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Paul Head, Mark Waldron, Nicola Theis and Stephen David Patterson

Context: Neuromuscular electrical stimulation (NMES) combined with blood flow restriction (BFR) has been shown to improve muscular strength and size better than NMES alone. However, previous studies used varied methodologies not recommended by previous NMES or BFR research. Objective: The present study investigated the acute effects of NMES combined with varying degrees of BFR using research-recommended procedures to enhance understanding and the clinical applicability of this combination. Design: Randomized crossover. Setting: Physiology laboratory. Participants: A total of 20 healthy adults (age 27 [4] y; height 177 [8] cm; body mass 77 [13] kg). Interventions: Six sessions separated by at least 7 days. The first 2 visits served as familiarization, with the experimental conditions performed in the final 4 sessions: NMES alone, NMES 40% BFR, NMES 60% BFR, and NMES 80% BFR. Main Outcome Measures: Maximal voluntary isometric contraction, muscle thickness, blood pressure, heart rate, rating of perceived exertion, and pain were all recorded before and after each condition. Results: The NMES 80% BFR caused greater maximal voluntary isometric contraction decline than any other condition (−38.9 [22.3] N·m, P < .01). Vastus medialis and vastus lateralis muscle thickness acutely increased after all experimental conditions (P < .05). Pain and ratings of perceived exertion were higher after NMES 80% BFR compared with all other experimental conditions (P < .05). No cardiovascular effects were observed between conditions. Conclusion: The NMES combined with 80% BFR caused greater acute force decrement than the other conditions. However, greater perceptual ratings of pain and ratings of perceived exertion were observed with NMES 80% BFR. These acute observations must be investigated during chronic interventions to corroborate any relationship to changes in muscle strength and size in clinical populations.

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Yumeng Li, Shuqi Zhang and Christina Odeh

The purposes of the study were (1) to compare postural sway between participants with Parkinson’s disease (PD) and healthy controls and (2) to develop and validate an automated classification of PD postural control patterns using a machine learning approach. A total of 9 participants in the early stage of PD and 12 healthy controls were recruited. Participants were instructed to stand on a force plate and maintain stillness for 2 minutes with eyes open and eyes closed. The center of pressure data were collected at 50 Hz. Linear displacements, standard deviations, total distances, sway areas, and multiscale entropy of center of pressure were calculated and compared using mixed-model analysis of variance. Five supervised machine learning algorithms (ie, logistic regression, K-nearest neighbors, Naïve Bayes, decision trees, and random forest) were used to classify PD postural control patterns. Participants with PD exhibited greater center of pressure sway and variability compared with controls. The K-nearest neighbor method exhibited the best prediction performance with an accuracy rate of up to 0.86. In conclusion, participants with PD exhibited impaired postural stability and their postural sway features could be identified by machine learning algorithms.

Open access

Amanda L. Ager, Dorien Borms, Magali Bernaert, Vicky Brusselle, Mazarine Claessens, Jean-Sébastien Roy and Ann Cools

Context: Proprioception deficits contribute to persistent and recurring physical disability, particularly with shoulder disorders. Proprioceptive training is thus prescribed in clinical practice. It is unclear whether nonsurgical rehabilitation can optimize shoulder proprioception. Objectives: To summarize the available evidence of conservative rehabilitation (ie, nonsurgical) on proprioception among individuals with shoulder disorders. Evidence Acquisition: PubMed, Web of Science, and EBSCO were systematically searched, from inception until November 24, 2019. Selected articles were systematically assessed, and the methodological quality was established using the Dutch Cochrane Risk of Bias Tool and the Newcastle-Ottawa Quality Assessment Scale. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were utilized for this review. The conservative treatments were categorized as follows: (1) conventional therapy, (2) proprioceptive training, (3) elastic kinesiology tape, and (4) other passive therapies. Evidence Synthesis: Twelve articles were included, yielding 58 healthy control shoulders and 362 shoulders affected by impingement syndrome, glenohumeral dislocations, nonspecific shoulder pain, rotator cuff dysfunction, or subluxation poststroke. The level of agreement between the evaluators was excellent (84.9%), and the studies were evaluated to be of fair to excellent quality (risk of bias: 28.5%–100%). This review suggests, with moderate evidence, that proprioceptive training (upper-body wobble board or flexible foil training) can improve proprioception in the midterm. No decisive evidence exists to suggest that conventional therapy is of added value to enhance shoulder proprioception. Conflicting evidence was found for the improvement of proprioception with the application of elastic kinesiology tape, while moderate evidence suggests that passive modalities, such as microcurrent electrical stimulation and bracing, are not effective for proprioceptive rehabilitation of the shoulder. Conclusions: Proprioceptive training demonstrates the strongest evidence for the effective rehabilitation of individuals with a shoulder proprioceptive deficit. Elastic kinesiology tape does not appear to affect the sense of shoulder proprioception. This review suggests a possible specificity of training effect with shoulder proprioception.

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Kyle M. Petit and Tracey Covassin

Context: Cognitive and physical rest are commonly utilized when managing a sport-related concussion (SRC); however, emerging research now suggests that excessive rest may negatively impact recovery. Despite current research recommendations, athletic trainers (ATs) may be behind in implementing this emerging research into clinical practice. Objective: To assess college ATs’ perceptions and implementation of an emerging SRC management approach (cognitive and physical rest and activity). Design: Cross-sectional study. Setting: Survey. Participants: A total of 122 (11.8%) ATs (53.3% female; 10.8 [9.8] y experience; 8.7 [6.9] SRCs managed annually) responded to the survey, which was randomly distributed to 1000 members of the National Athletic Trainers’ Association, as well as 31 additional ATs from varying universities. Main Outcome Measures: A 5-point Likert scale assessed the ATs’ perceptions and clinical practices as they relate to specific athlete behaviors (ie, texting, sleeping). The ATs were asked about their willingness to incorporate physical activity into clinical practice. Results: Playing video games (95.9%) and practicing (93.4%) were the activities most perceived to extend SRC recovery. However, sleeping more than usual (7.4%) and increased time in a dark environment (11.5%) were viewed as less likely to extend recovery. ATs restricted practicing (98.4%) and working out (91.8%) for athletes with SRC, while sleeping more than usual (6.6%) and increased time in a dark environment (13.1%) were less restricted. About 71% of the ATs would implement light physical activity for athletes with a symptom score of 1 to 5, 31% with scores of 6 to 10, and 15% with scores of 11 to 20. About 43%, 74%, and 97% believe that light, moderate, and vigorous physical activity, while symptomatic, will extend recovery, respectively. Conclusions: The ATs were receptive to including light physical activity into their SRC management, although only in certain situations. However, most ATs’ beliefs and clinical practices did not completely align with emerging research recommendations for the management of SRCs.

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Seth T. Strayer, Seyed Reza M. Moghaddam, Beth Gusenoff, Jeffrey Gusenoff and Kurt E. Beschorner

Pressure offloading is critical to diabetic foot ulcer healing and prevention. A novel product has been proposed to achieve this offloading with an insole that can be easily modified for each user. This insole consists of pressurized bubbles that can be selectively perforated and depressurized to redistribute weight to the nonulcer region of the foot. However, the effect of the insole design parameters, for example, bubble height and stiffness, on offloading effectiveness is unknown. To this end, a 3-dimensional finite element model was developed to simulate contact between the rearfoot and insole. The geometry of the calcaneus bone and soft tissue was based on the medical images of an average male patient, and material properties and loading conditions based on the values reported in the literature were used. The model predicts that increasing bubble height and stiffness leads to a more effectively offloaded region. However, the model also predicts that increasing stiffness leads to increasing contact pressures on the surrounding soft tissue. Thus, a combination of insole design parameters was determined, which completely offloads the desired region, while simultaneously reducing the contact pressure on the surrounding soft tissue. This design is expected to aid in diabetic foot ulcer healing and prevention.

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Heloisa Suzano de Almeida, Flávia Porto, Marcelo Porretti, Gabriella Lopes, Daniele Fiorot, Priscila dos Santos Bunn and Elirez Bezerra da Silva

This systematic review verified the effect of dance on postural control in people with Parkinson’s disease (PD) and investigated whether this practice can be as effective over a short period as when it is performed over a longer period in relation to the postural control of this population. The search was performed in April 2019 in nine databases. Only randomized/quasi-randomized controlled trials with participants with idiopathic PD were included. The meta-analysis of the 11 articles included, with 13 results, showed that the 211 participants with PD, who belonged to the group performing dance, had a standardized mean difference of postural control 0.82 [0.52, 1.12] greater than the 182 participants who were in a control situation. The statistically significant results of this meta-analysis indicate that dance can improve postural control in people with PD in a short period of time and therefore contribute to the prevention of falls.

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Waynne F. Faria, Filipe R. Mendonça, Géssika C. Santos, Sarah G. Kennedy, Rui G.M. Elias and Antonio Stabelini Neto

Purpose: To analyze the effects of 2 combined training methods on the cardiometabolic risk factors in adolescents. Methods: A total of 76 adolescents (16.1 [1.1] y, n = 44 female) were randomized into groups of moderate-intensity continuous training combined with resistance training (MICT + RT), high-intensity interval training combined with resistance training (HIIT + RT), or control. The training sessions were performed twice weekly for 12 weeks. The outcomes evaluated included body fat percentage, waist circumference, fasting blood glucose, fasting insulin, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, glycated hemoglobin, insulin resistance index, blood pressure, peak oxygen consumption (VO2peak), and cardiometabolic risk Z score. Results: The intervention groups presented a significant reduction in the cardiometabolic risk Z score after 12 weeks of the combined exercise program. In relation to the cardiometabolic risk Z score between groups, the HIIT + RT group presented a significant intervention effect when compared with the control group (Cohen d = 0.23; P < .05). Significant intervention effects were found when comparing the MICT + RT and control groups for body fat percentage, high-density lipoprotein, and VO2peak. Between the HIIT + RT and control groups, significant intervention effects were found for body fat percentage, blood pressure, and VO2peak. There were not significant differences between the HIIT + RT and MICT + RT groups. Conclusion: Twelve weeks of HIIT + RT and MICT + RT were effective in significantly reducing the cardiometabolic risk in these adolescents.