Evaluating the Impact of a Global Cleft Speech Mentorship Program on Expanding Practitioner Competency in low- and middle-income countries.

A primary challenge in global cleft care lies in the limited opportunities for cleft-specific training and mentorship available to speech practitioners worldwide, particularly in low-income and middle-income countries (LMICs). In addition, the limited number of speech therapists with cleft experience in LMICs creates a significant barrier to access to care for individuals with cleft lip and palate globally. The inaccessibility of cleft-specific clinical instruction and cleft-trained speech therapists impacts the effectiveness of intervention and, subsequently, the speech-language development of cleft-affected individuals worldwide. A structured virtual clinical mentorship program targeting speech practitioners of all skill levels in LMICs was established to address this gap in comprehensive cleft care provision. This article will examine the effectiveness of a structured cleft speech mentorship program in expanding practitioner competency in LMIC communities and, as a result, building capacity for cleft speech care globally. The authors will outline various aspects of the development and implementation of this cleft speech mentorship program, including rationale, participant recruitment, program requirements, and impact assessment tools utilized. An analysis of pre-program and post-program data will be conducted to evaluate the degree to which clinical skills were improved, identify persistent areas of weakness, and examine the effectiveness of the program in expanding speech practitioner competency.

Effects of a Cycling Dual Task on Emotional Word Choice in Parkinson's Disease.

Purpose Individuals with Parkinson's disease (PD) demonstrate language- and emotion-related impairments; however, emotional language production has received little attention within the literature despite the fact that deficits could significantly impact one's daily interactions with loved ones and others. Multitasking (i.e., dual tasking), specifically while completing language tasks, is a common everyday occurrence and typically impacts performance on 1 or both tasks. This study compared emotional word use during discourse production in individuals with PD and healthy older adults (HOAs) under single- and dual-task conditions. Method Participants completed a discourse task while sitting in a quiet room and while stationary cycling. Discourse output was analyzed along several emotional and intellectual language dimensions obtained from the Linguistic Inquiry and Word Count program (Pennebaker, Booth, & Francis, 2007 ). Results Groups did not differ on any outcome measure in the single-task condition. However, HOAs produced a higher percentage of words associated with affective processes and positive emotion while completing the dual-task condition, whereas the PD group exhibited a decrease in production of these words. Compared to the single-task condition, during cycling, individuals with PD also produced a lower percentage of inhibition-related words. Conclusions These results suggest that cycling, like other types of exercise, improves mood as manifested in discourse word choice in HOAs; however, it may lead to reduced use of emotional words in individuals with PD. Expressing emotion may also be more difficult in those with PD than in HOAs and, therefore, easily disrupted in distracting circumstances.

Effect of Creatine Supplementation on the Airways of Youth Elite Soccer Players.

INTRODUCTION: Owing to its well-established ergogenic potential, creatine is a highly popular food supplement in sports. As an oral supplement, creatine is considered safe and ethical. However, no data exist on the safety of creatine on lung function in athletes. The aim of this project was to evaluate the effects of a standard course of creatine on the airways of youth elite athletes. METHODS: Nineteen elite soccer players, 16-21 yr old, completed a stratified, randomized, double-blind, placebo-controlled, parallel-group trial. The creatine group (n = 9) ingested 0.3 g·kg⋅d of creatine monohydrate (CM) for 1 wk (loading phase) and 5 g·d for 7 wk (maintenance phase), and the placebo group (n = 10) received the same dosages of maltodextrin. Airway inflammation (assessed by exhaled nitric oxide, FENO) and airway responsiveness (to dry air hyperpnoea) were measured pre- and postsupplementation. RESULTS: Mild, unfavorable changes in FENO were noticed by trend over the supplementation period in the CM group only (P = 0.056 for interaction, η = 0.199), with a mean group change of 9 ± 13 ppb in the CM group versus -5 ± 16 ppb in the placebo group (P = 0.056, d = 0.695). Further, the maximum fall in forced expiratory volume in 1 s after dry air hyperpnoea was larger by trend postsupplementation in the CM group compared with the placebo group: 9.7% ± 7.5% vs 4.4% ± 1.4%, respectively (P = 0.070, d = 0.975). These adverse effects were more pronounced when atopic players only (n = 15) were considered. CONCLUSION: On the basis of the observed trends and medium to large effect sizes, we cannot exclude that creatine supplementation has an adverse effect on the airways of elite athletes, particularly in those with allergic sensitization. Further safety profiling of the ergogenic food supplement is warranted.

Generation of tidal volume via gentle chest pressure in children over one year old.

BACKGROUND: In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is a well-established technique to maintain oxygenation of tissues and organs until medical equipment and staff are available. During CPR, chest compressions help circulate blood and have been shown in animal models to be a means of short-term oxygenation. In this study, we tested whether gentle chest pressure can generate meaningful tidal volume in paediatric subjects. METHODS: This prospective cohort pilot study recruited children under the age of 17 years and undergoing any surgery requiring general anaesthetic and endotracheal intubation. After induction of general anaesthesia, tidal volumes were obtained before and after intubation by applying a downward force on the chest which was not greater than the patient's weight. Mean tidal volumes were compared for unprotected versus protected airway and for type of surgery. RESULTS: Mean tidal volume generated with an unprotected and protected airway was 2.7 (1.7) and 2.9 (2.3) mL/kg, respectively. Mean tidal volume generated with mechanical ventilation was 13.6 (4.9) mL/kg. No statistical significance was found when comparing tidal volumes generated with an unprotected or protected airway (p = 0.20), type of surgery (tonsillectomy and/or adenoidectomy versus other surgery) (unprotected, p = 0.09; protected, p = 0.37), and when age difference between groups was taken into account (p = 0.34). CONCLUSIONS: Using gentle chest pressure, we were able to generate over 20% of the tidal volume achieved with mechanical ventilation. Our results suggest that gentle chest pressure may be a means to support temporary airflow in children.

Attentional capture by spoken language: effects on netballers' visual task performance.

In two experiments, participants performed visual detection, visual discrimination and decision-making tasks, in which a binary (left/right) response was required. In all experimental conditions, a spoken word ("left"/"right") was presented monaurally (left or right ear) at the onset of the visual stimulus. In Experiment 1, 26 non-athletes located a target amongst an array of distractors as quickly as possible, in both the presence and absence of spoken cues. Participants performed superiorly in the presence of valid cues, relative to invalid-cue and control conditions. In Experiment 2, 42 skilled netballers completed three tasks, in randomised order: a visual detection task, a visual discrimination task and a netball decision-making task - all in the presence of spoken cues. Our data showed that spoken auditory cues affected not only target detection, but also performance on more complex decision-making tasks: cues that were either spatially or semantically invalid slowed target detection time; spatially invalid cues impaired discrimination task accuracy; and cues that were either spatially or semantically valid improved accuracy and speeded decision-making time in the netball task. When studying visual perception and attention in sport, the impact of concomitant auditory information should be taken into account in order to achieve a more representative task design.

Leg stiffness in human running: Comparison of estimates derived from previously published models to direct kinematic-kinetic measures.

It is not presently clear whether mathematical models used to estimate leg stiffness during human running are valid. Therefore, leg stiffness during the braking phase of ground contact of running was calculated directly using synchronous kinematic (high-speed motion analysis) and kinetic (force platform) analysis, and compared to stiffness calculated using four previously published kinetic models. Nineteen well-trained male middle distance runners (age=21.1±4.1yr; VO(2max)=69.5±7.5mlO(2)kg(-1)min(-1)) completed a series of runs of increasing speed from 2.5 to 6.5ms(-1). Leg stiffness was calculated directly from kinetic-kinematic analysis using both vertical and horizontal forces to obtain the resultant force in the line of leg compression (Model 1). Values were also estimated using four previously published mathematical models where only force platform derived and anthropometric measures were required (Models 2-5; Morin et al., 2005, Morin et al., 2011, Blum et al., 2009, Farley et al., 1993, respectively). The greatest statistical similarity between leg stiffness values occurred with Models 1 and 2. The poorest similarity occurred when values from Model 4 were compared with Model 1. Analyses suggest that the poor correlation between Model 1 other models may have resulted from errors in the estimation in change in leg length during the braking phase. Previously published mathematical models did not provide accurate leg stiffness estimates, although Model 2, used by Morin et al. (2005), provided reasonable estimates that could be further improved by the removal of systematic error using a correction factor (K=1.0496K(Model2)).

Development of lower limb stiffness and its contribution to maximum vertical jumping power during adolescence.

Maximum power production during multi-joint tasks increases as children grow older. Previous research suggests that in adults, maximum power production in jumping is related to lower limb stiffness. In a developmental context, the question arises as to whether the relationship between maximum power production and lower limb stiffness is age-dependent. The purpose of this study was to investigate the relationship between lower limb stiffness and peak power production in adolescents (AD) and pre-adolescents (PA). With institutional approval, two groups of pre-adults (pre-adolescents: 11-13 years of age, N=43; adolescents: 16-18 years of age, N=30) performed 30 two-legged hops at their preferred frequency and three maximum counter-movement jumps. AD produced significantly greater peak power during the counter-movement jump than PA (t(71)=-5.28, P<0.001) even when body mass was accounted for. Lower limb stiffness was significantly correlated with peak power production during the counter-movement jump in AD (R=0.62, P<0.001) but not in PA (R=0.26, P=0.10). When normalised to body mass, the relationship between lower limb stiffness and peak power also differed between the two age groups (R=0.30, P=0.11 for AD and R=0.02, P=0.88 for PA). In addition, we found that during hopping, both PA and AD behaved like a simple spring-mass system. Our findings highlight the importance of lower limb stiffness in the context of muscular power production during multi-joint tasks. They let us speculate that during adolescence, children acquire the ability to take greater advantage of elastic energy storage in the musculotendinous system when performing maximum counter-movement jumps.

Changes in muscle force-length properties affect the early rise of force in vivo.

Changes in contractile rate of force development (RFD), measured within a short time interval from contraction initiation, were measured after a period of strength training that led to increases in muscle fascicle length but no measurable change in neuromuscular activity. The relationship between training-induced shifts in the moment-angle relation and changes in RFD measured to 30 ms (i.e., early) and 200 ms (i.e., late) from the onset of isometric knee extension force were examined; shifts in the moment-angle relation were used as an overall measure of changes in quadriceps muscle fascicle length. A significant proportion of the variance in RFD measured only in the initial contraction phase (0-30 ms) could be explained by shifts in the moment-angle relation (r=-0.66-0.71; R2=0.44-0.50). Training-induced increases in muscle fascicle length may lead to a reduced or complete lack of adaptive gains in contractile RFD, especially in the early contraction phase.

Anatomical predictors of maximum isometric and concentric knee extensor moment.

The most important anatomical determinants of in vivo joint moment magnitude have yet to be defined. Relationships between maximal knee extensor moment and quadriceps muscle volume, anatomical (ACSA) and physiological (PCSA) cross-sectional area, muscle architecture and moment arm (MA) were compared. Nineteen untrained men and women performed maximal isokinetic knee extensions under isometric conditions (90 degrees joint angle) and at 30 degrees and 300 degrees s(-1). Magnetic resonance and ultrasound imaging techniques were used to measure vastus lateralis PCSA and fascicle length (FL), quadriceps ACSA, volume and patellar tendon MA. Muscle volume was the best predictor of extensor moment measured isometrically (R(2) = 0.60) and at 30 degrees s(-1)(R (2) = 0.74). PCSA x FL was the best predictor of moment at 300 degrees s(-1) (R(2) = 0.59). MA was not an important predictor. ACSA was the second best predictor at all three speeds and could be recommended as an ideal measure given its relative ease of measurement.

Effect of contraction mode of slow-speed resistance training on the maximum rate of force development in the human quadriceps.

This study examined the effects of slow-speed resistance training involving concentric (CON, n = 10) versus eccentric (ECC, n = 11) single-joint muscle contractions on contractile rate of force development (RFD) and neuromuscular activity (EMG), and its maintenance through detraining. Isokinetic knee extension training was performed 3 x week(-1) for 10 weeks. Maximal isometric strength (+11.2%) and RFD (measured from 0-30/50/100/200 ms, respectively; +10.5%-20.5%) increased after 10 weeks (P < 0.01-0.05); however, there was no effect of training mode. Peak EMG amplitude and rate of EMG rise were not significantly altered with training or detraining. Subjects with below-median normalized RFD (RFD/MVC) at 0 weeks significantly increased RFD after 5- and 10-weeks training, which was associated with increased neuromuscular activity. Subjects who maintained their higher RFD after detraining also exhibited higher activity at detraining. Thus, only subjects with a lesser ability to rapidly attain their maximum force before training improved RFD with slow-speed resistance exercise.

Influence of concentric and eccentric resistance training on architectural adaptation in human quadriceps muscles.

Studies using animal models have been unable to determine the mechanical stimuli that most influence muscle architectural adaptation. We examined the influence of contraction mode on muscle architectural change in humans, while also describing the time course of its adaptation through training and detraining. Twenty-one men and women performed slow-speed (30 degrees /s) concentric-only (Con) or eccentric-only (Ecc) isokinetic knee extensor training for 10 wk before completing a 3-mo detraining period. Fascicle length of the vastus lateralis (VL), measured by ultrasonography, increased similarly in both groups after 5 wk (Delta(Con) = +6.3 +/- 3.0%, Delta(Ecc) = +3.1 +/- 1.6%, mean = +4.7 +/- 1.7%; P < 0.05). No further increase was found at 10 wk, although a small increase (mean approximately 2.5%; not significant) was evident after detraining. Fascicle angle increased in both groups at 5 wk (Delta(Con) = +11.1 +/- 4.0%, Delta(Ecc) = +11.9 +/- 5.4%, mean = 11.5 +/- 3.2%; P < 0.05) and 10 wk (Delta(Con) = +13.3 +/- 3.0%, Delta(Ecc) = +21.4 +/- 6.9%, mean = 17.9 +/- 3.7%; P < 0.01) in VL only and remained above baseline after detraining (mean = 13.2%); smaller changes in vastus medialis did not reach significance. The similar increase in fascicle length observed between the training groups mitigates against contraction mode being the predominant stimulus. Our data are also strongly indicative of 1) a close association between VL fascicle length and shifts in the torque-angle relationship through training and detraining and 2) changes in fascicle angle being driven by space constraints in the hypertrophying muscle. Thus muscle architectural adaptations occur rapidly in response to resistance training but are strongly influenced by factors other than contraction mode.

The impact of ergometer design on hip and trunk muscle activity patterns in elite rowers: an electromyographic assessment.

THIS STUDY USED SURFACE ELECTROMYOGRAPHY (SEMG) TO EXAMINE WHETHER THERE WERE DIFFERENCES IN HIP AND TRUNK MUSCLE ACTIVATION DURING THE ROWING CYCLE ON TWO OF THE MOST WIDELY USED AIR BRAKED ERGOMETERS: the Concept 2C and the Rowperfect. sEMG methods were used to record the muscle activity patterns from the right: m. Erector spinae (ES), m. Rectus Abdominus (RA), m. Rectus Femoris (RF) and m. Biceps Femoris (BF) for their contributions as agonist-antagonist pairs underlying hip and trunk extension/flexion. The sEMG activity patterns of these muscles were examined in six young male elite rowers completing a 2 minute set at a moderate training intensity (23 stroke·min(-1) and 1:47.500 m(-1) split time, 300W). The rowers closely maintained the required target pace through visual inspection of the standard LCD display of each ergometer. The measurements of duration of each rowing cycle and onset of each stroke during the test were recorded simultaneously with the sEMG activity through the additional instrumentation of a foot-pressure switch and handle accelerometry. There were no significant differences between the two ergometer designs in group means for: work rate (i.e., rowing speed and stroke rate), metabolic load as measured by mean heart rate, rowing cycle duration, or timing of the stroke in the cycle. 2-D motion analysis of hip and knee motion for the rowing cycle from the video footage taken during the test also revealed no significant differences in the joint range of motion between the ergometers. Ensemble average sEMG activity profiles based on 30+ strokes were obtained for each participant and normalised per 10% intervals of the cycle duration as well as for peak mean sEMG amplitude for each muscle. A repeated measures ANOVA on the sEMG activity per 10% interval for the four muscles contributing to hip and trunk motion during the rowing cycle revealed no significant differences between the Concept 2C and Rowperfect (F = 0.070, df = 1,5, p = 0.802). The outcome of this study suggests that the two different ergometer designs are equally useful for dry land training. Key PointsThe effects of endurance training on HR recovery after exercise and cardiac ANS modulation were investigated in female marathon runners by comparing with untrained controls.Time and frequency domain analysis of HRV was used to investigate cardiac ANS modulation.As compared with untrained controls, the female marathon runners showed faster HR recovery after exercise, which should result from their higher levels of HRV, higher aerobic capacity and exaggerated blood pressure response to exercise.