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PURPOSE This study aimed to compare muscle activation of the diaphragm (DIA), scalenes (SA), parasternal intercostals (PS), and sternomastoid (SM) during submaximal intermittent neck flexion (INF) versus submaximal inspiratory threshold loading (ITL) until task failure in healthy adults. METHODS Twelve healthy adults performed submaximal ITL or INF tests in random order for 2 d. Surface electromyography was monitored to acquire root mean square (RMS) and median power frequency (MPF) from the SA, PS, SM, and DIA. Maximal inspiratory pressures and maximal voluntary contraction for neck flexion were determined. Next, participants performed the first submaximal test-ITL or INF-targeting 50% ± 5% of the maximal inspiratory pressure or maximal voluntary contraction, respectively, until task failure. After a rest, they performed the other test until task failure. Two days later, they performed ITL and INF but in the opposite order. The Borg scale assessed breathlessness and perceived exertion. RESULTS Endurance times for ITL and INF were 38.1 and 26.3 min, respectively. INF activated three of four inspiratory muscles at higher average RMS (PS, SM, and SA) and at different MPF (PS, SM, and DIA but not SA) compared with ITL. During ITL, RMS did not change in the four inspiratory muscles over time, but MPF decreased in PS, SM, and SA (P < 0.04). In contrast, RMS increased in three of four inspiratory muscles (SM, PS, and SA) during INF, but MPF did not change throughout its duration. Borg rating was 3.9-fold greater than ITL compared with INF. CONCLUSION At a similar percentage of maximal load, INF evokes greater activation of primary muscles of inspiration (PS and SA) and a major accessory muscle of inspiration (SM) compared with ITL during a prolonged submaximal protocol.

Background and purpose: Following a stroke, three-dimensional clavicular/scapular/humeral joint rotations may become restricted and contribute to post-stroke shoulder pain. This study examined whet...

Background To explore the movement patterns utilized by persons post stroke from the simultaneous perspective of pelvic and limb loading with the path of centre of mass during the movement transitions sit to stand and stand to sit. Methods A descriptive pilot study where kinetic and kinematic data were collected and compared between the contribution made by the less affected versus more affected lower limb and trunk during sit to stand and stand to sit following stroke. Movement analysis was undertaken using force-plates and a 3D VICON motion capture system. Findings Data were successfully collected on nine subjects of whom four presented with left side more affected and eight were male. Two patterns were demonstrated for pelvic loading, four patterns for limb loading and five patterns for deviation of centre of mass. There were no consistent patterns of movement demonstrated dependent upon the more or less affected side. There was no consistent relationship between pelvic and limb loading and deviation of centre of mass throughout the movement phases. Interpretation In contrast to assumptions often made with respect to limb loading, we found large variability in movement patterns utilized by person's with a hemiparetic presentation during sit to stand and stand to sit. The findings suggest that movement problems encountered by persons post-stroke are complex and identifies limitations with respect to current measurement techniques.

Gait disturbances are common in individuals with Parkinson's disease (PD). Although the basic patterns of walking are thought to be controlled by the brainstem and spinal networks, recent studies have found significant corticomuscular coherence in healthy individuals during walking. However, it still remains unknown how PD affects the cortical control of muscles during walking. As PD typically develops in older adults, it is important to investigate the effects of both aging and PD when examining disorders in patients with PD. Here, we assessed the effects of PD and aging on corticomuscular communication during walking by investigating corticomuscular coherence. We recorded electroencephalographic and electromyographic signals in 10 individuals with PD, 9 healthy older individuals, and 15 healthy young individuals. We assessed the corticomuscular coherence between the motor cortex and two lower leg muscles, tibialis anterior (TA) and medial gastrocnemius, during walking. Older and young groups showed sharp peaks in muscle activation patterns at specific gait phases, whereas the PD group showed prolonged patterns. Smaller corticomuscular coherence was found in the PD group compared with the healthy older group in the α band (8-12 Hz) for both muscles, and in the β band (16-32 Hz) for TA. Older and young groups did not differ in the magnitude of corticomuscular coherence. Our results indicated that PD decreased the corticomuscular coherence during walking, whereas it was not affected by aging. This lower corticomuscular coherence in PD may indicate lower-than-normal corticomuscular communication, although direct or indirect communication is unknown, and may cause impaired muscle control during walking.NEW & NOTEWORTHY Mechanisms behind how Parkinson's disease (PD) affects cortical control of muscles during walking remain unclear. As PD typically develops in the elderly, investigation of aging effects is important to examine deficits regarding PD. Here, we demonstrated that PD causes weak corticomuscular synchronization during walking, but aging does not. This lower-than-normal corticomuscular communication may cause impaired muscle control during walking.

Background While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined. Objective The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. Methods In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings. Results This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021. Conclusions This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered. International Registered Report Identifier (IRRID) DERR1-10.2196/18209

RATIONALE: While upper back pain in chronic obstructive pulmonary disease (COPD) suggests that postural dysfunction is a potential cause, the extent of postural deviation in COPD is unknown.OBJECTIVE: This study compared postural measurements in people with COPD to healthy controls and explored the relationship between posture deviations and pain in COPD.METHODS: Participants with COPD and age, gender, BMI and comorbidity-matched healthy controls. Participants underwent a postural geometric measurement in upright standing. 3-D motion analysis generated the coordinates of skeletal structures from anatomical landmarks. Participants with COPD completed questionnaires related to pain. Postural stability measures of center of pressure in the anteroposterior (A/P) and mediolateral (M/L) directions, spinal alignment, thoracic kyphosis, scapula and sternal orientation were completed.RESULTS: Twenty-one participants with COPD and 21 matched controls completed the study. The method of postural stability and...

Highlights • The association of mouth-breathing and postural changes in children is unclear. • The terminology and bone landmarks used to evaluate posture are poorly described. • There is lack of reference values describing postural measurements. • The reliability and validity of the methods used are unclear. • The association of mouth-breathing and postural deviations in children is low., Background Mouth breathing syndrome can cause sleep disturbances that compromise the performance of children in school. It might also cause postural abnormalities involving the head and cervical spine; however, the association between postural abnormalities and mouth breathing in children is unclear. Objective To assess the methodological quality of studies and determine if there is an association between mouth breathing and postural disorders in children. Methods Databases comprised MEDLINE, CINAHL, PEDro, LILACS, EMBASE and Cochrane Central Registrar of Controlled Trials. Searches were until March 2016 and included studies that evaluated postural disorders in children diagnosed with mouth breathing. The Downs and Black checklist was used to evaluate the quality of the evidences. Results Ten studies were included totaling 417 children from 5 to 14 years. Two studies used the New York State Postural Rating Scale, seven used photography and one used motion capture to measure posture. The methods used to analyze the data included the Postural Analysis Software (SAPO), Fisiometer, ALCimagem and routines in MATLAB program. Quality assessment resulted in low scores (

Background: Postural stability plays a key role in sport performance, especially after concussion. Specific to healthy child and youth athletes, little is known about the influence development and sex may have on postural stability while considering other subjective clinical measures used in baseline/preinjury concussion assessment. This study aims to describe age- and sex-based trends in postural stability in uninjured child and youth athletes at baseline while accounting for concussion-related factors. Hypotheses: (1) Postural stability performance will improve with age, (2) females will display better postural stability compared to males, and (3) concussion-like symptoms will affect postural stability performance in healthy children and youth. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: This study comprised 889 healthy/uninjured child and youth athletes (54% female, 46% male) between the ages of 9 and 18 years old. Participants completed preseason baseline testing, which included demographic information (age, sex, concussion history), self-report of concussion-like symptoms (Post-Concussion Symptom Inventory [PCSI]–Child and PCSI-Youth), and measures of postural stability (BioSway; Biodex Medical Systems). Two versions of the PCSI were used (PCSI-C, 9- to 12-year-olds; PCSI-Y, 13- to 18-year-olds). Postural stability was assessed via sway index under 4 sway conditions of increasing difficulty by removing visual and proprioceptive cues. Results: In children aged 9 to 12 years old, there were significant age- ( P < 0.05) and sex-based effects ( P < 0.05) on postural stability. Performance improved with age, and girls performed better than boys. For youth ages 13 to 18 years old, postural stability also improved with age ( P < 0.05). In both child and youth subgroups, postural stability worsened with increasing concussion-like symptoms ( P < 0.05). Conclusion: There are developmental and baseline symptom trends regarding postural stability performance. Clinical Relevance: These findings provide a preliminary foundation for postconcussion comparisons and highlight the need for a multimodal approach in assessing and understanding physical measures such as postural stability.

PURPOSE Resistance training is recommended in pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD); however, the acute cardiorespiratory responses to different intensities of resistance training are not known. We compared acute cardiorespiratory responses with high-intensity versus low-intensity resistance exercises in persons with COPD and healthy, matched controls. This research may assist in developing training parameters in COPD. METHODS Participants (n = 10 per group) performed 1 set of 10 repetitions of leg extension and arm elevation at 2 intensities: 40% (low) and 80% (high) of 1-repetition maximum. Minute ventilation ((Equation is included in full-text article.)E), oxygen uptake ((Equation is included in full-text article.)O2), and heart rate (HR) data were collected continuously and expressed as absolute values and relative to values at (Equation is included in full-text article.)O2peak derived from a cardiopulmonary exercise test. Blood pressure, oxygen saturation, and rating of perceived exertion (RPE) were monitored before and after each set of exercises. RESULTS Individuals with COPD showed similar (Equation is included in full-text article.)E, (Equation is included in full-text article.)O2, and HR with high- versus low-intensity exercises. RPE was higher after high- vs low-intensity leg extension (4 ± 1.4 vs 2 ± 1, P < .005) and arm elevation (3 ± 2 vs 1 ± 1.4, P < .005). Compared with healthy participants, relative (Equation is included in full-text article.)O2, (Equation is included in full-text article.)E, and HR were higher in COPD (≅40% vs 20% of the (Equation is included in full-text article.)O2peak; ≅60% vs 20% of (Equation is included in full-text article.)Epeak; and ≅80% vs 20% of HRpeak; all Ps ≤ .004). Absolute responses and RPE were similar between groups, irrespective of intensity and exercise. CONCLUSION Immediate cardiorespiratory responses to an acute bout of resistance exercise appear to be independent of the exercise intensity in COPD. Although people with COPD are working closer to their (Equation is included in full-text article.)O2peak, their responses and RPE are comparable with healthy controls.

Rationale, aims, and objectives Movement, a core aspect of physiotherapy practice, and integral to the clinical reasoning process has undergone limited theoretical development. Instead, research has focused on intervention effectiveness embedded within the positivist paradigm. The purpose of this study was to explore how expert neurorehabilitation therapists conceptualize movement as part of their clinical reasoning. Method A qualitative interpretive descriptive approach consisting of stimulated recall using video-recorded treatment sessions and in-depth interviews was used. Theoretical sampling was used to recruit members of the International Bobath Instructors Training Association (IBITA) who are recognized experts in neurorehabilitation. Interview transcripts were transcribed verbatim. Data analysis was progressive, iterative, and inductive. Results Twenty-two IBITA instructors from 7 different countries volunteered to participate. They ranged in clinical experience from 12 to 40 years and instructor experience from 1 to 35 years. The conceptualization of movement by the IBITA instructors involves the following elements: (1) movement comprises the whole person and the whole body, not just individual body segments; (2) active alignment of body segments is integral to movement performance; and (3) efficient movement requires the relative integration of postural control/stability and selective movement/mobility. Conclusions The IBITA instructors conceptualize movement from a person-centred perspective. The integration of postural control and selective movement, with alignment and variability as key components, forms the foundation of their understanding of movement. Further investigation into the role of postural control in movement recovery post central nervous system lesion is required. Likewise, the dimensions of movement critical to the conceptualization of movement are not well understood from the perspective of the physiotherapist or persons with neurological impairments.

Background and objective Cardiorespiratory responses and symptoms in response to endurance exercise in patients with COPD vary with the number and position of involved limbs. Responses to such variations have never been quantified for strength exercises. We therefore assessed acute cardiorespiratory responses during brief bouts of weight lifting exercises. Methods We compared double- versus single-limb leg extensions and arm elevations, as well as arm elevation done above or below shoulder level in patients with moderate to severe COPD (n = 10, 6 males, 66 (8.1 years), forced expiratory volume on 1 s (FEV1 ) % predicted = 34% (14%)). Minute ventilation, oxygen uptake, oxygen saturation, heart rate (HR), blood pressure (BP), rate of perceived exertion (RPE) and recovery time were collected during single sets of each exercise (10 repetitions at 80% of one repetition maximum). Results Ventilatory and gas exchange responses were not affected by the number of exercising limbs. Changes in HR, BP and RPE scores during arm elevation above shoulder level were greater after double- compared with single-arm elevation (P ≤ 0.001) and greater when exercising above compared with below shoulder level (P ≤ 0.01). Double-arm elevation above shoulder level required 1.5 min longer HR recovery time (P ≤ 0.041) compared with other exercises. Conclusion Double-arm elevation above shoulder level appears to be more challenging than other strength exercise variations. Partitioning exercises and limb position may reduce perceived exertion during training.

Changes in posture in individuals with an obstructive respiratory disease have been reported, but the extent of these deviations and their clinical significance is not well understood. This study aimed to systematically review the literature of the skeletal structural alignment in children and adults with an obstructive respiratory disease, describe the measurement techniques used, and determine the clinical relevance of any alternations.Observational cohort or cross-sectional studies of postural assessment were identified, with 2 reviewers independently assessing study quality.A total of 18 studies were included, 12 in cystic fibrosis (CF), 5 in asthma, and 1 in chronic obstructive pulmonary disease (COPD). The overall quality assessment rating was 12.6 out of 16. Increased thoracic kyphosis or scoliosis was found in both children and adults with CF. Increased shoulder protraction and elevation were evident in asthma and COPD, although changes in spinal curvature were variable. The clinical impact of postural changes was diverse, with an inconsistent influence on lung function. A mix of methods was applied for postural assessment.Skeletal structural malalignment appears to be present in some individuals with an obstructive respiratory disease, although the extent of alterations and its clinical impact is variable. Photogrammetry is used to provide a comprehensive assessment of posture in these populations.

Background Decreased oxygenation of muscle may be accentuated during exercise at high altitude. Monitoring the oxygen saturation of muscle (SmO2) during hand grip exercise using near infrared spectroscopy during acute exposure to hypoxia could provide a model for a test of muscle performance without the competing cardiovascular stresses that occur during a cycle ergometer or treadmill test. The purpose of this study was to examine and compare acute exposure to normobaric hypoxia versus normoxia on deoxygenation and recruitment of the flexor digitorum superficialis (FDS) during submaximal intermittent handgrip exercise (HGE) in healthy adults. Methods Twenty subjects (11 M/9 F) performed HGE at 50% of maximum voluntary contraction, with a duty cycle of 2 s:1 s until task failure on two occasions one week apart, randomly assigned to normobaric hypoxia (FiO2 = 12%) or normoxia (FiO2 = 21%). Near-infrared spectroscopy monitored SmO2, oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) over the FDS. Surface electromyography derived root mean square and mean power frequency of the FDS. Results Hypoxic compared to normoxic HGE induced a lower FDS SmO2 (63.8 ± 2.2 vs. 69.0 ± 1.5, p = 0.001) and both protocols decreased FDS SmO2 from baseline to task failure. FDS mean power frequency was lower during hypoxic compared to normoxic HGE (64.0 ± 1.4 vs. 68.2 ± 2.0 Hz, p = 0.04) and both decreased mean power frequency from the first contractions to task failure (p = 0.000). Under both hypoxia and normoxia, HHb, tHb and root mean square increased from baseline to task failure whereas O2Hb decreased and then increased during HGE. Arterial oxygen saturation via pulse oximetry (SpO2) was lower during hypoxia compared to normoxia conditions (p = 0.000) and heart rate and diastolic blood pressure only demonstrated small increases. Task durations and the tension-time index of HGE did not differ between normoxic and hypoxic trials. Conclusion Hypoxic compared to normoxic HGE decreased SmO2 and induced lower mean power frequency in the FDS, during repetitive hand grip exercise however did not result in differences in task durations or tension-time indices. The fiber type composition of FDS, and high duty cycle and intensity may have contributed greater dependence on anaerobiosis.

This study evaluated the effects of intense physical exercise on postural stability of children with cerebral palsy (CP). Center of pressure (CoP) was measured in 9 typically developing (TD) children and 8 with CP before and after a maximal aerobic shuttle-run test (SRT) using a single force plate. Anteroposterior and mediolateral sway velocities, sway area, and sway regularity were calculated from the CoP data and compared between pre- and postexercise levels and between groups. Children with CP demonstrated significantly higher pre-SRT CoP velocities than TD children in the sagittal (18.6 ± 7.6 vs. 6.75 1.78 m/s) and frontal planes (15.4 ± 5.3 vs. 8.04 ± 1.51 m/s). Post-SRT, CoP velocities significantly increased for children with CP in the sagittal plane (27.0 ± 1.2 m/s), with near-significant increases in the frontal plane (25.0 ± 1.5m/s). Similarly, children with CP evidenced larger sway areas than the TD children both pre- and postexercise. The diminished postural stability in children with CP after short but intense physical exercise may have important implications including increased risk of falls and injury.

A critical component for accelerating the clinical uptake of research data in the area of pediatric concussion or mild traumatic brain injury (MTBI) pertains to the establishment and utilization of common databases. The objective of the first phase of our CanPedCDE initiative was to agree upon pediatric common data elements (CDEs) that could best characterize children with MTBI over their recovery period. The selection of CDEs for our framework aimed to balance factors such as the comprehensiveness of outcomes collected, their applicability to diverse settings, as well as the costs associated with their use. Selection began by identifying relevant domains of functioning (e.g., post-concussion symptoms, attention, and balance). Two sources were used to make this process more efficient: 1) the World Health Organization International Classification of Functioning (ICF) Traumatic Brain Injury Core Set, and the U.S. National Institute of Neurological Disorders and Stroke Traumatic Brain Injury Common Data Elements, both of which had already suggested relevant domains to include in TBI research. The process was completed in two phases: 1) using an online survey of experts and 2) through an in-person consensus meeting. Measurement tools were also proposed that were best felt to capture these domains. Forty experts in MTBI in children from multiple health-related perspectives (e.g., emergency medicine, pediatrics, neurosurgery, nursing, physiotherapy, and neuroscience), as well as knowledge users, participated in the selection process. The final list of CDEs included 77 distinct areas of functioning, covering all categories of the ICF model. Outcome measures were attached to each element, when applicable. The CanPedCDE initiative addresses a significant limitation in MTBI research to date and may help both researchers and clinicians to organize and standardize their assessment of children and youth post-MTBI in order to move the field in promising directions.

The precise role of the human primary motor cortex in walking is unknown. Our previous study showed that the primary motor cortex may contribute to specific requirements of walking (i.e., maintaining a constant movement frequency and bilaterally coordinating the feet). Because aging can impair (i) the ability to fulfill the aforementioned requirements and (ii) corticomuscular communication, we hypothesized that aging would impair the motoneuronal recruitment by the primary motor cortex during bilateral cyclical movements. Here, we used corticomuscular coherence (i.e., coherence between the primary motor cortex and the active muscles) to examine whether corticomuscular communication is affected in older individuals during cyclical movements that shared some functional requirements with walking. Fifteen young men and 9 older men performed cyclical, anti-phasic dorsiflexion and plantarflexion of the feet while seated. Coherence between the midline primary motor cortex and contracting leg muscles cyclically increased in both age groups. However, the coherence of older participants was characterized by (i) lower magnitude and (ii) mediolaterally broader and more rostrally centered cortical distributions. These characteristics suggest that aging changes how the primary motor cortex participates in the cyclical movements, and such change may extend to walking.

The strength of time-dependent correlations known as stride interval (SI) dynamics has been proposed as an indicator of neurologically healthy gait. Most recently, it has been hypothesized that these dynamics may be necessary for gait efficiency although the supporting evidence to date is scant. The current study examines over-ground SI dynamics, and their relationship with the cost of walking and physical activity levels in neurologically healthy children aged nine to 15 years. Twenty participants completed a single experimental session consisting of three phases: 10 min resting, 15 min walking and 10 min recovery. The scaling exponent (α) was used to characterize SI dynamics while net energy cost was measured using a portable metabolic cart, and physical activity levels were determined based on a 7-day recall questionnaire. No significant linear relationships were found between a and the net energy cost measures (r < .07; p > .25) or between α and physical activity levels (r = .01, p = .62). However, there was a marked reduction in the variance of α as activity levels increased. Over-ground stride dynamics do not appear to directly reflect energy conservation of gait in neurologically healthy youth. However, the reduction in the variance of α with increasing physical activity suggests a potential exercise-moderated convergence toward a level of stride interval persistence for able-bodied youth reported in the literature. This latter finding warrants further investigation.

Rationale: Pain is common in people with chronic obstructive pulmonary disease (COPD) and the cause of upper and lower back pain in COPD may be postural dysfunction, including increased thoracic (Tx) kyphosis and altered scapula position. However, the extent of postural deviation in COPD is unknown. This study aimed to compare the postural characteristics of people with COPD to those of control subjects and explore the relationship between posture deviations and reports of pain in COPD. Methods: Subjects with COPD and age, gender, BMI and comorbidity-matched controls underwent a postural assessment in an upright standing position. Photogrammetry using digital photographs and 3-D motion analysis were used to generate the coordinates of skeletal structures from anatomical landmarks identified with reflective markers. The postural measures were spinal orientation, Tx kyphosis and scapula orientation. Those with COPD completed questionnaires related to pain. Results: Twenty-one subjects with COPD (mean FEV1 45% pd) and 21 matched controls completed the study. In controls, the spinal alignment (linear position of C7 in relation to S1 (anterior-posterior)) was 23mm(95% CI 12 to 33mm), while in COPD, the alignment was 42mm(95% CI 29 to 54); 50% of those with COPD exceeded the 95% CI of the control group. Tx kyphosis (p=0.03) and scapula anterior tilt (p=0.001) were increased in COPD compared to controls (p=0.03), but were unrelated to back pain intensity. Conclusions: Postural deviations are evident in COPD compared to those without lung disease, but appear to have no relationship to pain. Further work is needed to identify the contributing factors to these postural deviations.

Howcroft J, Klejman S, Fehlings D, Wright V, Zabjek K, Andrysek J, Biddiss E. Active video game play in children with cerebral palsy: potential for physical activity promotion and rehabilitation therapies. Objective To evaluate the potential of active video game (AVG) play for physical activity promotion and rehabilitation therapies in children with cerebral palsy (CP) through a quantitative exploration of energy expenditure, muscle activation, and quality of movement. Design Single-group, experimental study. Setting Human movement laboratory in an urban rehabilitation hospital. Participants Children (N=17; mean age ± SD, 9.43±1.51y) with CP. Intervention Participants played 4 AVGs (bowling, tennis, boxing, and a dance game). Main Outcome Measures Energy expenditure via a portable cardiopulmonary testing unit; upper limb muscle activations via single differential surface electrodes; upper limb kinematics via an optical motion capture system; and self-reported enjoyment via the Physical Activity Enjoyment Scale (PACES). Results Moderate levels of physical activity were achieved during the dance (metabolic equivalent for task [MET]=3.20±1.04) and boxing (MET=3.36±1.50) games. Muscle activations did not exceed maximum voluntary exertions and were greatest for the boxing AVG and for the wrist extensor bundle. Angular velocities and accelerations were significantly larger in the dominant arm than in the hemiplegic arm during bilateral play. A high level of enjoyment was reported on the PACES (4.5±0.3 out of 5). Conclusions AVG play via a low-cost, commercially available system can offer an enjoyable opportunity for light to moderate physical activity in children with CP. While all games may encourage motor learning to some extent, AVGs can be strategically selected to address specific therapeutic goals (eg, targeted joints, bilateral limb use). Future research is needed to address the challenge of individual variability in movement patterns/play styles. Likewise, further study exploring home use of AVGs for physical activity promotion and rehabilitation therapies, and its functional outcomes, is warranted.

Andrysek J, Klejman S, Steinnagel B, Torres-Moreno R, Zabjek KF, Salbach NM, Moody K. Preliminary evaluation of a commercially available videogame system as an adjunct therapeutic intervention for improving balance among children and adolescents with lower limb amputations. Objectives To examine the safety, feasibility, and balance performance effects of a 4-week home-based balance therapy program using a commercially available videogame system. Design A pilot study involving a preintervention and postintervention design was conducted with measurements taken at baseline, immediately postintervention (week 5), and at follow-up (week 13) for retention. Setting University hospital outpatient clinic and participants' places of residence. Participants Children and adolescents with unilateral lower limb amputation (n=6; 3 transfemoral [TF] and 3 Van Ness) and age-matched, typically developing individuals (n=10) for baseline comparison. Intervention Two videogames involving weight shifting in standing were each played at home for 20min/d, 4d/wk for a period of 4 weeks. A physical therapist provided initial instruction and monitoring. Main Outcome Measures Postural control characteristics using center of pressure (COP) displacements during quiet standing; functional balance using the Community Balance and Mobility Scale (CBM and compliance, safety, and feasibility using custom questionnaires. Results Average playing times for the first 3 weeks ranged from 16.0 to 21.1 minutes for the 2 games. At baseline, the children and adolescents with TF amputation had substantially greater COP displacements than the Van Ness group and typically developing children and adolescents. Immediately postintervention, the COP displacements decreased in the TF amputees, resulting in values that were closer to those of the typically developing children. The average increase in CB&M score from baseline to follow-up was 6 points across participants. Conclusions In-home, videogame-based balance training therapies can achieve excellent compliance in children and adolescents with lower limb amputation. With proper instructions and monitoring, the therapeutic intervention can be safely administered. Some improvements in postural control characteristics were seen in children and adolescents with balance deficits immediately postintervention, but long-term retention remains unclear.

Stroke is one of the major causes of permanent adult disability. Stroke frequently affects motor control of the arm, leading to diffculties in doing activities of daily living. This research focuses on developing an upper limb rehabilitation robotic prototype through user-centered design to aid stroke survivors in rehabilitating their arm. To gather requirements from end users, stroke therapy sessions were observed and a survey of stroke therapists was conducted. End user requirements were evaluated to determine technical targets for the mechanical design of the prototype. Evaluation of the prototype was done with stroke therapists in a focus group and a preliminary biomechanical study. As user-centered design would require more iterations of design, testing and evaluation, this project reports a first step in developing an affordable, portable device, which could increase access to stroke rehabilitation for the arm.

Aim New tools that capture hand function in everyday activities and contexts are needed for assessing children with hemiplegic cerebral palsy. This study evaluates a wearable wrist monitor and tests the hypothesis that wrist extension frequency (FreqE) is an appropriate indicator of functional hand use. Method Fifteen children (four females, 11 males; age range 6–12y; mean age 10y [SD 2y]) with hemiplegia (seven at level I and eight at level II on the Manual Ability Classification System) participated in the Assisting Hand Assessment (AHA) while wearing the wrist monitor. FreqEs were captured via the wrist monitor and validated using video analysis. Correlations between FreqE and AHA scores were calculated and a multivariate linear regression was conducted to explore other measures of wrist activity. Results Wrist extensions observed in video analyses were reliably detected by the wrist monitor (intraclass correlation coefficient, r=0.88; p

Despite widespread acceptance of clinical benefits, empirical evidence to evaluate the advantages and limitations of ambulation aids for balance control is limited. The current study investigates the upper limb biomechanical contributions to the control of frontal plane stability while using a 4-wheeled walker in quiet standing. We hypothesized that: (1) upper limb stabilizing moments would be significant, and (2) would increase under conditions of increased stability demand. Factors influencing upper limb moment generation were also examined. Specifically, the contributions of upper limb center-of-pressure ( COP hands ), vertical and horizontal loads applied to the assistive device were assessed. The results support a significant mechanical role for the upper limbs, generating 27.1% and 58.8% of overall stabilizing moments under baseline and challenged stability demand conditions, respectively. The increased moment was achieved primarily through the preferential use of phasic upper limb control, reflected by increased COP hands (baseline vs. challenged conditions: 0.29 vs. 0.72 cm). Vertical, but not horizontal, was the primary force direction contributing to stabilizing moments in quiet standing. The key finding that the upper limbs play an important role in effecting frontal plane balance control has important implications for ambulation aid users (e.g., elderly, stroke, and traumatic brain injury).

Parkinson's disease (PD) is known to increase asymmetry and variability of bilateral movements. However, the mechanisms of such abnormalities are not fully understood. Here, we aimed to investigate whether kinematic abnormalities are related to cortical participation during bilateral, cyclical ankle movements, which required i) maintenance of a specific frequency and ii) bilateral coordination of the lower limbs in an anti-phasic manner. We analyzed electroencephalographic and electromyographic signals from nine men with PD and nine aged-matched healthy men while they sat and cyclically dorsi- and plantarflexed their feet. This movement was performed at a similar cadence to normal walking under two conditions: i) self-paced and ii) externally paced by a metronome. Participants with PD exhibited reduced range of motion and more variable bilateral coordination. However, participants with and without PD did not differ in the magnitude of corticomuscular coherence between the midline cortical areas and tibialis anterior and medial gastrocnemius muscles. This finding suggests that either the kinematic abnormalities were related to processes outside linear corticomuscular communication or PD-related changes in neural correlates maintained corticomuscular communication but not motor performance.

Changes in gait parameters induced by the concomitant performance of one of two cognitive tasks activating working memory and spatial attention, was examined in healthy young adults (YA) and older adults (OA). There was a main effect of task condition on gait-speed (p = .02), stride-length (p < .001) and double-support time (p = .04) independent of the group. There were no significant differences between working memory and spatial attention associated gait changes. Working-memory and spatial-attention dual-tasking led to a decrease in gait-speed (p = .09 and 0.01) and stride-length (p = .04 and 0.01) and increase in double-support time (p = .01 and 0.03) in YA and decrease in stride-length (p = .04 and 0.01) alone in OA. Cognitive task associated changes in gait may be a function of limited attentional resources irrespective of the type of cognitive task.

The objective of the present study is to quantify the position of the Centre of Mass (COM) during quiet standing using a force plate and compare this technique to the quantification of the COM with an anthropometric model. The postural control of 18 healthy adolescents and 22 IS patients was evaluated using an Optotrak 3D kinematic system, and two AMTI force plates during quiet standing. The position of anatomical landmarks tracked by the Optotrak system served to estimate the position of the COM of both groups using an anthropometric model (COM(anth)). The force plate served to estimate the position of the COM through double integration of the horizontal ground reaction forces (COM(gl)). The mean position and root mean square (RMS) amplitude of COM(gl, )in reference to the base of support (BOS) and the first sacral prominence (S1) were quantified in the Anterior-Posterior (A/P) and Medial-Lateral (M/L) directions. There was a significant difference between the control subjects and IS patients for the displacement of the COM(gl) in reference to the BOS in both the A/P and M/L directions. There was no difference between groups for the mean position of the COM(gl), however, 63% of the IS and 43% of the controls had a lateral position of the COM(gl )in reference to S1 of greater than 5 mm. There was a significant difference between groups in the A/P and M/L directions for the amplitude of error between the COM(gl) and COM(anth) techniques.

To determine the potential differences in control underlying compensatory and voluntary reach-to-grasp movements the current study compared the kinematic and electromyographic profiles associated with upper limb movement. Postural perturbations were delivered to evoke compensatory reach-to-grasp in ten healthy young adult volunteers while seated on a chair that tilted as an inverted pendulum in the frontal plane. Participants reached to grasp a laterally positioned stable handhold and pulled (or pushed) to return the chair to vertical. The distinguishing characteristic between the two behaviors was the onset latency and speed of movement. Consistent with compensatory balance reactions, the perturbation-evoked reach response was initiated very rapidly (137 vs. 239 ms for voluntary). As well the movement time was shorter, and peak velocity was greater for PERT movements. In spite of the profound differences in timing, the sequence of muscle activity onsets and the order of specific kinematic events were not different between maximum velocity voluntary (VOL) and perturbation-evoked (PERT) reach-to-grasp movements. Peak velocity and grasp aperture occurred prior to hand contact with the target for PERT and VOL movements, and wrist trajectory was influenced by the direction of perturbation relative to the target. To achieve such target specific control for responses initiated within 100 ms of the perturbation, and when characteristics of body movement were unpredictable, the perturbation-evoked movements would need to incorporate sensory cues associated with body movement relative to the target into the earliest aspects of the movement. This suggests reliance on an internal spatial map constructed prior to the onset of perturbation. Parallels in electromyographic and kinematic profiles between compensatory and voluntary reach-to-grasp movements, in spite of temporal differences, lead to the view they are controlled by common neural mechanisms.

Little is known about the effects of acute exercise on the cognitive functioning of children with cerebral palsy (CP). Selected cognitive functions were thus measured using a pediatric version of the Stroop test before and after maximal, locomotor based aerobic exercise in 16 independently ambulatory children (8 children with CP), 6–15 years old. Intense exercise had: 1) a significant, large, positive effect on reaction time (RT) for the CP group (preexercise: 892 ± 56.5 ms vs. postexercise: 798 ± 45.6 ms, p < .002, d = 1.87) with a trend for a similar but smaller response for the typically developing (TD) group (preexercise: 855 ± 56.5 ms vs. postexercise: 822 ± 45.6 ms, p < .08, d = 0.59), and 2) a significant, medium, negative effect on the interference effect for the CP group (preexercise: 4.5 ± 2.5%RT vs. postexercise: 13 ± 2.9%RT, p < .04, d = 0.77) with no significant effect for the TD group (preexercise: 7.2 ± 2.5%RT vs. postexercise: 6.9 ± 2.9%RT, p > .4, d = 0.03). Response accuracy was high in both groups pre- and postexercise (>96%). In conclusion, intense exercise impacts cognitive functioning in children with CP, both by increasing processing speed and decreasing executive function.

Active videogames (AVGs) have potential in terms of physical activity and therapy for children with cerebral palsy. However, the effect of social interaction on AVG play has not yet been assessed. The objective of this study is to determine if multiplayer AVG versus solo affects levels of energy expenditure and movement patterns.Fifteen children (9.77 [standard deviation (SD) 1.78] years old) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) participated in solo and multiplayer Nintendo(®) "Wii™ Boxing" (Nintendo, Inc., Redmond, WA) AVG play while energy expenditure and punching frequency were monitored.Moderate levels of physical activity were achieved with no significant differences in energy measures during multiplayer and solo play. Dominant arm punching frequency increased during the multiplayer session from 95.75 (SD 37.93) punches/minute to 107.77 (SD 36.99) punches/minute. Conversely, hemiplegic arm punching frequency decreased from 39.05 (SD 29.57) punches/minutes to 30.73 (SD 24.74) punches/minutes during multiplayer game play. Children enjoyed multiplayer more than solo play.Opportunities to play AVGs with friends and family may translate to more frequent participation in this moderate physical activity. Conversely, increased hemiplegic limb use during solo play may have therapeutic advantages. As such, new strategies are recommended to promote use of the hemiplegic hand during multiplayer AVG play and to optimize commercial AVG systems for applications in virtual reality therapy.

Purpose: To explore Ontario physiotherapists' opinions on their ability to order diagnostic imaging (DI). Methods: An online questionnaire was sent to all registered members of the College of Physiotherapists of Ontario. Descriptive statistics were calculated using response frequencies. Practice characteristics were compared using χ2 tests and Wilcoxon rank–sum tests. Results: Of 1,574 respondents (21% response rate), 42% practised in orthopaedics and 53% in the public sector. Most physiotherapists were interested in ordering DI (72% MRI/diagnostic ultrasound, 78% X-rays/computed tomography scans). Respondents with an orthopaedic caseload of 50% or more (p

OBJECTIVE To develop a video-based system, mounted on a rollator to quantify the step width values of rollator users in the community. SUBJECTS A total of 5 able-bodied young adults, age range 24-28 years. METHODS A digital video camera system was mounted on the rollator frame to capture the position of the participant's feet during overground walking. A method of estimating step width from the video data was developed and evaluated against the output from a concurrently recording Vicon MX motion capture system. RESULTS Mean step widths of the rollator and motion capture systems were 14.40 cm (standard deviation (SD) 4.64) and 14.37 cm (SD 4.34), respectively, revealing a strong level of agreement; intra-class correlation coefficient 0.999 (95% confidence interval (95% CI) 0.987-1.000; and root-mean-square difference 0.70 cm. CONCLUSION The video-based system mounted on a rollator to collect foot placement data enabled accurate measurement of step width during rollator use. The ability to record foot placement measurements outside the laboratory setting, characterizing foot placement patterns occurring in the community, will enable research into how these assistive devices influence mobility during everyday use.

Objective: The main objectives of this study were to determine if the right and left lower limbs in the gait of elderly people developed similar muscle moment and power patterns and to determine whether their associated mechanical energies were different during two consecutive gait cycles. Design: A total of 18 able-bodied male subjects aged 71 ′ 6.8 yrs participated in this study. Data were collected using three Optotrak position sensors and two AMTI force platforms. Results: The peak muscle powers were very similar in the sagittal plane and reflected gait symmetry, except for greater and significant differences produced by the hip extensors. Differences in the frontal and transverse planes were mainly attributed to the actions taken by the muscles, leading the lower limbs to compensate and to dynamically balance and propel the body forward during two consecutive gait cycles. In terms of mechanical energy, 13% greater positive work was done in the left limb and was associated with asymmetrical behavior of the lower limbs to propel the body forward. The total negative work was similar for both limbs, and substantial work was done in the frontal plane by the hip, indicating the role of muscle activity in this plane to control the pelvis and trunk against gravitational forces. Conclusions: In addition to the importance of a balance-control function in the gait of healthy, elderly subjects, muscle activity made an important contribution to propelling the body forward. Gait asymmetry in elderly subjects seems to be related to different degrees of energy generated by the lower limbs for the propulsion function, whereas both limbs contribute similarly to the balance-control function.

The objective of this study was to verify the accuracy of surface measurements to estimate the magnitude of sagittal curvature changes at follow-up. Ninety-seven patients with idiopathic scoliosis were evaluated at two different visits (interval: 15.7 months). Kyphosis and lordosis were measured on the lateral radiograph. Surface measurements rely on localization of spinous process landmarks using a video-based system. Multiple regression analyses were performed to estimate the sagittal curvatures on the second visit. The regression was significant for both kyphosis and lordosis. The mean absolute difference between the estimate and the radiologic measurement was 3.3 degrees for kyphosis and 3.2 degrees for lordosis. The difference between the estimated change and the observed change between visits showed mean absolute differences of 3.4 degrees and 2.7 degrees, respectively. The proposed strategy could be used during follow-up to reduce patient irradiation without loss of sagittal information.

Despite the common use of rollators (four-wheeled walkers), understanding their effects on gait and balance is limited to laboratory testing rather than everyday use. This study evaluated the utility of an ambulatory assessment approach to examine balance and mobility in everyday conditions compared to a laboratory assessment.Standing and walking with a rollator was assessed in three neurological rehabilitation in-patients under two conditions: (1) in laboratory (i.e. forceplate, GaitRite), and (2) while performing a natural walking course within and outside of the institution. An instrumented rollator (iWalker) was used to measure variables related to the balance control (e.g. upper limb kinetics), destabilizing events (e.g. stumbling), and environmental context.Two of three patients demonstrated greater reliance on the rollator for standing balance (2.3-5.9 times higher vertical loading, 72-206% increase in COP excursion) and 29-42% faster gait during the walking course compared to the laboratory. Importantly, destabilizing events (collisions, stumbling) were recorded during the walking course. Such events were not observed in the laboratory.This study illustrated a greater reliance on the rollator during challenges in everyday use compared to laboratory assessment and provided evidence of specific circumstances associated with destabilizing events that may precipitate falls in non-laboratory settings. Implications for Rehabilitation The value of combining laboratory and ambulatory assessment approaches to provide a more comprehensive profile of the risks and benefits of rollator use to prevent falling was studied. Patients demonstrated greater reliance on rollator assistive devices for standing balance and exhibited higher gait speeds during ambulatory assessment, compared to standard laboratory protocols. Repeated instances of events that may precipitate falls (e.g. collisions, stumbling, and unloading behaviors) were observed only during the ambulatory assessment. Individual challenges to balance can be used to identify specific training targets, assess suitability for assistive devices, and recommend rehabilitation goals.

In this study, tasks of the hip in elderly and young gait were identified using principal-component analysis (PCA). Discrepancies between older and younger participants for hip-flexor and -extensor action during stance were also investigated. PCA was applied to the sagittal-hip-muscle-power curves of participants. Three principal components (PCs) were retained for further analysis. A t test revealed that all measures of gait spatiotemporal parameters were significantly lower in the older participants (p < .05). The first PC for both groups extracted the largest variation and described hip-power action during midistance. The second and third PCs in the older participants highlighted the role of the hip extensors and flexors during weight acceptance, late stance, and pull-off. The corresponding PCs for the younger participants were mainly associated with hip-extensor/flexor action during pull-off and weight acceptance. The results indicate that the hip-extensor/flexor muscles are mainly responsible for balance control in elderly gait but contribute to both balance control and propulsion in the gait of younger individuals.

A small leg length inequality, either true or functional, can be implicated in the pathogenesis of numerous spinal disorders. The correction of a leg length inequality with the goal of treating a spinal pathology is often achieved with the use of a shoe lift. Little research has focused on the impact of this correction on the three-dimensional (3D) postural organisation. The goal of this study is to quantify in control subjects the 3D postural changes to the pelvis, trunk, scapular belt and head, induced by a shoe lift. The postural geometry of 20 female subjects (X = 22, sigma = 1.2) was evaluated using a motion analysis system for three randomised conditions: control, and right and left shoe lift. Acute postural adaptations were noted for all subjects, principally manifested through the tilt of the pelvis, asymmetric version of the left and right iliac bones, and a lateral shift of the pelvis and scapular belt. The difference in the version of the right and left iliac bones was positively associated with the pelvic tilt. Postural adaptations were noted to vary between subjects for rotation and postero-anterior shift of the pelvis and scapular belt. No notable differences between conditions were noted in the estimation of kyphosis and lordosis. The observed systematic and variable postural adaptations noted in the presence of a shoe lift reflects the unique constraints of the musculoskeletal system. This suggests that the global impact of a shoe lift on a patient's posture should also be considered during treatment. This study provides a basis for comparison of future research involving pathological populations.

People with lower-limb amputation have reduced mobility due to loss of sensory information, which may be restored by artificial sensory feedback systems built into pros- theses. For an effective system, it is important to understand how humans sense, interpret, and respond to the feedback that would be provided. The goal of this study was to examine sen- sorimotor responses to mobility-relevant stimuli. Three experi- ments were performed to examine the effects of location of stimuli, frequency of stimuli, and means for providing the response. Stimuli, given as vibrations, were applied to the thigh region, and responses involved leg movements. Sensorimotor reaction time (RT) was measured as the duration between appli- cation of the stimulus and initiation of the response. Accuracy of response was also measured. Overall average RTs for one response option were 0.808 +/- 0.142 s, and response accura- cies were >90%. Higher frequencies (220 vs 140 Hz) of vibra- tion stimulus provided in anterior regions of the thigh produced the fastest RTs. When participants were presented with more than one stimulus and response option, RTs increased. Findings suggest that long sensorimotor responses may be a limiting fac- tor in the development of an artificial feedback system for mobility rehabilitation applications; however, feed-forward techniques could potentially help to address these limitations.

Background: Concussion is common in the sport of ice hockey and can cause deficits in cognitive function. In most situations, ice hockey participation requires the performance of more than one skill at a time. It has been reported that following concussion in athletes, performance deficits arise when locomotor and cognitive tasks are performed concurrently that may have otherwise gone unnoticed if assessed in isolation of one another. The purpose of this pilot study was to explore the effect of concussion on cognition during concurrent ice hockey specific tasks in youth ice hockey players. Methods: This single case pilot study compared the performance of 4 male youth ice hockey players who had experienced a concussion in the previous ice hockey season (mean age=11.7 ± 0.3 years; mean time since injury=92.5 ± 49.1 days) to a group of 10 non-injured controls (mean age=11.8 ± 0.8 years). Participants completed a randomized combination of three ice hockey specific tasks while concurrently completing a visual interference task (modified Stroop task). Results: Participants who experienced a concussion within the previous ice hockey season and were ≤ 58 days post-injury demonstrated significantly poorer cognitive performance (increased cognitive dual task cost) across all conditions when completing the visual interference task concurrently with ice hockey specific skills (p ≤ 0.05). Conclusion: This study acts as an initial step towards the development of a sport-specific assessment of functional performance following concussion in youth ice hockey players to help inform safer return to play.

The objective of this study was to investigate the relationship between medio-lateral foot placement characteristics and environmental context when individuals with Multiple Sclerosis (MS) walk with a rollator (four-wheeled walker).Ten women diagnosed with MS, who used rollators regularly, participated in this study. First, a rollator-based technique of calculating step width (SW) was validated in this patient population by comparing the output of an instrumented rollator (iWalker) to a laboratory-based Vicon Motion Capture System. Secondly, the iWalker-based technique was used to calculate the participants' SW and SW variability as they used the iWalker in four common outdoor community environments.There was a strong level of agreement between the iWalker and Vicon SW calculations, with an intra-class correlation coefficient of 0.993 and a root-mean-square difference of 0.71 cm. Furthermore, SW variability (P = 0.002), but not SW (P = 0.288), was influenced by the walking environment (i.e. between the in-lab vs. up-ramp and up-ramp vs. down-ramp conditions).Foot placement variability appears to be influenced by the walking environment of MS patients. Therefore, an enhanced understanding of walker-user interactions in relation to the environment must be established in order to improve mobility.

Paediatric spinal deformities are the most prevalent musculoskeletal conditions observed in children and youth. Idiopathic Scoliosis (IS), a sub-class of these spinal deformities is commonly recognized by a lateral curvature of the spine that is of unknown cause and has the greatest risk of progression during periods of rapid growth and development.[1,2,3] The emergence of our contemporary perspective that this lateral curvature and axial rotation of the spine [4] is also accompanied by significant spatial disorientation of the spine and thoracic cage, [5,6] has motivated clinicians and scientists to develop new models of assessment for the purpose of guiding clinical decisions, orthopaedic interventions, and the evaluation of clinical outcomes.

The Nintendo Wii Fit™ may provide an affordable alternative to traditional biofeedback or virtual reality systems for retraining or improving motor function in populations with impaired balance. The purpose of this study was to evaluate postural control strategies healthy individuals use to play Wii Fit™ videogames. Sixteen young adults played 10 trials of Ski Slalom and Soccer Heading respectively. Centre of pressure (COP) excursion and three-dimensional movement data were acquired to determine variability in medial-lateral COP sway and shoulder-pelvic movement. While there was no difference in medial-lateral COP variability between games during trial 1, there was a significant difference after 10 trials. COP sway increased (59-75 mm) for Soccer Heading while it decreased (67-33 mm) for Ski Slalom from trial 1 to trial 10. During Ski Slalom participants demonstrated decreased shoulder and pelvic movement combined with increased pelvic-shoulder coupling. Conversely, participants demonstrated greater initial shoulder tilt when playing Soccer Heading, with no reduction in pelvic rotation and tilt. Participants decreased pelvic and trunk movements when skiing, suggesting a greater contribution of lower extremity control while they primarily used a trunk strategy to play Soccer Heading.

The recent article by Akhbari and colleagues1 is representative of a growing body of clinical research aimed at providing evidence to support the clinical uptake of biomechanical techniques that measure postural stability.2–7 Overall, this body of work has sought to better understand the measurement properties of biomechanical variables that provide insight into the fundamental mechanisms that control postural stability. Although these biomechanical variables have shown promise for measuring clinical change over time,1–7 they have not often been examined in the context of randomized controlled trials.8 In the context of upright stance, postural stability is often defined as the ability of the nervous system to control the position of the centre of mass (COM) in relation to the base of support (BOS).9 Biomechanical measurements of postural stability have traditionally been achieved by measuring the forces exerted through the base of support (kinetics), the movement of the body (kinematics), and the activation of muscle (electromyography). Analysis of the time and frequency domain characteristics of these measures has provided valuable insight into the movement of the COM in relation to the BOS and the basic strategies used to control this movement.10 Combining these biomechanical measures with variations in the task performed, the environmental context, and individual characteristics has further revealed the complexity of the strategies that the nervous system adopts to control postural stability.9 In this context, we can gain considerable insight into the underlying structural and functional determinants of postural instability, particularly where there is an underlying orthopaedic, neuromuscular, or neurological condition. However, the infrastructure and operating costs of conducting such assessments and the expertise required to interpret biomechanical measures may prohibit their application in large-scale, long-term clinical trials. The recent emergence of accessible biomechanical sensor technology has provided new opportunities to measure postural stability in a variety of contexts beyond the traditional laboratory setting. Examples of this emerging technology include force sensors embedded in active gaming platforms, shoes, and walking surfaces;11–13 wireless accelerometers and inertial measurement units;14 and balance assessment platforms.1,15 Such technologies offer clinical researchers opportunities to bridge the gap between fundamental and translational research by accessing information once exclusive to the biomechanical laboratory environment. However, advances in this emerging area of clinical research will be achieved only through significant and sustained commitment to establishing the measurement properties of the biomechanical variables and integrating these variables into long-term prospective observational and randomized controlled trials. The work of Akhbari and colleagues1 is representative of several studies in the field that have taken the first step along this continuum, providing initial evidence of the potential promise of biomechanical techniques.

Background. The complex skeletal deformations that accompany Idioapthic Scoliosis pose a challenge to the clinician to non-invasively discriminate Idiopathic Scoliosis patients from children with no pathology. Therefore, the focus of this study is to non-invasively evaluate the position and amplitude of displacement of the pelvis, shoulders and thorax during quiet standing of Idiopathic Scoliosis patients and control subjects. Methods. The quiet standing posture of 18 healthy adolescent females and 22 Idiopathic Scoliosis subjects was evaluated using an Optotrak 3020 position sensor over a period of 120 s, with 4 repeat trials. Outcome measures included the mean position, root mean square amplitude and range over the duration of 120 s trials for both linear and angular measures of the pelvis, thorax and shoulders. Appropriate sample times were chosen and evaluated for stability over the 120 s period, and between trial reliability was evaluated. Findings. There was a significant difference between groups for the mean position of the shoulder blade rotation in reference to the base of support and to the pelvis. The Idiopathic Scoliosis patients had a significantly larger root mean square amplitude of anterior–posterior displacement of the T1 and S1 spinous processes in reference to the base of support. There was no difference between the sample durations to estimate the mean position of the body segments, however the root mean square increased significantly. Interpretation. This study demonstrates that postural abnormalities are evident during quiet standing in Idiopathic Scoliosis patients.

The objective of this study was to quantify the relationship between gibbosity and spinal deformation expressed by the angle of Cobb before and during treatment with a brace for different classes of idiopathic scoliosis patients. As part of the standard treatment with the Dynamic Corrective Brace (SpineCor), 89 idiopathic scoliosis patients underwent an initial radiological examination and gibbosity measurement with a scoliometer wearing and not wearing the brace. The 89 patients were classified in relation to the apex of the scoliosis curves: thoracic (n = 29); thoracolumbar (n = 40); lumbar (n = 7) and double (n = 13). With the dynamic corrective brace, the patients showed a mean decrease of 8.3 degrees for the major Cobb angle, and a mean decrease of 2.3 degrees for their gibbosity. There was a significant positive relationship between gibbosity and Cobb angle with and without the brace for the thoracic and thoracolumbar curves. A linear regression analysis identified a small mean estimation error for the thoracic curves (7.4 degrees no-brace; 2.7 degrees with brace) and thoracolumbar curves (5.2 degrees no-brace; 5.3 degrees with brace), indicating a predictive potential of the scoliometer. The measure of gibbosity with the scoliometer provides a fairly reliable estimation of Cobb angle at the initial clinical examination of a scoliosis patient. However, when initial Cobb angle and gibbosity are considered, the measure of gibbosity when wearing a brace provides the clinician with a highly reliable estimation of the Cobb angle while in a brace. This relationship also exists for the follow-up with a brace, permitting a judgement of the patient's evolution under the treatment with SpineCor.

The objective of this study was to assess the success of treatment during the follow-up of a group of 195 idiopathic scoliosis (IS) patients consecutively treated with the SpineCor system. A survival analysis was performed to estimate the cumulative probability of success during treatment, at follow-up and for the combined treatment and follow-up period. Success was defined as either a correction or stabilization of +/-5 degrees or more, and failure as a worsening of more than 5 degrees. The patient cohort was categorized before treatment into curves less than 30 degrees (group 1), and curves greater than 30 degrees (group 2). The survival analysis indicated a cumulative probability of success that increased during treatment with the patient wearing the brace (Year 1: 0.30, 0.39; Year 2: 0.62, 0.79; Year 3: 0.92, 0.89, for groups 1 and 2 respectively). During the post-treatment follow-up period, there was a stabilization (Year 1 post-treatment: 0.94, 0.89; Year 2 post-treatment: 0.85, 0.81), with an overall probability of success of 0.92 and 0.88 after 4 years of combined treatment and post-treatment follow-up. For the 29 patients who had a minimum follow-up of 2 years (initial Cobb angle: 30 degrees +/-9 degrees ), the trend during treatment was a decrease in spinal curvature at 3 months, with a mean difference of 10 degrees (SD 5 degrees ); at termination of treatment a mean difference of 7 degrees (SD 7 degrees ); and at the time of the 1- and 2-year follow-ups there was a difference of 4 degrees (SD 7 degrees ) and 5 degrees (SD 7 degrees ) respectively, with reference to the initial out of brace condition. At 2 years follow-up there was an overall correction of greater than 5 degrees for 55% of the patients, 38% had a stabilisation and 7% had worsened by more than 5 degrees. This initial cohort of patients demonstrated a general trend of initial decrease in spinal curvature in brace, followed by a correction and/or stabilisation at the end of treatment, which was maintained through 1, and 2 years' follow-up.

To determine the potential differences in control underlying compensatory and voluntary reach-to-grasp movements the current study compared the kinematic and electromyographic profiles associated with upper limb movement. Postural perturbations were delivered to evoke compensatory reach-to-grasp in ten healthy young adult volunteers while seated on a chair that tilted as an inverted pendulum in the frontal plane. Participants reached to grasp a laterally positioned stable handhold and pulled (or pushed) to return the chair to vertical. The distinguishing characteristic between the two behaviors was the onset latency and speed of movement. Consistent with compensatory balance reactions, the perturbation-evoked reach response was initiated very rapidly (137 vs. 239 ms for voluntary). As well the movement time was shorter, and peak velocity was greater for PERT movements. In spite of the profound differences in timing, the sequence of muscle activity onsets and the order of specific kinematic events were not different between maximum velocity voluntary (VOL) and perturbation-evoked (PERT) reach-to-grasp movements. Peak velocity and grasp aperture occurred prior to hand contact with the target for PERT and VOL movements, and wrist trajectory was influenced by the direction of perturbation relative to the target. To achieve such target specific control for responses initiated within 100 ms of the perturbation, and when characteristics of body movement were unpredictable, the perturbation-evoked movements would need to incorporate sensory cues associated with body movement relative to the target into the earliest aspects of the movement. This suggests reliance on an internal spatial map constructed prior to the onset of perturbation. Parallels in electromyographic and kinematic profiles between compensatory and voluntary reach-to-grasp movements, in spite of temporal differences, lead to the view they are controlled by common neural mechanisms.

Objective To determine the influence of concussion on cognitive performance while completing concurrent sport-specific tasks to further inform return to play protocols for youth athletes. Design This descriptive case pilot study compared the performance of youth ice hockey players who had experienced a concussion in the last ice hockey season to non-injured controls. Setting Youth athletes were assessed while performing ice hockey skills in an ice hockey arena. Participants Four male youth ice hockey players who experienced a concussion during the previous ice hockey season (mean age=11.7±0.29 years; mean time since injury=92.5±49.0 days) and nine non-injured control subjects (mean age=11.4±1.0 years). Intervention Participants completed a randomised combination of four tasks (unobstructed skating, visual interference task, avoiding a fixed obstacle, stickhandling an ice hockey puck). Outcome Measures Response errors and response reaction time dual-task costs during visual interference task (modified Stroop task). Results Participants who experienced a concussion within the past ice hockey season and were ≤58 days post-injury demonstrated significantly poorer cognitive performance (increased dual task cost) across all conditions when performing concurrent sport-specific skills (based on 95% CI). Conclusions Youth ice hockey players with a more recent concussion demonstrated greater cognitive deficits compared to controls. This study acts as an initial step towards the development of an ecologically valid, sport-specific assessment of functional performance following concussion in youth ice hockey players. Acknowledgements Ontario Neurotrauma Foundation, Quebec Rehabilitation Research Network (ONF-REPAR). Competing interests None.