There is an increasing emphasis on the use of closed kinetic chain exercises in the testing and rehabilitation of many patients with various pathologies. Because of this increased emphasis, there is a need for critical thinking in rehabilitation. Therefore, the purpose of this article is to provide an overview of the application of critical thinking in the following areas: examination, specific rehabilitation protocols, the need for outcome research, and the rationale and need for the integration of open and closed kinetic chain exercises and their application to testing and rehabilitation.
George J. Davies
Todd G. Goldbeck and George J. Davies
Functional testing of patients is essential to clinicians because it provides objective data for documentation that can be used for serial reassessment and progression through a rehabilitation program. Furthermore, new tests should require minimal time, space, and money to implement.
To determine the test-retest reliability of the Closed Kinetic Chain (CKC) Upper Extremity Stability Test.
Twenty-four male college students.
Each subject was tested initially and again 7 days later. Each subject performed 1 submaximal test followed by 3 maximal efforts. A 45-second rest was given after each 15-second test. The 2 maximal-test scores were averaged and compared with those from the retest.
The intraclass correlation coefficient was .922 for test-retest reliability. A paired-samples t test (.927) was conducted, and the coefficient of stability was .859. The results indicate that the CKC Upper Extremity Stability Test is a reliable evaluation tool.
Robert C. Manske and George J. Davies
Most patients on an index concentric isokinetic test of the shoulder internal and external rotators have significant torque-acceleration-energy (TAE) deficits.
To assess the effectiveness of rehabilitation on muscle power in patients with shoulder dysfunctions.
Physical therapy clinic.
67, mean age 28.7 ± 12.89 years.
Main Outcome Measures:
Concentric shoulder internal and external rotators measured with arm at 90° of abduction, 90° of elbow flexion. Isokinetic velocities tested: 60°, 180°, and 300°/s.
A paired t test (P < .05) compared the differences from index to discharge test for involved and uninvolved internal and external shoulder rotators. Percentages of TAE deficits involved vs uninvolved on discharge and change in TAE from index to discharge were also analyzed. Significant improvement of the involved shoulder for all velocities for both internal and external rotators was seen. The uninvolved extremity saw statistically significant improvements at all velocities for external rotators yet only at 300°/s for internal rotators. Involved-extremity TAE deficits returned to within 10% on discharge.
The study demonstrated improved muscle power as measured by TAE in shoulder internal and external rotators in a sample of patients treated in an outpatient clinic.
Bryan L. Riemann and George J. Davies
Context: Previous investigations have examined the reliability, normalization, and underlying projection mechanics of the seated single-arm shot-put (SSASP) test. Although the test is believed to reflect test limb strength, there have been no assessments determining whether test performance is directly associated with upper-extremity strength. Objective: To determine the relationship between isokinetic pushing force and SSASP performance and conduct a method comparison analysis of limb symmetry indices between the 2 tests. Design: Controlled laboratory study. Setting: Biomechanics laboratory. Patients (or Other Participants): Twenty-four healthy and physically active men (n = 12) and women (n = 12). Intervention(s): Participants completed the SSASP and isokinetic pushing tests using their dominant and nondominant arms. Main Outcome Measures: SSASP distance and isokinetic peak force. Results: Significant moderate to strong relationships were revealed between the SSASP distances and isokinetic peak forces for both limbs. The Bland–Altman analysis results demonstrated significantly (P < .002) greater limb symmetry indices for the SSASP (both medicine balls) than the isokinetic ratios, with biases ranging from −0.094 to −0.159. The limits of agreement results yielded intervals ranging from ±0.241 to ±0.340 and ±0.202 to ±0.221 from the biases. Conclusions: These results support the notion that the SSASP test reflects upper-extremity strength. The incongruency of the limb symmetry indices between the 2 tests is likely reflective of the differences in the movement patterns and coordination requirements of the 2 tests.
Bryan L. Riemann, Kelsey Piersol, and George J. Davies
Context: Single leg balance testing is a commonly used tool in sports medicine; however, there has been no consensus on trial duration needed to obtain reliable measures. Objective: This investigation sought to determine the minimum trial duration required to obtain the highest intrasession single and average trial reliability for single leg balance testing on stable and unstable surfaces using dominant and nondominant limbs. Design: Intrasession reliability.Setting:Biomechanics laboratory. Participants: 70 healthy (35 men, 35 women), physically active young adults aged 22.8 ± 2.8 y divided into 3 subgroups (n = 10, 30, 30) across a 3-phase study. Methods:3 phases of single leg balance testing were performed. For phase 1, the duration of time each participant could maintain posture on each limb/surface were computed. Phase 2 considered performance for 6 cumulative time intervals (5s, 10s, 15s, 20s, 25s, 30s). Phase 3 served to solidify results of phase 2 by computing reliability of 15s trials. Main outcome measures: Overall stability index of the center of pressure and platform tilt. Results: Intraclass correlation coefficients for phase 2 ranged from .74 (5s interval for nondominant limb on unstable surface) to .94 (20s interval for nondominant limb on stable surface). Phase 3 intraclass correlation coefficients ranged from .66 to .78 for single trial and .85 to .92 for 3 trial average with coefficients of variation ranging from 23.9% to 40.4% for single trial and 13.8% to 23.0% for 3 trial average. Conclusions:These results ultimately suggest 15s as the optimal trial duration to provide reliable measures while reducing compensatory event occurrence.
Matthew D. Watson, George J. Davies, and Bryan L. Riemann
Context: A recent report demonstrated moderate to strong relationships between seated single-arm shot-put (SSASP) test performance and isokinetic pushing forces at varying velocities, directly supporting the SSASP test as a reflection of multijoint upper-extremity strength. Yet, no previous work appears to have assessed whether the SSASP test is more reflective of shoulder flexion or elbow extension strength. Objective: To examine the relationship between isokinetic shoulder flexion and elbow extension strength and SSASP test performance and to compare limb symmetry indices (LSI) between the 2 tests. Design: Correlational design. Setting: Biomechanics laboratory. Patients (or Other Participants): A total of 30 healthy and physically active young adults. Intervention(s): Participants completed the SSASP test and concentric isokinetic (60°/s and 180°/s) shoulder flexion and elbow extension using their dominant and nondominant arms. Main Outcome Measures: SSASP test performance and isokinetic shoulder flexion and elbow extension peak torques as well as LSI between the 2 tests. Results: Strong relationships were observed between SSASP ranges and isokinetic peak torques at each velocity for both shoulder and elbow (r ≥ .804, P < .001). While the Bland–Altman results on the LSI only demonstrated a significant bias for the shoulder (60°/s, P = .009), limits of agreement results demonstrated extremely wide intervals (32.5%–52.1%). Conclusions: The SSASP test is a multijoint upper-extremity functional performance test that is reflective of equal shoulder flexion and elbow extension contributions; however, there was large variability regarding the agreement between the SSASP LSI and isokinetic shoulder and elbow strength LSI.
Michael A. Tabor, George J. Davies, Thomas W. Kernozek, Rodney J. Negrete, and Vincent Hudson
Many clinicians use functional-performance tests to determine an athlete’s readiness to resume activity; however, research demonstrating reliability of these tests is limited.
To introduce the Lower Extremity Functional Test (LEFT) and establish it as a reliable assessment tool.
Week 1: Subjects participated in a training session. Week 2: Initial maximal-effort time measurements were recorded. Week 3: Retest time measurements were recorded.
The University of Wisconsin–La Crosse (UW-L) and the University of Central Florida (UCF).
27 subjects from UW-L and 30 from UCF.
Main Outcome Measures:
Time measurements were analyzed using intraclass correlation coefficients (ICCs).
ICC values of .95 and .97 were established at UW-L and UCF, respectively.
The LEFT is a reliable assessment tool.
Chris J Durall, George J Davies, Thomas W Kernozek, Mark H Gibson, Dennis CW Fater, and J Scott Straker
It has been hypothesized that the fibers of the infraspinatus and subscapularis superior to the glenohumeral axis of rotation contribute directly to arm elevation.
To test this hypothesis by assessing the impact of 5 weeks of concentric isokinetic humeral-rotator training in a modified neutral position on scapular-plane arm-elevation peak torque.
Prospective, pretest/posttest with control group.
24 female and 6 male noninjured college students (N = 30).
Main Outcome Measures:
Scapular-plane-elevation peak torque at 60, 180, and 300°/s.
Repeated-measures ANOVA indicated no difference in peak torque between groups at any of the angular velocities tested (P < .05)
5 weeks of concentric isokinetic humeral-rotator training did not significantly increase scapular-plane-elevation peak torque.
Rebecca M. Dagger, Ian G. Davies, Kelly A. Mackintosh, Genevieve L. Stone, Keith P. George, Stuart J. Fairclough, and Lynne M. Boddy
Purpose: To assess the effects of the Children’s Health, Activity and Nutrition: Get Educated! intervention on body size, body composition, and peak oxygen uptake in a subsample of 10- to 11-year-old children. Methods: Sixty children were recruited from 12 schools (N = 6 intervention) to take part in the CHANGE! subsample study. Baseline, postintervention, and follow-up measures were completed in October 2010, March–April 2011, and June–July 2011, respectively. Outcome measures were body mass index z score, waist circumference, body composition assessed using dual-energy X-ray absorptiometry (baseline and follow-up only), and peak oxygen uptake. Results: Significant differences in mean trunk fat mass (control = 4.72 kg, intervention = 3.11 kg, P = .041) and trunk fat % (control = 23.08%, intervention = 17.75%, P = .022) between groups were observed at follow-up. Significant differences in waist circumference change scores from baseline to follow-up were observed between groups (control = 1.3 cm, intervention = −0.2 cm, P = .023). Favorable changes in body composition were observed in the intervention group; however, none of these changes reached statistical significance. No significant differences in peak oxygen uptake were observed. Conclusions: The results of the present study suggest the multicomponent curriculum intervention had small to medium beneficial effects on body size and composition health outcomes.