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Jonathon S. Schofield, Eric Parent, Justin Lewicke, Jason P. Carey, Marwan El-Rich and Samer Adeeb

Sit-to-stand transfer is a common prerequisite for many daily tasks. Literature often assumes symmetric behavior across the left and right side. Although this assumption of bilateral symmetry is prominent, few studies have validated this supposition. This pilot study uniquely quantifies peak joint moments and ground reaction forces (GRFs), using a Euclidian norm approach, to evaluate bilateral symmetry and its relation to lower limb motor-dominance during sit to stand in ten healthy males. Peak joint moments and GRFs were determined using a motion capture system and inverse dynamics. This analysis included joint moment contributions from all three body planes (sagittal, coronal, and axial) as well as vertical and shearing GRFs. A paired, one-tailed t test was used, suggesting asymmetrical joint moment development in all three lower extremity joints as well as GRFs (P < .05). Furthermore, using an unpaired two-tailed t test, asymmetry developed during these movements does not appear to be predictable by participants’ lower limb motor-dominance (P < .025). Consequently, when evaluating sit-to-stand it is suggested the effects of asymmetry be considered in the interpretation of data. The absence of a relationship between dominance and asymmetry prevents the suggestion that one side can be tested to infer behavior of the contralateral.

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Benjamin W. Infantolino, Daniel J. Gales, Samantha L. Winter and John H. Challis

The purpose of this study was to validate ultrasound muscle volume estimation in vivo. To examine validity, vastus lateralis ultrasound images were collected from cadavers before muscle dissection; after dissection, the volumes were determined by hydrostatic weighing. Seven thighs from cadaver specimens were scanned using a 7.5-MHz ultrasound probe (SSD-1000, Aloka, Japan). The perimeter of the vastus lateralis was identified in the ultrasound images and manually digitized. Volumes were then estimated using the Cavalieri principle, by measuring the image areas of sets of parallel two-dimensional slices through the muscles. The muscles were then dissected from the cadavers, and muscle volume was determined via hydrostatic weighing. There was no statistically significant difference between the ultrasound estimation of muscle volume and that estimated using hydrostatic weighing (p > 0.05). The mean percentage error between the two volume estimates was 0.4% ± 6.9. Three operators all performed four digitizations of all images from one randomly selected muscle; there was no statistical difference between operators or trials and the intraclass correlation was high (>0.8). The results of this study indicate that ultrasound is an accurate method for estimating muscle volumes in vivo.

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Andre Filipe Santos-Magalhaes and Karen Hambly

Context:

The assessment of physical activity and return to sport and exercise activities is an important component in the overall evaluation of outcome after autologous cartilage implantation (ACI).

Objective:

To identify the patient-report instruments that are commonly used in the evaluation of physical activity and return to sport after ACI and provide a critical analysis of these instruments from a rehabilitative perspective.

Evidence Acquisition:

A computerized search was performed in January 2013 and repeated in March 2013. Criteria for inclusion required that studies (1) be written in English and published between 1994 and 2013; (2) be clinical studies where knee ACI cartilage repair was the primary treatment, or comparison studies between ACI and other techniques or between different ACI generations; (3) report postoperative physical activity and sport participation outcomes results, and (4) have evidence level of I–III.

Evidence Synthesis:

Twenty-six studies fulfilled the inclusion criteria. Three physical activity scales were identified: the Tegner Activity Scale, Modified Baecke Questionnaire, and Activity Rating Scale. Five knee-specific instruments were identified: the Lysholm Knee Function Scale, International Knee Documentation Committee Score Subjective Form, Knee Injury and Osteoarthritis Outcome Score, Modified Cincinnati Knee Score, and Stanmore-Bentley Functional Score.

Conclusions:

Considerable heterogeneity exists in the reporting of physical activity and sports participation after ACI. Current instruments do not fulfill the rehabilitative needs in the evaluation of physical activity and sports participation. The validated instruments fail in the assessment of frequency, intensity, and duration of sports participation.

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Bernd J. Stetter, Erica Buckeridge, Vinzenz von Tscharner, Sandro R. Nigg and Benno M. Nigg

This study presents a new approach for automated identification of ice hockey skating strides and a method to detect ice contact and swing phases of individual strides by quantifying vibrations in 3D acceleration data during the blade–ice interaction. The strides of a 30-m forward sprinting task, performed by 6 ice hockey players, were evaluated using a 3D accelerometer fixed to a hockey skate. Synchronized plantar pressure data were recorded as reference data. To determine the accuracy of the new method on a range of forward stride patterns for temporal skating events, estimated contact times and stride times for a sequence of 5 consecutive strides was validated. Bland-Altman limits of agreement (95%) between accelerometer and plantar pressure derived data were less than 0.019 s. Mean differences between the 2 capture methods were shown to be less than 1 ms for contact and stride time. These results demonstrate the validity of the novel approach to determine strides, ice contact, and swing phases during ice hockey skating. This technology is accurate, simple, effective, and allows for in-field ice hockey testing.

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Kyoung-Seok Yoo, Hyun-Kyung Kim and Jin-Hoon Park

The present study examined the technical characteristics of sliding performance from push-off until stone release in curling delivery. Five elite performance level curlers (> 7 years experience) and five subelite level curlers (< 3 years experience) were analyzed during the action of delivery of a curling stone. The joint angles, angular velocities, and moments of the body center of mass (COM) were determined based on three-dimensional kinematic data. The plantar pressure data were measured using a validated in-shoe system. The results indicated that the gliding time and horizontal velocity of the mass center of the body during the sliding phase were not significantly different between the elite and subelite groups. However, there were significant differences in the gliding distance and the rate of changes in velocity profiles of body COM between the two groups. The moment of the body COM from its relative position to the ankle of the support limb in the anterior/posterior direction was positive in elite curlers and negative in subelite curlers. In addition, larger ankle dorsiflexion and greater contact area of the sliding foot were observed in elite curlers. These data suggest a superior ability of elite curlers to maintain a regulated movement speed and balance control during the performance of a curling stone delivery.

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Scott W. Cheatham

Background: In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals are nonexistent. The surveillance of such responses has not been documented. Purpose: To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States. Design: Cross-sectional descriptive survey study. Methods: A 20-question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education. Results: One thousand and forty-two professionals (N = 1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for preexercise and postexercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient-reported outcomes (74%), joint range of motion (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients, and 88% believe there is a gap in the research. Conclusion: The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

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James R. Rosemeyer, Bradley T. Hayes, Craig L. Switzler and Charlie A. Hicks-Little

Context:

Core stability has been shown to affect lower-extremity motion, but activation of the core has also been observed just before movements of the upper extremity. However, there is limited evidence regarding the effects that core musculature has on upper-extremity strength.

Objective:

To determine the effects of core fatigue on maximal shoulder strength.

Design:

Crossover study.

Setting:

Sports-medicine research laboratory.

Participants:

23 participants (15 male and 8 female, age 21.3 ± 2.5 y, height 174.5 ± 10.3 cm, weight 71.3 ± 12.0 kg).

Intervention:

All participants performed maximal voluntary isometric contractions in 3 different planes (sagittal, frontal, transverse) of shoulder-joint motion. A core-fatiguing protocol was conducted, and the same 3 shoulder-strength tests were repeated and compared with the initial measurements.

Main Outcome Measures:

Strength measures were recorded in kilograms with a dynamometer.

Results:

Results showed a significant decrease in strength in the frontal (−0.56 ± 1.06 kg, P = .020) and transverse (−0.89 ± 1.49 kg, P = .012) planes but not in the sagittal plane (−0.20 ± 0.98 kg, P > .05). Furthermore, regardless of the specific strength test measured, results revealed that the 1st (−7.05% ± 11.65%, P = .012) and 2nd (−5.71% ± 12.03%, P = .042) strength-test measurements after the fatiguing protocol were significantly decreased, while the 3rd strength-test measurement (−4.19% ± 12.48%, P = .140) did not show statistical significance.

Conclusion:

These results indicate that decrease in core stability may have an influence on shoulder strength. The literature suggests that the core is designed for endurance, and this study helps validate its recovery properties. Further research is needed to determine the significance of this effect and how injury rates coincide.

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Paul F. Greene, Christopher J. Durall and Thomas W. Kernozek

Context:

A torso-elevated side support (TESS) has previously been described for measuring endurance of the lateral trunk muscles. In some individuals, however, TESS performance may be hindered by upper extremity pain or fatigue. For this reason a novel test, the feet-elevated side-support test (FESS), was examined.

Objective:

To determine intersession reliability of a FESS and a TESS on the left and right sides using a single examiner, to evaluate the relationship between tests, and to compare reasons for test termination.

Design:

Nonexperimental prospective repeated measures.

Setting:

University laboratory.

Participants:

A convenience sample of 60 healthy participants from a university community (17 men, 43 women; age 21.1 ± 2.2 y; height 169.9 ± 9.5 cm; weight 67.1 ± 11.9 kg).

Results:

Intraclass correlation coefficient between 3 testing sessions = .87 with right FESS, .86 with left FESS, .78 with right TESS, and .91 with left TESS. Pearson correlation coefficients ranged from .59 (between left FESS and left TESS in women) to .75 (between left FESS and left TESS in men). Upper extremity pain or fatigue was the reason given for test termination in 42.5% of participants during the TESS and 5.0% during the FESS (P = .000, Fisher exact test).

Conclusions:

FESS and TESS had comparable intersession reliability by the same evaluator. Moderate to high correlations were found between FESS and TESS scores, suggesting that the tests assess similar qualities. Far fewer participants terminated the FESS because of upper extremity pain or fatigue. Thus, the FESS may be a suitable alternative to the previously validated TESS, particularly for individuals with upper extremity pain or weakness.

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Robert H. Wellmon, Dawn T. Gulick, Mark L. Paterson and Colleen N. Gulick

Context:

Smartphones are being used in a variety of practice settings to measure joint range of motion (ROM). A number of factors can affect the validity of the measurements generated. However, there are no studies examining smartphone-based goniometer applications focusing on measurement variability and error arising from the electromechanical properties of the device being used.

Objective:

To examine the concurrent validity and interrater reliability of 2 goniometric mobile applications (Goniometer Records, Goniometer Pro), an inclinometer, and a universal goniometer (UG).

Design:

Nonexperimental, descriptive validation study.

Setting:

University laboratory.

Participants:

3 physical therapists having an average of 25 y of experience.

Main Outcome Measures:

Three standardized angles (acute, right, obtuse) were constructed to replicate the movement of a hinge joint in the human body. Angular changes were measured and compared across 3 raters who used 3 different devices (UG, inclinometer, and 2 goniometric apps installed on 3 different smartphones: Apple iPhone 5, LG Android, and Samsung SIII Android). Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to examine interrater reliability and concurrent validity.

Results:

Interrater reliability for each of the smartphone apps, inclinometer and UG were excellent (ICC = .995–1.000). Concurrent validity was also good (ICC = .998–.999). Based on the Bland-Altman plots, the means of the differences between the devices were low (range = –0.4° to 1.2°).

Conclusions:

This study identifies the error inherent in measurement that is independent of patient factors and due to the smartphone, the installed apps, and examiner skill. Less than 2° of measurement variability was attributable to those factors alone. The data suggest that 3 smartphones with the 2 installed apps are a viable substitute for using a UG or an inclinometer when measuring angular changes that typically occur when examining ROM and demonstrate the capacity of multiple examiners to accurately use smartphone-based goniometers.

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Barbara C. Belyea, Ethan Lewis, Zachary Gabor, Jill Jackson and Deborah L. King

Context: Lower-extremity landing mechanics have been implicated as a contributing factor in knee pain and injury, yet cost-effective and clinically accessible methods for evaluating movement mechanics are limited. The identification of valid, reliable, and readily accessible technology to assess lower-extremity alignment could be an important tool for clinicians, coaches, and strength and conditioning specialists. Objective: To examine the validity and reliability of using a handheld tablet and movement-analysis application (app) for assessing lower-extremity alignment during a drop vertical-jump task. Design: Concurrent validation. Setting: Laboratory. Participants: 22 healthy college-age subjects (11 women and 11 men, mean age 21 ± 1.4 y, mean height 1.73 ± 0.12 m, mean mass 71 ± 13 kg) with no lower-extremity pathology that prevented safe landing from a drop jump. Intervention: Subjects performed 6 drop vertical jumps that were recorded simultaneously using a 3-dimensional (3D) motion-capture system and a handheld tablet. Main Outcomes Measures: Angles on the tablet were calculated using a motion-analysis app and from the 3D motion-capture system using Visual 3D. Hip and knee angles were measured and compared between both systems. Results: Significant correlations between the tablet and 3D measures for select frontal- and sagittal-plane ranges of motion and angles at maximum knee flexion (MKF) ranged from r = .48 (P = .036) for frontal-plane knee angle at MKF to r = .77 (P < .001) for knee flexion at MKF. Conclusion: Results of this study suggest that a handheld tablet and app may be a reliable method for assessing select lower-extremity joint alignments during drop vertical jumps, but this technology should not be used to measure absolute joint angles. However, sports medicine specialists could use a handheld tablet to reliably record and evaluate lower-extremity movement patterns on the field or in the clinic.