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Joanna M. Auger and Nancy L.I. Spencer

Justifications for access to physical activity for people who experience disability tend to focus on the health benefits associated with a medical model of disability. The result is often programs that are segregated and impairment-focused, with limited access to integrated settings that are also potentially inclusive. In this instrumental case study, the authors engaged 20 participants with and without impairment from an adult integrated indoor cycling program to explore what contributed to meaningful and inclusive experiences in this setting. Data were generated through semistructured interviews and reflective notes. Thematic analysis led to three themes: (a) “just going to a spin class” (b) “seamless”? and (c) “deliberate community.” Using a relational ethics framework, the findings are discussed with regard to their potential to inform the development of integrated and inclusive physical activity programs, with emphasis on program structure and instructor reflexivity and training.

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Craig R. Denegar and Justina Gray

Proprioceptive neuromuscular facilitation (PNF) stretching of the hamstrings improves flexibility but requires assistance from a clinician or partner. The original intent of our work was to assess the efficacy of self-assisted PNF hamstring stretching using a commercially available device. The authors observed improved flexibility in the stretched leg and, to a lesser extent, in the contralateral leg. While this was at first simply interesting, the finding became clinically relevant in the subsequent application in the care of a patient with low-back pain with radiating pain. This report provides study data and describes the translation of study findings into the care of a patient in a clinical setting.

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Tomonari Takeshita, Hiroaki Noro, Keiichiro Hata, Taira Yoshida, Tetsuo Fukunaga, and Toshio Yanagiya

The present study aimed to clarify the effect of the foot strike pattern on muscle–tendon behavior and kinetics of the gastrocnemius medialis during treadmill running. Seven male participants ran with 2 different foot strike patterns (forefoot strike [FFS] and rearfoot strike [RFS]), with a step frequency of 2.50 Hz and at a speed of 2.38 m/s for 45 seconds on a treadmill with an instrumented force platform. The fascicle behavior of gastrocnemius medialis was captured using a B-mode ultrasound system with a sampling rate of 75 Hz, and the mechanical work done and power exerted by the fascicle and tendon were calculated. At the initial contact, the fascicle length was significantly shorter in the FFS than in the RFS (P = .001). However, the fascicular velocity did not differ between strike patterns. Higher tendon stretch and recoil were observed in the FFS (P < .001 and P = .017, respectively) compared with the RFS. The fascicle in the positive phase performed the same mechanical work in both the FFS and RFS; however, the fascicle in the negative phase performed significantly greater work in the FFS than in the RFS (P = .001). RFS may be advantageous for requiring less muscular work and elastic energy in the series elastic element compared with the FFS.

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Irfan A. Khan and Kelley Henderson

Focused Clinical Question: What is the efficacy of structured foam rolling protocols at increasing hamstring muscle flexibility in active adults when compared with just maintaining regular levels of activity? Clinical Bottom Line: There is significant evidence to support the use of structured foam rolling programs in active adults to improve hamstring flexibility.

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Kelly Cheever and Melissa Kay

Context: Despite evidence implicating cervicogenic symptoms in the development of persistent postconcussion symptoms, factors that influence utilization of cervical clinical tests to identify cervicogenic symptoms following concussion are poorly understood. Objective: Explore barriers to the utilization of cervical clinical testing in multifaceted concussion evaluation. Design: Cross-sectional. Setting: Online survey. Patients or Other Participants: A total of 122 athletic trainers (AT) (age = 42.6 [6.4] y; female = 51.6%; 52% >10 y of clinical practice; 68% master’s degree or greater; 35% treated a minimum of 15 concussions/y). Main Outcome Measure(s): Perceived importance, clinical experience, number of concussions treated, utilization of cervical clinical tests following nonspecific cervical pathology and following concussion, comfort with cervical treatment modalities following a concussion, and recommendation for cervical-specific therapy to treat persistent postconcussion symptoms. Results: Ordinal logistic regression revealed perceived importance had the strongest positive impact on AT’s likelihood of high utilization of cervical clinical testing following concussion (95% CI, .17 to .99; P = .005), while clinical experience (95% CI, −.43 to .29; P = .71) and number of concussions treated/y (95% CI, −.21 to .31; P = .71) had no bearing. Moreover, low comfort with cervical treatments following a concussion (95% CI, −2.86 to −.26; P = .018) and low utilization of cervical clinical testing following nonspecific cervical pathology (95% CI, −7.01 to −3.39; P ≤ .001) had a strong positive impact on high utilization of cervical clinical testing following concussion. Two logistic regression models demonstrated how recommendations for cervical-specific therapy in persistent post-concussion symptom patients could be predicted based on (1) cervical test utilization and (2) perceptions and clinical experience with 79% and 78%, respectively. Conclusions: Perceived importance played a major role in utilization of cervical clinical test following concussion. ATs who utilized common cervical treatments when dealing with non-concussive injuries were more likely to utilize those same treatments to treat comorbid cervical pathology following a concussion.

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Katherine L. Helly, Katherine A. Bain, Matthew C. Hoch, Nicholas R. Heebner, Phillip A. Gribble, Masafumi Terada, and Kyle B. Kosik

Context: Static postural control deficits are commonly documented among individuals with chronic ankle instability (CAI). Evidence suggests individuals with CAI who seek medical attention after an ankle sprain report fewer subjective symptoms. It is unknown if seeking medical attention and receiving supervised physical rehabilitation has a similar effect on objective outcomes, such as static postural control. Objective: To compare measures of single-limb postural control and center of pressure (COP) location between participants with CAI who did or did not self-report attending supervised rehabilitation at the time of their first lateral ankle sprain. Design: Retrospective cohort. Setting: Laboratory. Patients (or Other Participants): Twenty-nine participants with CAI who did (n = 14) or did not (n = 15) self-report attending supervised rehabilitation. Intervention(s): Self-reported attendance or not of supervised rehabilitation at the time of initial injury. Main Outcome Measures: Participants performed three 20-second trials of single-limb stance on a force plate with eyes open. Main outcome measures included the COP velocities, time-to-boundary (TTB) absolute minima, mean of TTB minima, and SD of TTB minima in the anteroposterior and mediolateral directions. The spatial distribution of the COP data points under the foot was quantified within 4 equally proportional sections labeled anteromedial, anterolateral, posteromedial, and posterolateral. Results: Participants who reported attending supervised rehabilitation after their initial ankle sprain had a lower COP velocity in the anterior–posterior direction (P = .030), and higher TTB anterior–posterior absolute minimum (P = .033) and mean minima (P = .050) compared with those who did not attend supervised rehabilitation. Conclusions: Among individuals with CAI, not attending supervised rehabilitation at the time of initial injury may lead to worse static postural control outcomes. Clinicians should continue advocating for patients recovering from an acute ankle sprain to seek medical attention and provide continued care in the form of physical rehabilitation.

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Mark L. Latash and Vera L. Talis

The authors have presented an unpublished manuscript by Nikolai Aleksandrovich Bernstein written in the form of a diary in 1949. Bernstein focused on the concept of time as a coordinate in four-dimensional space and discussed a variety of issues, including the definition of time, its measurement, time travel, asymmetry of the past and future, and even linguistics. In particular, he offered a definition of life tightly linked to the concept of time. Overall, this manuscript offers a glimpse into Bernstein’s thinking, his sense of humor, and his sarcasm, intimately coupled with the very serious attitude to scientific discourse.

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Ali Brian, Sally Taunton Miedema, Jerraco L. Johnson, and Isabel Chica

Fundamental motor skills (FMS) are an underlying mechanism driving physical activity behavior and promoting positive developmental trajectories for health. However, little is known about FMS of preschool-aged children with visual impairments (VI). The purpose of this study was to examine the FMS of preschool-aged children (N = 25) with (n = 10) and without (n = 15) VI as measured using the Test of Gross Motor Development-3. Children without VI performed significantly higher than their peers for locomotor (M = +11.87, p = .014, η2 = .31) and ball skills (M = +13.69, p < .001, η2 = .56). Regardless of the presence of a VI, many participants struggled with developing FMS, with the greatest disparity resting within ball skills. These findings help to clarify the FMS levels of preschool-aged children with VI. Thus, there is a need for both further inquiry and intervention for all children.

Open access

John H. Challis

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Abdulaziz Almudhi and Hamayun Zafar

The current study was carried out with the aim of investigating the effect of maximally relaxed lying posture on disfluencies in young adults who stutter. A total of 24 participants (17 males, seven females; mean age = 24.9 ± 6.2 years) with developmental stuttering were a part of the study. The participants were asked to perform spontaneous speaking and reading aloud tasks in standard sitting and maximally relaxed lying postures. The severity of stuttering for the studied postures was estimated by using the Stuttering Severity Instrument. The results on the Stuttering Severity Instrument showed that stuttering parameters improved during the maximally relaxed lying posture compared with the standard sitting position. The results are discussed in the light of motor control concepts. It is concluded that the maximally relaxed lying posture can facilitate improvement in stuttering scores during spontaneous speaking as well as reading aloud in young adults who stutter. Reduced stuttering scores in the maximally relaxed lying posture suggest that speech therapists can position participants in this position while treating people who stutter.