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Christine M. Bonci, Beth Sloane and Karen Middleton

Management of the overhead athlete presenting with anterior instability requires an identification of factors influencing successful therapeutic intervention strategies. The importance of differentiating a diagnosis, of knowing something of the demands of the sport, and of addressing pertinent anatomical and biomechanical considerations of the throwing shoulder prior to implementing rehabilitation programs must be considered. An appreciation of the complexities of the throwing shoulder serves as a basis for the selection of rehabilitation activities aimed at returning the athlete to pretrauma levels of overarm proficiency. The challenge of regaining normal shoulder joint osteokinematics and neuromuscular function at a competitive status is described in terms of the proper selection and sequencing of rehabilitation exercises for the initiation and progression of range of motion, muscle strength, muscle reducation, and sport-specific functional activities. Time frames for progressing the various stages of rehabilitation, indications for exercise selection based on electromyographic studies, and attention to detail with regard to exercise execution are emphasized.

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Joaquin A. Barrios, Todd D. Royer and Irene S. Davis

Dynamic knee alignment is speculated to have a stronger relationship to medial knee loading than radiographic alignment. Therefore, we aimed to determine what frontal plane knee kinematic variable correlated most strongly to the knee adduction moment. That variable was then compared with radiographic alignment as a predictor of the knee adduction moment. Therefore, 55 subjects with medial knee OA underwent three-dimensional gait analysis. A subset of 21 subjects also underwent full-limb radiographic assessment for knee alignment. Correlations and regression analyses were performed to assess the relationships between the kinematic, kinetic and radiographic findings. Peak knee adduction angle most strongly correlated to the knee adduction moment of the kinematic variables. In comparison with radiographic alignment, peak knee adduction angle was the stronger predictor. Given that most epidemiological studies on knee OA use radiographic alignment in an attempt to understand progression, these results are meaningful.

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Casper de Boer, Johannes van der Steen, Francesco Mattace-Raso, Agnita J.W. Boon and Johan J.M. Pel

The early stages of neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) involve deterioration of specific (visuo)motor functions. The aim of the current study was to investigate differences in visuomotor behavior between age-matched groups of 17 patients with AD, 17 patients with PD, and 20 healthy control subjects across three eye-hand-coordination tasks of different cognitive complexity. In two of three tasks, timing and execution parameters of eyes and hand significantly differed between groups. Timing and execution parameters of the eyes and hands could potentially give a quantitative description of disease specific deficits in the spatial and temporal domains and may serve as a tool to monitor disease progression in AD and PD populations.

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Marc J. Philippon, Jesse C. Christensen and Michael S. Wahoff

Objective:

To report the 4-phase rehabilitation progression of a professional athlete who underwent arthroscopic intra-articular repair of the hip after injury during the 2006–07 season.

Design:

Case study; level of evidence, 4.

Main Outcome Measures:

Objective values were obtained by standard goniometric measurements, handheld dynamometer, dynamic sports testing, and clinical testing for intra-articular pathology.

Results:

This case report illustrates improvements in hip mobility, muscle-force output, elimination of clinical signs of intra-articular involvement, and ability to perform high-level sport-specific training at 9 wk postsurgery. At 16 wk postsurgery, the patient was able to return to full preparation for sport for the following season.

Conclusion:

After the 4-phase rehabilitation program, the patient demonstrated improvement in all areas of high-level function after an arthroscopic intra-articular repair of the hip. The preoperative management to return to sport is outlined, with clinical outcomes and criteria for return to competition.

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Tania Pizzari, Helen McBurney, Nicholas F. Taylor and Julian A. Feller

Objective:

To investigate the subjective experience of anterior cruciate ligament (ACL) rehabilitation and identify variables that influence adherence as perceived by ACL-reconstructed patients.

Design:

A qualitative study using in-depth interviews to gather data and thematic coding to analyze findings.

Setting:

Participants were interviewed at home or in their workplace.

Participants:

Eleven patients were interviewed at an average of 4.8 months (SD = 0.8) after ACL reconstruction.

Results:

Using thematic coding of the interview data, 3 categories of variables influencing adherence emerged: environmental factors, physical factors, and psychological factors. Variables specifically affecting adherence to home exercise were perceived lack of time and a lack of self-motivation. Fear of reinjury emerged as a significant consideration for those who were nonadherent. Factors such as therapist support, the rehabilitation clinic, and the progression of exercises were identified as being important for attendance at physiotherapy appointments and adherence during appointments.

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William C. Whiting, Robert J. Gregor and Marie Halushka

Eight male javelin throwers were filmed while throwing new-rules javelins during competition at five meets over a 2-year period. Body segment kinematics and javelin release parameters were assessed relative to their contribution to throwing performance. The data suggest that successful throws, as judged by distance thrown, are characterized by higher release speeds, longer last-step lengths, less flexion of the front-leg knee during the final plant phase, and an orderly progression of peak speeds at the hip, shoulder, and elbow from the onset of double leg support until release. Individual variability in performance was associated with differences measured between several throwing variables. Limitations inherent to two-dimensional analysis were identified that highlighted the need for three-dimensional investigation of the javelin throw.

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Todd G. Goldbeck and George J. Davies

Context:

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.

Purpose:

To determine the test-retest reliability of the Closed Kinetic Chain (CKC) Upper Extremity Stability Test.

Participants:

Twenty-four male college students.

Methods:

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.

Results:

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.

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Lori A. Bolgla, Scott W. Shaffer and Terry R. Malone

Context:

Knee extension exercise is an important part of knee rehabilitation. Clinicians prescribe non-weight bearing exercise initially and progress patients to weight bearing exercise once they can perform a straight leg raise (SLR).

Objective:

Compare VM activation during a SLR and weight bearing exercises.

Design:

One-way repeated measures design.

Setting:

University Laboratory.

Subjects:

Fifteen healthy subjects.

Intervention:

One SLR exercise and 6 weight-bearing knee extension exercises.

Main Outcome Measures:

Electromyographic amplitudes for the VM expressed as a percent maximum voluntary isometric contraction.

Results:

The SLR had greater activation than the single leg stance and bilateral squat exercises. The step-up and unilateral leg press exercises had the greatest activation.

Conclusions:

SLR performance can be an important indicator for exercise progression. These results provide foundational knowledge to assist clinicians with exercise prescription.

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Reint H. Geuze

The functional integrity of the bimanual neuromotor system of Parkinson's disease (PD) subjects (stage II) compared to controls (2 × n = 16) was evaluated by measures of coordination stability of tapping in in-phase. anti-phase. and 90°-phase. Recently, intentional influence was modeled as an additive attractor function on the intrinsic dynamics, resulting in predictions tested by Scholz and Kelso (1990). In this study, the intentional influence was modulated by attaching cognitive meaning to the rhythmical pattern, which was expected to enhance the stability of coordination and, if effective, might be profitable to PD patients. Half of the PD subjects significantly lacked stability. They were less stable than controls, lost coordination at lower frequencies, and needed more time to switch between phase patterns. The reduction of stability was reflected in the progression of the disease. Cognitive meaning reduced variability of the single hands but not of relative phase, and no effect on switching time was found. The results suggest a weaker coupling strength between the limbs in PD patients lacking stability.

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Jay R. Ebert and Peter K. Edwards

Autologous chondrocyte implantation (ACI) has demonstrated good clinical success in the repair of articular cartilage defects in the knee. Postoperative rehabilitation after ACI is considered critical in returning the patient to an optimal level of function by attempting to create the appropriate mechanical environment for cartilage regrowth, and it involves a progressive program that emphasizes full motion, progressive partial weight bearing (PWB), and controlled exercises. While evidence-based research is clearly lacking in all components of ACI rehabilitation, one important element in this treatment algorithm that has been subjected to some early scientific study is the gradual progression of the patient back to full weight-bearing (WB) gait after surgery. With the continual advancement of ACI surgical techniques, along with clinical experience and improved knowledge of histology and of the maturation process of chondrocytes, proposed postoperative WB protocols have evolved to better reflect the nature of the specific ACI surgery. The purpose of this article is to present the varied PWB programs that have been practiced alongside the evolving ACI surgical technique, the experimental basis for such protocols, the issues pertinent to the accurate prescription of WB, and future directions for developing such methods to best return patients to an optimal level of function after ACI.