Training program intervention to encourage physical activity for health in people with transtibial amputation: A feasibility study.

BACKGROUND: People with transtibial amputation (PTTA) would benefit from increased physical activity levels (PAL) but generic programs developed to support increased PAL do not address the barriers which PTTA experience. OBJECTIVE: To evaluate the effect of a 12-week training program, developed for PTTA, on their PAL. METHODS: Ten PTTA participated in a 12-week training program, which involved one instructor-led supervised group session per week. The program incorporated balance, flexibility, cardiovascular endurance, strength, and agility, as well as educational elements. Personalized starting level and progression intensity were based on the instructor's assessment in the first training session. The effect of the intervention on PAL (self-report questionnaire and accelerometer), fitness, walking symmetry, and adverse effects was determined by analysis of variance before and after the intervention. RESULTS: There was a significant increase in self-reported time in moderate-intensity activity and accelerometer-measured step count and time in movement after the program compared with baseline ( p = 0.02). The distance walked in the Six-Minute Walk Test (6MWT) ( p < 0.001), time to perform agility test ( p = 0.01), and lower-limb strength power ( p = 0.01) and endurance ( p = 0.01) were significantly greater after the program, and no adverse effects were identified. CONCLUSIONS: This study demonstrated an intervention designed specifically for PTTA that can increase PAL.

Voluntary torque production is unaffected by changes in local thermal sensation during normothermia and hyperthermia.

NEW FINDINGS: What is the central question of this study? Hyperthermia reduces the human capacity to produce muscular force, which is associated with decreased neural drive: does mitigating a reduction in neural drive by altering localised thermal sensation help to preserve voluntary force output? What is the main finding and its importance? Altering thermal sensation by cooling and heating the head independent of core temperature did not change neural drive or benefit voluntary force production. Head cooling did slow the rate of rise in core temperature during heating, which may have practical applications in passive settings. ABSTRACT: This study investigated altered local head and neck thermal sensation on maximal and rapid torque production during voluntary contractions. Nine participants completed four visits in two environmental conditions: at rectal temperatures ∼39.5°C in hot (HOT; ∼50°C, ∼39% relative humidity) and ∼37°C in thermoneutral (NEU; ∼22°C, ∼46% relative humidity) conditions. Local thermal sensation was manipulated by heating in thermoneutral conditions and cooling in hot conditions. Evoked twitches and octets were delivered at rest. Maximum voluntary torque (MVT), normalised surface electromyography (EMG) and voluntary activation (VA) were assessed during brief maximal isometric voluntary contractions of the knee extensors. Rate of torque development (RTD) and EMG were measured during rapid voluntary contractions. MVT (P = 0.463) and RTD (P = 0.061) were similar between environmental conditions despite reduced VA (-6%; P = 0.047) and EMG at MVT (-31%; P = 0.019). EMG in the rapid voluntary contractions was also lower in HOT versus NEU during the initial 100 ms (-24%; P = 0.035) and 150 ms (-26%; P = 0.035). Evoked twitch (+70%; P < 0.001) and octet (+27%; P < 0.001) RTD during the initial 50 ms were greater in the HOT compared to NEU conditions, in addition to a faster relaxation rate of the muscle (-33%; P < 0.001). In conclusion, hyperthermia reduced neural drive without affecting voluntary torque, likely due to the compensatory effects of improved intrinsic contractile function and faster contraction and relaxation rates of the knee extensors. Changes in local thermal perception of the head and neck whilst hyperthermic or normothermic did not affect voluntary torque.

Heat acclimation reduces the effects of whole-body hyperthermia on knee-extensor relaxation rate, but does not affect voluntary torque production.

PURPOSE: This study investigated the effects of acute hyperthermia and heat acclimation (HA) on maximal and rapid voluntary torque production, and their neuromuscular determinants. METHODS: Ten participants completed 10 days of isothermic HA (50 °C, 50% rh) and had their knee-extensor neuromuscular function assessed in normothermic and hyperthermic conditions, pre-, after 5 and after 10 days of HA. Electrically evoked twitch and octet (300 Hz) contractions were delivered at rest. Maximum voluntary torque (MVT), surface electromyography (EMG) normalised to maximal M-wave, and voluntary activation (VA) were assessed during brief maximal isometric voluntary contractions. Rate of torque development (RTD) and normalised EMG were measured during rapid voluntary contractions. RESULTS: Acute hyperthermia reduced neural drive (EMG at MVT and during rapid voluntary contractions; P < 0.05), increased evoked torques (P < 0.05), and shortened contraction and relaxation rates (P < 0.05). HA lowered resting rectal temperature and heart rate after 10 days (P < 0.05), and increased sweating rate after 5 and 10 days (P < 0.05), no differences were observed between 5 and 10 days. The hyperthermia-induced reduction in twitch half-relaxation was attenuated after 5 and 10 days of HA, but there were no other effects on neuromuscular function either in normothermic or hyperthermic conditions. CONCLUSION: HA-induced favourable adaptations to the heat after 5 and 10 days of exposure, but there was no measurable benefit on voluntary neuromuscular function in normothermic or hyperthermic conditions. HA did reduce the hyperthermic-induced reduction in twitch half-relaxation time, which may benefit twitch force summation and thus help preserve voluntary torque in hot environmental conditions.

The effects of combined action observation and motor imagery on corticospinal excitability and movement outcomes: Two meta-analyses.

Motor simulation interventions involving motor imagery (MI) and action observation (AO) have received considerable interest in the behavioral sciences. A growing body of research has focused on using AO and MI simultaneously, termed 'combined action observation and motor imagery' (AOMI). The current paper includes two meta-analyses that quantify changes in corticospinal excitability and motor skill performance for AOMI compared to AO, MI and control conditions. Specifically, the first meta-analysis collated and synthesized existing motor evoked potential (MEP) amplitude data from transcranial magnetic stimulation studies and the second meta-analysis collated and synthesized existing movement outcome data from behavioral studies. AOMI had a positive effect compared to control and AO but not MI conditions for both MEP amplitudes and movement outcomes. No methodological factors moderated the effects of AOMI, indicating a robust effect of AOMI across the two outcome variables. The results of the meta-analyses are discussed in relation to existing literature on motor simulation and skill acquisition, before providing viable directions for future research on this topic.

Progressive hyperthermia elicits distinct responses in maximum and rapid torque production.

OBJECTIVES: To investigate the effect of progressive whole-body hyperthermia on maximal, and rapid voluntary torque production, and their neuromuscular determinants. DESIGN: Repeated measures, randomised. METHODS: Nine participants performed sets of neuromuscular assessments in HOT conditions (∼50°C, ∼35% relative humidity) at rectal temperatures (Tre) of 37, 38.5 and 39.5°C and in CON conditions (∼22°C, ∼35% relative humidity) at a Tre of ∼37°C and pre-determined comparative time-points. Electrically evoked twitch (single impulse) and octet (8 impulses at 300Hz) responses were measured at rest. Maximum voluntary torque (MVT), surface electromyography (EMG) normalised to maximal M-wave, and voluntary activation (VA) were measured during 3-5s isometric maximal voluntary contractions. Rate of torque development (RTD) and normalised EMG were measured during rapid voluntary isometric contractions from rest. RESULTS: All neuromuscular variables were unaffected by time in CON. In HOT, MVT, normalised EMG at MVT and VA were lower at 39.5°C compared to 37°C (p<0.05). Early- (0-50ms) and middle- (50-100ms) phase voluntary RTD were unaffected by increased Tre (p>0.05), despite lower normalised EMG at Tre 39.5°C (p<0.05) in rapid contractions. In contrast, late-phase (100-150ms) voluntary RTD was lower at 38.5°C and 39.5°C compared to 37°C (p<0.05) in HOT. Evoked twitch and octet RTD increased with increased Tre (p<0.05). CONCLUSIONS: Hyperthermia reduced late-phase voluntary RTD, likely due to reduced neural drive and the reduction in MVT. In contrast, early- and middle-phase voluntary RTD were unaffected by hyperthermia, likely due to the conflicting effects of reduced neural drive but faster intrinsic contractile properties.

Lower limb tri-joint synchrony during running gait: A longitudinal age-based study.

Biomechanical research exploring the age-based mechanics of running gait can provide valuable insight into the reported decline in master endurance running performance. However, few studies have shown consistent biomechanical differences in the gait of trained distance runners compared to their younger counterparts. It might be that differences occur in the interaction between joints. The aim was to explore the differences in tri-joint synchrony of the lower limb, quantified through cluster phase analysis, of runners at 50 years of age compared to seven years later. Cluster phase analysis was used to examine changes in synchrony between 3 joints of the lower limb during the stance phase of running. Ten male, endurance-trained athletes M50 (age = 53.54 ±â€¯2.56 years, mass = 71.05 ±â€¯7.92 kg) participated in the study and returned after seven years M57 (age = 60.49 ±â€¯2.56 years, mass = 69.08 ±â€¯8.23 kg). Lower limb kinematics (Vicon, 120 Hz) and ground reaction forces (Kistler, 1080  Hz) were collected as participants performed multiple trials at a horizontal running velocity = 3.83 ±â€¯0.40 m·s-1 over the force plate. Significant increase (31%) in rate of force development in the absorption phase, and significantly reduced sagittal plane knee joint range of motion (30.50 v 23.68°) were found following the seven years of ageing. No further discrete single joint measures were significantly different between M50 and M57. Joint synchrony between the hip, knee and ankle was significantly higher at M57 compared to M50 during the absorption phase of stance. The force attenuation strategy is compromised after seven years of ageing, which is associated with more synchronous movements in the lower limb joints. Increased joint synchrony as a function of age could be a mechanism associated with this key injury provoking phase of running gait.

The effect of alterations in foot centre of pressure on lower body kinematics during the five-iron golf swing.

The research aimed to evaluate the effects of an intervention aimed at altering pressure towards the medial aspect of the foot relating to stability mechanisms associated with the golf swing. We hypothesised that by altering the position of the foot pressure, the lower body stabilisation would improve which in turn would enhance weight distribution and underpinning lower body joint kinematics. Eight professional golf association (PGA) golf coaches performed five golf swings, recorded using a nine-camera motion analysis system synchronised with two force platforms. Following verbal intervention, they performed further five swings. One participant returned following a one-year intervention programme and performed five additional golf swings to provide a longitudinal case study analysis. Golf performance was unchanged evidenced by the velocity and angle of the club at ball impact (BI), although the one-year intervention significantly changed the percentage of weight experienced at each foot in the final 9% of downswing, which provided an even weight distribution at BI. This is a highly relevant finding as it indicates that the foot centre of pressure was central to the base of support and in-line with the centre of mass (CoM), indicating significantly increased stability when the CoM is near maximal acceleration.

Stance limb kinetics of older male athletes endurance running performance.

The aim of this study was to examine the age-based, lower limb kinetics of running performances of endurance athletes. Six running trials were performed by 24 male athletes, who were distinguished by three age groupings (S35: 26-32 years, M50: 50-54 years, M60+: 60-68 years). Lower limb coordinate and ground reaction force data were collected using a nine camera infra-red system synchronised with a force plate. A slower anteroposterior (M ± SD S35 = 4.13 ± 0.54 m/s: M60+ = 3.34 ± 0.40 m/s, p < 0.05) running velocity was associated with significant (p < 0.05) decreases in step length and discrete vertical ground contact force between M60+and S35 athletes. The M60+athletes simultaneously generated a 32% and 42% reduction (p < 0.05) in ankle joint moment when compared to the M50 and S35 athletes and 72% (p < 0.05) reduction in knee joint stiffness when compared to S35 athletes. Age-based declines in running performance were associated with reduced stance phase force tolerance and generation that may be accounted for due to an inhibited force-velocity muscular function of the lower limb. Joint-specific coaching strategies customised to athlete age are warranted to maintain/enhance athletes' dynamic performance.

Asymmetrical loading demands associated with vertical jump landings in people with unilateral transtibial amputation.

Loading symmetry during vertical jump landings between a person with amputation's intact and prosthetic limbs was assessed to determine the role of each limb in controlling the downward momentum of the center of mass during landing. Six participants with unilateral transtibial amputation (TTA) and ten nondisabled participants completed 10 maximal vertical jumps, of which the highest jump was analyzed. Contralateral symmetry was assessed through the Symmetry Index (SI), while symmetry at the group level was assessed through a Mann-Whitney U test. Participants with TTA performed quasi-unilateral landings onto the intact limbs, resulting from either the incapability of the prosthetic ankle to plantar flex or increased residual-limb knee and hip flexion. In the loading phase, the participants with TTA displayed reduced prosthetic-side peak vertical forces (p = 0.04) along with reduced prosthetic-side ankle range of motion (p < 0.001), extensor moments (p = 0.03), and negative work generated (p = 0.00). Individual asymmetries were evident in the peak vertical force magnitudes (SI = 51%-140%), duration from touchdown to peak vertical force (SI = 52%-157%), ankle joint angles at touchdown (SI = 100%-538%), ranges of motion (SI = 147%-200%), knee (SI = 66%-179%) and hip (SI = 87%-132%) extensor moments, and work done at the ankle (SI = 155%-199%) and hip (SI = 83%-204%). High peak forces (25.25 +/- 4.89 N·kg(-1) intact limb and 14.61 +/- 8.28 N·kg(-1) prosthetic limb) from significantly lower (p < 0.001) landing heights than the nondisabled participants indicate a potential injury risk associated with landing for people with TTA.

Mechanisms to absorb load in amputee running.

BACKGROUND: We aimed to determine if a shock absorbing pylon (SAP) influenced the ground reaction force characteristics and the shock absorbing mechanisms compared to a rigid pylon (Rigid) during the loading phase in running. OBJECTIVES: To determine if the SAP influences the mechanisms of loading compared to the Rigid condition. STUDY DESIGN: A convenience sample of transtibial amputees participated in a laboratory-based study. The prosthetic set-up was randomly altered fd\sdsd. METHODS: Five recreationally active male transtibial amputees age: 18-50 years; mean mass: 86.7 ± 17.5 kg; height: 1.77 ± 0.07 m) volunteered from a population-based sample. They completed a within-participant-designed study assessing a SAP and a Rigid condition during running. Kinematic and kinetic data were collected during two sessions following a one-week customization period. RESULTS: Loading rate, peak vertical and horizontal ground reaction forces and the time to each measure along with knee and hip angular displacement, absorbing powers and work done between the SAP and Rigid conditions were not systematically affected by the prosthetic condition. CONCLUSIONS: The effect of the SAP was minimal and inconsistent in the loading phase, with only some amputees presenting higher and others with lower values for the tested variables.

Kinetic and kinematic compensations in amputee vertical jumping.

A unilateral transtibial amputation causes a disruption to the musculoskeletal system, which results in asymmetrical biomechanics. The current study aimed to assess the movement asymmetry and compensations that occur as a consequence of an amputation when performing a countermovement vertical jump. Six unilateral transtibial amputees and 10 able-bodied (AB) participants completed 10 maximal vertical jumps, and the highest jump was analyzed further. Three-dimensional lower limb kinematics and normalized (body mass) kinetic variables were quantified for the intact and prosthetic sides. Symmetry was assessed through the symmetry index (SI) for each individual and statistically using the Mann-Whitney U test between the intact and prosthetic sides for the amputee group. A descriptive analysis between the amputee and AB participants was conducted to explore the mechanisms of amputee jumping. The amputee jump height ranged from 0.09 to 0.24 m. In the countermovement, all ankle variables were asymmetrical (SI > 10%) and statistically different (p < .05) for the amputees. At the knee and hip, there was no statistical difference between the intact and prosthetic sides range of motion, although there was evidence of individual asymmetry. The knees remained more extended compared with the AB participants to prevent collapse. In propulsion, the prosthesis did not contribute to the work done and the ankle variables were asymmetrical (p < .05). The knee and hip variables were not statistically different between the intact and prosthetic sides, although there was evidence of functional asymmetry and the contribution tended to be greater on the intact compared with the prosthetic side. The lack of kinetic involvement of the prosthetic ankle and both knees due to the limitation of the prosthesis and the altered musculoskeletal mechanics of the joints were the reason for the reduced height jumped.

Patellar tracking during the gait cycle.

PURPOSE: To assess normal patellar tracking during walking using the 9-camera infrared system. METHODS: Four men and 6 women aged 25 to 33 (mean, 29) years each performed 16 walking trials on one occasion. They had prominent patellae with minimal soft tissues (minimising skin artefacts), and their knees and lower limbs were normal and symmetrical. 12 retro-reflective markers (2.5 cm in diameter) were taped to anatomic landmarks of the lower body. Two additional markers (1.4 cm in diameter) were first placed on the medial and lateral points and then proximal and distal points of the patella. Patellar motion relative to the centre of the knee joint was defined as angles between the centre of the knee joint and the 2 sets of patellar markers (medial-lateral and proximal-distal). The mean, maximum, and minimum values of these angles in a standing position were recorded, as was patellar tracking during walking. The X, Y, and Z coordinates for each marker were smoothed out throughout the capturing time. A single gait cycle per trial was chosen for analysis. RESULTS: During walking, the centre of the knee joint and the patella did not move in unison, and the extent of separation was subject dependent. In 70% of the participants, the maximum angle between the centre of the knee joint and each set of markers occurred in the swing phase (0-43%) of the gait cycle. When analysing both sets of markers together, the percentage of participants became 60%. The extent of knee flexion was subject dependent. There was more medial-lateral motion (shift) of the patella than proximal-distal (tilt) motion during the gait cycle. These indicated that the maximum amount of patellar shift and tilt occurred in the swing and early stance phases of the gait cycle and that abnormal patellar motion can be detected if excessive shift or tilt occurs outside of these phases. CONCLUSION: Patella mal-tracking could be attributed to the position of the lower body segments rather than the absorption or generation of forces.