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Sandra K. Hnat, Musa L. Audu, Ronald J. Triolo, and Roger D. Quinn

Estimating center of mass (COM) through sensor measurements is done to maintain walking and standing stability with exoskeletons. The authors present a method for estimating COM kinematics through an artificial neural network, which was trained by minimizing the mean squared error between COM displacements measured by a gold-standard motion capture system and recorded acceleration signals from body-mounted accelerometers. A total of 5 able-bodied participants were destabilized during standing through: (1) unexpected perturbations caused by 4 linear actuators pulling on the waist and (2) volitionally moving weighted jars on a shelf. Each movement type was averaged across all participants. The algorithm’s performance was quantified by the root mean square error and coefficient of determination (R 2) calculated from both the entire trial and during each perturbation type. Throughout the trials and movement types, the average coefficient of determination was 0.83, with 89% of the movements with R 2 > .70, while the average root mean square error ranged between 7.3% and 22.0%, corresponding to 0.5- and 0.94-cm error in both the coronal and sagittal planes. COM can be estimated in real time for balance control of exoskeletons for individuals with a spinal cord injury, and the procedure can be generalized for other gait studies.

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Alexandra M. Rodriguez, Alison Ede, Leilani Madrigal, Tiffanye Vargas, and Christy Greenleaf

This study aimed to assess the internalization of sociocultural attitudes and appearance comparison among U.S. athletes with physical disabilities. Female (n = 19) and male (n = 25) athletes between the ages of 18 and 73 years completed a quantitative survey along with two exploratory open-ended questions related to body appearance and influencers. Results showed significant correlations between internalization of the thin and low-body-fat ideal and appearance comparison (r = .55, p < .05) and internalization of the muscular ideal and appearance comparison (r = .76, p < .05) among women. For men, results showed a significant association between internalization of the muscular ideal and appearance comparison (r = .52, p < .05). The findings prompt further investigation of whether appearance comparison and internalization influence body dissatisfaction and disordered eating among athletes with physical disabilities.

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Ghada Regaieg, Sonia Sahli, and Gilles Kermarrec

The purpose of this study was to examine the effects of two pedagogical strategies in adapted physical education (hybrid virtual/real vs. conventional) on fundamental movement skills (FMS) in children with intellectual disability age 7–10 years. Children with intellectual disability (N = 24) were randomly assigned to either the hybrid (experimental group) or the conventional (control group) group and were evaluated across 10 weeks. The hybrid program was based on virtual and real game situations, while the conventional program was based on adapted sports. FMS were evaluated using the Test of Gross Motor Development-2 at pre- and postprogram for both groups. Both programs significantly improve locomotor skills, with significantly better improvement in the experimental group. However, a significant improvement was observed only among the experimental group for object-control skills and gross motor quotient. Based on these results, a hybrid program may be considered for FMS improvement.

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Darda Sales and Laura Misener

This study examined para swimmers’ athlete development experiences from the perspectives and reflections of athletes, and parents of athletes, with a focus on the constraints and challenges experienced. Guided by interpretive phenomenological analysis, 12 participants engaged in the interview process (seven parents and five athletes). Five themes were identified: fundamental skill development, personal connection, coaching, classification, and connecting with others “like me.” Through a discussion of the differences in development experiences between the participants in this study and the current literature on athlete development, the authors highlight areas of concern in applying a non-para-specific athlete development model to para swimmers. This study identifies several areas of consideration in the future design of a para athlete development framework or model.

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Shlomo Hammer, Elad Spitzer, and Shmuel Springer

Context: Achilles tendinopathy (AT) is a common musculoskeletal injury among runners. Eccentric exercises are considered first-line treatment. However, during the early stages of rehabilitation, patients are usually instructed to stop running. Backward running (BR) on a negative slope provides a similar eccentric load while enabling ongoing physical activity; thus, it may be suggested as an alternative treatment. Objectives: To determine the feasibility of a BR program as a treatment option for AT in runners. Design: Prospective, single-arm feasibility study. Setting: Outpatient clinic. Patients: Recreational runners diagnosed with AT and referred to the Meuhedet Health Services Physical Therapy Clinic in Jerusalem, Israel, from September 2019 to February 2020. Intervention: The patients completed a 5-week (9 sessions) rehabilitation program of supervised BR on a negatively inclined treadmill. Main Outcome Measures: Compliance with the program was evaluated by calculating the percentage of patients who completed the full protocol with no adverse events. Personal running-related goals were set before the program and were assessed following rehabilitation using the goal attainment scaling method. Forward-running time until the onset of relevant Achilles tendon pain, and the Victorian Institute of Sports Assessment Scale-Achilles were measured at baseline (T0), before treatment session 6 (T1), and after the last session (T2). Results: Among the 15 patients recruited, 14 (93%), average age 48.8 (10.4) years (86% males), completed the full protocol with no adverse events. Almost all participants (85.7%) achieved their running-related functional goals. Postintervention, the median forward-running time increased from 52.5 (92.5) to 900 (522.5) seconds (P = .008, effect size = .858), and the median Victorian Institute of Sports Assessment Scale-Achilles score improved by 28 points (P = .003, effect size = .881). Conclusions: BR on a negative slope may be a feasible treatment method for runners suffering from AT. Future randomized control trials are required to further validate the efficacy of this method.

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Matthew Zaremba, Joel Martin, and Marcie Fyock-Martin

Clinical Scenario: Knee pathologies often require rehabilitation to address the loss of knee-extensor (KE) strength, function, and heightened pain. However, in the early stages of rehabilitation, higher loads may be contraindicated. Blood flow restriction (BFR) resistance training does not require high loads and has been used clinically to promote strength improvements in a variety of injured populations. BFR resistance training may be an effective alternative to high-intensity resistance training during early rehabilitation of knee pathologies. Clinical Question: Following a knee injury, does BFR resistance training improve KE strength and function, and reduce patient-reported pain? Summary of Key Findings: Four randomized controlled trial studies met the inclusion criteria. Each included study evaluated the use of BFR resistance training on knee pathologies and the effects on KE strength, functional outcomes, and pain compared with high- or low-load resistance training. All 4 studies reported significant improvements in KE strength, function, and pain through a variety of outcome measures, following BFR resistance training use as the treatment. Clinical Bottom Line: There is consistent evidence to support the use of BFR resistance training as a treatment intervention following knee injury and as a means to improve KE strength and function and to reduce pain. Strength of Recommendation: Grade A evidence supporting the use of BFR resistance training for improvement in KE strength and function, and the reduction of patient-reported pain following an acute or chronic knee pathology.

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Elizabeth Hollenczer, Angelica Esposito, and Erin M. Moore

Clinical Scenario: Due to the Female Athlete Triad (Triad) being a 3-pronged syndrome, treatments can vary depending on the symptoms that clinicians focus on. With reproductive and bone health compromised, assessment and recovery methods include monitoring menstrual regularity and dual-energy X-ray absorptiometry scans. Low levels of estrogen have demonstrated negative effects on bone mineral density (BMD). Clinical Question: Does supplemental estrogen improve BMD in athletes with Female Athlete Triad symptoms? Summary of Key Findings: Supplemental estrogen does improve BMD with estrogen patches demonstrating increased improvement compared with oral contraceptive pills. Clinical Bottom Line: Restoration of regular menstruation, improvement of BMD, and ensuring optimal energy levels is the best approach for treating Triad symptoms. Transdermal patches are a new treatment option that address both menstrual function and BMD but still require further research. Strength of Recommendation: Available studies demonstrated a level 2 evidence for supplemental estrogen (oral contraceptive pills and estrogen patches) providing improvements for bone health related to the Triad.

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Adam J. Wells and Bri-ana D.I. Johnson

Context: The Dynavision D2 Mode A test (ModeA) is a 1-minute reaction time (RT) test commonly used in sports science research and clinical rehabilitation. However, there is limited data regarding the effect of repeated testing (ie, training) or subsequent periods of no testing (ie, detraining) on test–retest reliability and RT performance. Therefore, the purpose of this study was to examine the test–retest reliability, training, and detraining effects associated with the D2 ModeA test. Design: Repeated measures/reliability. Methods: Twenty-four recreationally active men and women completed 15 training sessions consisting of 2 ModeA tests per session (30 tests). The participants were then randomized to either 1 or 2 weeks of detraining prior to completing 15 retraining sessions (30 tests). The training and retraining periods were separated into 10 blocks for analysis (3 tests per block). The number of hits (hits) and the average RT per hit (AvgRT) within each block were used to determine RT performance. Intraclass correlation coefficients, SEM, and minimum difference were used to determine reliability. Repeated-measures analysis of variance/analysis of covariance were used to determine training and detraining effects, respectively. Results: The ModeA variables demonstrated excellent test–retest reliability (intraclass correlation coefficient2,3 > .93). Significant improvements in hits and AvgRT were noted within training blocks 1 to 5 (P < .05). No further improvements in RT performance were noted between training blocks 6 through 10. There was no effect of detraining period on RT. The RT performance was not different between blocks during retraining. Conclusions: It appears that 15 tests are necessary to overcome the training effect and establish reliable baseline performance for the ModeA test. Detraining for 1 to 2 weeks did not impact RT performance. The authors recommend that investigators and clinicians utilize the average of 3 tests when assessing RT performance using the D2 ModeA test.

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Oladipo Eddo, João R. Vaz, Jaime Ludwick, Bryndan Lindsey, Joel Martin, Shane Caswell, and Nelson Cortes

Trunk modification is associated with knee abduction moment reduction in both healthy groups and individuals with knee osteoarthritis. Ambulatory-related changes in trunk kinematics have been implicated in increased trunk moment. The purpose of this study was to investigate the effect of dose-specific lateral trunk lean on trunk kinetics during ipsilateral and contralateral stance phases. Nineteen healthy participants completed 10 baseline walking trials, followed by 10 trials employing lateral trunk lean. Trunk modification magnitudes were determined based on the average baseline trunk angle. Five trials of both small and large trunk modification magnitudes were completed. Visual real-time biofeedback was projected as a line graph displaying the trunk angle during stance, and a highlighted bandwidth was designated the target range. A 1-factor repeated-measures analysis of variance or Friedman test was used to assess differences between the conditions (P < .05) in trunk dependent measures. Trunk kinetics displayed significant increases, even during modest modifications to the trunk angle. The participants experienced increased peak frontal plane trunk moment and angular impulse during ipsilateral stance. The observed increase in the peak lateral joint reaction force is suggestive of a compromised loading environment at the spine. Implementing trunk modification might result in unintended secondary changes along the kinetic chain, but further investigation is required.