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Introduction
Varus knee alignment has been identified as a risk factor for the progression of medial knee osteoarthritis. However, the underlying mechanisms have not been elucidated yet in children. Thus, the aims of the present study were to examine differences in ground reaction forces, loading rate, impulses, and free moment values during running in children with and without genu varus.
Methods
Thirty-six boys aged 9–14 volunteered to participate in this study. They were divided in two age-matched groups (genu varus versus healthy controls). Body weight adjusted three dimensional kinetic data (Fx, Fy, Fz) were collected during running at preferred speed using two Kistler force plates for the dominant and non-dominant limb.
Results
Individuals with knee genu varus produced significantly higher (p = .01; d = 1.09; 95%) body weight adjusted ground reaction forces in the lateral direction (Fx) of the dominant limb compared to controls. On the non-dominant limb, genu varus patients showed significantly higher body weight adjusted ground reaction forces values in the lateral (p = .01; d = 1.08; 86%) and medial (p < .001; d = 1.55; 102%) directions (Fx). Further, genu varus patients demonstrated 55% and 36% greater body weight adjusted loading rates in the dominant (p < .001; d = 2.09) and non-dominant (p < .001; d = 1.02) leg, respectively. No significant between-group differences were observed for adjusted free moment values (p>.05). Discussion Higher mediolateral ground reaction forces and vertical loading rate amplitudes in boys with genu varus during running at preferred running speed may accelerate the development of progressive joint degeneration in terms of the age at knee osteoarthritis onset. Therefore, practitioners and therapists are advised to conduct balance and strength training programs to improve lower limb alignment and mediolateral control during dynamic movements.
Age-related decline in executive functions and postural control due to degenerative processes in the central nervous system have been related to increased fall-risk in old age. Many studies have shown cognitive-postural dual-task interference in old adults, but research on the role of specific executive functions in this context has just begun. In this study, we addressed the question whether postural control is impaired depending on the coordination of concurrent response-selection processes related to the compatibility of input and output modality mappings as compared to impairments related to working-memory load in the comparison of cognitive dual and single tasks. Specifically, we measured total center of pressure (CoP) displacements in healthy female participants aged 19–30 and 66–84 years while they performed different versions of a spatial one-back working memory task during semi-tandem stance on an unstable surface (i.e., balance pad) while standing on a force plate. The specific working-memory tasks comprised: (i) modality compatible single tasks (i.e., visual-manual or auditory-vocal tasks), (ii) modality compatible dual tasks (i.e., visual-manual and auditory-vocal tasks), (iii) modality incompatible single tasks (i.e., visual-vocal or auditory-manual tasks), and (iv) modality incompatible dual tasks (i.e., visual-vocal and auditory-manual tasks). In addition, participants performed the same tasks while sitting. As expected from previous research, old adults showed generally impaired performance under high working-memory load (i.e., dual vs. single one-back task). In addition, modality compatibility affected one-back performance in dual-task but not in single-task conditions with strikingly pronounced impairments in old adults. Notably, the modality incompatible dual task also resulted in a selective increase in total CoP displacements compared to the modality compatible dual task in the old but not in the young participants. These results suggest that in addition to effects of working-memory load, processes related to simultaneously overcoming special linkages between input- and output modalities interfere with postural control in old but not in young female adults. Our preliminary data provide further evidence for the involvement of cognitive control processes in postural tasks.
Background
In isometric muscle function, there are subjectively two different modes of performance: one can either hold isometrically – thus resist an impacting force – or push isometrically – therefore work against a stable resistance. The purpose of this study is to investigate whether or not two different isometric muscle actions – the holding vs. pushing one (HIMA vs PIMA) – can be distinguished by objective parameters.
Methods
Ten subjects performed two different measuring modes at 80% of MVC realized by a special pneumatic system. During HIMA the subject had to resist the defined impacting force of the pneumatic system in an isometric position, whereby the force of the cylinder works in direction of elbow flexion against the subject. During PIMA the subject worked isometrically in direction of elbow extension against a stable position of the system. The signals of pressure, force, acceleration and mechanomyography/-tendography (MMG/MTG) of the elbow extensor (MMGtri/MTGtri) and the abdominal muscle (MMGobl) were recorded and evaluated concerning the duration of maintaining the force level (force endurance) and the characteristics of MMG-/MTG-signals. Statistical group differences comparing HIMA vs. PIMA were estimated using SPSS.
Results
Significant differences between HIMA and PIMA were especially apparent regarding the force endurance: During HIMA the subjects showed a decisively shorter time of stable isometric position (19 ± 8 s) in comparison with PIMA (41 ± 24 s; p = .005). In addition, during PIMA the longest isometric plateau amounted to 59.4% of the overall duration time of isometric measuring, during HIMA it lasted 31.6% (p = .000). The frequency of MMG/MTG did not show significant differences. The power in the frequency ranges of 8–15 Hz and 10–29 Hz was significantly higher in the MTGtri performing HIMA compared to PIMA (but not for the MMGs). The amplitude of MMG/MTG did not show any significant difference considering the whole measurement. However, looking only at the last 10% of duration time (exhaustion), the MMGtri showed significantly higher amplitudes during PIMA.
Conclusion
The results suggest that under holding isometric conditions muscles exhaust earlier. That means that there are probably two forms of isometric muscle action. We hypothesize two potential reasons for faster yielding during HIMA: (1) earlier metabolic fatigue of the muscle fibers and (2) the complexity of neural control strategies.
Mental arithmetic exhibits various biases. Among those is a tendency to overestimate addition and to underestimate subtraction outcomes. Does such “operational momentum” (OM) also affect multiplication and division? Twenty-six adults produced lines whose lengths corresponded to the correct outcomes of multiplication and division problems shown in symbolic format. We found a reliable tendency to over-estimate division outcomes, i.e., reverse OM. We suggest that anchoring on the first operand (a tendency to use this number as a reference for further quantitative reasoning) contributes to cognitive biases in mental arithmetic.
Introduction: Chronic low back pain (LBP) is a major cause of disability; early diagnosis and stratification of care remain challenges.
Objectives: This article describes the development of a screening tool for the 1-year prognosis of patients with high chronic LBP risk (risk stratification index) and for treatment allocation according to treatment-modifiable yellow flag indicators (risk prevention indices, RPI-S).
Methods: Screening tools were derived from a multicentre longitudinal study (n = 1071, age >18, intermittent LBP). The greatest prognostic predictors of 4 flag domains ("pain," "distress," "social-environment," "medical care-environment") were determined using least absolute shrinkage and selection operator regression analysis. Internal validity and prognosis error were evaluated after 1-year follow-up. Receiver operating characteristic curves for discrimination (area under the curve) and cutoff values were determined.
Results: The risk stratification index identified persons with increased risk of chronic LBP and accurately estimated expected pain intensity and disability on the Pain Grade Questionnaire (0-100 points) up to 1 year later with an average prognosis error of 15 points. In addition, 3-risk classes were discerned with an accuracy of area under the curve = 0.74 (95% confidence interval 0.63-0.85). The RPI-S also distinguished persons with potentially modifiable prognostic indicators from 4 flag domains and stratified allocation to biopsychosocial treatments accordingly.
Conclusion: The screening tools, developed in compliance with the PROGRESS and TRIPOD statements, revealed good validation and prognostic strength. These tools improve on existing screening tools because of their utility for secondary preventions, incorporation of exercise effect modifiers, exact pain estimations, and personalized allocation to multimodal treatments.
Background
Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain.
Methods/design
This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints.
Discussion
We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.
Background
Foot orthoses are usually assumed to be effective by optimizing mechanically dynamic rearfoot configuration. However, the effect from a foot orthosis on kinematics that has been demonstrated scientifically has only been marginal. The aim of this study was to examine the effect of different heights in medial arch-supported foot orthoses on rear foot motion during gait.
Methods
Nineteen asymptomatic runners (36±11years, 180±5cm, 79±10kg; 41±22km/week) participated in the study. Trials were recorded at 3.1 mph (5 km/h) on a treadmill. Athletes walked barefoot and with 4 different not customized medial arch-supported foot orthoses of various arch heights (N:0 mm, M:30 mm, H:35 mm, E:40mm). Six infrared cameras and the `Oxford Foot Model´ were used to capture motion. The average stride in each condition was calculated from 50 gait cycles per condition. Eversion excursion and internal tibia rotation were analyzed. Descriptive statistics included calculating the mean ± SD and 95% CIs. Group differences by condition were analyzed by one factor (foot orthoses) repeated measures ANOVA (α = 0.05).
Results
Eversion excursion revealed the lowest values for N and highest for H (B:4.6°±2.2°; 95% CI [3.1;6.2]/N:4.0°±1.7°; [2.9;5.2]/M:5.2°±2.6°; [3.6;6.8]/H:6.2°±3.3°; [4.0;8.5]/E:5.1°±3.5°; [2.8;7.5]) (p>0.05). Range of internal tibia rotation was lowest with orthosis H and highest with E (B:13.3°±3.2°; 95% CI [11.0;15.6]/N:14.5°±7.2°; [9.2;19.6]/M:13.8°±5.0°; [10.8;16.8]/H:12.3°±4.3°; [9.0;15.6]/E:14.9°±5.0°; [11.5;18.3]) (p>0.05). Differences between conditions were small and the intrasubject variation high.
Conclusion
Our results indicate that different arch support heights have no systematic effect on eversion excursion or the range of internal tibia rotation and therefore might not exert a crucial influence on rear foot alignment during gait.
Introduction: Several sports demand an early start into long-term athlete development (LTAD) because peak performances are achieved at a relatively young age (e.g., gymnastics). However, the challenging combination of high training volumes and academic demands may impede youth athletes' cognitive and academic performances. Thus, the aims of this study were to examine the effects of a 1-year sport-specific training and/or physical education on physical fitness, body composition, cognitive and academic performances in youth athletes and their non-athletic peers.
Methods: Overall, 45 prepubertal fourth graders from a German elite sport school were enrolled in this study. Participating children were either youth athletes from an elite sports class (n = 20, age 9.5 ± 0.5 years) or age-matched peers from a regular class (n = 25, age 9.6 ± 0.6 years). Over the 1-year intervention period, the elite sports class conducted physical education and sport-specific training (i.e., gymnastics, swimming, soccer, bicycle motocross [BMX]) during school time while the regular class attended physical education only. Of note, BMX is a specialized form of cycling that is performed on motocross tracks and affords high technical skills. Before and after intervention, tests were performed for the assessment of physical fitness (speed [20-m sprint], agility [star agility run], muscle power [standing long jump], flexibility [stand-and-reach], endurance [6-min-run], balance [single-leg stance]), body composition (e.g., muscle mass), cognitive (d2-test) and academic performance (reading [ELFE 1–6], writing [HSP 4–5], calculating [DEMAT 4]). In addition, grades in German, English, Mathematics, and physical education were documented.
Results: At baseline, youth athletes showed better physical fitness performances (p < 0.05; d = 0.70–2.16), less relative body fat mass, more relative skeletal muscle mass (p < 0.01; d = 1.62–1.84), and similar cognitive and academic achievements compared to their non-athletic peers. Athletes' training volume amounted to 620 min/week over the 1-year period while their peers performed 155 min/week. After the intervention, significant differences were found in 6 out of 7 physical fitness tests (p < 0.05; d = 0.75–1.40) and in the physical education grades (p < 0.01; d = 2.36) in favor of the elite sports class. No significant between-group differences were found after the intervention in measures of body composition (p > 0.05; d = 0.66–0.67), cognition and academics (p > 0.05; d = 0.40–0.64). Our findings revealed no significant between-group differences in growth rate (deltas of pre-post-changes in body height and leg length).
Discussion: Our results revealed that a school-based 1-year sport-specific training in combination with physical education improved physical fitness but did not negatively affect cognitive and academic performances of youth athletes compared to their non-athletic peers. It is concluded that sport-specific training in combination with physical education promotes youth athletes' physical fitness development during LTAD and does not impede their cognitive and academic development.
Motivated by conflicting evidence in the literature, we re-assessed the role of facial feedback when detecting quantitative or qualitative changes in others’ emotional expressions. Fifty-three healthy adults observed self-paced morph sequences where the emotional facial expression either changed quantitatively (i.e., sad-to-neutral, neutral-to-sad, happy-to-neutral, neutral-to-happy) or qualitatively (i.e. from sad to happy, or from happy to sad). Observers held a pen in their own mouth to induce smiling or frowning during the detection task. When morph sequences started or ended with neutral expressions we replicated a congruency effect: Happiness was perceived longer and sooner while smiling; sadness was perceived longer and sooner while frowning. Interestingly, no such congruency effects occurred for transitions between emotional expressions. These results suggest that facial feedback is especially useful when evaluating the intensity of a facial expression, but less so when we have to recognize which emotion our counterpart is expressing.
The term Adaptive Force (AF) describes the capability of adaptation of the nerve-muscle-system to externally applied forces during isometric and eccentric muscle action. This ability plays an important role in real life motions as well as in sports. The focus of this paper is on the specific measurement method of this neuromuscular action, which can be seen as innovative. A measuring system based on the use of compressed air was constructed and evaluated for this neuromuscular function. It depends on the physical conditions of the subject, at which force level it deviates from the quasi isometric position and merges into eccentric muscle action. The device enables – in contrast to the isokinetic systems – a measure of strength without forced motion. Evaluation of the scientific quality criteria of the devices was done by measurements regarding the intra- and interrater-, the test-retest-reliability and fatiguing measurements. Comparisons of the pneumatic device with a dynamometer were also done. Looking at the mechanical evaluation, the results show a high level of consistency (r²=0.94 to 0.96). The parallel test reliability delivers a very high and significant correlation (ρ=0.976; p=0.000). Including the biological system, the concordance of three different raters is very high (p=0.001, Cronbachs alpha α=0.987). The test retest with 4 subjects over five weeks speaks for the reliability of the device in showing no statistically significant differences. These evaluations indicate that the scientific evaluation criteria are fulfilled. The specific feature of this system is that an isometric position can be maintained while the externally impacting force rises. Moreover, the device can capture concentric, static and eccentric strength values. Fields of application are performance diagnostics in sports and medicine.