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1.
J Neurosurg Pediatr ; : 1-8, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38875723

RESUMO

OBJECTIVE: Selective dorsal rhizotomy (SDR) is a neurosurgical procedure to reduce spasticity in children with cerebral palsy and spastic diplegia. The authors developed a procedure called focal SDR for children with spasticity predominantly in the L5 or S1 motor distribution, which can be combined with orthopedic correction of fixed soft-tissue or bony deformity. The authors describe in detail the technique of minimally invasive focal SDR and propose selection criteria. METHODS: The authors conducted a retrospective study of patients who underwent focal SDR at their institution and underwent baseline and 1-year postoperative 3D gait analysis. Modified Ashworth scale (MAS) and Gait Deviation Index (GDI) scores were the primary outcome measures. RESULTS: Ten patients met the study criteria, all with an underlying diagnosis of cerebral palsy. All underwent focal SDR at the unilateral or bilateral S1 level, and 4 additionally underwent focal SDR at the L5 level unilaterally or bilaterally. All but 1 patient underwent concurrent orthopedic surgery. The improvement in spasticity of the plantar flexors, as measured by the MAS score, was 2.2 (p < 0.001). In the patients who underwent L5 focal SDR, there was an improvement in the hamstring MAS score of 1.4 (p = 0.004). The mean improvement in the GDI score following focal SDR was 11 (range -6 to 29, p < 0.001). CONCLUSIONS: Focally impairing spasticity in the gastrocsoleus complex and/or hamstrings muscle group in the setting of less functionally impactful proximal tone is extremely common in cerebral palsy. The novel technique of focal SDR, combined with orthopedic intervention, improves spasticity scores and overall gait mechanics. Further investigation is warranted to define the ideal candidacy and outcomes.

2.
Gait Posture ; 113: 40-45, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38838379

RESUMO

BACKGROUND: Children with neuromuscular disorders, such as cerebral palsy, frequently develop foot deformities, such as equinopronovalgus and equinosupovarus, leading to walking difficulties and discomfort. Traditional assessment methods, including clinical measures and radiographs, often fail to capture the dynamic nature of these deformities, resulting in suboptimal treatment. 3D gait analysis using multisegment foot models offers a more detailed understanding of these deformities. RESEARCH QUESTION: To determine whether the combination of multisegment foot models, multivariate functional principal component analysis, and k-means cluster analyses could identify distinct, clinically relevant foot types in a large pediatric cohort with cerebral palsy. METHODS: This was a retrospective analysis of 3D gait data from 197 patients with cerebral palsy collected using a multisegment foot model. Multivariate functional principal component analysis was used to reduce these data prior to using k-means clustering to identify foot posture clusters. Further analyses, including ANOVA and Fisher's Exact tests, were used to evaluate demographic, radiographic, and gait characteristics to explain the clinical relevance of each cluster. RESULTS: Analysis of kinematic data from 371 feet revealed six clinically significant clusters, with a low misclassification rate of 2 %. One-factor ANOVAs demonstrated significant differences across clusters for all MPCs, whereas no significant differences were noted in basic anthropometric variables. Significant variations were observed in radiographic and gait function variables, and a strong association between GMFCS levels and cluster categorization was identified. SIGNIFICANCE: The novel approach of integrating multivariate functional principal component analysis and k-means clustering identified a spectrum of foot deformities in children with CP, ranging from equinosupovarus to marked equinopronovalgus. This methodology provides an objective classification based on kinematic data and can facilitate improved diagnosis and treatment of cerebral palsy-related foot deformities.

3.
BMJ Open Sport Exerc Med ; 9(4): e001730, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38143720

RESUMO

Objective: To describe the incidence of injuries and illnesses among paediatric Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games, and the 2022 Beijing Olympic and Paralympic Games. Methods: An electronic medical record system documented all injuries and illnesses that occurred while competing in the four Games periods. Incidence (IR) with 95% CI per 1000 athlete days were calculated for both injuries and illnesses. Incidence rate ratios (IRR) were calculated to compare injury and illness rates based on age (paediatric vs non-paediatric) sex, Games period and sport type. Results: Two hundred paediatric athletes (age range, 15-21 years) competed across the four Games periods, representing 16.1% of all Team USA athletes. The overall injury IR (95% CI) was 13.4 (9.8 to 18.1), and the overall illness IR was 5.5 (3.3 to 8.7). There were no differences in incidence between paediatric and non-paediatric athletes for either injury (IRR (95% CI): 0.9 (0.6 to 1.2)) or illness (IRR (95% CI): 0.9 (0.5 to 1.5)). Female paediatric athletes were more likely to sustain an injury compared with male paediatric athletes (IRR (95% CI): 2.4 (1.1 to 5.3)). The most common mechanism of injury was gradual onset (IR, 4.3 (2.3 to 7.2)), and injuries most commonly occurred during practices (IR, 7.0 (4.5 to 10.5)). Conclusion: Paediatric athletes account for a substantial proportion of Team USA athletes. It is essential that paediatric sports medicine experts are included in the medical team given that paediatric Team USA athletes are just as likely as their adult teammates to sustain an injury or illness.

4.
Gait Posture ; 83: 262-267, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33220659

RESUMO

BACKGROUND: Impairments in gait and balance function are typical after concussion. There is evidence that these neuromuscular deficits persist past the typical time of symptom resolution. The ability to quantify these changes in gait and balance may provide useful information when making return to play decisions in clinical settings. RESEARCH QUESTION: Are changes in gait function and postural control evident across the course of a concussion management program? METHODS: A retrospective analysis of a convenience sample of 38 patients who were seen for concussion between October 2017 and May 2019 was performed. Gait and balance measures were assessed at their initial clinic visit post-injury and at their clearance visit using inertial measurement units. During dual-task walking trials, the medial-lateral motion of the center of mass and gait velocity were measured. Postural sway complexity and jerk index were measured during both eyes-open and eyes-closed balance trials. RESULTS: Paired samples t-tests and Wilcoxon signed rank tests were used to determine whether statistically significant changes occurred for the gait and balance variables, respectively. Medial-lateral sway decreased (4.4 ± 1.3 cm to 4.0 ± 1.2 cm, p = 0.018) and gait velocity increased (0.78 ± 0.23 m/s to 0.91 ± 0.18 m/s, p < 0.001) from initial to clearance testing. Jerk index decreased (6.41 ± 11.06 m2/s5 to 5.73 ± 4.28 m2/s5, p = 0.031) and (11.87 ± 26.42 m2/s5 to 7.87 ± 8.38 m2/s5, p = 0.003) from initial to clearance testing for the eyes-open and eyes-closed conditions, respectively. Complexity index increased (2.38 ± 1.08-2.86 ± 0.72, p = 0.010) from initial to clearance testing for the eyes-closed condition. There was no change in complexity index for the eyes-open condition. SIGNIFICANCE: These preliminary results support the potential use of measures of gait and postural control to assess recovery following a concussion in a clinical setting.


Assuntos
Concussão Encefálica/complicações , Análise da Marcha/métodos , Equilíbrio Postural/fisiologia , Adolescente , Adulto , Atenção , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
5.
Phys Med Rehabil Clin N Am ; 31(1): 107-115, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31760984

RESUMO

Gait abnormalities in cerebral palsy are complex and difficult to accurately characterize. Clinical gait analysis shows the prerequisite components of a clinical test to aid in the treatment planning for patients with cerebral palsy. Clinical gait analysis can be used to distinguish between different levels of impairment, can be used to monitor progress and outcomes, and is beginning to show promise for prediction of postsurgical outcomes. Clinical gait analysis can also provide important and relevant information for treatment planning, enhance the likelihood of positive outcomes, and reduce the number of negative outcomes.


Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/cirurgia , Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/cirurgia , Fenômenos Biomecânicos , Humanos
6.
Clin Biomech (Bristol, Avon) ; 68: 23-28, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31146080

RESUMO

BACKGROUND: Physiological complexity represents overall health of a system and its underlying capacity to adapt to stresses. The primary purpose of this study was to determine if physiological complexity of gait both ON and OFF anti-Parkinson medication differed between regular and non-exercisers with Parkinson's disease. METHODS: Twenty participants with idiopathic Parkinson's disease were enrolled in this cross-sectional study (regular exercisers n = 10, non-exercisers n = 10). Two data collection sessions were completed during a single visit, first after a 12-hour overnight withdrawal from anti-Parkinson medications (OFF), and again one-hour after taking anti-Parkinson medications (ON). During each session participants completed a 2-minute walking task at their preferred pace while wearing wireless inertial measurement units on each lower extremity segment (thigh, shank, foot). Multivariate multiscale entropy was calculated from the tri-axial accelerometer signals and converted to a complexity index for analysis. FINDINGS: Regular exercisers demonstrated significantly higher complexity indices ON and OFF anti-Parkinson medications compared to non-exercisers (ON F = 3.84 P = 0.02; OFF F = 3.61, P < 0.03). Regular exercisers did not significantly differ in complexity between OFF and ON states (most affected leg F = 0.15 P = 0.71; least affected leg F = 0.30 P = 0.60), but non-exercisers demonstrated significantly decreased complexity in the least affected leg OFF anti-Parkinson medications (F = 5.17 P < 0.04). INTERPRETATION: Enhanced gait complexity in the regular exercisers may indicate that ongoing exercise is a key ingredient contributing to health in persons with Parkinson's disease. Exercising on a regular basis with Parkinson's disease may augment one's ability to adapt to barriers encountered during gait regardless of medication state.


Assuntos
Exercício Físico/fisiologia , Marcha/fisiologia , Doença de Parkinson/fisiopatologia , Idoso , Análise de Variância , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Caminhada/fisiologia
7.
Comput Methods Biomech Biomed Engin ; 22(6): 658-663, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30822140

RESUMO

Complexity represents the adaptability of the biological system, therefore the assessment of complexity during tasks such as walking may be particularly useful when attempting to better understand the recovery processes after stroke. The purpose of this study was to determine whether the complexity of lower extremity gait kinematics in persons with chronic hemiparesis due to stroke is different from that of individuals without disability during a gait task. The group of participants with chronic stroke exhibited reduced gait complexity across all body segments compared to those without disability. The decreased complexity of gait after stroke may represent diminished adaptability in the neuromotor system and may have significant implications when it comes to negotiating diverse environmental constraints and the ability to relearn pre-stroke gait patterns.


Assuntos
Marcha/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Fenômenos Biomecânicos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
NeuroRehabilitation ; 43(2): 147-154, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30040764

RESUMO

BACKGROUND: The emergence of mobile technology allows the examination of balance through direct measures of postural sway in a cost-effective, convenient and portable fashion. However, there is insufficient evidence for use in populations with neurologic conditions. OBJECTIVES: 1) To determine the test-retest reliability of the Sway Balance™ mobile application in measuring postural sway in individuals with Parkinson disease, 2) To examine the concurrent validity of Sway Balance™ with inertial measurement units and 3) To determine if Sway Balance™ scores can predict disease severity. METHODS: Thirty subjects with early stage idiopathic Parkinson disease completed three trials of two Sway Balance™ protocols while postural sway was simultaneously measured by two inertial measurement units and Sway Balance™, then repeated testing one week later. RESULTS: Sway Balance demonstrated high test-retest reliability for both protocols (ICC = 0.72 and 0.92) and good to excellent inverse correlation with the inertial measurement units across both protocols (ρ= -0.61- -0.92; p < 0.001). Sway Balance™ did not accurately predict disease severity. CONCLUSION: Sway Balance™ demonstrates strong test-retest reliability and concurrent validity with measures from inertial measurement units. Questions remain regarding the ability of Sway Balance™ to accurately characterize balance of individuals who demonstrate difficulty maintaining the test condition.


Assuntos
Aplicativos Móveis/normas , Exame Neurológico/normas , Doença de Parkinson/patologia , Equilíbrio Postural , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
9.
Res Q Exerc Sport ; 84(3): 305-12, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24261009

RESUMO

UNLABELLED: Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training. PURPOSE: To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking. METHOD: Eighteen men performed the following tasks: unloaded walking, walking with a 32-kg load, fatigued walking with a 32-kg load, and fatigued walking. After the second walking task, muscle fatigue was elicited through a fatiguing protocol consisting of metered step-ups and heel raises with a 16-kg load. Each walking task was performed at 1.67 m x s(-1) for 5 min. Walking movement was tracked by a VICON motion capture system at 120 Hz. Ground reaction forces were collected by a tandem force instrumented treadmill (AMTI) at 2,400 Hz. Lower-extremity joint mechanics were calculated in Visual 3D. RESULTS: There was no interaction between load carriage and fatigue on lower-extremity joint mechanics (p > .05). Both load carriage and fatigue led to pronounced alterations of lower-extremity joint mechanics (p < .05). Load carriage resulted in increases of pelvis anterior tilt, hip and knee flexion at heel contact, and increases of hip, knee, and ankle joint moments and powers during weight acceptance. Muscle fatigue led to decreases of ankle dorsiflexion at heel contact, dorsiflexor moment, and joint power at weight acceptance. In addition, muscle fatigue increased demand for hip extensor moment and power at weight acceptance. CONCLUSION: Statistically significant changes in lower-extremity joint mechanics during loaded and fatigued walking may expose military personnel to increased risk for overuse injuries.


Assuntos
Extremidade Inferior/fisiologia , Militares , Fadiga Muscular/fisiologia , Caminhada/fisiologia , Suporte de Carga/fisiologia , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Teste de Esforço , Articulação do Quadril/fisiologia , Humanos , Articulação do Joelho/fisiologia , Masculino , Adulto Jovem
10.
Clin Biomech (Bristol, Avon) ; 28(4): 448-53, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23453726

RESUMO

BACKGROUND: Locomotor interventions are commonly assessed using functional outcomes, but these outcomes provide limited information about changes toward recovery or compensatory mechanisms. The study purposes were to examine changes in gait symmetry and bilateral coordination following body-weight supported treadmill training in individuals with chronic hemiparesis due to stroke and to compare findings to participants without disability. METHODS: Nineteen participants with stroke (>6 months) who ambulated between 0.4 and 0.8 m/s and 22 participants without disability were enrolled in this repeated-measures study. The stroke group completed 24 intervention sessions over 8 weeks with 20 minutes of walking/session. The non-disabled group served as a comparison for describing changes in symmetry and coordination. Bilateral 3-dimensional motion analysis and gait speed were assessed across 3 time points (pre-test, immediate post-test, and 6-month retention). Continuous relative phase was used to evaluate bilateral coordination (thigh-thigh, shank-shank, foot-foot) and gait symmetry was assessed with spatiotemporal ratios (step length, swing time, stance time). FINDINGS: Significant improvements in continuous relative phase (shank-shank and foot-foot couplings) were found at post-test and retention for the stroke group. Significant differences in spatiotemporal symmetry ratios were not found over time. Compared to the non-disabled group, changes in bilateral coordination moved in the direction of normal recovery. Most measures of continuous relative phase were more responsive to change after training than the spatiotemporal ratios. INTERPRETATIONS: After body-weight supported treadmill training, the stroke group made improvements toward recovery of normal bilateral coordination. Bilateral coordination and gait symmetry measures may assess different aspects of gait.


Assuntos
Ataxia/fisiopatologia , Ataxia/reabilitação , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Ataxia/etiologia , Peso Corporal , Doença Crônica , Teste de Esforço , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Paresia/reabilitação , Acidente Vascular Cerebral/complicações
11.
Sports Biomech ; 11(2): 190-6, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22900400

RESUMO

The purpose of this study was to determine if body position, weight transfer, and/or pelvis/trunk rotations changed as a result of a golf specific fatiguing protocol and whether these changes affected resultant club head velocity at impact and shot consistency. Six male golfers and one female golfer participated in the study, who had a mean age, height, and body mass of 23.9 +/- 3.9 years, 177.4 +/- 4.9 cm, and 75.3 +/- 9.9 kg, respectively. Path analysis was used to determine the relationships between fatigue, biomechanical variables, and resultant club head velocity at impact and shot consistency. In the statistical models representing the effects of biomechanical variables calculated at the top of the swing and ball contact, golf specific fatigue was associated with a 2.0% and 2.5% reduction in the club head velocity and a 7.1% and 9.4% improvement in the shot consistency, respectively. These data suggest that golf specific fatigue was not related to the initial lower body sagittal plane angles at address nor was simulated golf specific fatigue related to peak transverse plane pelvis and trunk rotational velocities (or their timings) in a manner that indicates a relationship to resultant club head velocity and shot consistency.


Assuntos
Desempenho Atlético/fisiologia , Fadiga/metabolismo , Golfe/fisiologia , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Modelos Estatísticos , Movimento/fisiologia , Adulto Jovem
12.
Clin Biomech (Bristol, Avon) ; 27(9): 887-92, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22809736

RESUMO

BACKGROUND: The purpose was to examine changes in kinetic symmetry in persons with chronic stroke immediately and 6-months after body-weight supported treadmill training. METHODS: Fifteen participants at least six-months post stroke and able to ambulate between 0.4 and 0.8m/s and 20 participants without neurological conditions completed all phases of the study and were included in the analysis. The non-disabled group served as a comparison for describing changes in kinetic symmetry. The stroke group completed 24 sessions of body-weight supported treadmill training over 8-weeks with 20 minutes of total walking per session. Bilateral 3-dimensional motion analysis and gait speed were assessed 1-week before training (pre-test), 1-week after training (post-test) and 6-months after training (retention) in a repeated measures design. Relative propulsion of the paretic leg and relative positive work of the hip, knee and ankle joints of both legs were calculated to evaluate symmetry of kinetic forces. FINDINGS: Statistically significant differences in relative propulsion and positive joint work within the paretic and non-paretic legs were not found over time. The stroke group significantly improved gait speed from pre- to post-test (p=.001) and pre-test to retention (p=.008). In comparison to the non-disabled group, forces produced by the stroke group were asymmetrical demonstrating compensatory adaptation. INTERPRETATION: Although the participants with chronic stroke walked faster after body-weight supported treadmill training, the relative percentages of propulsion and positive work remained unchanged. These findings suggest that the increase in speed was likely due to strengthening existing compensatory strategies rather than through recovery of normal kinetic symmetry.


Assuntos
Peso Corporal , Terapia por Exercício/métodos , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Aptidão Física , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Teste de Esforço , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
13.
Mil Med ; 177(2): 152-6, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22360059

RESUMO

Load carriage and muscular fatigue are two major stressors experienced by military recruits during basic training. The purpose of this study was to assess the influences of load carriage and muscular fatigue on ground reaction forces and ground reaction loading rates during walking. Eighteen healthy males performed the following tasks in order: unloaded and unfatigued walking, loaded and unfatigued walking, fatiguing exercise, loaded and fatigued walking, and unloaded and fatigued walking. The fatiguing exercise consisted of a series of metered step-ups and heel raises with a 16-kg rucksack. Loaded walking tasks were performed with a 32-kg rucksack. Two-way repeated measures analysis of variances were used to determine the effects of fatigue and load carriage on ground reaction forces and loading rates. Muscular fatigue has a significant influence on peak vertical ground reaction force and loading rate (p < 0.01). Load carriage has a significant influence on peak ground reaction forces and loading rates (p < 0.001). As both muscular fatigue and load carriage lead to large increases of ground reaction forces and loading rates, the high incidence of lower extremity overuse injuries in the military may be associated with muscular fatigue and load carriage.


Assuntos
Fadiga Muscular/fisiologia , Resistência Física/fisiologia , Esforço Físico/fisiologia , Caminhada/fisiologia , Suporte de Carga/fisiologia , Análise de Variância , Fenômenos Biomecânicos , Humanos , Masculino , Militares , Carga de Trabalho , Adulto Jovem
14.
J Appl Biomech ; 27(2): 108-15, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21576718

RESUMO

The purpose of the study was to investigate the effects of fatigue on lower extremity joint kinematics, and kinetics during repetitive drop jumps. Twelve recreationally active males (n = 6) and females (n = 6) (nine used for analysis) performed repetitive drop jumps until they could no longer reach 80% of their initial drop jump height. Kinematic and kinetic variables were assessed during the impact phase (100 ms) of all jumps. Fatigued landings were performed with increased knee extension, and ankle plantar flexion at initial contact, as well as increased ankle range of motion during the impact phase. Fatigue also resulted in increased peak ankle power absorption and increased energy absorption at the ankle. This was accompanied by an approximately equal reduction in energy absorption at the knee. While the knee extensors were the muscle group primarily responsible for absorbing the impact, individuals compensated for increased knee extension when fatigued by an increased use of the ankle plantar flexors to help absorb the forces during impact. Thus, as fatigue set in and individuals landed with more extended lower extremities, they adopted a landing strategy that shifted a greater burden to the ankle for absorbing the kinetic energy of the impact.


Assuntos
Articulações/fisiologia , Movimento/fisiologia , Fadiga Muscular/fisiologia , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Articulação do Quadril/fisiologia , Humanos , Articulação do Joelho/fisiologia , Masculino , Músculo Esquelético/fisiologia
15.
Arch Phys Med Rehabil ; 91(12): 1914-9, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21112434

RESUMO

OBJECTIVES: To examine changes in balance, balance confidence, and health-related quality of life immediately and 6 months after body weight-supported treadmill training (BWSTT) for persons with chronic stroke (primary objective) and to determine whether changes in gait speed after BWSTT were associated with changes in these dimensions of health (secondary objective). DESIGN: Prospective pre-/posttest pilot study with 6 months retention. SETTING: University research laboratory settings. PARTICIPANTS: A convenience sample of participants (N=19; at least 6mo poststroke; able to ambulate 0.4-0.8m/s) were recruited. INTERVENTION: BWSTT was provided for 24 sessions over 8 weeks with 20 minutes of total walking each session. MAIN OUTCOME MEASURES: Berg Balance Scale (BBS), Activities-Specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), comfortable 10-m walk test (CWT), and fast 10-m walk test (FWT). Proportions of participants who achieved minimal detectable changes (MDCs) were examined for all measures. RESULTS: Statistically significant improvements were found from pre- to posttest for BBS, ABC, SIS mobility, SIS stroke recovery, and CWT scores (P<.05) and from pretest to retention on BBS, ABC, CWT, and FWT scores (P<.05). For most participants, improvements did not exceed MDCs. Changes in gait speed and BBS, ABC, and SIS scores were not associated. CONCLUSIONS: The findings of this study suggest that effects of BWSTT may transfer beyond gait to positively influence balance, balance confidence, and health-related quality of life. However, for most participants, BWSTT was not sufficient to induce improvements in balance and balance confidence beyond measurement error or long-term retention of enhanced perceptions of quality of life.


Assuntos
Terapia por Exercício/métodos , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Equilíbrio Postural/fisiologia , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Doença Crônica , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Recuperação de Função Fisiológica , Autoimagem , Resultado do Tratamento , Suporte de Carga/fisiologia
16.
Adapt Phys Activ Q ; 27(1): 60-72, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20147770

RESUMO

Bone mineral density (BMD) loss is a medical concern for individuals with spinal cord injury (SCI). Concerns related to osteoporosis have lead researchers to use various interventions to address BMD loss within this population. Whole body vibration (WBV) has been reported to improve BMD for postmenopausal women and suggested for SCI. The purpose of this case study was to identify the effects of WBV on BMD for an individual with SCI. There were three progressive phases (standing only, partial standing, and combined stand with vibration), each lasting 10 weeks. Using the least significant change calculation, significant positive changes in BMD were reported at the trunk (0.46 g/cm(2)) and spine (.093 g/cm(2)) for phase 3 only. Increases in leg lean tissue mass and reduction in total body fat were noted in all three phases.


Assuntos
Densidade Óssea , Osteoporose/prevenção & controle , Traumatismos da Medula Espinal/fisiopatologia , Vibração , Absorciometria de Fóton , Tecido Adiposo , Adulto , Índice de Massa Corporal , Feminino , Humanos , Osteoporose/etiologia , Postura , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Coluna Vertebral
17.
J Sports Sci Med ; 7(1): 144-50, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-24150147

RESUMO

While it seems that whole body vibration (WBV) might be an effective modality to enhance physical performance, the proper prescription of WBV for performance enhancement remains unknown. The purpose of this study was to compare the immediate effect of various WBV accelerations on counter movement jump (CMJ) height, the duration of any effect, and differences between men and women. Forty-four participants (33 men, 11 women) participated in no less than four CMJ familiarization sessions and completed all vibration sessions. Participants performed a pre-test (three maximal CMJs), followed randomly by one of five WBV accelerations; 1g (no-WBV control), 2.16g, 2.80g, 4.87g, and 5.83g. Participants performed three maximal CMJs immediately, five, and 10 minutes following each 45 sec WBV session. The mean of the three performances was used and calculated as a percentage of the pre-vibration mean value. A Repeated Measures Analysis of Variance (ANOVA; acceleration x time x gender) model was used to analyze the data. The two-way interactions of acceleration-gender (p = 0.033) and time-gender (p = 0.050) were significant. Women performed significantly better following the 2.80g (p = 0.0064) and 5.83g (p = 0. 0125) WBV sessions compared to the 1g (control) session. Men, however, did not experience performance enhancing effects following any of the vibration sessions. While significant differences did not occur between time in either gender, the effects of the 45 sec WBV session in women were transient, lasting approximately five minutes. During the prescription of WBV, gender should be considered given that the results of this study seem to indicate that men and women respond differently to WBV. The results of this study suggest that WBV might be a useful modality as applied during the pre-competition warm-up. Key pointsWBV accelerations of 2.80g (40 Hz, 2-4 mm) and 5.83g (50 Hz, 4-6 mm) seem to elicit a performance enhancement effect following short-duration (45 sec) exposure in untrained women.The performance enhancement effect of a short-duration is transient, lasting less than 10 minutes following exposure.Men and women might differ in their response to the WBV stimulus, as measured by countermovement jump.

18.
J Strength Cond Res ; 19(4): 959-63, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16287363

RESUMO

The stiffness of muscle-tendon units (MTUs) influences many aspects of human movement from athletic performance to injury risk. Presently the controlled-release technique of measuring MTU stiffness has been applied almost exclusively to the distal joints of the body, i.e., the ankle. This is primarily because of the mechanical limitations of implementing this technique. However, in order to better understand how the elastic properties of the MTU affect both performance and injury potential, measurements of MTU stiffness of the more proximal joints must be made. The knee flexors are a logical choice because of the integral role of MTU stiffness of this muscle group in both hamstring strains and knee injury. The purpose of this study was to modify a commercial ergometer so that it could be used to measure the musculotendinous stiffness of the knee flexors. Data are presented for a representative participant to illustrate the feasibility and capability of this ergometer, and the measured MTU stiffness was 519 N.m.rad(-1) at a knee flexion moment of 100 N.m. Our results indicate that it is indeed possible to modify a commercial ergometer and measure musculotendinous stiffness of large muscle groups crossing proximal joints.


Assuntos
Ergometria/instrumentação , Articulação do Joelho/fisiopatologia , Músculo Esquelético/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adulto , Desenho de Equipamento , Estudos de Viabilidade , Humanos
19.
J Strength Cond Res ; 18(3): 668-74, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15320681

RESUMO

There has been an increasing volume of research focused on the load that elicits maximum power output during jump squats. Because of a lack of standardization for data collection and analysis protocols, results of much of this research are contradictory. The purpose of this paper is to examine why differing methods of data collection and analysis can lead to conflicting results for maximum power and associated optimal load. Six topics relevant to measurement and reporting of maximum power and optimal load are addressed: (a) data collection equipment, (b) inclusion or exclusion of body weight force in calculations of power, (c) free weight versus Smith machine jump squats, (d) reporting of average versus peak power, (e) reporting of load intensity, and (f) instructions given to athletes/ participants. Based on this information, a standardized protocol for data collection and reporting of jump squat power and optimal load is presented.


Assuntos
Perna (Membro)/fisiologia , Movimento/fisiologia , Músculo Esquelético/fisiologia , Medicina Esportiva/métodos , Análise e Desempenho de Tarefas , Suporte de Carga/fisiologia , Peso Corporal , Humanos , Projetos de Pesquisa , Medicina Esportiva/instrumentação , Levantamento de Peso/fisiologia
20.
J Electromyogr Kinesiol ; 14(4): 515-21, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15165601

RESUMO

The maximal height attained in a vertical jump is heavily influenced by the execution of a large countermovement prior to the upward motion. When a jump must be executed without a countermovement, as in a squat jump, the maximal jump height is reduced. During such conditions, the human body may use other strategies in order to increase performance. The purpose of this research was to investigate the effects of two strategies employed during the initiation of the squat jump: the premovement silent period (PSP), and the small amplitude countermovement (SACM). Fifteen elite male volleyball players (20.6 +/- 1.6 years) and 13 untrained males (20.2 +/- 1.7 years) performed 10 maximal effort squat jumps from identical starting positions. The electromyographic activity of the vastus lateralis and biceps femoris was measured in conjunction with the vertical ground reaction force and vertical displacement. It was found that the presence of a PSP or a SACM of 1-3 cm did not increase maximal squat jump height significantly (p > 0.05), in neither the highly trained athletes nor the untrained individuals. These results suggest that these strategies do not play a major role in the determination of jump height. Researchers have assumed that a squat jump is purely concentric, and that there are no facilitating mechanisms present that may influence the performance of the jump. This study provides evidence to support this assumption.


Assuntos
Locomoção/fisiologia , Contração Muscular/fisiologia , Adulto , Análise de Variância , Fenômenos Biomecânicos , Eletromiografia , Humanos , Masculino , Movimento , Fibras Musculares Esqueléticas/fisiologia , Músculo Esquelético/fisiologia , Processamento de Sinais Assistido por Computador , Esportes/fisiologia , Gravação de Videoteipe , Suporte de Carga/fisiologia
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