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Context: Analyzing flick movement kinematics biomechanically is important to prevent sport-related injuries in underwater hockey players since the aquatic-based flick movement is completely different from land-based flick movements. The study aimed to describe the flick movement kinematic biomechanically in underwater hockey players. Moreover, this study further aimed to investigate the effect of the Thrower's Ten exercises on flick movement kinematics in underwater hockey players. Design: Descriptive laboratory study. Methods: Seventeen underwater hockey players (age: 26.2 [4.3] y; sports age: 6.2 [4.5] y) were included. First, 2 underwater cameras using motion capture video analysis MATLAB were used to biomechanically analyze the angular changes on the shoulder, elbow, wrist, and body while players were performing the flick movements. Players were then recruited to the Thrower's Ten exercise program for 6 weeks. Flick movement kinematics and flick-throwing distance were recorded at baseline and 6 weeks. Results: The flick movement kinematic patterns demonstrated increased shoulder flexion (from 102.5° to 144.9°), wrist extension (from 9.5° to 10.8°), and upper-extremity rotation (from 5.7° to 56.8°) while decreased elbow extension (from 107.7° to 159.2°) from the stick met the puck until the competition of the movement. The Thrower's Ten exercises improved the elbow extension (P =.04), wrist extension (P =.01), body rotation (P <.001), and flick-throwing distance (P <.001) from baseline to 6 weeks. Conclusion: This study describes the underwater flick kinematic technique biomechanically and interprets preliminary findings for the first time. Thus, 6 weeks of Thrower's Ten exercise program provides more body muscle movements than the smaller ones during the flick movements and higher flick-throwing distance in underwater hockey players. [ABSTRACT FROM AUTHOR]

Nitrate ( NO 3 − ) has properties that can improve muscle function, leading to improvements in metabolic cost of exercise as well as enhance force production. Gymnastics is a whole-body sport, involving events that demand a high level of strength and fatigue resistance. However, the effect of NO 3 − supplementation on both upper- and lower-body function in gymnasts is unknown. This study examined the effect of acute beetroot juice (BRJ) supplementation on isokinetic strength and endurance of the upper- and lower-body in highly trained international-level male gymnasts. In a double-blind, randomized crossover design, 10 international-level male gymnasts completed two acute supplementation periods, consuming either 2 × 70 ml NO 3 − -rich (∼12.8 mmol/L of NO 3 − ) or NO 3 − -depleted (PLA) BRJ. Maximal strength of the upper-leg and upper-arm at 60°/s, 120°/s, 180°/s, and 300°/s, and muscular endurance (50 repeated isokinetic contractions at 180°/s) were assessed. Plasma NO 3 − (BRJ: 663 ± 164 μM, PLA: 89 ± 48 μM) and nitrite ( NO 2 − ) concentrations (BRJ: 410 ± 137 nmol/L, PLA: 125 ± 36 nmol/L) were elevated following BRJ compared to PLA (both p <.001). Maximal strength of knee and elbow extensors and flexors did not differ between supplements (p >.05 for all velocities). Similarly, fatigue index of knee and elbow extension and flexion was not different between supplements (all p >.05). Acute BRJ supplementation, containing ∼12.8 mmol/L of NO 3 − , increased plasma NO 3 − and NO 2 − concentrations, but did not enhance isokinetic strength or fatigue resistance of either upper or lower extremities in international-level male gymnasts. [ABSTRACT FROM AUTHOR]

Purpose: This 2-year longitudinal study examined the development of upper-extremity bone mineral density (BMD), bone mineral content (BMC), and lean mass (LM) asymmetry magnitudes in male and female youth tennis players. Methods: Dominant and nondominant upper-extremity BMD, BMC, and LM values of 49 male and 31 female players were measured yearly using dual X-ray absorptiometry. From these values, asymmetry magnitudes were calculated and expressed as a percentage. Maturity offset was estimated using anthropometric measurements. Linear mixed effect models examined the development of BMD, BMC, and LM asymmetry magnitudes according to players' maturity offset, sex, and training volume. Results: Adjusted for sex and training volume, a 1-year increment in maturity offset was associated with a significant increase in BMD (1.3% [2.2%]; P <.001) and BMC (0.6% [2.4%]; P =.011) asymmetry magnitudes. Male players displayed significantly higher LM asymmetry magnitudes (Δ3.2% [8.4%]; P =.002) compared with their female counterparts. Training volume was not significantly associated with asymmetry magnitude development. Conclusion: In contrast to LM, male and female youth tennis players' upper-extremity bones are still responsive to mechanical loading with a significant increase in BMD and BMC asymmetry magnitudes according to maturity offset. [ABSTRACT FROM AUTHOR]

Studies on postactivation performance enhancement (PAPE) have used different exercises as a conditioning activity to investigate potentiation, but exclusively in upper limbs (UL) or lower (LL) limbs, or contralateral potentiation. A single exercise capable of inducing PAPE in both UL and LL is currently unknown. The present study explored the effect of the clean and jerk (C&J) as a conditioning activity for simultaneously producing PAPE interlimbs at the fourth, seventh, and 12th minutes postintervention. Twelve male weightlifters with 1-repetition maximum (1RM) in the C&J equivalent to ≥1.15 × body mass were randomly submitted to 2 experimental conditions (C&J and control [CON]). The C&J condition consisted of general warm-up (running on a treadmill and self-selected preparatory exercises) and 4 sets of 3 repetitions of C&J with 2 minutes between them (30%1RM, 50%1RM, 65%1RM, and 80%1RM) followed by a countermovement jump and a bench-press throw on a Smith machine after 4, 7, and 12 minutes, to measure the magnitude of PAPE in UL and LL. No previous exercise preceded countermovement-jump and bench-press-throw tests in the CON besides general warm-up. The main finding was that, regardless of time, the C&J resulted in greater height on countermovement jump and Smith machine bench-press throw when compared with the CON, presenting a similar effect size between UL and LL (34.6 [3.9] vs 33.4 [4.1] cm [+3.66%]; P =.038; effect size = 0.30 and 30.3 [4.7] vs 29.0 [5.1] cm [+4.44%]; P =.039; effect size = 0.26), respectively. Thus, C&J can be useful to produce PAPE simultaneously among members. [ABSTRACT FROM AUTHOR]

Background: Trunk rotation during pitching correlates with pitching velocity and load on the joints of the upper limb. Trunk rotation is often focusing on during teaching the pitching motion. Athletes who exhibit early trunk rotation during pitching often have low thoracic spine rotational range of motion. The purpose of this study was to investigate the relationship between the range of thoracic spine rotation measured using the lumbar locked rotation test (LLR-t), hip-shoulder separation (H/S) and thoracic rotation angle at stride foot contact (SFC), and ball velocity. Study design: Descriptive laboratory study. Methods: Fifteen healthy male high school students belonging to a baseball club were recruited for participation. The throwing side and non-throwing side LLR-t was performed using an inclinometer. Hip-shoulder separation and thoracic rotation angle during SFC were measured using a pitching motion analysis application: Pitch AI. In addition, a tracking device specifically designed for pitching：Pitching2.0 was employed to measure ball velocity. Correlations between LLR angle, H/S, trunk rotation angles at SFC, and ball velocity were examined using Pearson's correlation coefficient. Result: There was a positive correlation（r=0.52，p=0.047） between the LLRt angle and H/S. Additionally, there was a negative correlation（r=-0.62, p =0.01） between the LLRt angle on the throwing side and thoracic rotation angle. There was a positive correlation(r=0.54, p=0.04) between ball velocity and H/S and a negative correlation(r=-0.56, p=0.03) between ball velocity and thoracic rotation angle during SFC. Conclusion: The LLR-t measures thoracic rotation angle with the pelvis-lumbar spine fixed. The results indicated that throwing side LLR was related to the thoracic angle during SFC and hip-shoulder separation. Level of evidence: 3 [ABSTRACT FROM AUTHOR]

Background: The seated wall angel (SWA) is an intervention to improve upper quarter mobility but has not been described as a clinical test with scoring. Hypothesis/ Purpose: To explore the clinical utility of the SWA as a test with scoring. The authors hypothesized that SWA test scores would be lower on the injured than uninjured side, improve over time, and show stronger association with patient-reported shoulder function than shoulder mobility tests. Study Design: Prospective cohort. Methods: Patients diagnosed with anterior shoulder instability and referred to physical therapy participated. Testing occurred after physical therapy examination (initial) and six weeks later (follow-up). Rehabilitation was not controlled. Testing included clinical tests (SWA, passive shoulder external rotation range of motion, total arc of motion) and patient-reported outcomes including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, (ASES) and the Western Ontario Shoulder Instability Index (WOSI). The SWA test was scored 0 to 3 points bilaterally based on number of body contacts with the wall (i.e., elbows and fingertips, posterior fingers, posterior forearm). Passive range of motion was measured with a standard goniometer. SWA scores were compared between sides at initial testing and compared between testing timepoints on the injured side. Associations among injured side clinical test values and patient-reported outcome scores were examined. Results: Mean (SD) SWA score on the injured side was significantly lower than the uninjured side at initial testing [1.6 (1.0) vs 2.2 (1.1), p = 0.045] and significantly increased at follow-up testing [2.4 (1.0), p = 0.041]. Only SWA test score was significantly correlated with ASES (r=0.597) and WOSI (r=-0.648) scores at initial testing, and SWA test score was significantly correlated with WOSI score at follow-up testing (r=-0.611). Conclusions: The clinical utility of the SWA test is supported by distinguishing the injured and uninjured sides and having stronger associations with patient-reported shoulder function than shoulder mobility tests. [ABSTRACT FROM AUTHOR]

Background: Post-stroke clinical changes not only affect extremities and trunk muscles but also the respiratory muscles. Purpose: To determine the effect of robot-assisted arm training with conventional rehabilitation (CombT) on respiratory muscle strength, activities of daily living (ADL), and quality of life in patients with stroke and to compare the results with conventional rehabilitation (CR). Methods: It was a two-arm, single-blinded, randomized controlled trial in which 66 patients were randomly allocated to either CombT or CR to receive 30 sessions (5/week) over 6 weeks. The respiratory muscle strength (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), activities of daily life (ABILHAND questionnaire), and quality of life (Stroke Impact Scale (SIS)) were measured before and 6 weeks after training. Results: The CombT group showed significantly better MIP, MEP, and performance in ADLs after 6 weeks of training compared to the CR group (p <.01). The effect size was large for MIP (d = 0.9) and MEP (d = 0.9), whereas medium for performance in ADLs (d = 0.62). Also, the SIS-arm strength (p <.01), hand function (p =.04), ADLs (p =.02), and recovery (p =.04) were significantly better in CombT group with a medium (d = 0.6, d = 0.5, d = 0.5, and d = 0.5, respectively) effect size compared with CR group. Conclusions: Both CombT and CR groups improved respiratory muscle strength, performance in ADLs, and quality of life in patients with stroke. However, CombT appears to offer more comprehensive benefits, highlighting its valuable role in respiratory and functional recovery after stroke. [ABSTRACT FROM AUTHOR]

Carbohydrate (CHO) and caffeine (CAF) mouth rinsing have been independently reported to benefit sport performance. The proposed mechanisms by which mouth rinsing CHO exerts an influence are reported to be different from those for mouth rinsing CAF. However, the potential ergogenic effects of combining CHO and CAF in a single mouth rinse solution, are unclear. This study aimed to review the available evidence of CHO–CAF combined mouth rinse on exercise and cognitive performance in human participants. A systematic literature search was conducted using five databases until April 2024, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. Among the nine randomized crossover studies included, only one study showed significant improvements in lower-body muscular endurance with CHO–CAF mouth rinse (effect size (ES): 0.48; p < 0.05), while two studies reported non-statistically significant improvements in repeated sprint performance compared to other mouth rinse and placebo conditions (ES: 0.20–0.81; p = 0.07–0.18). However, for other performance measures, including repeated jumps, upper-body strength and endurance, endurance cycling, and intermittent recovery run, most evidence (five studies) did not demonstrate significant ergogenic effects. Notably, of the two studies that examined cognitive performance, both reported significant improvements with CHO–CAF mouth rinse compared with the placebo condition (ES: 0.45–3.45; p < 0.05). Overall, a synergistic influence of CHO–CAF mouth rinse on physical exercise performance is not evident, but preliminary evidence suggests potential benefits on cognitive performance. Future studies are required to address various methodological issues identified in this review, while practitioners and athletes should exercise caution when considering this novel nutritional strategy. [ABSTRACT FROM AUTHOR]

Purpose: Assessing feasibility and initial impact of the Home-Graded Repetitive Arm Supplementary Program combined with in-home accelerometer-based feedback (AH-GRASP) on perceived and actual daily-life upper limb (UL) activity in stroke survivors during the chronic phase with good UL motor function but low perceived daily-life activity. Material and methods: A 4-week intervention program (4 contact hours, 48 h self-practice) encompassing task-oriented training, behavioral techniques, phone-based support, monitoring, and weekly feedback sessions using wrist-worn accelerometery was implemented using a pre-post double baseline repeated measures design. Feasibility, clinical assessments, patient-reported outcomes, and accelerometer data were investigated. Results: Of the 34 individuals approached, nineteen were included (recruitment rate 56%). Two dropped out, one due to increased UL pain (retention rate 89%). Seven (41%) achieved the prescribed exercise target (120 min/day, six days/week). Positive patient experiences and improvements in UL capacity, self-efficacy, and contribution of the affected UL to overall activity (p < 0.05, small to large effect sizes) were observed. Additionally, seven participants (41%) surpassed the minimal clinically important difference in perceived UL activity. Conclusions: A home-based UL exercise program with accelerometer-based feedback holds promise for enhancing perceived and actual daily-life UL activity for our subgroup of chronic stroke survivors. IMPLICATIONS FOR REHABILITATION: Implementing a home-based exercise program with accelerometer-based feedback and telephone supervision may effectively improve upper limb activity after stroke. This program is most suitable for individuals with mild upper limb impairment and should be tailored to their abilities, preferences, and limitations to enhance engagement. The AH-GRASP program shows promising recruitment and retention rates, safety, and positive patient experiences. To improve adherence, consider dividing exercises into shorter sessions that accommodate patient's schedules, attention and endurance levels. [ABSTRACT FROM AUTHOR]

Motor competence is important for lifelong physical activity (PA). The current study aimed to examine associations between PA and motor competence. In total, 43 children aged 7–12 years with intellectual disabilities and/or autism spectrum disorder completed anthropometric measures, the Bruininks-Oseretsky Test of Motor Proficiency-2, and wore a wrist accelerometer to capture total PA, moderate-to-vigorous PA (MVPA), average acceleration, and intensity gradient. No significant associations were found between PA outcomes and motor competence. Motor competence performance was commonly 'below average' or 'average'. The weakest subtests were upper limb coordination and strength. The strongest subtest was running speed and agility. Total weekly MVPA was 336.1 ± 150.3 min, higher than UK recommendations of 120-180 per week for disabled children and young people. Larger scale studies are needed to better understand the relationship between PA and motor competence. Future research should also consider the influence of environmental factors on PA in this group. [ABSTRACT FROM AUTHOR]

High competence in fundamental motor skills (FMS) and adequate physical fitness (PF) levels are a solid foundation for acquiring an active and healthy lifestyle during childhood and adolescence. In this cross-sectional study, we aimed to compare gender and age groups and identify correlations between FMS and PF in young elementary school students. We used a structured questionnaire to gather sociodemographic information from parents, and we characterized the children's economic profile with the Brazil Social Economic Status Criterion. We collected FMS data using the Furtado-Gallagher Children Observational Movement Pattern Assessment System (FG-COMPASS), and we used the Brazil Sports Project Battery Test to measure PF levels. Statistical analyses involved descriptive data and inferential tests to determine group differences in FMS and PF levels. Hierarchical regression helped identify the associations between FMS and PF, as controlled by sociodemographic factors. Participants were 720 students (and parents) of both genders (383 girls, 337 boys; M age = 8.8, SD = 1.52 years) from grades 1 to 5 in an elementary school in a municipality in the western region of the Paraná state in Brazil. The results showed significant differences in children's motor skills and PF based on gender and age. The hierarchical regression model showed different combinations of flexibility, abdominal resistance, upper limb strength, agility, speed, and lower limb strength, which explained 33.7% of the variability in the global FMS index, 41% of the variability in manipulative skills, and 12.7% of the variability in locomotor skills. In addition, there was a positive association between FMS and PF related to neuromuscular development for both sexes, regardless of age. [ABSTRACT FROM AUTHOR]

Background: Throwing velocity is an important research topic in sports science, and it is an essential performance variable for athletes in overarm-throwing sports like baseball, team handball, water polo, softball, and cricket. The aim of the present review was to investigate the effect of specific strength training on throwing velocity for overarm throws. Methods: The literature was analysed using the Preferred Reporting Items for Systematic reviews and Meta-analyses, searching in SPORTDiscus and MEDLINE. Seventeen studies were included in this review, and the training studies were divided into four categories: (a) overweight and underweight balls, (b) forearm loading, (c) pulley device training, and (d) strength training with a resistance band. Results: All strength training studies with resistance band and the forearm loading categories increased the throwing velocity, varying from 3.7 to 26%. However, only half of these studies found that training was associated with a significantly higher increase versus the control group. Findings were inconsistent in other categories. Conclusion: Based on the findings of the present review, no clear conclusion can be made on which of the specific strength training methods is best for increasing throwing velocity. However, some recommendations can be offered. Firstly, the throwing training period should be long enough (≥ 6 weeks) with a high enough workload. Throwing training with a resistance band increases throwing velocity significantly for junior and less experienced overarm-throwing athletes. Furthermore, throwing with underweighted balls of similar size will ensure a positive effect on throwing velocity. Also, throwing training with combined over- and underweighted balls can be used if the overweighted balls are carefully selected to ensure there is no negative impact on throwing kinematics and injuries. For the other categories, the results were conflicting. Furthermore, due to the low number of studies in the pulley device and forearm loading categories, more studies should be conducted to investigate their effects on throwing velocity. Key Points: • All strength training studies with resistance band and the forearm loading categories increased the throwing velocity, varying from 3.7 to 26%. • Only half of these studies found that training was associated with a significantly higher increase versus the control group, while findings were inconsistent in other categories. • Due to the low number of studies in the pulley device and forearm loading categories, more studies should be conducted to investigate their effects on throwing velocity. [ABSTRACT FROM AUTHOR]

Background: Therapy intensity is among the most critical factors influencing neurorehabilitative outcomes. Because of its simplicity, time spent in therapy is the most commonly used measure of therapy intensity. However, time spent in therapy is only a vague estimate of how hard a patient works during therapy. Several measures have been proposed to better capture the amount of work a patient puts forth during therapy. Still, it has never been analyzed how these measures respond to changes in therapist-selected exercise intensity in children with neurological conditions. Objectives: To investigate the response and the reliability of heart rate variability (HRV), skin conductance (SC), activity counts per minute (AC/min), movement repetitions per minute (MOV/min), and perceived exertion to different therapist-tailored intensity levels of upper limb technology-assisted therapy in children with neurological conditions. Methods: In this pilot cross-sectional study, participants engaged in three personalized, randomized exergame intensity levels ("very easy", "challenging", "very difficult") for eight minutes each. We assessed all measures at each intensity level. The experiment was conducted twice on two consecutive days. We quantified reliability using intra-class correlation coefficients (ICC). Results: We included 12 children and adolescents aged 11.92 (±3.03) years. HRV, MOV/min, and perceived exertion could differentiate among the three intensity levels. HRV, MOV/min, perceived exertion, and AC/min showed moderate to excellent (0.62 ≤ ICC ≤ 0.98) test-retest reliability. Conclusion: HRV, MOV/min, and perceived exertion show potential for becoming valid and reliable intensity measures for an upper limb robotic rehabilitative setting. However, studies with larger sample sizes and more standardized approaches are needed to understand these measures' responses better. [ABSTRACT FROM AUTHOR]

This study examined the validity and reliability of the power slap test (PS) as an assessment for upper body pulling power to predict water polo functional performance and competitive experience of female water polo players. Seventeen female water polo players from the national and development squads were recruited. Subjects completed test-retest sessions of PS testing and 1 session of functional performance tests for the 15-m arms-only sprint (15 mAOS) and the 5-m maximum shooting velocity (5 mMSV). All PS, 15 mAOS and 5 mMSV results were compared for predictability. Power slap scores demonstrated high reliability for left PS (intraclass correlations [ICC]: 0.96, 90% confidence interval [CI]: 0.91-0.98), right PS (ICC: 0.96, 90% CI: 0.90-0.98), left and right center of mass (COM) displacement (ICC: 0.98, 90% CI: 0.96-0.99; ICC: 0.95, 90% CI: 0.88-0.98), and summed PS (ICC: 0.96, 90% CI: 0.92-0.99). All absolute PS scores and left COM displacement (COMdispL) demonstrated large correlations with the 15 mAOS times (r520.542 to 20.52, r2 5 0.27-0.29, p, 0.05). No performance parameters of the PS were correlated with the 5 mMSV performance (p. 0.05). This study validates the reliability of the PS as a dryland assessment tool for upper body pulling power. Only absolute PS scores and COMdisp were validated as weak predictors of the arms-only sprint times over 15 m. Its predictive power significantly improved when considered in combination with shooting performance. All absolute and normalized kinetic and kinematic PS parameters did not predict functional performance and competitive experience. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe handbike configurations and the prevalence of experienced sitting and riding-related problems among recreational handcyclists training for a mountain time trial (HandbikeBattle). In this cross-sectional study, 150 participants of the HandbikeBattle, who used an arm-power (recumbent) handbike, filled out a questionnaire (on comfort, stability and power generation) while handbike characteristics were measured. Crank width was variable among handcyclists and was wider than the shoulder width (median crank/shoulder width ratio: 1.19). About 60% of the participants found sitting in the handbike never fatiguing or painful and 74–76% indicated to sit stable in the handbike when sitting or when generating power. About 80% of the participants thought that their pedal position was optimal. Although the overall scores regarding sitting position and riding settings were high (both questions median: 8.0 on 1.0–10.0 scale), 50% and 31% of the participants, respectively, believed that their sitting position and riding settings could be improved. In addition, 10% of the participants thought that the configuration could lead to an injury and had an injury at the time of filling out the questionnaire. It can be concluded that although the majority of the participants seemed to be satisfied with their handbike configurations a large variety in handbike configurations was seen. There is a need for the development of evidence-based guidelines for handbike fitting in the future. IMPLICATIONS FOR REHABILITATION: A large variety in handbike configurations is seen in recreationally-active handcyclists. Although the majority of the recreationally-active handcyclists seemed to be satisfied with their handbike configurations, 31–50% of them thought that their handbike configuration could be improved. Evidence-based guidelines for handbike fitting should be developed in the future. [ABSTRACT FROM AUTHOR]

Purpose: Brachial plexus birth injuries (BPBI) can have lifelong effects on the development and functional use of the upper extremity. Currently there is no agreement with regards to what patient-reported outcome (PRO) measures should be used. Therefore, the ability to compare the effects of treatment between individuals and institutions is challenging. This study aimed to achieve consensus among clinicians on the use of PRO measures within this patient group to allow for improved comparison of treatments and outcomes in the future. Materials and Methods: Online, a 3 round Delphi survey was completed by 35 international multi-disciplinary specialist centers. Results: All respondents (100%) agreed that PRO measures are useful for clinical evaluation and patient treatment. None of the outcome measures scored >75% agreement for ability to assess responsiveness and current state in children with BPBI as most outcome measures were judged as not specific for BPBI. Additionally, participant centers were asked their perspective on the best available PRO option for each of the 3 categories: functional use of the upper limb, quality of life and pain. This resulted in endorsement by the participant centers of the Brachial Plexus Outcome Measure – Self-Evaluation, the Pediatric Quality of Life Inventory, and Visual Analogue Scale/Brief Pain Inventory respectively. Conclusion: International specialists in BPBI agree that PRO measures are important to use both clinically and in research in children aged 5 years and above. IMPLICATIONS FOR REHABILITATION: Patient-reported outcome measures were judged as useful both in clinic and in research for brachial plexus birth injury (BPBI), according to a panel of specialized centers. Currently available outcome measures were judged as not specific for BPBI. The panel endorsed the following measures as best available: the Brachial Plexus Outcome Measure – Self-Evaluation scale for functional evaluation, the Pediatric Quality of Life Inventory for disease-related quality of life and the Faces Pain Scale - Revised/Visual Analogue Scale/Brief Pain Inventory for pain [ABSTRACT FROM AUTHOR]

Background: Ways to help older adults overcome barriers to performing regular exercise is a challenge to nurses. Objective: The study evaluated the acceptability of a portable exercise bike for arm/foot pedaling among older patients with cardiovascular diseases (CVDs). Methods: Participants reported their physical activity levels using the International Physical Activity Questionnaire (short form) and thereafter performed two 6-minute-long arm/foot pedal biking sessions using a portable exercise bike. Participants provided qualitative feedback (one open-ended question) on the bike while exercising and completed the quantitative Acceptability Use Questionnaire following the two exercise sessions. Results: Twenty-five older adults (52% male and 48% female), with a mean (SD) age of 70 (6.4) years and a body mass index of 30 (7.4), completed the study. Most participants performed moderate to light physical activity at home with a daily mean (SD) sitting/sedentary time of 8 (3.4) hours. The mean scores from the Acceptability Use Questionnaire and the participants' comments alluded to the bike's multitasking utility and acceptability. Three broad themes derived from the qualitative analysis were: (1) the acceptability of the bike with participants who had musculoskeletal problems; (2) the ability to operate and use the bike for aerobic exercise engaging both arms and legs; and (3) the importance of overall utility, ease of use, and cost of the bike. Conclusions: The portable exercise bike was found acceptable in a group of older adults with CVDs. The bike has the potential to be applied in home-based exercise interventions. [ABSTRACT FROM AUTHOR]

Background: Poststroke shoulder pain (PSSP) is a common poststroke complication. Even though it is a common phenomenon, it is unclear how it impacts the patient's life. Objective: To investigate the differences in upper extremity function, sleep quality, and functional independence between patients with and without PSSP. Methods: This cross-sectional study included 63 participants with stroke (32 patients with PSSP and 31 patients without PSSP). Shoulder pain was evaluated with a Visual Analog Scale and the participants were divided into two groups as those with and without PSSP. The upper extremity function was assessed with the Disabilities of the Arm, Shoulder, and Hand Questionnaire, the Arm Motor Ability Test, and the Nine Hole Peg Test. Sleep quality was assessed with Pittsburgh Sleep Quality Index and the functional independence was assessed with the Functional Independence Measure. All data were analyzed using the program IBM SPSS Statistics 22.0. The Mann-Whitney U test was used to compare the non-normally distributed parameters, and the Chi-square test was used to compare the ordinal variables. The Spearman correlation test was used for the relationship and a linear regression test was used for regression. Results: Upper extremity function decreased (p <.05), only the sleep disturbance sub-parameter of sleep quality increased (p =.01), and functional independence increased in patients with PSSP (p <.001). There was a moderate relationship between pain and upper extremity function and a fair relationship between pain and sleep quality (use of sleep medications, daytime dysfunction sub-parameters) (p <.05). Conclusions: PSSP impairs upper extremity functions, which play an important role in activities of daily living, and reduces functional independence. These results suggest that it is important to evaluate shoulder pain and examine the factors affecting pain in the rehabilitation of patients with stroke. [ABSTRACT FROM AUTHOR]

Summary: We assessed multiple components of muscle function in ten adults with X-linked hypophosphatemia (XLH) receiving burosumab treatment. Lower limb power (+ 9%), short physical performance battery (SPPB) score (+ 1.2 points), and physical activity (+ 65%) increased following 6 months of treatment, and hand grip increased (+ 10%) between 6 and 12 months of treatment. Purpose: X-linked hypophosphatemia (XLH) is a rare genetic disorder of phosphate metabolism. Burosumab is a monoclonal antibody treatment shown to improve phosphate homeostasis and improve symptoms as well as fracture healing when used as a therapy for XLH in adults. However, little is known about its effects on the large deficits in multiple components of physical function previously reported in XLH. Methods: Ten adults (6 females, age 41.1 ± 15.7 y) were recruited from specialist centres in London and Bristol. During clinical visits for initial burosumab treatment and at 6-month and 12-month follow-up, physical function, and physical activity (PA) assessments were performed. In detail, lower limb power was assessed by mechanography via a countermovement jump, mobility by short physical performance battery (SPPB), functional capacity by 6-min walk test (6MWT), upper limb strength by hand grip dynamometry, and PA via an International Physical Activity Questionnaire (IPAQ). Differences between baseline and 6-month follow-up, and in a subset of 5 patients between 6- and 12-month follow-up, were assessed. Results: Lower limb power increased by 9% (P = 0.049) from baseline to 6 months, as did SPPB score (+ 1.2 points, P = 0.033) and total PA (+ 65%, P = 0.046) although hand grip and 6MWT did not differ. Only for hand grip was a significant improvement (+ 10%, P = 0.023) seen between 6 and 12 months. Conclusions: Burosumab treatment is associated with improved lower limb function and mobility at 6 months, with improvement in hand grip strength at 12 months. Future studies should explore the underlying mechanisms and describe on function and other patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP). Methods: We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children's facial expressions and affective states, indicative of their level of engagement during intervention sessions. Results: We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE. Conclusions: Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP. [ABSTRACT FROM AUTHOR]

Importance: Upper extremity (UE) dysfunction resulting from stroke significantly affects a person's ability to complete self-care activities, consequently diminishing functional independence. Effective interventions that improve UE function in persons with stroke are needed. Objective: To explore the effectiveness of the Bimanual Arm Trainer (BAT) compared with traditional occupational therapy treatment sessions (i.e. a control group) on improving UE function after acute ischemic stroke. Design: Clinical trial, two-group, nonrandomized repeated-measures design. Setting: Inpatient rehabilitation facility. Participants: Twenty-seven persons with ischemic stroke and an Action Research Arm Test (ARAT) score ≤17. Intervention: Minimum of three 10-min sessions on the BAT. Outcomes and Measures: ARAT, Upper Extremity Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA–UE). Results: Both the intervention and control groups showed significant improvement on the ARAT from evaluation to discharge (main effect of time: p =.02). There was no statistically significant main effect of group and no significant Time × Group interaction (p =.63). FMA–UE scores also improved significantly in the intervention group from evaluation to discharge (p <.001). FMA–UE scores were not available for the control group. Conclusions and Relevance:Both the intervention and control groups demonstrated significant improvements in UE function from evaluation to discharge. There were no statistically significant differences between groups, indicating that the BAT results in similar improvements in UE function, as would be expected in traditional occupational therapy. Further research is warranted to examine additional BAT programs, use different outcome measures, and assess participants over a longer time span. Plain-Language Summary: The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function among stroke patients. There is limited research on BAT's effectiveness in improving arm function among stroke patients. In an acute inpatient rehabilitation setting, we compared outcome scores of patients who received traditional occupational therapy services with those who also used the BAT. Both groups achieved significant improvements in arm function from evaluation to discharge. We found that the addition of the BAT interventions did not significantly affect the outcome measure scores for either group. We conclude that more research is needed to examine additional BAT programs, use different outcome measures, and assess participants over a longer period of time. The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function after a stroke. [ABSTRACT FROM AUTHOR]

Background/Objectives: This quasi-experimental study examined the effectiveness of an intensive, group-based pediatric constraint-induced movement therapy (pCIMT) program for young children. Methods: Thirty-five children aged 21 months to 6 years, with unilateral hemiparesis (HP), or weakness on one side of the body from varying etiologies, participated in a 4-week intensive, interprofessional, theme- and group-based pCIMT clinic program in the Midwest, United States. The program ran for 4 weeks with 3 h of therapy per day, 5 days per week with 3 weeks of 24 h casting for the unaffected arm, followed by 1 week of bimanual focus. Outcome measures included the Quality Upper Extremity Skills Test (QUEST), Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory (PEDI). Results: The participants statistically significantly improved the unilateral function of the HP arm in four of five QUEST variables (p < 0.009), bimanual coordination as measured by the AHA (p < 0.001), and some areas of occupational performance as measured by the COPM (p < 0.001) and PEDI (p < 0.05). Conclusions: This study revealed the intensive, group-based pCIMT clinic model was effective and feasible to implement with the support from various stakeholders. [ABSTRACT FROM AUTHOR]

This study proposes an integrated ergonomic evaluation designed to identify unsafe postures, whereby postural risks during industrial work are assessed in the context of virtual reality-based smart manufacturing. Unsafe postures were recognised by identifying the displacements of the centre of mass (COM) of body keypoints using a computer vision-based deep learning (DL) convolutional neural network approach. The risk levels for the identified unsafe postures were calculated using ergonomic risk assessment tools rapid upper limb assessment and rapid whole-body assessment. An analysis of variance was conducted to determine significant differences between the vertical and horizontal directions of postural movements associated with the most unsafe postures. The findings assess the ergonomic risk levels and identify the most unsafe postures during industrial work in smart manufacturing using DL method. The identified postural risks can help industry managers and researchers acquire a better understanding of unsafe postures. Practitioner summary: This study aims to identify unsafe postures and calculate risk levels in a VR-based smart manufacturing context. Deep learning is applied to identify unsafe postures by detecting COM displacements and risk levels are calculated using ergonomic risk assessment tools. Results revealed the most unsafe body postures, crucial for workers' safety. [ABSTRACT FROM AUTHOR]

Occupations including first responders and military require manual tasks; therefore changes in hand strength and dexterity could affect performance. We hypothesised that pinch strength, grip strength, and dexterity will change after unloaded and loaded exercise. Twenty-four male (25 ± 4.0 yrs; 86.3 ± 9.3 kg) and 10 female (25 ± 6.0 yrs; 62.1 ± 5.9 kg) participants completed 3 conditions for 5 minutes: (1) no exercise (2) run with no load at 3.0 m/s and (3) run wearing a 9.1 kg belt. Heart rate was different among conditions (p ≤ 0.05). Pinch strength was significantly different for the non-dominant hand after exercise (p = 0.005) for male participants, but not for the dominant hand. Grip strength was significantly different for the non-dominant hand between loaded and unloaded run (p = 0.035) for male participants. Pinch and grip strength did not change after exercise for female participants. Dexterity times were not different after exercise, but female participants were significantly faster (p ≤ 0.039) than male participants. Practitioner Summary: Grip strength, pinch strength, and dexterity are maintained in the first 15 minutes after running exercise for male and female participants. The dominant hand should be used if greater and more consistent strength and dexterity are needed for tasks that involve use of the hands after exercise. Abbreviations: ANOVA: Analysis of Variance; CV: Coefficient of Variation; Dom: Dominant hand; Non-Dom: Non-dominant hand. [ABSTRACT FROM AUTHOR]

Background: The body of literature regarding the use of an upper limb exoskeleton during authentic working conditions is sparse. Objective: The aim of this study was to evaluate the effectiveness of an upper limb exoskeleton in reducing muscle strain during authentic industrial construction work. Methods: Fifteen male participants, comprising of roofers, scaffolders, builders, bricklayers, and graders performing overhead work participated in the study. During work without (REF) and with exoskeleton (EXO), muscle activity from 8 muscles, heart rate (HR), metabolic equivalent (MET), and upper arm elevation angles were recorded. Results: When using the exoskeleton, a significant reduction of 20.2% in average muscle activity of 8 muscles was found. The largest effect focused on m. deltoideus, where 46.2 and 32.2% reduction occurred in medial and anterior parts of the muscle, respectively. HR and MET were unaffected. Upper arm elevation angles were similar between REF and EXO, indicating equal biomechanical loading. Conclusions: This study indicates that exoskeletons show great promise in reducing the potential for musculoskeletal strain during authentic overhead construction work. [ABSTRACT FROM AUTHOR]

The primary aims of the study were to perform a descriptive analysis of hitting energetics off a pitching machine and to compare between the rear- and lead-side lower and upper extremities. Eighty-five high school to minor league baseball athletes participated. Five full-effort swings off a pitching machine with the fastest exit velocity were used for analysis. Energy flow was quantified using a segment power analysis. Wilcoxon signed-rank test revealed significant differences between rear- and lead-side energetics during both swing phases. During the stride, the rear knee and shoulder generated more energy than the lead side. Throughout the swing phase the lead knee, hip, and elbow generated more energy than the rear side, but at the shoulder the rear side generated significantly more energy than the lead. Most intriguing, differing energy transfer directions between the rear and lead knee and shoulder joints were reported. Furthermore, descriptive results revealed energy is predominantly transferred across the knee, shoulder, and elbow joints, while the hips primarily display energy generation. The descriptive nature of the study provides a foundation for future research and can be used as a resource for training personnel to design effective training protocols aimed at maximizing performance. [ABSTRACT FROM AUTHOR]

Purpose: Constraint-induced movement therapy (CIMT) is a recommended intervention for arm recovery after acquired brain injury but is underutilised in practice. The purpose of this study is to describe the development of a behaviour change intervention targeted at therapists, to increase delivery of CIMT. Methods: A theoretically-informed approach for designing behaviour change interventions was used including identification of which behaviours needed to change (Step 1), barriers and enablers that needed to be addressed (Step 2), and intervention components to target those barriers and enablers (Step 3). Data collection methods included file audits and therapist interviews. Quantitative data (file audits) were analysed using descriptive statistics. Qualitative data analysis (interviews) was informed by the Theoretical Domains Framework (TDF) and Behaviour Change Wheel. Results: Fifty two occupational therapists, physiotherapists and allied health assistants participated in focus groups (n = 7) or individual interviews (n = 6). Key barriers (n = 20) and enablers (n = 10) were identified across 11 domains of the TDF and perceived to influence CIMT implementation. The subsequent behaviour change intervention included training workshops, nominated team champions, community of practice meetings, three-monthly file audit feedback cycles, poster reminders and drop-in support during CIMT. Conclusion: This study describes the development of a behaviour change intervention to increase CIMT delivery by clinicians. Trial registration: Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617001147370. IMPLICATIONS FOR REHABILITATION: Constraint induced movement therapy (CIMT) is a highly effective intervention for arm recovery after acquired brain injury, recommended in multiple clinical practice guidelines, yet delivery of CIMT is often not part of routine practice. The Behaviour Change Wheel, COM-B (capability, opportunity, motivation- behaviour) system and Theoretical Domains Framework (TDF) helped identify barriers and enablers to CIMT delivery by therapists, and design a theoretically-informed behaviour change intervention. The effect of the behaviour change intervention on therapists practice can now be evaluated to determine if it increases the delivery of CIMT more routinely in practice. [ABSTRACT FROM AUTHOR]

To effectively evaluate the gross motor ability of autistic children, we proposed a method of computerised evaluation of gross motor skills (CEGM). The CEGM integrates Dynamic Time Warping (DTW) method and OpenPose technology to automatically detect key joints and return a score. Ten items were selected for evaluation based on the gross motor subtest of the Psychoeducational Profile – Third Edition (PEP-3) scale, including upper limb movement, lower limb movement, and body coordination performance. 30 autistic participants (males: 23, female: 7) with an average age of 5.00 years were recruited in this study. Then we compared the results of evaluation using CEGM and the original PEP-3 gross motor subtest in autistic children. The results showed that in the evaluations using CEGM and PEP-3, Cronbach's α coefficients and Spearman-rank correlation coefficients were all greater than 0.80, intraclass correlation coefficient (ICC) were all greater than 0.90, indicating good agreement in evaluating the gross motor ability of autistic children. Moreover, compared to the PEP-3, the evaluation using CEGM provided precise quantitative indicators (trajectory, velocity, and angle of joint). Therefore, our findings demonstrate that CEGM can be used in the initial evaluation of the gross motor ability of autistic children. [ABSTRACT FROM AUTHOR]

Purpose: To explore the attitudes and experiences of clinicians and individuals with chronic stroke on the use of shared decision-making (SDM) during upper extremity rehabilitation to improve daily arm use in the home environment. Specifically, we aimed to describe clinician and client perspectives regarding the facilitators and barriers to using SDM within the context of a self-directed upper extremity intervention for individuals living in the community with chronic stroke. Methods: Data were collected within the context of an interventional study examining the feasibility of the Use My Arm-Remote intervention. Focus group interviews were conducted with the clinicians (n = 3) providing the intervention and individual semi-structured interviews with the participants (n = 15) of the study. All interview data were collected after the end of the intervention period. Data were analyzed using thematic analysis. Results: The following themes were identified: (1) Equal partnership; (2) Enhancing clinician confidence; and (3) This is different. Facilitators and barriers were identified within each theme. Key facilitators for clinicians were competence with SDM and patient characteristics; while facilitators for patients were open and trusting relationships with clinicians and personalized experience. Key barriers to SDM for clinicians were lack of expertise in SDM and participant buy in; while patients identified a lack of foundational knowledge of stroke rehabilitation as a potential barrier. Conclusions: Key barriers were analyzed using the consolidated framework for advancing implementation science to interpret results and identify strategies for enhancing the implementation of SDM in a virtual setting. The CFIR-ERIC tool highlighted the need for targeted educational meetings and materials to address the training and educational needs of both clinicians and patients for future iterations of this intervention. [ABSTRACT FROM AUTHOR]

Objective Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss. Methods A volunteer sample of injured (n  = 579) and uninjured (n  = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann–Whitney U and Kruskal–Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores. Results DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18–2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07–13.60) times higher for people with UL loss compared to the Uninjured group. Conclusion People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years. Impact For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique. [ABSTRACT FROM AUTHOR]

Background: Symptoms seen in Parkinson's Disease (PD) affect the quality of life (QoL) of individuals. Objectives: This study aimed to examine the relationship of QoL with tremor severity and upper limb functionality in individuals with PD. Methods: Parkinson's Disease Quality of Life Questionnaire (PDQ-39) was used to examine the QoL of the participants, electromyography was used to measure the tremor amplitude, Nine-Hole Peg Test (NHPT) was used to evaluate the upper limb functionality and dynamometer was used to evaluate grip and pinch strength. Resting and postural tremor amplitudes were recorded from both sides of the hand and forearm. The relationship between QoL and other parameters was tested with Spearman Correlation Analysis. Mann-Whitney U test was used to compare individuals with and without tremor. Results: It was obtained that tremor amplitude was significantly related to: activities of daily living (rho = 0.597); emotional well-being (rho = 0.694); stigma (rho = 0.524); social support (rho = 0.595 and 0.559), and communication [rho = 0.532 (right forearm), 0.564 (left forearm), and 0.527 (right hand)] sub-parameters of PDQ-39 (p <.05). The relationship of the grip and pinch strength with the PDQ-39 sub-parameters was significant (p <.05), except for social support and communication. The relationship between NHPT and almost all parameters of PDQ-39 (p <.05), except bodily discomfort and social support, was significant. Conclusion: It was concluded that future studies focusing on QoL could also consider tremor severity and grip strength as well as dexterity in individuals with PD. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with acquired brain injury (ABI) experience high rates of poor functional outcomes such as inability to complete activities of daily living (ADL). Occupational therapy needs to be customised to the individual's function, goals, and environment to facilitate improvement in ADLs after ABI. Virtual reality (VR) is a novel treatment approach that aims to improve skills within an individualised environment. This study aimed to review the current literature for the use of VR platforms that incorporate ADLs to improve functional outcomes after ABI. Methods: This review followed the six‐stage framework by Arksey & O'Malley (2005). Electronic databases were searched for peer‐reviewed journal articles based on inclusion and exclusion criteria. Results: One thousand and six hundred eighty articles were screened, including 413 full text articles and 13 articles were included for review. Among the 13 articles, six were RCTs and the rest were pre‐post intervention studies. Studies largely used non‐immersive VR platforms, which incorporated ADLs such as grocery shopping, aiming to improve functional outcomes. Consumer and community consultation: Consumer and community were not involved in executing this study. Conclusion: This review suggests mixed results if VR is effective at treating upper limb, cognition, and ADL function after ABI. Using their clinical reasoning, occupational therapists can determine the suitability of VR for ADL rehabilitation for specific patient populations and settings. Plain Language Summary Individuals who sustain an acquired brain injury can have difficulty performing their daily activities such as, making a meal or getting dressed, because of limited function (e.g., physical and cognitive problems). To help improve their ability to complete daily activities, occupational therapy needs to be customised to the individual's function, goals, and environment. Virtual reality is a new rehabilitation approach that allows individuals to improve their function in an individualised environment. In this study, we reviewed the current studies that have used virtual reality platforms that incorporate daily activities to improve function after acquired brain injury. We searched databases and screened the titles and abstracts of 1,680 studies. Then, 413 full‐text studies were screened, and 13 studies were included. Studies mostly used non‐immersive platforms to practise daily activities such as, grocery shopping, aiming to improve function after acquired brain injury. This review suggests mixed results if virtual reality can effectively treat function after acquired brain injury. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine whether the width of the base of support (BOS) has an influence on early postural adjustments (EPA) and armed upper limb and COM kinematics during lunging. Eight elite female fencers participated in the study. The displacement of the centre of foot pressure (COP) and kinematics of centre of mass (COM) were recorded using force platforms. The kinematics of the wrist of the armed upper limb were obtained using a 3D accelerometer. The results show that EPA were characterised by a very small COP displacement (about 0.6 to 1.2 cm). The COP amplitude showed a tendency to decrease with an increase in BOS width under reaction time conditions. In contrast, a greater BOS width was associated with a significant increase in COM acceleration at foot-off and peak COM acceleration during lunging also under reaction time instructions. The kinematics of the wrist were not influenced by BOS. The results show that in elite fencers, the upper limb movement is dissociated from the whole body movement. We suppose that a small COP amplitude is a postural skill which is integrated into the lunging skill and might influence the acceleration of COM. [ABSTRACT FROM AUTHOR]

Water-polo players frequently perform overhead throws that could result in shoulder imbalances. For overhead throws, execution of the 'eggbeater kick' (cyclical movement of the legs) is required to lift the body out of the water. Although a symmetrical action, inter-limb differences in task execution could lead to knee frontal plane projection (FPPA) differences. The present study examined imbalances shoulder and knee FPPA in female players. Eighteen competitive female field players (24.1 ± 5.5 years, 1.68 ± 0.06 m, 72.9 ± 13.3 kg) had their shoulder strength assessed in a shot-mimicking position with a portable dynamometer, standing and seated (isolating the shoulder contribution). Anterior: posterior and shooting: non-shooting shoulder comparison were made. Additionally, players performed a drop jump. Knee FPPA was recorded from digitising and comparing the frames just before landing and at stance phase. During standing, players exhibited higher shooting: non-shooting asymmetry (p = 0.032) in the anterior contraction direction, while during seated the shooting shoulder anterior: posterior asymmetry was higher (p = 0.032). Interlimb knee FPPA asymmetry was higher in the stance phase (p = 0.02). Despite the overhead throwing and egg-beater demands impacting differently on each limb, considerable asymmetries do not develop, suggesting the overall training requirements (e.g. swimming, resistance training) were sufficient to maintain the asymmetry within desirable limits. [ABSTRACT FROM AUTHOR]

Purpose: To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF). Materials and Methods: Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life. Results: 776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life. Conclusions: While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this. PREVIOUS PRESENTATION WORK: Portions of this content were presented at the 2023 Academy of Neurologic Physical Therapy Annual Conference and will be presented at the 2023 TIRR & UT Health International Stroke Rehab & Recovery Conference. IMPLICATIONS FOR REHABILITATION: The majority of therapeutic goals for an episode of outpatient neurorehabilitation were classified into the Activity and Participation component of the International Classification of Functioning, Disability, and Health. However, less than 1% of therapeutic goals measured direct activity performance in daily life. If people with neurological diagnoses seek out outpatient rehabilitation to improve functioning in their real-world environment, than therapeutic goal setting should reflect this. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of mirror therapy (MT) and therapeutic exercise (TE) with the unaffected hand, on pain, sensitivity and functionality in individuals with unilateral carpal tunnel syndrome (CTS). Material and methods: A randomized controlled trial was carried out. Thirty-nine adults with unilateral CTS were included and randomly allocated to a six-week training programme based on MT (n = 20) or TE (n = 19). Visual Analogue Scale, Semmes-Weinstein monofilament test, Two-point discrimination (2PD), Disabilities of the Arm, Shoulder and Hand (DASH) and Boston Carpal Tunnel Questionnaire (BCTQ) were assessed before (T0) and after the intervention (T1), and at one-month follow-up (T2). Results: At T1, MT and TE showed significant improvements in pain (p = 0.001 and p = 0.03, respectively), however, only MT maintained the achieved effects at T2 (p = 0.01). In addition, 2PD significantly improved in MT in the first (p = 0.04) and fourth fingers (p = 0.02) at T1. The DASH score decreased at T1 in MT (p < 0.001) and TE (p = 0.01). Additionally, the BCTQ score improved in MT (p < 0.001), and TE (p < 0.001) at T1. The effects were maintained at T2 for DASH and BCTQ scores. Conclusions: Training of the unaffected hand resulted in a significant improvement of the affected hand in both groups; nevertheless, MT achieved a longer duration of the effects. IMPLICATIONS FOR REHABILITATION: Training of the unaffected hand may improve pain, sensitivity and functionality in people with unilateral tunnel carpal syndrome. Mirror therapy achieved longer duration of the effects on pain and hand functionality. Our research may inform clinical decision-making and guide the development of therapeutic interventions for patients with carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the impact of combining transcranial direct current stimulation with end-effector robot-assisted treatment on upper limb function, spasticity, and hand dexterity in chronic stroke patients. Design: This was a prospective, double-blind randomized trial with 20 equally allocated stroke patients. The experimental group received dual transcranial direct current stimulation (anode over affected M1, cathode over contralateral M1) alongside robot-assisted treatment, while the control group received sham transcranial direct current stimulation with the same electrode placement + robot-assisted treatment. Each patient underwent 20 combined transcranial direct current stimulation and robot-assisted treatment sessions. The primary outcome measure was the Fugl-Meyer Upper Limb motor score, with secondary outcomes including AMADEO kinematic measures, Action Research Arm Test, and Functional Independence Measure. Assessments were conducted at baseline, after rehabilitation, and 3 mos later. Results: Combining bilateral transcranial direct current stimulation with robot-assisted treatment did not yield additional improvements in Fugl Meyer Upper Limb motor score, Functional Independence Measure, or Action Research Arm Test scores among stroke patients. However, the real transcranial direct current stimulation group showed enhanced finger flexion in the affected hand based on AMADEO kinematic measures. Conclusions: The addition of transcranial direct current stimulation to robot-assisted treatment did not result in significant overall functional improvements in chronic stroke patients. However, a benefit was observed in finger flexion of the affected hand. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms that can impact daily activities. Objectives: Activity-based interventions, particularly when combined with motivational strategies, may enhance upper extremity function and participation in people with PD. Methods: This study will include forty-five patients with PD aged 35 to 85 years, categorized as stages I to III according to the Hoehn and Yahr Scale. Patients will be recruited from neurological and rehabilitation centers and randomly assigned to one of three intervention groups: Activity-based interventions with motivational strategy, activity-based interventions without motivational strategy, and conventional interventions. All participants will undergo a 24-session intervention, three times a week. The study will assess various outcomes at multiple time points, including baseline, session 10, session 18, post-intervention (week 9), and follow-up (week 17). Primary outcome measures will focus on motor control of the upper extremity and participation, while secondary outcome measures will include cognitive function and quality of life. Results: This proposed randomized controlled trial (RCT) aims to investigate the potential beneficial effects of activity-based interventions, combined with motivational strategies, on upper extremity function and participation in activities of daily living (ADLs) for individuals with PD. Conclusions: The expected outcome of this study is to provide valuable insights that can assist occupational therapists in making informed decisions regarding intervention plans for people with PD. [ABSTRACT FROM AUTHOR]

Background: Growth-specific physical characteristics in adolescence may mediate throwing-related loads and movement patterns associated with elbow injuries. In a previous study, the authors calculated the forearm-hand inertia, which is the moment of inertia centered at the elbow joint. Purpose: To determine the relationship of forearm-hand inertia values with throwing motion patterns and elbow valgus load in adolescent baseball players. Study Design: Descriptive laboratory study. Methods: A total of 35 adolescent baseball players underwent measurements by dual-energy x-ray absorptiometry (DXA) scans and a throwing trial. Forearm-hand inertia was determined as the joint moment around the elbow using the subregion analysis mode of DXA. Elbow valgus torque and ball speed during throwing were measured using a dedicated sensor and speed gun, and throwing efficiency was calculated by dividing the elbow valgus load by the ball speed. Players were divided according to the throwing motion pattern in which maximum acceleration occurred: pelvis–upper arm–forearm (proximal-to-distal sequencing [PDS] group; n = 19) or pelvis-forearm–upper arm (proximal upper extremity [PUE] group; n = 16). The groups were compared in terms of ball speed, elbow valgus torque, throwing efficiency, and forearm-hand inertia using t tests and analysis of covariance, with forearm-hand inertia as covariates. The chi-square test was used to examine the relationship between throwing motion patterns and forearm-hand inertia. Results: The PUE group had a higher elbow valgus load (effect size [ES] = 0.65; P =.03), throwing efficiency (ES = 0.63; P =.02), and forearm-hand inertia values (ES = 0.64; P =.04) than the PDS group. In addition, a significant relationship was observed with throwing patterns when forearm-hand inertia values were 350 kg·m2 (OR, 2.36; 95% CI, 1.09-5.12; P =.012) and 400 kg·m2 (OR, 1.68; 95% CI, 0.99-2.85; P =.037). Conclusion: Study results indicated that growth-specific physical characteristics in adolescent baseball players exhibited in forearm-hand inertia mediated the relationship between high elbow valgus and poor throwing efficiency caused by poor throwing motion patterns. Clinical Relevance: A better understanding of the details in muscle function with throwing mechanics may prevent future injuries. [ABSTRACT FROM AUTHOR]

Background and objective: Stroke is one of the neurological disorders which is caused by disturbance in blood supply to the brain resulting in weakness in contralateral limbs and axial musculature. Stroke is the leading cause of physical impairment where the most prominent motor deficit is paresis of one side of body, which is contralateral to the event. This study was conducted with an aim to assess the effectiveness of bilateral upper extremity training on trunk performance, posture and gait in patients with subacute stroke. Method: 30 subjects with subacute stroke were selected for the study. Subjects were treated for 3 days/week for 12 sessions with 45 minutes of task oriented, strengthening training and PNF technique for bilateral upper extremity along with conventional training. The rehabilitation protocol consists of bilateral functional exercises, activity of daily living goal, exercises in multiple movement games, strengthening exercises for lower limb, controlled sitting training, sit to stand training, weight bearing and balance training Conclusion: Significant improvement in all items of TIS, PASS and DGI were observed after intervention (P< 0.001). The study concluded that bilateral upper extremity training is more effective in improving trunk control, posture and gait in subacute stroke patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine prevalence of musculoskeletal complaints (MSCs) in adults with major congenital upper limb differences (CoULD) compared to able-bodied controls, and to examine associations of MSCs and disability with various biopsychosocial factors. Materials and methods: Questionnaire-based cross-sectional study assessing MSCs, disability (using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH)), general and mental health status, physical work demands, and upper extremity range of motion. Results: Seventy-one individuals with CoULD (participation rate: 41%) and 71 controls matched on age, gender, and education were included (49% female, mean age 28.9 years). Year prevalence of MSCs was significantly higher in the CoULD group (35%) than in the control group (18%). The CoULD group was less often employed and had lower scores on all measures of upper limb range of motion and hand grip. MSCs were associated with higher DASH scores and higher reported work demands. Disability was associated with female gender, more joints with limited range of motion, unemployment, and lower general and mental health. Factors associated with disability did not differ between groups. Conclusions: MSCs are a frequent problem in young adults with major CoULD. To prevent or reduce MSC and disability, clinicians and researchers should be aware of the associated factors. Implications for rehabilitation: The year prevalence of musculoskeletal complaints (MSCs) in those with major congenital upper limb differences (CoULD) was approximately double to that of the control group, implying a potential relationship between CoULD and MSCs. Rehabilitation professionals should develop personalized strategies to manage work demands in those with CoULD, considering the association between MSCs and higher reported work demands. Recognizing the impact of a negatively perceived body image on mental health, clinicians should integrate psychological counseling into rehabilitation treatments to support mental well-being and improve overall quality of life in those with CoULD. Rehabilitation professionals should educate individuals with CoULD about the potential associations between upper limb work demands, MSCs, and disability. [ABSTRACT FROM AUTHOR]

This study compared lower extremity, trunk, and upper extremity kinematics between tee and front toss hitting in youth baseball athletes. Twenty youth baseball athletes (14.3±2.9 yrs) performed three maximal effort swings off front toss and tee. Kinematic data were collected during the preparatory and acceleration phases. Lower extremity, trunk, and upper extremity kinematics were compared between tee and front toss hitting using 1-dimensional statistical parametric mapping (SPM). There was a significant difference in trunk kinematics between tee and front toss during the preparatory phase (p=.001); the trunk rotated more toward the back side when hitting off a tee compared to front toss (p<0.001). There was also a significant difference in trunk kinematics between tee and front toss for 67% of the acceleration phase; the trunk rotated more towards the back side from 0 to 67% when hitting off the tee (p<0.001). Significant differences were found in trunk kinematics between tee and front toss hitting in youth baseball players, where the trunk is less rotated toward the pitcher in the tee than in the front toss. Coaches utilize various training modalities to enhance hitting performance; however, differences in trunk kinematics should be considered between modalities when developing fundamental hitting techiques in youth baseball athletes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the muscle-to-bone ratio (MBR) in National Collegiate Athletic Association Division I football players (collegiate football players [CFP]) to healthy, age-matched controls. In addition, we examined MBR in CFP by position. A total of 553 CFP and 261 controls had their total and regional lean mass (LM), fat mass (FM), and bone mineral content (BMC) determined by dual x-ray absorptiometry (DXA). College football players were categorized by positions defined as offensive linemen (OL), defensive linemen (DL), tight end, linebacker (LB), running back (RB), punter or kicker, quarterback (QB), defensive back (DB), and wide receiver (WR). There were significant differences between CFP and controls for total LM (80.1 ± 10.0 vs. 56.9 ± 7.8 kg), FM (22.2 ± 12.5 vs. 15.2 ± 7.1 kg), and BMC (4.3 ± 0.5 vs. 3.1 ± 0.5 kg). Although there were significant differences in body composition between CFP and controls, there was no significant differences in total MBR between CFP and controls (18.6 ± 1.4 vs. 18.8 ± 1.7). Regionally, CFP had significantly lower trunk MBR than controls (26.7 ± 2.7 vs. 28.7 ± 4.2), but no difference was seen in leg or arm MBR. Positional differences in CFP were noted as total MBR being significantly higher in DL (19.0 ± 1.4) than in DB (18.1 ± 1.3), WR (18.1 ± 1.3), and LB (18.2 ± 1.3). OL had a significantly higher total MBR (19.2 ± 1.3) than DB(18.1 ± 1.3), LB (18.2 ± 1.3), QB (18.1 ± 1.0), and WR (18.1 ± 1.3). In addition, RB had significantly higher total MBR (18.8 ± 1.3) than DB (18.1 ± 1.3) and WR (18.1 ± 1.3). This study may provide athletes and training staff with normative values when evaluating total and regional MBR with DXA. [ABSTRACT FROM AUTHOR]

Objective To investigate the predictive value of thoracic sympathetic ganglion block (TSGB) in response to ketamine infusion therapy (KIT) and spinal-cord stimulation (SCS) in patients with chronic upper-extremity pain including complex regional pain syndrome (CRPS). Design Retrospective Setting Tertiary hospital single-center Subjects Patients who underwent TSGB receiving KIT or SCS within a 3-year window. Methods Positive TSGB outcomes were defined as ≥2 0–10 Numerical Rating Scale (NRS) score reduction at 2 weeks post-procedure. Positive KIT and SCS outcomes were determined by ≥2 NRS score reduction at 2–4 weeks post-KIT and ≥4 NRS score reduction at 2–4 weeks post-SCS implantation, respectively. Results Among 207 patients who underwent TSGB, 38 received KIT and 34 underwent SCS implantation within 3 years post-TSGB; 33 patients receiving KIT and 32 patients receiving SCS were included. Among 33 patients who received KIT, 60.6% (n  = 20) reported a ≥ 2 0–10 NRS pain-score reduction. Positive response to TSGB occurred in 70.0% (n  = 14) KIT responders, significantly higher than that in 30.8% (n  = 4) KIT non-responders. Multivariable analysis revealed a positive association between positive responses to TSGB and KIT (OR 7.004, 95% CI 1.26–39.02). Among 32 patients who underwent SCS implantation, 68.8% (n  = 22) experienced short-term effectiveness. Positive response to TSGB was significantly higher in SCS responders (45.5%, n  = 10) than in non-responders (0.0%). However, there were no associations between pain reduction post-TSGB and that post-KIT or post-SCS. Conclusions A positive response to TSGB is a potential predictor for positive KIT and SCS outcomes among patients with chronic upper-extremity pain, including CRPS. [ABSTRACT FROM AUTHOR]

Softball pitchers often pitch several games within a day and over consecutive days during a competitive season. High volumes of pitches thrown can decrease muscular strength, resulting in less proximal force generation and upper extremity compensation to maintain performance. Therefore, the purpose of this study was to assess upper and lower extremity muscular strength after pitching in a simulated game. Fourteen softball pitchers (17.9 ± 2.3 years, 166.4 ± 8.7 cm, 72.2 ± 12.6 kg) completed baseline isokinetic strength assessment for knee, hip, trunk and pitching elbow flexion and extension as well as trunk rotation. Seven days later, participants pitched a simulated game consisting of 105 fastballs prior to repeating all strength assessments. Changes in muscular strength were assessed using paired samples t-tests, with significance set a priori as p ≤ 0.05. Normalised (%BW) stride leg knee extension peak torque was significantly higher (p = 0.020) post-simulated game (75.1 ± 24.6%BW) as compared to baseline (64.0 ± 19.5%BW) and trunk flexion peak torque was significantly higher (p = 0.009) post-simulated game (84.8 ± 47.0%BW) as compared to baseline (63.5 ± 47.1%BW). This study showed an increase in knee extension and trunk flexion strength after an acute bout of pitching. The findings give insight into muscular changes following pitching which can assist in appropriate softball training and recovery. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to assess the efficacy of robot-assisted rehabilitation training on upper and lower limb motor function and fatigue in Parkinson's disease (PD), and to explore the best-acting robotic rehabilitation program. Methods: We searched studies in seven databases and the search period was from the build to 30 June 2023. Two researchers independently screened studies and assessed the quality of the studies for data extraction. Results: A total of 21 studies were included, 18 studies related to lower limbs rehabilitation and 3 studies related to upper limbs rehabilitation, involving a total of 787 participants. The results showed that robot-assisted rehabilitation significantly improved indicators of lower limb motor function UPDRS Part III (WMD = −3.58, 95% CI = −5.91 to −1.25, p = 0.003) and BBS (WMD = 4.24, 95% CI = 2.88 to 5.54, p < 0.001), as well as non-motor symptoms of fatigue (WMD = −13.39, 95% CI = −17.92 to −8.86, p < 0.001) in PD patients. At the level of upper limb function, there was no statistically significant difference in the outcome measures of PFS (WMD = −0.25, 95% CI = −4.44 to 3.93, p = 0.9) and BBT (WMD = 1.73, 95% CI = −2.85 to 6.33, p = 0.458). Conclusion: Robot-assisted rehabilitation significantly improved motor function, fatigue, and balance confidence in PD patients, but current evidence doesn't show that intelligent rehabilitation systems improve upper limb function. In particular, robotics combined with virtual reality worked best. IMPLICATIONS OF REHABILITATION: Robot-assisted rehabilitation significantly improves motor symptoms, lower limb motor function, fatigue, and balance confidence in Parkinson's disease (PD) patients. Robotics combined with virtual reality is the most effective application and should be encouraged. In the robotic rehabilitation of PD patients, the focus needs to be on the duration of the training and the long-term benefits it provides. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between trunk control, upper and lower extremity function with functional activity, activities of daily living and quality of life in patients with Parkinson's Disease (PwPD). Materials and Methods: The study was completed with 52 PwPD. Trunk control was evaluated with the Trunk Impairment Scale (TIS); upper extremity function with 9-Hole Peg Test (9-HPT) bilaterally; lower extremity function with 30-Second Sit-To-Stand Test (30STS); functional activity level with The Parkinson Activity Scale (PAS); activities of daily living with Barthel Index (Bl); quality of life with The Parkinson's Disease Quality of Life Questionnaire (PDQ-39). Results: 30STS and right-left 9-HPT results was correlated with PAS and PDQ-39, but not with Bl in PwPD. All TIS scores except the coordination sub-parameter were found to be associated with PAS, all TIS scores except the static sitting balance sub-parameter were found to be associated with Bl, and all TIS scores were found to be associated with PDQ-39 in PwPD (p between 0.293 and 0.689; p<0.05 for all). Conclusion: Physical activity level and quality of life were associated with upper and lower extremity function and trunk control, whereas activities of daily living were only associated with trunk control in PwPD. These results suggest that physiotherapy and rehabilitation applications that will improve trunk control in addition to limb functions should be included in treatment protocols. [ABSTRACT FROM AUTHOR]

Music therapists may use auditory cueing to facilitate movement exercises when working on motor goals with adults with Parkinson's disease (PD). There is minimal research, however, comparing the effects of different auditory cueing techniques on the kinematic parameters of movements in adults with PD. The purpose of this exploratory study was to compare how rhythmic and sonified musical cues impact the smoothness and path variance of a repetitive, volitional arm movement in adults with PD. Seven adults with PD and 10 neurotypical adults completed 3 trials of a repetitive arm-reaching task in each of the 3 auditory cueing conditions. The position of each participant's wrist was recorded in 3 dimensions using an infrared motion capture system. Data from the motion capture system were processed for normalized jerk (NJ) and spatiotemporal index (STI). No significant differences in STI or NJ were observed between groups in the no cueing condition. Repeated measures analyses revealed no significant differences in NJ or STI for the PD group across conditions. Participant-level analysis of the PD group revealed a trend of less efficient movement performance in the rhythmic cueing condition and improved movement performance in the sonified cueing condition. These findings warrant further research to inform music therapists' use of auditory-motor cueing. [ABSTRACT FROM AUTHOR]

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Objectives. This study aimed to investigate the effects of academician's demographic characteristics and computer usage habits on upper limb musculoskeletal disorders (MSDs) and function. Methods. A cross-sectional observational study was conducted with 100 academicians. Data were collected using questionnaires, which included the patient-rated wrist evaluation questionnaire – Turkish version (PRWE-T), the Cornell musculoskeletal discomfort questionnaire – Turkish version (CMDQ-T), the upper extremity functional index – Turkish version (UEFI-T), demographic characteristics and average daily computer usage time. Results. A low-level significant correlation was found between the age of the individuals and the CMDQ-T forearm (p = 0.044; r = 0.202) and CMDQ-T wrist (p = 0.001; r = 0.337) scores. Women had higher CMDQ-T neck scores and lower UEFI-T scores than men (p < 0.05). Academicians who used computers for 6 h a day or more had higher PRWE-T and CMDQ-T neck, shoulder, upper arm and forearm scores, and had a lower UEFI-T score (p < 0.05). Conclusion. Neck, shoulder, upper arm and forearm symptoms were higher and upper extremity function was impaired in academicians who used computers for 6 h a day or more. Besides, gender and age were associated with upper limb MSDs and function, but occupation duration did not affect those outcomes in academicians. [ABSTRACT FROM AUTHOR]