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Open access

Jennifer L. Ostrowski, Alexa Beaumont, and Emily Dochterman

Clinical Scenario: Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear. Clinical Question: In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies? Summary of Key Findings: Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP. Clinical Bottom Line: There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology. Strength of Recommendation: There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis.

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Geneviève N. Olivier, Christopher S. Walter, Serene S. Paul, Leland E. Dibble, and Sydney Y. Schaefer

Motor performance is classically described as improving nonlinearly with practice, demonstrating rapid improvements early in practice with stabilization later, which is commonly modeled by exponential decay functions. However, retrospective analyses of our previously collected data challenge this theoretical model of motor skill acquisition, suggesting that a majority of individual learners actually demonstrate patterns of motor improvement different from this classical model. A convenience sample of young adults, older adults, and people with Parkinson disease trained on the same functional upper-extremity task. When fitting three-parameter exponential decay functions to individual participant data, the authors found that only 13.3% of young adults, 40.9% of older adults, and 66.7% of adults with Parkinson disease demonstrated this “classical” skill acquisition pattern. Thus, the three-parameter exponential decay pattern may not well-represent individuals’ skill acquisition of complex motor tasks; instead, more individualized analysis methods may be warranted for advancing a theoretical understanding of motor skill acquisition.

Open access

Félix Croteau, Shawn M. Robbins, and David Pearsall

Context: Previous authors suggest that lack of strength is an important risk factor for injuries in water polo. Hand-held dynamometers have potential as a clinical tool to measure strength, but they have not been validated in water polo players. Objective: The purpose of this study was to estimate intertrial variability and concurrent validity of hand-held dynamometer shoulder strength measurements in elite water polo players. Methods: A total of 19 male and 20 female elite water polo players performed isometric external (ER) and internal (IR) rotation strength tests against a hand-held dynamometer bilaterally in supine position with the shoulder in a 90–90 position. In addition, concentric IR and ER was captured at 90 deg/s with an isokinetic dynamometer, and torque values were determined near the 90–90 position. Main Outcome Measures: Spearman correlation coefficients were calculated for ER torque, IR torque, and ER/IR ratios between the devices. Two-way mixed-model intraclass correlations were used to assess intertrial variability. Results: Correlations between the devices were strong to very strong (ρ = .65–.82, P < .01) for absolute IR and ER but low for ER/IR ratios (ρ = .29, P = .07). There was less agreement at higher torque values. Intertrial variability was low with intraclass correlation values .88 to .93, P < .05. Conclusions: These results show that hand-held dynamometers are adequate clinical alternatives to measure absolute shoulder strength in water polo players. Stronger players may require stronger evaluators to resist the player’s push and obtain reliable results.

Open access

Robert C. Lynall, Rachel S. Johnson, Landon B. Lempke, and Julianne D. Schmidt

Context: Reaction time is commonly assessed postconcussion through a computerized neurocognitive battery. Although this measure is sensitive to postconcussion deficits, it is not clear if computerized reaction time reflects the dynamic reaction time necessary to compete effectively and safely during sporting activities. Functional reaction time assessments may be useful postconcussion, but reliability must be determined before clinical implementation. Objective: To determine the test–retest reliability of a functional reaction time assessment battery and to determine if reaction time improved between sessions. Design: Cohort. Setting: Laboratory. Participants: Forty-one participants (21 men and 20 women) completed 2 time points. Participants, on average, were 22.5 (2.1) years old, 72.5 (11.9) cm tall, had a mass of 71.0 (13.7) kg, and were mostly right leg and hand dominant (92.7%). Interventions: Participants completed 2 clinical reaction time tests (computerized Stroop and drop stick) and 5 functional reaction time tests (gait, jump landing, single-leg hop, anticipated cut, and unanticipated cut) across 2 sessions. Drop stick and functional reaction time assessments were performed in single (motor task only) and dual task (motor task with cognitive task). Main Outcome Measures: Reaction time (in seconds) was calculated during all assessments. Test–retest reliability was determined using 2-way mixed-effects intraclass correlation coefficients (3, k). Paired samples t tests compared mean reaction time between sessions. Results: Test–retest reliability was moderate to excellent for all reaction time outcomes (intraclass correlation coefficients [3, k] range = .766–.925). Several statistically significant between-session mean differences were observed, but effect sizes were negligible to small (d range = 0.05–0.44). Conclusions: The functional reaction time assessment battery displayed similar reliability to the standard computerized reaction time assessment battery and may provide important postinjury information, but more research is needed to determine clinical utility.

Open access

Tetsuo Fukunaga

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W. Tolentino-Castro, L. Mochizuki, and H. Wagner

According to the literature, persons with intellectual disabilities have poor motor control in tasks in which motor anticipation is needed. Our study aimed to assess their motor behavior during interceptive tasks (a tennis ball interception with external-and-oneself throw conditions). A stick-bar was used as a reference or to support cloth to occlude a ball’s trajectory. Catch performance and interceptive behavior were analyzed (26 persons). The results show that high/low values of the initial approaching movement led to successful/successful catches, respectively. Our results are in line with the literature about the impact of poor motor control on performance in those with intellectual disabilities. We suggest that low anticipation may relate to problems in real-life situations.

Open access

Chris M. Edwards

Clinical Scenerio: Neck pain is a costly symptom in both civilian and military worlds. While traditional treatments include deep neck flexor stabilizing exercises, manual therapy, electrical therapy, and other nonsurgical interventions, scapular orientation and stability training has emerged as a possible tool to reduce neck pain severity. Methods that can be coached at a distance could be of value in virtual appointments or circumstances where access to a qualified manual therapist is limited. Focused Clinical Question: What is the effectiveness of including exercise programs targeting scapular kinematics and stability to decrease neck pain? Summary of Key Findings: Exercise programs targeting scapular kinematics and stability, with coaching and individualized progressions, appear to reduce neck pain severity. Clinical Bottom Line: Evidence supports the inclusion of exercises for scapular kinematics and stability at a prescription of 3 sessions per week, with a duration of 4 or 6 weeks. Exercise programs should include a “learning” or coaching phase to ensure exercises are performed as intended, and exercise progressions should be based on participant ability rather than predetermined timelines. Further research is needed to better understand the benefits of this potential strategy and the statistical impact of scapular-focused exercise interventions on neck pain in specific populations like military and athletes. Strength of Recommendation: There is ‘Fair’ to ‘Good’ evidence from 2 level 1b single-blind randomized control studies and 1 level 2b pre-post test control design study supporting the inclusion of exercise programs targeting scapular kinematics and stability to decrease chronic neck pain severity.

Open access

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

Context: Monitoring training loads and consequent fatigue responses are usually a result of personal trainers’ experiences and an adaptation of methods used in sports for people without disabilities. Currently, there is little scientific evidence on the relationship between training load and fatigue resulting from training sessions in wheelchair sports. Analogous to the vertical jump, which has been associated with competitive performance and used to assess fatigue in Olympic sports, the medicine ball throw (MBT) is a fast, feasible, and accessible test that might be used to measure performance outcomes in Paralympic athletes. Objective: To test the MBT responsiveness to detect meaningful changes after training sessions in beginner wheelchair basketball players (WBP). Design: Cross-sectional study. Setting: Rehabilitation Hospital Network, Paralympic Program. Participants: Twelve male WBP. Main Outcomes Measures: The participants performed 3 consecutive days of training sessions involving exercises of wheelchair basketball skills, strength, and power. The MBT test was performed pre and post training sessions. Results: The smallest worthwhile change for MBT was 0.10 cm, and the lower and upper limits were 3.54 and 3.75 m, respectively. On the first day, the MBT started below the smallest worthwhile change lower limit and increased above the upper limit (3.53 and 3.78 m, respectively). On the second day, the MBT pretraining and posttraining session results were near the sample mean (3.62 and 3.59 m, respectively). On the third day, the WBP started the MBT test training higher than the upper limit (3.78 m) and decreased to near the mean (3.58 m). Conclusions: During 3 consecutive days of training sessions, the magnitude-based inference model presented meaningful changes in MBT test performance. The accurate association of the magnitude-based inference model with the MBT allows coaches and sports team staff to interpret the correct magnitude of change in WBP performance.

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James W. Roberts, Nicholas Gerber, Caroline J. Wakefield, and Philip J. Simmonds

The failure of perceptual illusions to elicit corresponding biases within movement supports the view of two visual pathways separately contributing to perception and action. However, several alternative findings may contest this overarching framework. The present study aimed to examine the influence of perceptual illusions within the planning and control of aiming. To achieve this, we manipulated and measured the planning/control phases by respectively perturbing the target illusion (relative size-contrast illusion; Ebbinghaus/Titchener circles) following movement onset and detecting the spatiotemporal characteristics of the movement trajectory. The perceptual bias that was indicated by the perceived target size estimates failed to correspondingly manifest within the effective target size. While movement time (specifically, time after peak velocity) was affected by the target configuration, this outcome was not consistent with the direction of the perceptual illusions. These findings advocate an influence of the surrounding contextual information (e.g., annuli) on movement control that is independent of the direction predicted by the illusion.

Open access

Jared Patus

Clinical Scenario: Traditional loading (TL) is a common technique to employ when engaging in countermovement jumps (CMJ). Accentuated eccentric loading (AEL) is a newer modality that is being explored for acute CMJ performance. Focused Clinical Question: In adult, resistance-trained males, will AEL have a superior impact on acute CMJ performance compared to TL? Summary of Key Findings: The literature was searched for studies that examined the influence of AEL on acute CMJ performance compared to a TL protocol. TL was defined as any loading condition that utilized an equivalent resistance during both the eccentric and concentric contractions. Three studies met the inclusion and exclusion criteria, and were identified and included in the critically appraised topic. Each of the 3 studies found that various AEL conditions were either equal to or better than TL when examining subsequent CMJ performance. In no specific CMJ outcome measure was TL deemed to have a greater impact than AEL. Clinical Bottom Line: AEL provides more favorable acute CMJ performance than TL in adult, resistance-trained males. Strength of Recommendation: Consistent findings from 2 randomized crossover studies and one repeated-measured design investigation suggest level 2b evidence to support AEL as an ideal protocol for acute CMJ performance.