Biomechanical and neuromuscular control characteristics of sit-to-stand transfer in young and older adults: A systematic review with implications for balance regulation mechanisms.

BACKGROUND: Falls are major health concerns in older adults. Sit-to-stand transfer is an important functional movement that can predict falling risk in older adults. Aging-associated declines in neuromechanical control of movement may negatively impact sit-to-stand performance. This systematic review aims to summarize differences in neuromechanical characteristics of younger vs. older adults that likely affect balance regulation during sit-to-stand. METHODS: Five databases (Academic search complete, MEDLINE, APA PsycInfo, Pubmed, and SPORTDiscus) were systematically searched from January 1985 through March 2023. Three reviewers assessed the quality of methodology, study design, results, and risk of bias using the Appraisal tool for Cross-Sectional Studies. Studies reported neuromuscular and biomechanical characteristics during sit-to-stand in young versus older adults were included. FINDINGS: Seventeen studies (343 older and 225 younger adults) were included. Compared to younger adults, older adults showed slower sit-to-stand time, higher trunk flexion, postural sway, agonist-antagonist muscle co-activation of the ankle and knee muscles, and lower ankle dorsiflexion torque. Lower magnitude and rate of vertical ground reaction force development and lower vertical momentum during rising were observed with aging during fast-speed sit-to-stand. There was heterogeneity among studies on sit-to-stand speed, foot position, use of arms, and seat height adjustability. INTERPRETATIONS: Higher trunk angular displacement and velocity accompanied by higher anterior momentum, likely to compensate for knee extensor muscle weaknesses, may lead to higher postural sway upon standing and therefore require higher knee and ankle muscle co-activation to maintain balance stability. Thus, additional attention to trunk control strategies is needed during clinical evaluations.

Evidence-Based Practice Doctor of Physical Therapy Curricular Guideline Utilization: A Convergent Parallel Mixed Methods Study.

INTRODUCTION: In 2014, an expert panel from the American Physical Therapy Association Academy of Research Evidence-Based Practice (EBP) special interest group created the Doctor of Physical Therapy (DPT) EBP Curricular Guideline (EBP-CG). This study describes faculty awareness of the EBP-CG, DPT curricular alignment with its terminal objectives, EBP-CG uses, and challenges addressing the objectives. REVIEW OF LITERATURE: DPT educators frequently use core curriculum guidelines (CGs) that articulate entry-level knowledge and skills to determine competencies. No such guidelines existed for EBP in 2012 leading to the EBP-CG development to assist educators. Few CGs have been studied for their impact on content standardization. A mixed methods design was chosen to more completely describe this CG's impact. SUBJECTS: Faculty teaching EBP in US accredited DPT programs. METHODS: A mixed-methods design explored what EBP-CG objectives are addressed, to what expected mastery levels, and how faculty use the document. RESULTS: Eighty-three of 252 accredited programs completed the survey; 14 respondents were interviewed. The EBP-CG was valued and viewed as reflecting curricular content. Its 33 objectives were taught by most respondents at knowledge and practice levels with independent mastery expected for 7. Interviewees described EBP as commonly practiced through group over individual projects. More EBP curriculum credits predicted more objectives taught (R = .29, R2 = .09, P = .03) and expected for mastery (R = .28, R2 = .08, P = .04). No interviewees shared the EBP-CG with clinical partners or Directors of Clinical Education; EBP carryover from classroom to practice is unknown. DISCUSSION AND CONCLUSION: Respondents confirmed that the EBP-CG objectives were useful and consistent with curricular content. Four EBP preparation gaps were identified: 1) limited EBP-CG awareness by faculty who teach EBP, 2) use of group over independent projects to practice EBP, 3) communication gaps between academic and clinical education settings about the EBP-CG, and 4) no consensus on minimum EBP competencies.

The Effectiveness of a Functional Movement Assessment and 4-Week Exercise Training Program for Female High School Athletes.

ABSTRACT: Boucher, BK, Rich, AJ, Gobert, D, Gardner, B, Metzner, P, King, C, and Buse, M. The effectiveness of a functional movement assessment and 4-week exercise training program for female high school athletes. J Strength Cond Res 35(1): 102-110, 2021-The extent to which young females participate in school-sponsored athletics has grown significantly over the past 2 decades. The number of females in high school sports increased for the 25th consecutive year in 2012-2013, reaching an all-time record. Unfortunately, sports-related injury rates for female athletes have also continued to rise. A body of research exists to suggest that dysfunctional movement may be linked to increased risk of injury, and training programs designed to improve movement patterns are effective to both enhance performance and reduce the risk of injury. Effective training programs incorporate corrective exercises to retrain dysfunctional movement patterns. The Functional Movement ScreenTM (FMSTM) is a tool developed to assess 7 fundamental movement patterns. The FMSTM has been used extensively with a wide range of athletes at various levels of performance. The aim of this study was to investigate the effectiveness of a movement-training program with female high school athletes using the FMSTM. The overall purpose was to assess the effectiveness of a 4-week corrective exercise-training program at improving FMSTM scores. Data analysis using Wilcoxon signed-rank test revealed a statistically significant change in total group FMSTM scores (Z = -2.214, p = 0.027) after the corrective exercise-training program. Mean total group FMSTM scores increased from 14.43 ± 1.90 (pretest) to 17.29 ± 1.38 (posttest). Findings suggest that positive outcomes to a corrective exercise-training program, which targets specific movement impairments, can be achieved in a relatively short period of time.

Recovery 9 years post stroke with standardized electrical stimulation.

ABSTRACT This case report summarizes results of a new standardized evidence-based treatment protocol regarding neuromuscular electrical stimulation (NMES) and somatosensory stimulation (SS) for a chronic stroke patient. The protocol included treatment five times per week, up to 3 hr per day for 20 months. Treatment included 20 min active NMES followed by two to three hr of SS. Repetitive task practice activities were performed during SS for targeted muscle groups. Remarkable functional recovery was noted with all outcome measures, including the Chedoke-McMaster Stroke Assessment and the Action Research Arm Test, suggesting prolonged NMES and SS therapy should be investigated further.

Perspective from the practice committee: is autonomous practice in neurologic physical therapy defined differently based on the type of practice setting?

The answer to the question, "Is autonomous practice in neurologic physical therapy defined differently based on the type of practice setting?" is no. Autonomous practice is a characteristic of the physical therapist, embodying excellence, communication and collaboration, and advocacy and caring. It is our belief that many physical therapists already practice autonomously, even though they may not recognize their practice as being autonomous; and it is our hope that physical therapists who are functioning as autonomous practitioners will provide peer mentoring to help bring their colleagues to the same level of practice and the same recognition. The full position statement on autonomous practice is available on the Neurology Section Web site at http://www.neuropt.org/go/healthcareprofessionals/autonomous-practice.

Application of cross time-frequency analysis to postural sway behavior: the effects of aging and visual systems.

In this paper, the effects of visual feedback and aging on postural sway systems and signals are investigated by analyzing the transient phase difference between "input" and "output" which correspond to center of pressure (COP) and center of mass (COM), respectively. In order to analyze the transient phase difference characteristics of COP and COM, a relatively new cross time-frequency analysis technique that provides time- and frequency-localized phase difference information is utilized. The feedback control process in the postural sway is interpreted in terms of a feedback compensator which is characterized in terms of a phase difference. Using the experimental results of the transient phase difference obtained from the cross time-frequency distribution, it is demonstrated that the postural control of young persons are more stable and rely more on visual sensory feedback to stabilize postural control compared to that of the elderly persons.

Retinal location of the preferred retinal locus relative to the fovea in scanning laser ophthalmoscope images.

PURPOSE: It is difficult to determine the position of a preferred retinal locus (PRL) relative to the fovea in scanning laser ophthalmoscope (SLO) images as a result of disease-related retinal morphologic changes that obscure the fovea. To overcome this problem, we developed a method for determining retinal foveal position based on normal fixation position relative to the optic disk. The normal foveal position measurements can then be used to estimate the distance between a PRL and the fovea. METHODS: Using the SLO, foveal position was determined for 50 normal subjects by measuring the retinal locus of fixation relative to the optic disk in undistorted SLO images. The resulting normal foveal fixation area is described by a bivariate normal ellipse that can be plotted on any undistorted SLO image. Measurement reliability was assessed by repeated measurements. The PRL relative to the normal foveal fixation area was determined for 24 subjects with macular degeneration and bilateral central scotomas. RESULTS: The normal foveal fixation area based on all 50 subjects is described by a p = 0.9 bivariate ellipse whose centroid is located 12.6 degrees temporal to the temporal optic disk edge and 1.4 degrees inferior to a horizontal line bisecting the disk. PRL area is shown to increase with distance from the foveal fixation ellipse centroid. The shape of the PRL, characterized by the ratio of PRL ellipse major to minor axis, was found to depend on whether the PRL was vertically or horizontally aligned with the foveal fixation centroid. CONCLUSIONS: PRL position relative to the fovea can be reliably estimated by plotting the normal foveal fixation bivariate ellipse on undistorted SLO images of retinas in which the fovea is obscured as a result of the disease process.

Distortion and size calibration of the scanning laser ophthalmoscope (SLO) laser-beam raster.

PURPOSE: The Rodenstock scanning laser ophthalmoscope (SLO) is useful for mapping retinal function and for developing and evaluating visual rehabilitation methods. It is essential to know the visual angle subtended by stimuli in the SLO laser-beam raster and to accurately measure angular distances between objects in the final SLO image. To accomplish this, the angular extent of the SLO laser-beam raster must be calibrated. METHODS: We developed a simple method and apparatus for calibrating the raster and used it for repeated calibrations during a 3-month period. RESULTS: The laser-beam raster is quite stable in shape and size, but it is trapezoidally distorted in the vertical direction. Consequently, SLO images are distorted. CONCLUSIONS: Trapezoidal distortion of the SLO laser-beam raster can cause stimulus size to change as much as 10% from the top to the bottom of the raster. Measurements of fixed horizontal retinal landmark distances in SLO images can also vary as much as 10%. We developed a straightforward mathematical method for correcting distortion in SLO image measurements.