Metabolic demands of rock climbing in transfemoral amputees.

This pilot study compared the energy expenditure required to climb an indoor rock wall, in amputees utilizing five prosthetic configurations. Three experienced climbers (1M age 21 yr, 2F ages 30 and 49 yr) with unilateral transfemoral amputation climbed a 9.14 m indoor rock wall, 5.9 Yosemite Decimal Scale rating, using the following prosthetic configurations: 1. no prosthesis; 2. stubby prosthesis-foot forward; 3. stubby prosthesis-foot backward; 4. articulated prosthesis-knee unlocked; 5. articulated prosthesis-knee locked. Subjects climbed three times with each configuration resulting in 15 climbs per subject. Metabolic data was collected using the COSMED K4b(2) system. VO(2) was 15, 18 and 20% greater in the articulated unlocked condition (mean+/-SE: 20.5+/-0.8 ml.kg (-1).min (-1)), and 11, 13 and 15% greater in the articulated locked condition (19.7+/-0.9 ml.kg (-1).min (-1)), compared to the no prosthesis (17.8+/-0.7 ml.kg (-1).min (-1)), stubby backward (17.4+/-0.7 ml.kg (-1).min (-1)) and stubby forward (17.1+/-0.9 ml.kg (-1).min (-1)) conditions. Participants expended 11-20% more energy using the articulated prostheses than with the stubby and no prosthesis conditions. In persons with transfemoral amputation, use of an articulated prosthesis in indoor rock climbing may be a disadvantage in many aspects including competition, training, rehabilitation and satisfaction with the activity.

Competency revalidation study: a description of advanced clinical practice in sports physical therapy.

The first board-certified sports clinical specialists (SCSs) obtained their specialty credentials in 1986. A history of the development process is provided. The Sports Specialty Council and American Board of Physical Therapy Specialties are responsible for maintaining currency in the examination. Therefore, a review of current practice standards was conducted in 1992. The purpose of this article is to present an overview of the methodology and results of the survey. Complete details are found in the document entitled "Description of Advanced Clinical Practice: Sports Physical Therapy" (DACP), which is available through the Sports Physical Therapy Section. A random sample of 2,000 members of the Sports Physical Therapy Section and all clinical specialists certified at the time (N = 49) were surveyed. A total of 507 members (25.3%) and 49 SCSs (100%) returned the questionnaire. The domain of knowledge required by the SCS was divided into nine different areas, with multiple competency statements in each area. Respondents rated each competency statement on three scales: importance, entry-level preparation, and frequency of use. A panel of content area experts then reviewed the results to develop the final competencies and examination blueprint. These competency statements will form the basis of the SCS examination and be implemented in 1995. Competency and examination revision is a constantly evolving process, and this document should serve as a guide for further revisions.

Initial management of acute ankle sprains with rapid pulsed pneumatic compression and cold.

Sports medicine practioners must be prepared to aggressively treat musculoskeletal trauma with both therapeutically sound and time efficient regimens. Thorough early treatment is essential for prevention of further trauma, for an expedient recovery, and for the earliest possible return to activity. The present study sought to evaluate the efficacy of rapid pulsed pneumatic compression along with cold in the amelioration of the acute symptoms associated with lateral ankle ligament sprains. Active range of motion and volumetric measures of ankle edema were made before and after 20-minute compression treatments on a series of 19 acute grade I lateral ankle ligament sprains. The number of treatments required before initiation of rehabilitation exercise ranged from one to eight with a mean of three. Rapid pulsed pneumatic compression along with cold is a safe and therapeutically sound method of controlling pain, loss of motion, and edema associated with this common injury. J Orthop Sports Phys Ther 1982;4(1):39-43.

An alternative management protocol for lateral ankle sprains*.

Soft tissue ankle injuries, particularly lateral ligament sprains, cause considerable disability and loss of time from activities. These injuries are commonly and frequently treated by physical therapists. Controversy exists over the efficacy of various methods for the nonoperative management of these injuries. A comprehensive program for the management of the lateral ankle sprain, involving the fabrication of a thermoplastic ankle stirrup and the initiation of a selfdirected home program of ankle rehabilitation using surgical tubing, is detailed. Based upon the experimental work of Brostrom, Noyes, and others, the early application of stress with protective motion has been found to facilitate the strength and structural integrity of healing ligaments. The ankle stirrup regimen allows weight bearing and easy removal for treatment or exercise. Joint stiffness, muscular atrophy, and circulatory stasis are minimized. The ankle stirrup provides an aggressive yet therapeutically sound approach to the management of this injury. J Orthop Sports Phys Ther 1981;2(4):187-190.