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Context: The aim of this study was to investigate the effects of 8-week ballistic-strength-training program using a validated specific throwing device (ie, Arm/Shoulder Specific Strength Device), on isokinetic shoulders' rotation muscle-torques and ratios as well as range of motion in team handball players. Design: A repeated-measures experimental design with a randomized controlled trial was used. Methods: Twenty-six high-level competitive male U-19 team handball players were randomly assigned into training (TG, n = 15) and control (n = 11) groups. The TG undertook a twice a week for 8-week periodized throws program with an individually predetermined optimal load. The program incorporated shackled eccentric and concentric exercises using the Arm/Shoulder Specific Strength Device. Peak torques, functional, and conventional ratios for both arms at different angular velocities (60°·s−1, 180°·s−1, and 300°·s−1) were assessed over time and between groups, using an isokinetic dynamometer. Results: A significant improvement for TG (P <.01; d = 1.13 [moderate]; +20.2%) of the concentric peak torques for dominant arm in external rotation was observed at 300°·s−1. Significant (P <.05–.01) increases were also noted for nondominant arm at the 3 studied angular velocities. In addition, 300°·s−1 eccentric peak torques of the dominant arm and nondominant arm have significantly improved for both external and internal rotations (P <.05; d =.99 [moderate] and d = 1.21 [large]; +15.7% and + 17.9%, respectively) with small changes at the other angular assessed velocities. Posttraining, TG's dominant arm showed significant improvements (P <.05–.01) in functional and conventional ratios at all velocities. Notably, significant differences (P <.05–.01) were observed at 60°·s−1 and across all velocities when comparing the TG with the control group. TG showed significant increase for internal rotation and external rotation shoulder range of motions (P <.05; d = 1.22–1.27 [large]), +5.0% and +7.7%, respectively). Conclusions: The specific 8-week throwing training program on the Arm/Shoulder Specific Strength Device showed significant performance improvements in almost all assessed isokinetic concentric and eccentric peak torques as well as internal and external range of motion increase for both arms while ensuring rotator cuff torque ratios and shoulder mobility in team handball real sport-specific condition. [ABSTRACT FROM AUTHOR]

Purpose: Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle. Methods: Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle. Results: The 3 times repeated measures and the 2 days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant. Conclusions: The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively. [ABSTRACT FROM AUTHOR]

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was.43 during the landing phase (P =.04) and with peak hip internal rotation was −.68 (P <.001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r =.40, P =.05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. Methods: 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. Results: After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. Conclusion: ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients. Implications for Rehabilitation: Extracorporeal shock wave therapy represents a useful non-invasive, additional modality for reduction of foot spasticity and equinus deformity in chronic stroke patients. The application of such a modality improves limb posture, range of motion, and muscle extensibility. Early extracorporeal shock wave rehabilitative intervention in stroke patients reduces fat infiltration and fibrosis replacement of spastic muscle. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic ankle instability (CAI) presents neuromuscular control and functional performance difficulties. Although ankle-focused rehabilitation is widely practised, the relative effects of exercises targeting thoracic mobility and lumbopelvic stabilization in addressing CAI have not been thoroughly investigated. OBJECTIVE: The study aims to compare the effects of thoracic mobility and lumbopelvic stabilization exercises in patients with CAI. METHODS: The study was designed as a prospective randomized controlled clinical trial. A total of 30 participants (mean age = 31.93 ± 7.31; 21F/9M) who scored 27 points or on the Cumberland ankle instability tool voluntarily were enrolled in the study. The participants were randomly divided into two groups. In addition to the rehabilitation protocols, each participant was given a home exercise program, including ankle-strengthening exercises (3 times a week). The first group trained with thoracic mobility (TM), while the second group did lumbopelvic stabilization (LS) exercises under supervision twice a week for eight weeks. Participants' pre and post-treatment assessments spanned an 8-week rehabilitation period, during which ankle and hip joint range of motion measurements were obtained using an electronic goniometer. Additionally, dynamic balance was assessed through the Y balance test, while ankle proprioception was evaluated using joint position sense measurements. The flexibility was assessed with an active straight leg raise test. RESULTS: Y balance, CAIT, and active straight leg raise test scores were improved in the eighth week in the thoracic mobility group (p < 0.05), while only active straight leg raise test and CAIT scores were significantly different in the lumbopelvic stabilization group (p < 0.05) according to intra group variables. In comparing the post-treatment scores between the groups, the thoracic mobility group had superior results in the joint position sense test for the right side of the hip and plantarflexion. (hip; TM: 70.71 ± 6.80, LS: 68.76 ± 5.50, plantarflexion; TM: 44.24 ± 7.28, LS: 38.30 ± 5.08). CONCLUSION: The findings suggest that while both interventions are effective in addressing various aspects of ankle instability, the thoracic mobility exercises may offer additional benefits, particularly in enhancing joint position sense, thereby providing valuable insights for the optimization of rehabilitation protocols for individuals with chronic ankle instability. [ABSTRACT FROM AUTHOR]

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Objectives. This study aimed to investigate the consistency between results of the American Conference for Governmental Occupational Hygienists (ACGIH) threshold limit value (TLV) for hand activity and proposed action levels of objective measurements in risk assessments of work-related musculoskeletal disorders. Methods. Wrist velocities and forearm muscular load were measured for 11 assemblers during one working day. Simultaneously, each assembler's hand activity level (HAL) during three sub-cycles was rated twice on two separate occasions by two experts, using a HAL scale. Arm/hand exertion was also rated by the assemblers themselves using a Borg scale. In total, 66 sub-cycles were assessed and assigned to three exposure categories: A) below ACGIH action limit (AL) (green); B) between AL and TLV (yellow); and C) above TLV (red). The median wrist velocity and the 90th percentile of forearm muscular load obtained from the objective measurements corresponding to the sub-cycles were calculated and assigned to two exposure categories: A) below or C) above the proposed action level. Results. The agreement between ACGIH TLV for hand activity and the proposed action level for wrist velocity was 87%. Conclusions. The proposed action level for wrist velocity is highly consistent with the TLV. Additional studies are needed to confirm the results. [ABSTRACT FROM AUTHOR]

Background: In recent decades, early rehabilitation after Achilles tendon rupture (ATR) repair has been proposed. The aim of this prospective cohort study was to compare different immobilisation durations in order to determine the optimal duration after open surgery for ATR repair. Methods: This study included 1088 patients (mean age, 34.9 ± 5.9 years) who underwent open surgery for acute ATR repair. The patients were categorised into four groups (A, B, C, and D) according to postoperative immobilisation durations of 0, 2, 4, and 6 weeks, respectively. All patients received the same suture technique and a similar rehabilitation protocol after brace removal,; they were clinically examined at 2, 4, 6, 8, 10, 12, 14, and 16 weeks postoperatively, with a final follow-up at a mean of 19.0 months. The primary outcome was the recovery time for the one-leg heel-rise height (OHRH). Secondary outcomes included the time required to return to light exercise (LE) and the recovery times for the range of motion (ROM). Data regarding the surgical duration, complications, the visual analogue scale (VAS) score for pain, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were also collected. Results: The recovery times for OHRH, LE, and ROM were significantly shorter in groups A and B than in groups C and D (P < 0.001). The VAS scores decreased over time, reaching 0 in all groups by 10 weeks. The mean scores in groups A and B were higher than those in the other groups at 2 and 4 weeks (P < 0.001), whereas the opposite was true at 8 weeks (P < 0.001). ATRS and the AOFAS Ankle-Hindfoot scale score increased across all groups over time, showing significant between-group differences from weeks 6 to 16 (P < 0.001) and weeks 6 to 12 (P < 0.001). The mean scores were better in groups A and B than in groups C and D. Thirty-eight complications (3.5%) were observed, including 20 re-ruptures and 18 superficial infections. All complications were resolved at the last follow-up, with no significant between-group differences. Conclusions: Immobilisation for 2 weeks after open surgery for ATR repair may be the optimal strategy for early rehabilitation with relatively minimal pain and other complications. Trial registration: ClinicalTrials.gov (NCT04663542). [ABSTRACT FROM AUTHOR]

This article describes a new design for the sum-channel, circularly-polarized, radiating patch element of a multimode patch-monopole monopulse feed. Such feeds are suitable for the prime-focus illumination of a deep symmetric reflector. A relatively simple and compact feed design allows for a compact single-mirror antenna with monopulse tracking. The feed is about a wavelength in diameter, also making it suitable for illuminating smaller antennas, for example, in LEO-satellite ground (client) stations. The design applies a slotted circular patch as a circularly-polarized sum-channel element. The design variables are optimized mainly for the sum-channel aperture illumination efficiency in an S-band satellite ground station. After a few cut-and-try iterations, the final feed prototype was produced and measured. In addition to an additional degree of freedom in the geometry and potentially easier fabrication, the new sum-channel radiating-element shape allows for a slightly better monopulse channel isolation, and a higher radiation-pattern symmetry compared to the previous design. [ABSTRACT FROM AUTHOR]

Background: Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown. Purpose: To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach. Results: At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group (P ≥.999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group (P =.301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales. Conclusion: Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment—including exercise therapy for ≥3 months—does not relieve patient's symptoms. Registration: Clinical Trials NCT01288768 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: The Latarjet procedure is increasingly being utilized for the treatment of glenoid bone loss and has a relatively high neurological complication rate. Understanding the position-dependent anatomy of the axillary nerve (AN) is crucial to preventing injuries. Purpose: To quantify the effects of changes in the shoulder position and degree of glenoid bone loss during the Latarjet procedure on the position of the AN. Study Design: Controlled laboratory study. Methods: A total of 10 cadaveric shoulders were dissected, leaving the tendons of the rotator cuff and deltoid for muscle loading. The 3-dimensional position of the AN was quantified relative to the inferior glenoid under 3 conditions: (1) intact shoulder, (2) Latarjet procedure with 15% bone loss, and (3) Latarjet procedure with 30% bone loss. Measurements were obtained at 0°, 30°, and 60° of glenohumeral abduction (equivalent to 0°, 45°, and 90° of shoulder abduction) and at 0°, 45°, and 90° of humeral external rotation (ER). Results: Abduction of the shoulder to 60° resulted in a posterior (9.5 ± 1.1 mm; P <.001), superior (3.0 ± 1.2 mm; P =.013), and lateral (19.1 ± 2.3 mm; P <.001) shift of the AN, and ER to 90° resulted in anterior translation (10.0 ± 1.2 mm; P <.001). Overall, ER increased the minimum AN-glenoid distance at 30° of abduction (14.9 ± 1.3 mm [0° of ER] vs 17.3 ± 1.5 mm [90° of ER]; P =.045). The Latarjet procedure with both 15 and 30% glenoid bone loss resulted in a superior and medial shift of the AN relative to the intact state. A decreased minimum AN-glenoid distance was seen after the Latarjet procedure with 30% bone loss at 60° abduction and 90° ER (17.7 ± 1.6 mm [intact] vs 13.9 ± 1.6 mm [30% bone loss]; P =.007), but no significant differences were seen after the Latarjet procedure with 15% bone loss. Conclusion: Abduction of the shoulder induced a superior, lateral, and posterior shift of the AN, and ER caused anterior translation. Interestingly, the Latarjet procedure, when performed on shoulders with extensive glenoid bone loss, significantly reduced the minimum AN-glenoid distance during shoulder abduction and ER. These novel findings imply that patients with substantial glenoid bone loss may be at a higher risk of AN injuries during critical portions of the procedure. Consequently, it is imperative that surgeons account for alterations in nerve anatomy during revision procedures. Clinical Relevance: This study attempts to improve understanding of the position-dependent effect of shoulder position and glenoid bone loss after the Latarjet procedure on AN anatomy. Improved knowledge of AN anatomy is crucial to preventing potentially devastating AN injuries during the Latarjet procedure. [ABSTRACT FROM AUTHOR]

Background: Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. Purpose: The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. Patients and methods: In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6 weeks, 12 weeks, 6 months, 1 year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. Results: The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. Conclusion: In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. Level of evidence IV: Retrospective case series study. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical, radiological, and functional outcomes after of radioscapholunate (RSL) fusion for intra-articular malunion of the distal radius. Methods: This retrospective study included 26 patients (17 males and 9 females) with intra-articular malunion of distal radius fractures who underwent RSL arthrodesis using locked miniplates (without distal scaphoid excision) between 2012 and 2020. Their mean age was 43 years (range, 32–56). Patients were assessed radiographically for union and clinically for range of motion, grip strength, and pain (assessed by Visual Analogue Scale (VAS) for pain). Functional evaluation was performed by using the Mayo modified wrist score (MMWS) and the Disabilities for the Arm, Shoulder, and Hand (DASH) questionnaire. Results: All patients showed complete healing at the fusion site after a mean of 8.7 weeks (range, 8–12). The mean follow-up period was 72 months (range, 60–84). The pinch strength improved from a mean of 6.2 kg (range, 3–12) to a mean of 9.8 kg (range, 5–18) which represents 80% of the contralateral side. The mean pinch strength was 7 kg (range, 5–18) which presents 80% of the other side. VAS for pain showed a mean improvement of 72.6%. The DASH score improved to a mean of 19.2 (range, 14–24). The MMWS improved to a mean of 68 (range, 45–86). At the final follow-up period, no degenerative changes were detected in the midcarpal joint. Conclusion: RSL arthrodesis (using locked miniplates without distal scaphoid excision) is a reliable surgical procedure to manage cases of radiocarpal OA after intra-articular malunion of distal radius fractures with good clinical and radiological outcomes. Level of evidence: Level IV- therapeutic. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee. Design: A randomized-controlled trial. Setting: Special Rehabilitation Services in Taboão da Serra. Participants: Patients with bilateral knee osteoarthritis. Intervention: Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks. Main outcome measures: The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up). Results: There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was −3.08 points (95% confidence interval −4.13; −2.02), p < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was −2.40 points (95% confidence interval −3.34; −1.45), p < 0.01 with an effect size of 1.24; and mean difference for disability was −4.08 points (95% confidence interval −5.89; −2.26), p < 0.01 with an effect size of 1.04. Conclusion: Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months. [ABSTRACT FROM AUTHOR]

Objective: The Posterior Standing Overhead Arm Reach (SOAR) test has been previously reported as a reliable clinical measure of closed chain hip extension motion. The proposed Medial SOAR test expands on that testing approach to provide a similar measure of functional hip adduction motion. This was a preliminary intrarater and interrater reliability and validity study of the Medial SOAR test as a measure of functional hip adduction. Design: Cross-sectional. Setting: University motion analysis laboratory. Participants: Fifty hips were assessed in 25 (22 female) asymptomatic participants (mean age = 23.4 years, SD = 0.8). Main measures: Maximum hip adduction during the Medial SOAR test was measured with a standard goniometer independently by two examiners. The test was also performed using three-dimensional motion capture. The intrarater and interrater reliability of the goniometric measure was determined using intraclass correlation coefficients, and the relationship between measures obtained via goniometry and three-dimensional motion capture was assessed with Pearson correlations and Bland–Altman analysis. Results: Intrarater reliability (ICC2,3) was 0.88 (95% CI = 0.80–0.92) for Examiner 1 and 0.87 (95% CI = 0.79–0.92) for Examiner 2. The standard error of measurement and minimal detectable change were less than 3.0°. Interrater reliability demonstrated an intraclass correlation coefficient = 0.62 (95% CI = 0.28–0.79). Pearson correlations were significant with low-to-moderate associations (r = 0.49, P < 0.001; r = 0.24, P = 0.045). Conclusions: Similar to the previously reported Posterior SOAR test, the Medial SOAR test demonstrated acceptable intrarater and interrater reliability, along with low-to-moderate associations with three-dimensional motion capture. The Medial SOAR test has the potential to provide a reliable and accurate assessment of closed chain hip adduction. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is an orthopaedic operation that improves quality of life and reduces pain in patients with disabling arthritis of the knee. One commonly recognized complication is flexion contracture of the knee. Early physical therapy helps prevent flexion contracture and improve range of motion (ROM) postoperatively. This study evaluated postoperative sleeping position and its effect on terminal knee extension and ROM following primary TKA. We hypothesized that patients who slept in the supine position would achieve earlier knee extension and greater ROM when compared to those in the lateral recumbent position. A total of 150 consecutive primary TKAs were performed by a single surgeon (J.M.C.) from April 2014 to December 2014. The data were collected prospectively to determine preoperative ROM, postoperative ROM, and sleeping position. Mean postoperative terminal extension ROM at 1 month was 2.9 degrees in the supine group versus 6.0 degrees (p < .001) in the lateral group. No significant demographic differences between the two groups at baseline were found. Our results demonstrate that sleeping position affects initial postoperative terminal extension, however, not overall ROM. We found a statistically significant difference in extension when comparing patients in the supine versus lateral group. Patients who slept in the lateral position lacked 6 degrees of extension which is greater than the 5 degrees needed for normal gait mechanics. Those in the supine group lacked 2.9 degrees of extension, allowing for normal gait mechanics. This study identifies an easy, effective means of increasing patients initial ability to achieve knee extension and satisfaction following TKA. [ABSTRACT FROM AUTHOR]

Objective Lower limb deformity in children with cerebral palsy (CP) is a common musculoskeletal problem and planovalgus is the most prevalent, characterized by talus median subluxation, calcaneal valgus, and supinated forefoot. According to studies, one issue in orthopedics and pathology is the accurate diagnosis and proper treatment of planovalgus deformity in children with bilateral spastic cerebral palsy, which has attracted researchers’ attention. Accordingly, the present study investigates the effect of planovalgus deformity on the motor performance and balance of these children. Materials & Methods This cross-sectional study employed a descriptive-analytical design. The convenient sampling method was used among children with bilateral spastic cerebral palsy, diagnosed with unilateral planovalgus, who were referred to the clinics of the University of Social Welfare and Rehabilitation Sciences (Nezam Mafi) and occupational therapy clinics from September 2022 to February 2023 in Tehran City, Iran. Meanwhile, all participants were willing to cooperate in this research. A total of 27 participants were evaluated by an occupational therapist based on the specified criteria and gross motor function classification system (GMFCS), which included the assessments of balance, muscle strength, range of motion, and pain. Data analysis was done using the SPSS software, version 16. Results The results revealed a statistically significant difference between the mean range of motion of ankle dorsiflexion and knee extension between the two limbs (P<0.001). The mean muscle strength of the quadriceps and ankle plantar flexors indicated a statistically significant difference in the affected limb (P<0.001). Additionally, the mean displacement of the center of pressure of the foot also demonstrated a statistically significant difference regarding topographical involvement (P<0.001). Conclusion Planovalgus deformity is one of the most common ankle deformities, which is of great concern for children with cerebral palsy. The results obtained from the assessments of the child’s balance and motor function demonstrated the importance of assessment strategies and early interventions to achieve better rehabilitation outcomes for children with CP and planovalgus deformity. [ABSTRACT FROM AUTHOR]

Background: Tendinitis is a prevalent musculoskeletal disorder affecting the shoulder joint. Low-power lasers have been demonstrated to have beneficial effects, such as pain reduction and increased range of motion, in treating shoulder tendinitis. Objectives: The aim of this study was to examine the impact of high-power lasers on improving the clinical symptoms of individuals with rotator cuff tendinopathy. Methods: This study was a randomized, single-blind clinical trial involving 41 patients who were divided into 2 groups: The intervention group (21 participants) and the control group (20 participants). Both groups received the same physiotherapy treatment. However, the intervention group additionally received high-power laser treatment. Before and after the treatment, all patients completed the Visual Analog Scale (VAS) to assess pain intensity and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire to evaluate shoulder functional activity. Shoulder range of motion was measured using a goniometer. Results: The average scores of both the VAS and DASH questionnaires showed a significant decrease after treatment in both the high-power laser and control groups (P = 0.001). However, the decrease in the intervention group was greater than that in the control group, and this difference was also statistically significant (P = 0.001). Following treatment, both groups exhibited a statistically significant reduction in the painful range of motion of the shoulder joint (P = 0.002). However, the difference between the 2 groups in this regard was not significant (P = 0.20). Conclusions: The combination of high-power laser treatment with conventional physiotherapy appears to have enhanced therapeutic effects. The laser's anti-inflammatory mechanism may have contributed to accelerated pain reduction and improved joint function. However, further studies are necessary to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

Background The hip's primary function is to dynamically support the weight of the trunk while allowing the force and load transmission axial skeleton to the lower extremity and henceforth allowing mobility. The function of the hip is not only to take the load of the trunk to the lower extremity but also to perform daily activities which include walking, running, jumping, sitting, etc. Hip muscle strength is required to stabilize the pelvic and trunk during squatting and walking (single stance) and to perform other daily living activities. The prevalence rate reports that males are more physically active than females. The number of physical activities has shown to be decreased in teens and young adults between the ages of 14 and 22 years due to transitions in their lifestyle. These changes can be behavioral and due to body composition. The objectives of the study are to determine the influence of hip mobility and strength on the spatial and temporal parameters of gait. Methodology This is a cross-sectional study involving a total of 50 young female populations that have been selected based on the inclusion criteria. Hip range of motion using a universal goniometer was measured in three trials with 30 seconds of rest between each measurement. The hip muscle strength was measured using a handheld dynamometer with 5 seconds hold and three trials taking 30 seconds of rest between each measurement. Spatial parameters of gait were measured by using Kinovea software V.0.8.15, and temporal parameters of gait were measured by asking the subject to walk comfortably in their own speed for 1 minute and the video was taken and measured. Result The hip internal rotation and external rotation has shown to have a statistical significance with spatial and temporal parameters of gait. The hip abductors, adductors, internal rotators, and external rotator muscle strength have shown to have statistical significance with spatial and temporal parameters of gait. Descriptive statistics were used for demographic characteristics, and Pearson's correlation coefficient is used for determining association between outcome variables. Conclusion The hip abductors, adductors, internal rotators, and external rotators have shown to have influence on gait parameters specially with walking speed. The hip internal and external rotation has shown to have influence on gait parameters. [ABSTRACT FROM AUTHOR]

Background: Weakness of the gluteus muscle is associated with multiple types of injuries such as low back, hip and knee pathology. However, there is no research regarding the effect of gluteal isometric exercises on abdominals, back extensors and quadriceps muscles strength. Hence, this study aimed to demonstrate the effect of gluteal isometric exercises on abdominals, back extensors and quadriceps strength. Methods: A total of 100 healthy students aged between 18 and 25 years were recruited to participate in an 8-week program of gluteal muscle isometric exercises. The strength of the abdominal, back extensor, and quadriceps muscles was assessed both at baseline and after the 8-week intervention period. Results: A paired sample t-test revealed significant improvements in abdominal muscles, back extensor muscle strength (p<0.001), and quadriceps muscle strength (p=0.037) after an 8-week intervention. The greatest increases were observed in the abdominals (59.05%), back extensors (46.78%), and quadriceps (7.13%). Conclusion: This study demonstrates that gluteal isometric exercises had a significant positive effect on the strength of abdominals, back extensors and quadriceps muscles. [ABSTRACT FROM AUTHOR]

Background The modified Thomas test (MTT) is commonly used to assess the flexibility of hip musculature, including the iliopsoas, rectus femoris, and tensor fascia latae. This measurement is important to include in a comprehensive musculoskeletal examination. However, existing research shows conflicting results regarding its reliability, particularly due to variations in controlling pelvic tilt during testing, which may lead to inaccurate measurements of hip extension when quantifying the test outcomes. Purpose/Hypothesis This study aimed to evaluate the intra- and inter-rater reliability of the Modified Thomas Test (MTT) in assessing hip flexor length using a goniometer. It was hypothesized that controlling for pelvic tilt would enhance the reliability of these measurements. Study Design Intra- and inter-rater reliability study Methods Sixty-four healthy individuals were recruited to participate in this study. The MTT was performed twice on each leg by both an experienced and a student physical therapist. Blinded goniometric measurements for hip extension range of motion (ROM) in the MTT position were taken with neutral pelvic tilt being enforced via palpation. A double-blind protocol was used where both examiners were unaware of each other's measurements and the goniometer was covered to blind the measuring therapist to the values as well. ROM values were entered into a Microsoft Excel spreadsheet and quantified using SPSS software. Statistical analysis included calculating Intraclass Correlation Coefficients (ICCs) and Standard Errors of Measurement (SEMs) using SPSS software. Results The study included 64 participants (mean age = 23.7 ± 4.34 years). The MTT demonstrated high intra-rater reliability (ICC = 0.911) and inter-rater reliability (ICC = 0.851). The SEMs indicated minimal variability around the mean scores. The average hip extension ROM measured was 5.43± 9.73 degrees. Conclusion These results suggest that the MTT is a reliable tool for assessing hip flexor length in clinical practice, particularly when pelvic tilt is controlled. These results have important implications for accurately testing orthopedic limitations that can contribute to low back, hip, and knee pain. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Context: Limited research reveals that the use of different soft tissue mobilization techniques increases tissue mobility in different regions of the body. Objective: The purpose of this study was to determine whether there is a difference between administering instrument-assisted soft tissue mobilization (IASTM) and therapeutic cupping (TC) on hamstring tightness. Design: Subjects attended one session wherein treatment and leg order were randomized before attending the session. A statistical analysis was completed using a 2 (intervention) × 2 (time) repeated-measures analysis of variance at α level ≤.05. Participants: Thirty-three subjects between the age of 18–35 years old with bilateral hamstring tightness participated in this study. Interventions: The IASTM and TC were administered on different legs for 5 minutes and over the entire area of the hamstring muscles. One TC was moved over the entire treatment area in a similar fashion as the IASTM. Main Outcome Measures: The intervention measurements included soreness numeric rating scale, Sit-n-Reach (single leg for side being tested), goniometric measurement for straight-leg hip-flexion motion, and superficial skin temperature. The timeline for data collection included: (1) intervention measurements for the first randomized leg, (2) 5-minute treatment with the first intervention treatment, (3) intervention measurements repeated for postintervention outcomes, and (4) repeat the same steps for 1 to 3 with the contralateral leg and the other intervention. Results: There was a main effect over time for Sit-n-Reach, measurement (pre-IASTM—29.50 [8.54], post-IASTM—32.11 [8.31] and pre-TC—29.67 [8.21], post-TC—32.05 [8.25]) and goniometric measurement (pre-IASTM—83.45 [13.86], post-IASTM—92.73 [13.20] and pre-TC—83.76 [11.97], post-TC—93.67 [12.15]; P <.05). Conclusion: Both IASTM and TC impacted hamstring mobility during a single treatment using only an instrument-assisted soft tissue mobilization technique without any additional therapeutic intervention. [ABSTRACT FROM AUTHOR]

To evaluate the balance in patients with total knee arthroplasty (TKA) and knee osteoarthrosis (KOA), measured by postural stability computerized evaluation (PSCE), and to evaluate the effect of post-TKA patients' characteristics in their performance on PSCE. An observational cross-sectional study was conducted in two sets of patients: (A) patients with KOA and primary TKA surgery scheduled and (B) patients who underwent primary TKA >9 months. Sociodemographic, radiographic, clinical and PSCE parameters (using the Biodex Balance System) were assessed. Post-TKA patients placed more load on the replaced knee than the contralateral osteoarthritic knee (p = 0.027). They had less imbalance on the balance tests performed with the eyes open, on stable (p = 0.032), and unstable platforms (p = 0.022). These patients also showed better postural stability in monopodalic stance, both standing on the TKA (p = 0.010) and contralateral knee (p = 0.017). Age, weight, pain on the operated knee, extension deficit on the operated knee, and Berg Balance Scale scores on post-TKA patients were significantly associated with their performance on PSCE tests. PSCE can be useful to quantify the balance of post-TKA and KOA patients. Total knee arthroplasty is the definitive treatment for knee osteoarthrosis and it has several benefits, but its effect on balance is still unknown. Postural stability computerized evaluation is used to evaluate balance on vestibular diseases and it has been recently studied on musculoskeletal conditions. Postural stability computerized evaluation may be useful to evaluate patients' balance before and after total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Patients with knee osteoarthritis (KOA) are at high risk for falls, which is attributed to their impaired balance control. Identifying factors associated with balance control facilitates the development of precise KOA rehabilitation programs. This study was to investigate the correlations of balance control with proprioception, plantar tactile sensation (PTS), pain, joint range of motion (ROM), and strength among older adults with and without KOA, as well as the magnitudes and sequence of correlation of these factors to balance control. Methods: A total of 240 older adults with (n = 124, female: 84, age: 68.8 ± 4.0 years) and without (n = 116, female: 64, age: 67.9 ± 3.5 years) KOA were recruited and assigned to the KOA and control groups. Their proprioception, PTS, pain, ROM, and strength were measured. Pearson or Spearman correlations were used to test whether they were significantly related to their Berg Balance Scale (BBS), and factor analysis and multivariate linear regression were used to determine the degrees of correlation between each factor and the BBS. Results: Compared to the control group, the KOA group had lower BBS score, larger proprioception and PTS thresholds, smaller ROM, and less strength (p: 0.008, < 0.001–0.016, < 0.001–0.005, < 0.001–0.014, and < 0.001–0.002, respectively). In the KOA group, the BBS was weakly to moderately correlated with proprioception, PTS, pain, ROM, and strength (r: 0.332–0.501, 0.197–0.291, 0.340, 0.212–0.508, and 0.236–0.336, respectively). While in the control group, the BBS was correlated with proprioception and strength (r: 0.207–0.379, and 0.212–0.410). In the KOA group, BBS = 54.41+ (0.668*strength) - (0.579*PTS) - (1.141*proprioception) + (1.054* ROM) - (0.339*pain). While in the control group, BBS = 53.85+ (0.441*strength) - (0.677*proprioception). Conclusion: Worse proprioception and PTS, smaller ROM, and less strength were detected among older adults with KOA, and their proprioception, PTS, pain, ROM, and strength were all related to balance control. Proprioception had the strongest correlations, followed by ROM, strength, pain, and PTS. Precise KOA rehabilitation programs may be proposed following the sequence of improving the five factors. Key points: • Worse proprioception and plantar tactile sensation, smaller joint range of motion, and less strength were detected among older adults with knee osteoarthritis. • Among older adults with knee osteoarthritis, balance control was sequentially correlated with proprioception, joint range of motion, strength, pain, and plantar tactile sensation. • Precise knee osteoarthritis rehabilitation programs may be proposed following the sequence of improving proprioception, joint range of motion, strength, pain, and plantar tactile sensation. [ABSTRACT FROM AUTHOR]

Background/Aims: Dry needling is widely used to treat myofascial pain and related musculoskeletal conditions. Recently, the use of dry needling for the management of post-stroke spasticity has been proposed. The aim of this study was to evaluate the immediate effect of dry needling of spastic muscles on pain, spasticity, and pain pressure threshold in the elbow and wrist muscles of patients who have had a stroke. Methods: This quasi-experimental, pre–post design feasibility study implemented dry needling in wrist or elbow flexors. Outcome measures evaluated muscle spasticity using the Modified Modified Ashworth Scale, pain pressure threshold and range of motion. Results: A total of eight participants (seven men and one woman) were included in the study. The average age was 57.00 ± 13.88 years. The Modified Modified Ashworth Scale scores decreased from 1.81 ± 0.84 to 1.25 ± 0.46 in the elbow flexors (P=0.066) and from 1.86 ± 0.69 to 1.29 ± 0.49 in the wrist extensors (P=0.046). Range of motion increased in the elbow, and there was a statistically significant increase in the range of motion in the wrist (P=0.027). Pain pressure threshold also increased statistically significantly in muscles related to the wrist and elbow (P=0.043 and P=0.035 respectively). Conclusions: Dry needling may decrease spasticity, increase range of motion and pain pressure threshold in treated muscles and improve functional gains in the spastic limb. Further, more extensive studies are essential to assess the use of dry needling in managing post-stroke spasticity. Implications for practice: Physiotherapists can use dry needling in spastic muscles when treating patients who have had a stroke. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the intrarater and interrater reliability and validity of range of motion measurements obtained with a universal goniometer, digital inclinometer, and smartphone application in patients with total knee arthroplasty. Methods: Range of motion of the knee joint was measured by two examiners with a universal goniometer, digital inclinometer, and a smartphone application. Data were obtained from 51 knees of 27 patients at postoperative 6 months. Two measurements made by the first examiner were compared to assess interrater reliability, and measurements from both examiners were compared to assess intrarater reliability. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Spearman's rho values. Results: With all three methods, active and passive knee flexion range of motion measurements showed high intrarater and interrater reliability (ICC = 0.749–0.949). Concurrent validity analysis also demonstrated statistically significant, moderate to strong correlation among the three methods (r = 0.775–0.941). Conclusion: The universal goniometer, digital inclinometer, and smartphone application were all found to be reliable and valid assessment tools in clinical practice for patients with total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Objectives: Patients with injuries to the deep fibers of the medial collateral ligament (dMCL) have a worse prognosis than patients with injuries to the superficial fibers (sMCL). The anterior medial (ANTMED) rotation test has been developed to differentiate between injuries to the dMCL and sMCL. The current study tested the hypothesis that the width of the medial knee gap would be greater during the valgus stress test than the ANTMED rotation test. Methods: Fifty‐three participants were included in the study. Participants did not have a history of knee injury. Ultrasound images of the participants' medial knees were collected during the valgus stress test and the ANTMED rotation test. Repeated measures ANOVA was used to test differences in the medial knee gap between the tests, stress condition, and side. Results: No difference between the tests in the medial knee joint gap width in the no‐stress condition. The increase in the joint gap width was greater during the valgus stress test than the ANTMED rotation test. The medial knee gap increased during both the valgus stress (4.0 ± 0.12 mm) and the ANTMED rotation test (2.9 ± 0.12 mm). Conclusions: A greater increase in the medial knee gap was seen during the valgus stress test compared to the ANTMED rotation test. Knee external rotation increases the tension within the dMCL. Increased tension in the dMCL could explain the test differences in the increase in the joint gap found in the current study. The ANTMED rotation test may prove useful to identify injury to the dMCL. [ABSTRACT FROM AUTHOR]

Purpose: In incomplete spinal cord injury (SCI), there is a partial decrease in motor or sensory or autonomic function. Mainly due to the motor impairment in SCI, a muscle–machine interface is a tool that can bring functional benefits to this population. Objective: To investigate the feasibility of the non-invasive myoelectric signal–functional electrical stimulation (MES-FES) interface on the response of the quadriceps muscle in an individual with incomplete SCI. Methods: This is a quasi-experimental, uncontrolled, longitudinal case report study carried out with an individual with incomplete SCI in the chronic phase. The assessments performed before (pre) and after eight (post8) interventions were neuromuscular assessment (surface electromyography (EMG) in rectus femoris (RF) and vastus lateralis (VL) muscles); muscle strength (load cell); knee extension range of motion (goniometry); spasticity (Modified Ashworth Scale); and quality of life (Spinal Cord Injury Quality-of-Life Questionnaire (SCI-QoL.Br)). The MES-FES interface was associated with physical therapy exercises on the extension knee joint muscle group. Results: Improvement in neuromuscular activation (normalized increase in EMGRMS of 2% (RF) and 3.3% (VL)) and synchronism of the motor units (normalized reduction in EMGMDF of 22.8% (RF) and 5.9% (VL)); 1.4 kgf increase in quadriceps strength; 10.6° increase in knee joint extension amplitude; 1 point spasticity reduction; improved quality of life, confirmed by a 12-point reduction in the SCI-QoL.Br score. Moreover, along with interventions, the participant increased the correct FES activation rate, indicating a user learning curve (ρ = 0.78, p-value = 0.04). Conclusions: The MES-FES interface associated with physical therapy promotes neuromuscular and quality of life improvements in the SCI participant. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the efficacy of manual therapy and exercise versus synchronized telerehabilitation with self-manual therapy and exercise in treating Subacromial Pain Syndrome (SAPS). Sixty individuals diagnosed with SPS, aged 18–50 years, were randomly assigned to home exercise (HE), manual therapy (MT), and telerehabilitation (TR) groups. Treatment protocols were administered over 8 weeks and included specific exercises and therapy interventions. Outcome measures included the Visual Pain Scale (VAS), shoulder range of motion (ROM) via goniometric measurements, Quick Disability Arm-Shoulder-Hand Problems Survey (Q-DASH), and patient satisfaction. Results revealed that both MT and TR groups exhibited reduced pain, increased ROM, lower Q-DASH scores, and higher patient satisfaction than the HE group. However, no significant differences were found between the MT and TR groups regarding pain levels, ROM, Q-DASH scores, or patient satisfaction. The study concludes that both telerehabilitation and manual therapy effectively alleviate pain and are well-received by patients with SPS. Additionally, manual therapy demonstrates superiority in enhancing functional levels compared to exercise-based interventions (Registration: NCT05200130). [ABSTRACT FROM AUTHOR]

Background: Generalized joint hypermobility (GJH) is prevalent among young adults, necessitating effective monitoring of musculoskeletal health, particularly among college-aged females. This study aimed to identify physical fitness and health-related quality of life (HR-QoL) characteristics associated with GJH. Methods: A total of 67 participants were assessed: 26 with GJH (mean age 20.06, SD 1.2 years), and 41 without (mean age 20.15, SD 2.2 years). Assessments included hypermobility, anthropometric data, foot posture, balance, flexibility, strength, and HR-QoL. We used the Mann–Whitney test for two independent samples, categorical variables were analyzed with Cramer's V test. The results indicated that participants with GJH exhibited inferior balance and back muscle static strength endurance but greater flexibility compared to those without GJH. Significant differences were observed in foot posture. However, handgrip strength, explosive strength, and abdominal muscle static strength endurance did not differ significantly between groups. No significant differences were observed in HR-QoL components between the two groups. In conclusion, there appears to be a link between GJH and increased flexibility, impaired balance, reduced back muscle static strength endurance, and altered posture of both feet. [ABSTRACT FROM AUTHOR]

The purpose of the present cross-sectional study was to examine the relationship between heart rate variability (HRV) and the range of cervical motion, disability, pain intensity, pain catastrophizing, and quality of life in patients with chronic, non-specific neck pain. Thirty-five patients, aged 20–48 years, with chronic non-specific neck pain, completed validated questionnaires regarding neck pain intensity, pain-associated disability, catastrophic thoughts, and quality of life. The range of cervical motion was assessed using a digital goniometer. HRV indices were recorded in three positions (supine, sitting, and standing) through a smartphone application. Several significant correlations were observed between HRV indices and neck pain disability, the helplessness factor of catastrophizing, neck rotation, and quality of life. These correlations were only observed in the standing position. Pain catastrophizing was positively correlated with disability and pain intensity during active neck movement (Pearson r = 0.544, p < 0.01; Pearson r = 0.605, p < 0.01, respectively). Quality of life was negatively correlated with pain intensity during active movement (Pearson r = −0.347, p < 0.05). HRV indices were correlated with the psychological and physical domains of neck pain. These cardiac indices have been related to neck pain variables in some previous studies. Further research is needed to confirm this relationship in different daily conditions. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effects of four different immobilization methods [single sugar tong splint (SSTS), double sugar tong splint (DSTS), short arm cast (SAC), and long arm cast (LAC)] commonly used for restricting forearm rotation in the upper extremity. Methods: Forty healthy volunteers were included in the study. Dominant extremities were used for measurements. Basal pronation and supination of the forearm were measured with a custom-made goniometer, and the total rotation arc was calculated without any immobilization. Next, the measurements were repeated with the SAC, LAC, SSTS and DSTS. Each measurement was compared to the baseline value, and the percentage of rotation restriction was calculated. Results: The most superior restriction rates were observed for the LAC (p = 0.00). No statistically significant difference was detected between the SSTS and DSTS in terms of the restriction of supination, pronation or the rotation arc (p values, 1.00, 0.18, and 0.50, respectively). Statistically significant differences were not detected between the SAC and the SSTS in any of the three parameters (p values, 0.25; 1.00; 1.00, respectively). When the SAC and DSTS were compared, while there was no significant difference between the two methods in pronation (p = 0.50), a statistically significant difference was detected in supination (p = 0.01) and in the total rotation arc (p = 0.03). Conclusion: The LAC provides superior results in restricting forearm rotation. The SAC and SSTS had similar effects on forearm rotation. The DSTS, which contains, in addition to the SSTS, a sugar tong portion above the elbow, does not provide additional rotational stability. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to compare maximal force, force steadiness, and the discharge characteristics of motor units in the tibialis anterior (TA) muscle during submaximal isometric contractions for ankle dorsiflexion and adduction of the foot. Methods: Nineteen active young adults performed maximal and submaximal isometric dorsiflexion and adduction contractions at five target forces (5%, 10%, 20%, 40%, and 60% maximal voluntary contraction [MVC]). The activity of motor units in TA was recorded by high-density EMG. Results: The maximal force was similar between dorsiflexion and adduction, despite EMG amplitude for TA being greater (P < 0.05) during dorsiflexion than adduction. The coefficient of variation (CV) for force (force steadiness) during dorsiflexion was always less (P < 0.05) than during adduction, except of 5% MVC force. No differences were observed for mean discharge rate; however, the regression between the changes in discharge rate relative to the change of force was significant for dorsiflexion (R² = 0.25, P < 0.05) but not for adduction. Discharge variability, however, was usually less during dorsiflexion. The CV for interspike interval was less (P < 0.05) at 10%, 20%, and 40% MVC but greater at 60% MVC during dorsiflexion than adduction. Similarly, the SD values of the filtered cumulative spike train of the motor units in TA were less (P < 0.05) at 5%, 10%, 20%, and 40% MVC during dorsiflexion than adduction. Conclusions: Although the mean discharge rate of motor units in TA was similar during foot adduction and ankle dorsiflexion, discharge variability was less during dorsiflexion resulting in less accurate performance of the steady adduction contractions. The neural drive to bifunctional muscles differs during their accessory function, which must be considered for training and rehabilitation interventions. [ABSTRACT FROM AUTHOR]

Background: Superior capsular reconstruction (SCR) and lower trapezius tendon transfer (LTT) have recently been used to manage irreparable posterosuperior rotator cuff tears (PSRCTs). There has been a paucity of comparative biomechanical considerations between the 2 procedures. Purpose: To compare the glenohumeral stability and biomechanical properties between SCR and LTT in PSRCTs involving the entire infraspinatus tendon region. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders were tested at 0°, 20°, and 40° of shoulder abduction. Maximum internal, external, and total humeral range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were compared among 4 conditions: (1) intact rotator cuff, (2) PSRCTs involving the entire infraspinatus tendon region, (3) LTT using Achilles allograft (12 N and 24 N of loading), and (4) SCR using fascia lata allograft. Results: Although a decrease in total ROM was noted in LTT with 12 N compared with the tear condition, LTT with both 12 N and 24 N as well as SCR did not restrict total rotational ROM compared with the intact condition. LTT had decreased total ROM compared with tear condition at 20° of abduction (P =.042), while no significant decrease was confirmed at all abduction angles after SCR. SCR and LTT with 24 N decreased superior translation compared with the PSRCT condition at 0° and 20° of abduction (P <.037) but not significantly at 40° of abduction, whereas LTT with a 24-N load decreased glenohumeral superior translation at all abduction angles (P <.039). Both SCR and LTT decreased subacromial contact pressure compared with the tear condition (P <.014) at all abduction angles. SCR decreased subacromial contact pressure at 0° and 40° of abduction (P =.019 and P =.048, respectively) compared with LTT with 12 N of loading, while there was no difference between SCR and LTT with 24 N of loading in all abduction angles. SCR increased the contact area compared with the PSRCT condition at all abduction angles (P <.023), whereas LTT did not increase the contact area. Conclusion: SCR and LTT decreased glenohumeral superior translation and contact pressure compared with PSRCT conditions. The LTT was superior to SCR in terms of superior translation of the humeral head at a higher shoulder abduction angle, whereas the SCR showed more advantageous subacromial contact characteristics compared with LTT. Clinical Relevance: These biomechanical findings provide insights into these 2 fundamentally different procedures for the treatment of young and active patients with PSRCTs involving the entire infraspinatus tendon region. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to demonstrate the relationship between exercise barriers-benefits with joint range of motion (ROM), quality of life, and physical performance in individuals with total hip arthroplasty (THA). Material and Method: A cross-sectional observational study was conducted with fifty older individuals with THA. Patients were evaluated with the 5-Times Sit and Stand Test (5TSTS), Exercise Benefits and Barriers Scale (EBBS), and EuroQol (EQ-5D-5L) Quality of Life Scale. In addition, the patient's active ROM was measured with a universal goniometer. Results: There was a significant low correlation between body mass index (BMI) and EBBS-Benefits sub-score (r=-0.286 p<0.05). EQ-5D-5L VAS was weakly correlated with EBBS (r=-0.291, p<0.05). 5TSTS was moderately correlated with EBBS Barriers sub-score, EBBS Benefits sub-score, and EBBS total score, respectively (r1=0.354, r2=0.440, r3=0.444, p1<0.05, p2,3<0.01). EBBS Barriers sub-score strongly correlated with EBBS Benefits sub-score and EBBS total score, respectively (r1=0.709, r2=0.826, p<0.01). In addition, the EBBS Benefits sub-score was highly correlated with the EBBS total score (r=0.983, p<0.01). There was a low to moderate correlation between the EBBS Barriers sub-score and all active ROM measures (p<0.05). Conclusion: Individuals' exercise barriers and benefits were mainly associated with physical performance. Participants with higher exercise benefits from exercise had higher physical performance, ROM, and quality of life. [ABSTRACT FROM AUTHOR]

Objective The purposes of this pilot study were to compare short-term outcomes of the Perception-Action Approach (P-AA) and standard care based on 5 components of first-choice interventions listed in the congenital muscular torticollis (CMT) clinical practice guideline. Changes in postural alignment, symmetrical use of both sides of the body during movement and play, gross motor development, and behavior observed during therapy were considered. Methods Thirty-two participants were enrolled in a 2-group (P-AA and standard care) randomized, single-blind trial with pre–posttest measures. Participants were infants with CMT, age range 5 to 35 weeks at enrollment. Outcome measures administered at initial and final evaluations included still photography, arthrodial goniometry, Muscle Function Scale, Alberta Infant Motor Scale, and Functional Symmetry Observation Scale. Participants in both groups attended 3 intervention sessions. Their behavior exhibited during therapy was compared using the Therapy Behavior Scale Version 2.2. Results Data collection was interrupted by the COVID-19 pandemic lockdown. Twenty-four infants completed the study (10 in P-AA and 14 in the standard care group). There were no significant differences between the groups in performance at initial and final evaluations. Both groups improved on most outcome measures. The P-AA group made greater gains on the Functional Symmetry Observation Scale, and the Therapy Behavior Scale Version 2.2 scores were higher in the P-AA group; however, these results did not reach significance. Conclusion Results suggest that similar short-term outcomes may be obtained in infants with CMT undergoing P-AA and standard care interventions. Definitive conclusions regarding the efficacy of the P-AA in infants with CMT cannot be made at this time. Nevertheless, the pilot findings provide valuable preliminary data for a future efficacy trial, which will require funding. Impact This was the first randomized controlled trial to provide evidence for use of P-AA intervention in infants with CMT. Lay Summary Compared to standard treatment, the Perception-Action Approach (P-AA) provided similar short-term benefits to infants with congenital muscular torticollis. The P-AA group participants demonstrated higher symmetry and behavior scores, which needs to be confirmed in a larger future study. [ABSTRACT FROM AUTHOR]

The purpose of this case series was to explore the influence of powered wheelchair standing device (PWSD) use on participants': (1) activities and participation; (2) quality of life; and (3) lower extremity passive range of motion (LE PROM). Eight participants enrolled in the case series (five adults and three children). Outcome measures included: the Canadian Occupational Performance Measure (COPM), the EQ-5D-5L or the EQ-5D-Y, the Patient-Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), LE PROM measurements and PWSD use data automatically collected by each PWSD. Participants were provided with a front wheel-drive PWSD designed for both outdoor and indoor use for up to 12-months of use. Four participants completed the 12-month case series. Three participants achieved clinically significant improvements in performance on the COPM. Three of the four participants reporting issues with constipation achieved clinically significant improvements in their total PAC-QOL scores. Almost all participants demonstrated changes in some LE PROM. Applying the Human Activity Assistive Technology model may help to explain differences in both PWSD use and outcomes amongst the individual participants in this case series. The participants who were most successful in using the PWSD were in environments with sufficient space to use the PWSD to perform everyday activities and had higher frequencies of PWSD use. The outcomes of this case series may assist both researchers and clinicians when implementing future PWSD studies recommending PWSDs to their clients/patients. A wide variety of factors may influence powered wheelchair standing device (PWSD) use. PWSD use may lead to improvements in activities, participation, quality of life and lower extremity passive range of motion. The participants who were most successful in using the PWSD were in environments that permitted use of the PWSD during the performance of everyday activities. COVID-19 restrictions prohibited in-person sessions with a therapist, which could have assisted participants in better integrating the PWSD in their daily lives. [ABSTRACT FROM AUTHOR]

Although the use of KT has increased considerably in the clinical practice in the last years, there is limited evidence about the effects of its application in proprioception. The aim of this study was to determine the effect of KT on joint position sense and force sense on the wrist of healthy subjects. Fifty-four subjects were analyzed in a randomized, crossover, single-blind study design. To determine the force sense, the subjects had to reach 50% of their maximum grip force. Wrist joint position sense was assessed during active repositioning tests at the target angles of 30° flexion and extension of wrist. A digital dynamometer was used to determine the sense of force and a digital goniometer was used to determine the joint position sense. Subjects were evaluated with KT (I- strip on ventral aspect of forearms from origin to insertion) and placebo (an inelastic tape was applied following the same procedure as KT). No significant differences have been found in the force sense, neither in the comparisons between control and interventions (p =0.286), nor between pre and post-intervention (p =0.111). For wrist joint position sense, a statistically significant effect (p < 0.05) was found at 30º of extension between the control and experimental group in favor of the control group. The application of KT did not produce changes in FS and only caused a significant improvement in JPS in extension (30º). The results appear to indicate that the application of KT to improve proprioception in healthy subjects should be reconsidered. • Kinesio tape applied on forearm did not improve force sense in healthy subjects. • Kinesio tape did not improve wrist joint position sense in healthy subjects. • The effect of Kinesio tape may be time-dependent. [ABSTRACT FROM AUTHOR]

Proprioception of the elbow is necessary for daily activities. Proprioception can be impaired with injury or pathology, and rehabilitation efforts seek to improve proprioception for improved upper extremity functioning. In clinical practice, joint position sense (JPS) testing is often utilized to assess conscious proprioception; however, varying methods exist with little evidence of psychometric properties, especially for the elbow. The primary aim of this study was to create a standardized elbow JPS test protocol using goniometry measurement to determine the most reliable testing position. The secondary aim was to determine if the elbow JPS test had acceptable test-retest reliability in healthy adults. This was a cross-sectional study using a convenience sample of healthy adults. Three elbow positions (45°, 60°, and 75° of elbow flexion) were measured twice on the same day by a single rater using a universal goniometer. We calculated the absolute error in degrees between each position and reposition and the intraclass correlation coefficient (3,1) for relative reliability. We also calculated the standard error of the measurement and visually inspected Bland-Altman plots for absolute reliability. Sixty-eight healthy adults (mean age 27.9 years, standard deviation 8.59) were assessed. The mean absolute error for all positions for test and retest was 5.7°. The intraclass correlation coefficients were moderate to good (0.57-0.75), and the standard error of the measurement was 2° (rounded) for all positions. The limits of agreement were moderately narrow, and the Bland-Altman plots showed a random distribution of errors for each position, indicating clinically acceptable measurement error. The joint position reproduction test for JPS using goniometry demonstrated moderate to good test-retest reliability and acceptable measurement error in healthy adults. The elbow joint angle of 60° flexion was the most reliable for JPS testing, providing insight for JPS assessment in clinical practice. • Goniometry joint position sense testing has moderate to good test-retest reliability. • Elbow joint position sense testing is most reliable at 60° of elbow flexion. • Further research is needed with patient populations to guide clinical assessment. [ABSTRACT FROM AUTHOR]

Accurate proprioception in the thumb carpometacarpal (CMC) joint is necessary during activities such as performing fine manipulative tasks, such as coin handling, opening doors, using keys, and pressing control buttons. The primary aim of the present study was to examine the test-retest reliability of CMC joint position sense (JPS) in healthy subjects. The secondary aim was to determine the most reliable JPS testing position for the thumb CMC joint. This was a cross-sectional study of a convenience sample of healthy adults. Three thumb positions (20°, 30°, and 40° of thumb abduction) were measured twice on the same day by a single rater using a universal goniometer. The absolute error in degrees between each position and reposition was calculated. The intraclass correlation coefficient (2,1) was calculated for relative reliability. The standard error of the measurement was calculated. Sixty-four healthy adults (mean age 27.8 years, standard deviation = 8.7) were assessed. The intraclass correlation coefficients were poor (−0.08 to 0.22), and the standard error of the measurement was 1.4° for all positions. The joint position reproduction test for JPS using goniometry demonstrated poor test-retest reliability and acceptable measurement error in healthy adults. • Joint position sense (JPS) error is the most widely used clinical measure of proprioception. • Intraclass correlation coefficient values of the JPS testing of the thumb demonstrated poor (0.04-0.40) test-retest reliability. • JPS testing demonstrated acceptable measurement error in healthy adults. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the relationship between the scores of upper extremity functional tests with isokinetic strength, range of motion, shoulder proprioception, and posture of male volleyball players. Methods: A total of 30 male university volleyball players aged 18 to 24 years were selected by the convenience sampling method. The concentric... [ABSTRACT FROM AUTHOR]

Background: Chronic venous insufficiency (CVI) often leads to venous ulcers. The relationship between ankle joint range of motion (ROM) and venous ulcers remains under-investigated. This study aims to clarify this relationship using ultrasound imaging. Methods: We conducted a study on 20 patients with unilateral venous ulcers. Ankle ROM and popliteal vein blood flow were measured using a goniometer and ultrasound, respectively. The measurements were compared between the affected and unaffected limbs. Results: A significant reduction in ROM and popliteal vein blood flow was observed in the limbs with venous ulcers compared to the unaffected limbs. The data suggest a correlation between reduced ankle mobility and the development of venous ulcers. Conclusion: The study underscores the importance of maintaining ankle mobility in patients with CVI to prevent venous ulcers. A multifactorial approach is essential for managing these conditions effectively. [ABSTRACT FROM AUTHOR]

Context: Iliotibial band syndrome (ITBS) is a common overuse injury in runners with parallels to our findings of overuse in Greco Roman wrestlers. Despite research indicating coordination and movement-based factors about the hip, no studies were found using functional motor control (FMC) in runners or wrestlers with ITBS. Thus, we compared FMC exercises and therapeutic exercises (TEs) on pain, function, muscle strength, and range of motion (ROM) in national-level Greco Roman wrestlers with ITBS. Design: Controlled laboratory study. Methods: Sixty national-level Greco Roman wrestlers diagnosed with ITBS were randomly assigned to 8 weeks of FMC exercises, TE, and a control group (20 individuals for each group). Pain (visual analog scale), function (triple hop test for distance, single-leg vertical jump test, and agility T test), muscle strength (handheld dynamometer), and ROM (goniometer) were measured at baseline and 8 weeks after intervention as posttest. Results: Although both interventions significantly reduced pain (P < .001, η² = .87), improved function (triple hop test P = .004, η² = .94; single-leg vertical jump P = .002, η² = .93; and T test P < .001, η² = .93) and strength (hip abduction (P < .001, η² = .52), hip external rotation (P = .02, η² = .95), knee flexion (P ≤ .001, η² = .94), and knee extension (P < .001, η² = .91) compared with the control group, FMC showed more significant improvements in comparison with TE. Significant differences (P = .001) were observed between FMC and TE compared with the control group in ROM outcome. However, TE was more effective than FMC in improving ROM hip abduction (P < .001, η² = .93), hip adduction (P = .000, η² = .92), hip internal rotation (P < .001, η² = .92), and hip external rotation (P < .001, η² = .93). Conclusion: FMC exercises were superior to TE in terms of pain, function, and muscle strength, whereas TE was more effective for improving ROM. FMC exercise is suggested as an effective intervention for improvement of the outcomes related to ITBS in national-level Greco Roman wrestlers. [ABSTRACT FROM AUTHOR]

The biomechanical relationship between horse and rider in equine-assisted activities and therapies has been largely unexplored. The three-dimensional stimulation of the horse's gait has potential to improve rider musculature and coordination, especially in an older adult population. This study utilized dual-axis goniometers and video motion capture tracking to simultaneously track horse and rider hip flexion and extension. Ten older adult riders participated in 8 weeks of horseback riding lessons, where pelvis kinematics and balance assessments were compared between Weeks 1 and 8. Pelvic roll of the rider and horses' hip flexion and extension were successfully tracked and summed improvements in balance assessments were also evident after 8 weeks of horseback riding lessons. Future research will assess deeper kinematic relationships between a horse's gait and rider biomechanical responses. [ABSTRACT FROM AUTHOR]

Isometric strength training has been reported to benefit various sport-related dynamic performances. However, it is still unknown whether performing isometric strength training at single or multiple joint angles would elicit greater benefit. Purpose: To compare the effects of isometric bench press performed at single (SIBP) and multiple (MIBP) joint angles on dynamic strength and overhead throwing performance. Methods: Sixteen male softball and baseball athletes performed overhead throwing, 1-repetition-maximum (1RM) bench press, and ballistic push-up during pretest and posttest. They were then randomly assigned to either SIBP or MIBP to undergo 12 strength training sessions. During the training, isometric bench press was performed at only 90° elbow angle for SIBP but at 60°, 90°, and 120° elbow angles for MIBP. Results: A significant main time effect was observed for bench press 1RM (P =.003) and relative 1RM (P <.001). Similarly, a significant main time effect was observed for ballistic push-up peak power only (P =.037). There was no significant change in overhead throwing velocity in either group. There was also no significant difference in change in all measures between groups. However, a moderate effect in favor of MIBP was observed for change in ballistic push-up peak power (P =.180, g = 0.67). Conclusions: Based on the current findings, the inclusion of both SIBP and MIBP were equally beneficial to maximal strength development. However, performing MIBP had a greater effect on power development. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effects of individually designed insoles on physical activity level, balance, and functional performance in patients with pes planus. Materials and Methods: 38 participants were divided into 2 groups as 3D printed (n=20) and placebo (n=18). In the 3D printed group, medial longitudinal arch support, medial wedge of the foot, medial heel wedge, and transverse arch support were given to the insoles according to the needs of the participants. The placebo group received placebo insoles. Muscle strength, range of motion, static and dynamic balance, physical and physical activity levels were measured at baseline, and eight weeks later (clinicaltrials.gov ID: NCT05306886). Results: Muscle strengths of the plantar flexion (p=0.030) and eversion increased after the use of insoles in the 3D printed and placebo groups (p=0.020). There was no change in static balance in both groups (p=0.386), but there were significant improvements in dynamic balance in 3D printed groups (p=0.019). Gait speed improved in both 3D printed (p=0.001) and placebo groups (p=0.015). There was no significant difference in the explosive power between the groups (p=0.272). The shuttle run test improved significantly in the placebo group (p=0.015), but no significant change was observed in the 3D printed group (p=0.886). While the physical activity levels in the placebo group showed a significant improvement (p=0.017), the physical activity level decreased in the 3D printed group (p=0.489). Conclusions: In this study, it was found that the use of personalized insoles is effective in improving physical activity, balance, and performance, while placebo insoles were found to be more effective in increasing muscle strength and explosive muscle strength. [ABSTRACT FROM AUTHOR]

To examine intraobserver and interobserver reliability of the clinical measurement of pediatric joint motion of upper and lower extremities, based on participant condition and measurement technique. PubMed, CINAHL, and Web of Science were searched using combinations of children or adolescents, range of motion, and reliability. Reference lists and citations of reviewed studies were searched for additional publications. Thirty-one studies of pediatric samples of developing typically, orthopedic injuries, athletes, cerebral palsy, and other diagnoses were reviewed. For techniques, measurements were made most frequently with a goniometer followed by visual estimation, inclinometer, smartphone apps, and specialized devices. The reliability of hip abduction measurements of participants with cerebral palsy was evaluated most often and varied widely for both intraobserver and interobserver. In general, goniometric results indicated greater reliability for upper than lower extremities and for intraobserver than interobserver. As the other techniques were each utilized in only a few studies, involving different participant conditions, joint motions and statistics, the analysis of their reliability was limited. Intraobserver and interobserver reliability have not been established for pediatric joint motion measurements. Further research should include various joint motion measurements for different pediatric conditions using appropriate statistics. Results would provide important information for making clinical decisions. [ABSTRACT FROM AUTHOR]

Background Low back pain (LBP) is a leading cause of disability. Recurrent low back pain (rLBP) is defined as two or more episodes of LBP in a 12-month period, each lasting more than 24 hours and separated by at least one pain-free month. Many studies have shown that hip and trunk variables have an influence on LBP. However, most of these are studies of participants with acute or chronic LBP rather than rLBP. Purpose To examine the difference between hip and trunk variables of university students with and without rLBP. Study Design Cross-Sectional Methods Participants with and without rLBP between 18 and 35 years of age not currently undergoing clinical orthopedic care were recruited for this cross-sectional study. Bilateral hip range of motion (ROM) and trunk ROM were measured with a goniometer or measuring tape (hip motions in all planes along with trunk flexion, extension, and lateral flexion). Strength of the hip extensors, abductors, and external rotators was measured using a handheld dynamometer, and a single-leg bridge endurance test was performed to assess differences and correlations between outcomes. Results Twenty-six subjects aged 18 to 35 years with rLBP (n=10) and without rLBP (n=16) participated. Statistically significant differences between the two groups were found for right and left hip flexion (p = 0.029 and 0.039, respectively), right hip adduction (p = 0.043), and right hip extension (p = 0.021). No significant differences were found between groups for strength, endurance, or other ROM measures. Conclusion The findings of this study show statistically significant although clinically non-meaningful differences in hip flexion, extension, and adduction ROM in the rLBP group compared to the control group. This lack of clinically meaningful difference may be relevant to testing procedures and treatment of patients or athletes with rLBP. This study also suggests that hip strength and endurance may not play a major role in the development or treatment of rLBP. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

The notion of Fuzzy Graphs (FGs) and Intuitionistic Fuzzy Graphs (IFGs) is generalized in the Picture Fuzzy Graph (PFG), which is a more common platform for expressing the degree of positive, negative, and neutral membership functions. Picture Fuzzy Soft Graphs (PFSGs) are powerful mathematical tools for modeling real-world vagueness. The concept of vulnerability parameters of PFSG is provided in this research work by introducing the novel cardinality, domination number, integrity, and Domination Integrity (ÐÏ) of PFSG. Furthermore, a decision-making method for the PFSG has been presented using ÐÏ to suggest an algorithm for determining the ideal location for establishing a city diagnosis center. [ABSTRACT FROM AUTHOR]