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Recommendations for Implementation of Dog Therapy Intervention in the Athletic Training Facility

Rebecca Covach, Lindsey Keenan, and Emily Duckett

Dog therapy is implemented in various healthcare fields because of its unique ability to reduce perceived anxiety and hormonal stress, increase positive patient relationships with practitioners, and assist with demonstrating procedures. However, implementation of dog therapy in a clinical athletic training setting is not frequently discussed in relevant literature. This article outlines recommendations for the use and efficacy of therapy dogs in an athletic training facility, based on data from several studies across various healthcare fields. We provide information regarding best practice recommendations to incorporate therapy dogs into athletic training services, as well as the necessary administrative aspects and safeguards. Athletic trainers can use these recommendations and framework to explore the implementation of dog therapy into clinical practice.

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The Amount and Pattern of Reciprocal Compensations Predict Performance Stability in a Visually Guided Finger Force Production Task

Valéria Andrade, Nicole S. Carver, Francis M. Grover, Scott Bonnette, and Paula L. Silva

Previous work suggests that synergistic activity among motor elements implicated in force production tasks underlies enhanced performance stability associated with visual feedback. A hallmark of synergistic activity is reciprocal compensation, that is, covariation in the states of motor elements that stabilizes critical performance variables. The present study examined if characteristics of reciprocal compensation are indicators of individuals’ capacity to respond adaptively to variations in the resolution of visual feedback about criterion performance. Twenty healthy adults (19.25 ± 1.25 years; 15 females and five males) pressed two sensors with their index fingers to produce a total target force equivalent to 20% of their maximal voluntary contraction under nine conditions that differed in the spatial resolution of real-time feedback about their performance. By combining within-trial uncontrolled manifold and sample entropy analyses, we quantified the amount and degree of irregularity (i.e., non-repetitiveness) of reciprocal compensations over time. We found a U-shaped relationship between performance stability and gain. Importantly, this relationship was moderated by the degree of irregularity of reciprocal compensation. Lower irregularity in reciprocal compensation patterns was related to individuals’ capacity to maintain (or minimize losses in) performance under changes in feedback resolution. Results invite future investigation into how interindividual variations in reciprocal compensation patterns relate to differences in control strategies supporting adaptive responses in complex, visually guided motor tasks.

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Leveraging the Momentum

Luke Donovan

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Aerobic Exercise as an Intervention for Mild Traumatic Brain Injury: A Critically Appraised Topic

Makayla Florez, Erin Roberge, and Jennifer Ostrowski

Clinical Scenario: As of 2020, the lifetime prevalence of at least one self-reported concussion is 24.6%. Athletic trainers in all settings work with patients who are at risk of sustaining a concussion or mild traumatic brain injury (mTBI) and developing persistent postconcussive symptoms. Aerobic exercise is emerging as an intervention for decreasing symptoms in patients who have sustained mTBI; however, the majority of research has been performed on pediatric patients. It is of interest whether aerobic exercise is an effective intervention for adult patients with mTBI. Focused Clinical Question: In adults who have sustained mTBI, does traditional therapy decrease symptoms more than aerobic exercise? Summary of Search: A systematic search of 4 databases was performed to answer this question. Three randomized controlled trials were identified that compared aerobic exercise to traditional therapy, which consists of physical and cognitive rest. Two studies found no significant differences in symptoms between the 2 groups while 1 study found decreased symptoms in the aerobic exercise group. Clinical Bottom Line: The current evidence is clear that there is no decrease in mTBI symptoms with traditional therapy as compared with aerobic exercise, with 1 study showing decreased symptoms with aerobic exercise. Strength of Evidence: Based on the Center for Evidence-Based Medicine grades of evidence, the clinical bottom line is based on grade A evidence.

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Analzying Dual-Task Paradigms to Improve Postconcussion Assessment and Management

Diana Robertson, Landon B. Lempke, and Robert C. Lynall

Context: Dual-task (simultaneous cognitive–motor activities) assessments have been adapted into reliable and valid clinical concussion measures. However, abundant motor and cognitive variations leave researchers and clinicians uncertain about which combinations elicit the intended dual-task effect. Our objective was to examine differences between commonly employed dual-task motor and cognitive combinations among healthy, college-aged individuals. Design: Cross-sectional laboratory study. Methods: Twenty participants (age: 21.3 [2.4] y; height: 176.0 [9.1] cm; mass: 76.0 [16.4] kg; 20% with concussion history) completed 4 motor tasks (gait, tandem gait, single-leg balance, and tandem balance) under 5 cognitive conditions (single task, subtraction, month reversal, spelling backward, and visual Stroop) in a research laboratory. The motor performance outcomes were spatiotemporal variables for gait and tandem gait and center of pressure path length (in centimeters) for single-leg and tandem balance. Cognitive outcomes were response rate (responses/second) and cognitive accuracy. We used separate repeated-measures analyses of variance for each motor and cognitive outcome with post hoc Tukey t tests. Results: Gait velocity, gait stride length, and tandem gait velocity demonstrated significant cognitive–motor interactions (P’s < .001) such that all dual-task conditions resulted in varyingly slower or shorter movement than single task. Conversely, single-leg balance (P = .627) and tandem balance (P = .434) center of pressure path length did not significantly differ among the dual-task cognitive conditions or relative to single task. Statistically significant cognitive–motor interactions were observed only for spelling backward accuracy (P = .004) and response rates for spelling backward, month reversal, and visual Stroop (P’s < .001) such that worse accuracy, but faster response rates, occurred during motor tasks. Conclusions: Gait and tandem gait motor tasks accompanied with spelling backward or subtraction cognitive tasks demonstrated consistently strong dual-task effects and, therefore, may be the best suited for clinical and research use following concussion.

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Effectiveness of Percutaneous Needle Electrolysis to Reduce Pain in Tendinopathies: A Systematic Review With Meta-Analysis

Matheus Hissa Lourenço Ferreira, Guilherme Augusto Santos Araujo, and Blanca De-La-Cruz-Torrez

Context: Tendon injuries are common disorders in both workers and athletes, potentially impacting performance in both conditions. This is why the search for effective treatments is continuing. Objective(s): The objective of this study was to analyze whether the ultrasound-guided percutaneous needle electrolysis technique may be considered a procedure to reduce pain caused by tendinosis. Evidence Acquisition: The search strategy included the PubMed, SCOPUS, CINAHL, Physiotherapy Evidence Database, SciELO, and ScienceDirect up to the date of February 25, 2024. Randomized clinical trials that assessed pain caused by tendinosis using the Visual Analog Scale and Numeric Rating Scale were included. The studies were evaluated for quality using the Cochrane Risk of Bias 2, and the evidence strength was assessed by the GRADEpro GDT. Evidence Synthesis: Out of the 534 studies found, 8 were included in the review. A random-effects meta-analysis and standardized mean differences (SMD) were conducted. The ultrasound-guided percutaneous needle electrolysis proved to be effective in reducing pain caused by tendinosis in the overall outcome (SMD = −0.97; 95% CI, −1.26 to −0.68; I 2  = 58%; low certainty of evidence) and in the short-term (SMD = −0.83, 95% CI, −1.29 to −0.38; I 2  = 65%; low certainty of evidence), midterm (SMD = −1.28; 95% CI, −1.65 to −0.91; I 2  = 0%; moderate certainty of evidence), and long-term (SMD = −0.94; 95% CI, −1.62 to −0.26; I 2  = 71%; low certainty of evidence) subgroups. Conclusion(s): The application of the ultrasound-guided percutaneous needle electrolysis technique for reducing pain caused by tendinosis appears to be effective. However, due to the heterogeneity found (partially explained), more studies are needed to define the appropriate dosimetry, specific populations that may benefit more from the technique, and possible adverse events.

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Muscle Coordination During Maximal Butterfly Stroke Swimming: Comparison Between Competitive and Recreational Swimmers

Keisuke K. Yamakawa, Rena Nishiwaki, and Yasuo Sengoku

This study aimed to clarify the differences in muscular coordination during butterfly swimming between high- and low-performance swimmers using muscle synergy analysis. Eight female competitive swimmers and 8 female recreational swimmers participated in this study. The participants swam a 25-m butterfly stroke with maximum effort. Surface electromyography was measured from 12 muscles and muscle synergy analysis was performed from the data using nonnegative matrix factorization algorithms. From the results of the muscle synergy analysis, 4 synergies were extracted from both groups. Synergies 1 and 2 were characterized by coactivation of the upper and lower limb muscles in the recreational swimmers, whereas only synergy 1 was characterized by this in the competitive swimmers. Synergy 3 was involved in arm recovery in both groups. Synergy 4 was only involved in the downward kick in the competitive swimmers. From these results, it can be concluded that muscle synergies with combined coordination of upper and lower limb muscles were extracted more in the recreational swimmers and that the competitive swimmers controlled the downward kick with an independent synergy and that the adjustment of the timing of the downward kick may be an important factor for the efficient performance of butterfly swimming.

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Specific Contribution of the Transversus Abdominis for Postural Control Against Perturbation Caused by Kinesthetic Illusion

Hiroshi Akuzawa, Tsuyoshi Morito, Tomoki Oshikawa, Yu Okubo, Simon Brumagne, and Koji Kaneoka

Functional independence of the transversus abdominis (TrA) from other trunk muscles for postural control is still unclear. This study aimed to clarify the specific function of the TrA to control standing posture by vibratory stimulation of the triceps surae. Fifteen men participated in this study. Muscle activity of the TrA, internal oblique, lumbar multifidus, gluteus maximus, rectus femoris, biceps femoris, gastrocnemius, and tibialis anterior was measured using fine-wire and surface electrodes. Participants were asked to maintain a quiet standing posture with and without vibration of the triceps surae, which induced a kinesthetic illusion and the concomitant backward sway of the body. The muscle activity of each muscle for 10 s was extracted with and without vibration. The muscle activity levels were compared between the conditions by a paired t-test or Wilcoxon signed-rank test. The activity of the TrA and rectus femoris was increased, whereas the internal oblique showed no change as a result of the induced kinesthetic illusion. In addition, the activity of the multifidus and biceps femoris was decreased. The TrA and rectus femoris could contribute to control the backward sway of the body. Furthermore, the TrA may have functional independence from the internal oblique during standing postural control. These results warrant further study in patients with low back pain.

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Marker-Based Versus IMU-Based Kinematics for Estimates of Lumbar Spine Loads Using a Full-Body Musculoskeletal Model

Maria Prado, Sakiko Oyama, and Hugo Giambini

Musculoskeletal modeling, typically implemented using marker-based systems in laboratory environments, is commonly used for noninvasive estimations of loads. Inertial measurement units (IMUs) have become an alternative for the evaluation of kinematics. However, estimates of spine joint contact forces using IMUs have yet to be thoroughly evaluated. Dynamics tasks and static postures from activities of daily living were captured on 11 healthy subjects using both systems simultaneously. Spine kinematics obtained from IMU- and marker-based systems and L4–L5 joint contact forces were compared. Lateral bending resulted in a weak agreement with significant differences between the 2 systems (P = .02, average root mean-squared error = 4.81), whereas flexion–extension and axial rotation exhibited the highest agreement with no significant differences (P < .05, average root mean-squared error = 5.51 and P < .31, average root mean-squared error = 5.08, respectively). All tasks showed excellent correlations (R 2 = .76–.99) in estimated loads between systems. Differences in predicted loads at the L4–L5 were only observed during flexion–extension (1041 N vs 947 N, P = .0004) and walking with weights (814 N vs 727 N, P = .004). Different joint reaction force outcomes were obtained in 2 of the 8 tasks between systems, suggesting that IMUs can be robust tools allowing for convenient and less expensive evaluations and for longitudinal assessments inside and outside the laboratory setting.

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