchair mobility performance of female and male beginner WBP. It is suggested to measure the distance of a 5-kg medicine ball thrown by athletes during training and testing routines to follow the players’ progression.

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Michael W. Kirkwood, David R. Howell, Brian L. Brooks, Julie C. Wilson, and William P. Meehan III

While placebo effects are well recognized within clinical medicine, “nocebo effects” have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.

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Michael W. Kirkwood, David R. Howell, Brian L. Brooks, Julie C. Wilson, and William P. Meehan III

While placebo effects are well recognized within clinical medicine, “nocebo effects” have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.

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Jenny L. Toonstra, Dana Howell, Robert A. English, Christian Lattermann, and Carl G. Mattacola

Context: Patient expectations have been shown to be a major predictor of outcomes. Fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, preoperative function, or disease characteristics. It is currently unknown what factors may influence patient expectations prior to cartilage repair of the knee, and to what degree. Furthermore, understanding the importance and values of those expectations for recovery using mixed methods has not previously been conducted in this patient population. The purpose of this mixed methods study is to examine and explore the relationships between patient expectations and functional outcome in patients undergoing cartilage repair of the knee. Design: A mixed methods design was used. Methods: Twenty-one patients scheduled to undergo cartilage repair of the knee were included. Participants completed the Hospital for Special Surgery Knee Surgery Expectations Survey and the Knee Injury and Osteoarthritis Outcome Score at their preoperative visit. Knee Injury and Osteoarthritis Outcome Scores were also obtained at 3 and 6 months postsurgery. A selected sample of 6 participants participated in semi-structured interviews 6 months postsurgery. Pearson correlation coefficients were used to determine relationships between expectations and functional outcome. Results: Patients have moderate expectations for recovery, and these expectations were positively associated with preoperative pain, activities of daily living, and quality of life. Expectations also correlated with symptoms 3 months postsurgery, but there were no other significant correlations between preoperative expectations and postoperative function in the short term. Four qualitative themes emerged as participants described how previous recovery experiences shaped their expectations. Conclusions: Formalized patient and caregiver education, prehabilitation, and the use of psychological skills during rehabilitation may help to manage patient expectations and provide more focused and individualized care, thus improving outcomes.