Use of the Spencer Technique on Collegiate Baseball Players: Effect on Physical Performance and Self-Report Measures.

CONTEXT: Repeated overhead throwing in baseball players alters range of motion (ROM), contributing to shoulder injury. The Spencer technique has been used, anecdotally, to reduce the effects of throwing-induced limitations in ROM. OBJECTIVE: To quantify the effects of a single administration of the Spencer technique on the ROM and performance of collegiate baseball pitchers. METHODS: Pitchers from the Seton Hill University men's baseball team were randomly assigned to 2 treatment groups: Spencer technique or sham therapy. The first week consisted of baseline outcome measurements (1 week before treatment), including ROM (flexion, extension, abduction, adduction, internal rotation, and external rotation) of the dominant throwing arm, 10 maximum velocity throws, and self-reported performance using the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES). The second week consisted of pretreatment ROM measurement, followed by a single treatment and repeated measurement of all outcomes. RESULTS: Of 16 players, 15 met inclusion criteria. An effect of training on ROM between weeks 1 and 2 for all players consisted of significantly decreased internal rotation (P=.02) and increased external rotation (P=.04). A differential effect of treatment was found on the mean difference in internal rotation after treatment, compared with the mean difference before treatment on the same day (P=.01). Additionally, a trend toward statistical significance for abduction (P=.08) was noted. Analyses reveal that these effects were caused by significant increases in the internal rotation and abduction for the Spencer group only (P=.02). All other analyses of ROM, as well as performance measured by maximum velocity throws and the KJOC-SES, revealed no differential effect of treatment. CONCLUSION: The results of this study support the use of the Spencer technique in counteracting the potentially negative effects of repeated throwing on internal rotation. However, a single administration did not affect functional ability in this study. Future studies of longer duration and including differing levels of play, injury status, and playing position will be needed to further evaluate the full potential of the Spencer technique in athletes who engage in repeated overhead arm movements.

A feasibility study of conducting the Montreal Cognitive Assessment remotely in individuals with movement disorders.

Remote assessments of individuals with a neurological disease via telemedicine have the potential to reduce some of the burdens associated with clinical care and research participation. We aim to evaluate the feasibility of conducting the Montreal Cognitive Assessment remotely in individuals with movement disorders. A pilot study derived from two telemedicine trials was conducted. In total, 17 individuals with movement disorders (8 with Parkinson disease and 9 with Huntington disease) had Montreal Cognitive Assessment examinations evaluated in-person and remotely via web-based video conferencing to primarily determine feasibility and potential barriers in its remote administration. Administering the Montreal Cognitive Assessment remotely in a sample of movement disorder patients with mild cognitive impairment is feasible, with only minor common complications associated with technology, including delayed sound and corrupted imaging for participants with low connection speeds. The Montreal Cognitive Assessment has the potential to be used in remote assessments of patients and research participants with movement disorders.

Randomized controlled clinical trial of "virtual house calls" for Parkinson disease.

IMPORTANCE: The burden of neurological disorders is increasing, but access to care is limited. Providing specialty care to patients via telemedicine could help alleviate this growing problem. OBJECTIVE: To evaluate the feasibility, effectiveness, and economic benefits of using web-based videoconferencing (telemedicine) to provide specialty care to patients with Parkinson disease in their homes. DESIGN: A 7-month, 2-center, randomized controlled clinical trial. SETTING: Patients' homes and outpatient clinics at 2 academic medical centers. PARTICIPANTS: Twenty patients with Parkinson disease with Internet access at home. INTERVENTION: Care from a specialist delivered remotely at home or in person in the clinic. MAIN OUTCOME MEASURES: The primary outcome variable was feasibility, as measured by the percentage of telemedicine visits completed as scheduled. Secondary outcome measures included clinical benefit, as measured by the 39-item Parkinson Disease Questionnaire, and economic value, as measured by time and travel. RESULTS: Twenty participants enrolled in the study and were randomly assigned to telemedicine (n = 9) or in-person care (n = 11). Of the 27 scheduled telemedicine visits, 25 (93%) were completed, and of the 33 scheduled in-person visits, 30 (91%) were completed (P = .99). In this small study, the change in quality of life did not differ for those randomly assigned to telemedicine compared with those randomly assigned to in-person care (4.0-point improvement vs 6.4-point improvement; P = .61). Compared with in-person visits, each telemedicine visit saved participants, on average, 100 miles of travel and 3 hours of time. CONCLUSION AND RELEVANCE: Using web-based videoconferencing to provide specialty care at home is feasible, provides value to patients, and may offer similar clinical benefit to that of in-person care. Larger studies are needed to determine whether the clinical benefits are indeed comparable to those of in-person care and whether the results observed are generalizable. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01476306.