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Background: In prior work, laboratory-based measures of hip motor function and ankle proprioceptive precision were critical to maintaining unipedal stance and fall/fall-related injury risk. However, the optimal clinical evaluation techniques for predicting these measures are unknown., Objective: To evaluate the diagnostic accuracy of common clinical maneuvers in predicting laboratory-based measures of frontal plane hip rate of torque development (Hip(RTD)) and ankle proprioceptive thresholds (AnkPRO) associated with increased fall risk., Design: Prospective, observational study., Setting: Biomechanical research laboratory., Participants: A total of 41 older subjects (aged 69.1 ± 8.3 years), 25 with varying degrees of diabetic distal symmetric polyneuropathy and 16 without., Assessments: Clinical hip strength was evaluated by manual muscle testing (MMT) and lateral plank time, defined as the number of seconds that the laterally lying subject could lift the hips from the support surface. Foot/ankle evaluation included Achilles reflex and vibratory, proprioceptive, monofilament, and pinprick sensations at the great toe., Main Outcome Measures: Hip(RTD), abduction and adduction, using a custom whole-body dynamometer. AnkPRO determined with subjects standing using a foot cradle system and a staircase series of 100 frontal plane rotational stimuli., Results: Pearson correlation coefficients (r) and receiver operator characteristic (ROC) curves revealed that LPT correlated more strongly with Hip(RTD) (r/P = 0.61/<.001 and 0.67/<.001, for abductor/adductor, respectively) than did hip abductor MMT (r/P = 0.31/.044). Subjects with greater vibratory and proprioceptive sensation, and intact Achilles reflexes, monofilament, and pin sensation had more precise AnkPRO. LPT of <12 seconds yielded a sensitivity/specificity of 91%/80% for identifying Hip(RTD) < 0.25 (body size in Newton-meters), and vibratory perception of <8 seconds yielded a sensitivity/specificity of 94%/80% for the identification of AnkPRO >1.0°., Conclusions: LPT is a more effective measure of Hip(RTD) than MMT. Similarly, clinical vibratory sense and monofilament testing are effective measures of AnkPRO, whereas clinical proprioceptive sense is not., (Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Aims: Distal symmetric polyneuropathy increases fall risk due to inability to cope with perturbations. We aimed to 1) identify the frontal plane lower limb sensorimotor functions which are necessary for robustness to a discrete, underfoot perturbation during gait; and 2) determine whether changes in the post-perturbed step parameters could distinguish between fallers and non fallers., Methods: Forty-two subjects (16 healthy old and 26 with diabetic PN) participated. Frontal plane lower limb sensorimotor functions were determined using established laboratory-based techniques. The subjects' most extreme alterations in step width or step length in response to a perturbation were measured. In addition, falls and fall-related injuries were prospectively recorded., Results: Ankle proprioceptive threshold (APrT; p=.025) and hip abduction rate of torque generation (RTG; p=.041) independently predicted extreme step length after medial perturbation, with precise APrT and greater hip RTG allowing maintenance of step length. Injured subjects demonstrated greater extreme step length changes after medial perturbation than non-injured subjects (percent change = 18.5 ± 9.2 vs. 11.3 ± 4.57; p = .01)., Conclusions: The ability to rapidly generate frontal plane hip strength and/or precisely perceive motion at the ankle is needed to maintain a normal step length after perturbation, a parameter which distinguishes between subjects sustaining a fall-related injury and those who did not., (© 2014.)

Objective: The purpose of this study was to describe a new computer-controlled research apparatus for measuring in vivo uterine ligament force-displacement behavior and stiffness and to present pilot data for women with and without prolapse., Study Design: Seventeen women with varying uterine support underwent testing in the operating room (OR) after anesthetic induction. A tripod-mounted computer-controlled linear servoactuator was used to quantify force-displacement behavior of the cervix and supporting ligaments. The servoactuator applied a caudally directed force to a tenaculum at 4 mm/sec velocity until the traction force reached 17.8 N (4 lbs). Cervix location on Pelvic Organ Prolapse Quantification system (POP-Q) in the clinic, in the OR, at rest, and with minimal force (<1.1 N); maximum force (17.8 N) was recorded. Ligament "stiffness" between minimum and maximum force was calculated., Results: The mean ± SD subject age was 54.5 ± 12.7 years; parity was 2.9 ± 1.1; body mass index was 29.0 ± 4.3 kg/m(2), and POP-Q point C was -3.1 ± 3.9 cm. POP-Q point C was correlated most strongly with cervix location at maximum force (r = +0.68; P = .003) and at rest (r = +0.62; P = .009). Associations between cervix location at minimum force (r = +0.46; P = .059) and ligament stiffness (r = -0.44; P = .079) were not statistically significant. Cervix location in the OR with minimal traction lay below the lowest point found on POP-Q for 13 women., Conclusion: POP-Q point C was correlated strongly with cervix location at rest and at maximum traction force; however, only 19% of the variation in POP-Q point C location was explained by ligament stiffness. The cervix location in the OR at minimal traction lay below POP-Q point C value in three-fourths of the women., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Background: There is recognition that teenagers and young adults with cancer merit age-appropriate specialist care. However, outcomes associated with such specialist care are not defined. Patient experience and patient-reported outcomes such as quality of life are gaining importance. Nevertheless, there is a lack of theoretical basis and patient involvement in experience surveys for young people., Objective: We previously proposed a conceptual model of the lived experience of cancer. We aimed to refine this model adding to areas that were lacking or underreported. The proposed conceptual framework will inform a bespoke patient experience survey for young people., Methods: Using participatory research, 11 young people aged 13 to 25 years at diagnosis, participated in a 1-day workshop consisting of semistructured peer-to-peer interviews., Results: Eight core themes emerged: impact of cancer diagnosis, information provision, place of care, role of health professionals, coping, peers, psychological support, and life after cancer., Conclusions: The conceptual framework has informed survey development for a longitudinal cohort study examining patient experience and outcomes associated with specialist cancer care., Implications for Practice: Young people must be kept at the center of interactions in recognition of their stated needs of engagement, of individually tailored information and support unproxied by parents/family. Age-appropriate information and support services that help young people deal with the impact of cancer on daily life and life after cancer must be made available. If we are to develop services that meet need, patient experience surveys must be influenced by patient involvement. Young people can be successfully involved in planning research relevant to their experience.

Introduction: Changes occur in muscles and nerves with aging. In this study we explore the relationship between unipedal stance time (UST) and frontal plane hip and ankle sensorimotor function in subjects with diabetic neuropathy., Methods: UST, quantitative measures of frontal plane ankle proprioceptive thresholds, and ankle and hip motor function were tested in 41 subjects with a spectrum of lower limb sensorimotor function ranging from healthy to moderately severe diabetic neuropathy., Results: Frontal plane hip and ankle sensorimotor function demonstrated significant relationships with UST. Multivariate analysis identified only composite hip strength, ankle proprioceptive threshold, and age to be significant predictors of UST (R(2) = 0.73), explaining 46%, 24%, and 3% of the variance, respectively., Conclusions: Frontal plane hip strength was the single best predictor of UST and appeared to compensate for less precise ankle proprioceptive thresholds. This finding is clinically relevant given the possibility of strengthening the hip, even in patients with significant peripheral neuropathy., (Copyright © 2011 Wiley Periodicals, Inc.)

Purpose: To identify key components of a specialist teenager and young adult (TYA) cancer unit from the perspective of young people and health professionals., Patients and Methods: A facilitated workshop was held in England at which participants prioritized 15 core features of a specialist cancer unit identified in a literature review. Themes were transferred onto cards and organized using a pyramid. Notes were made of the discussion and how decisions were reached. The exercise was repeated in a survey at a patient conference. Data were analyzed by weighting the ranked position and by content analysis., Results: Eleven young people and 22 health professionals attended the workshops, and 64 young people completed the survey. Young people's top three priorities were a dedicated unit, contact with peers, and provision for partners/parents to live in the unit with them. Health professionals prioritized best chance of survival and best quality of life, access to expertise, access to computers/Internet, and age-appropriate equipment., Conclusions: Priorities varied across and within healthcare professionals and young people, and were dependent on viewpoint and personal experience. This is an essential first step toward a fuller description of the benefit of specialist TYA cancer services and highlights the importance of consulting users in service development.

Objective: The purpose of this article is to characterize pelvic floor injury after vaginal childbirth with serial MRI., Subjects and Methods: MR images (3-T) were obtained early (1 month) and late (7 months) after first childbirth in 19 women with risk factors for pelvic floor injury. All women underwent multiplanar intermediate-weighted sequences, and 11 women underwent fluid-sensitive sequences. MR images were evaluated for levator edema and tears and for pubic abnormalities., Results: Three women had unilateral high-grade tears, three had unilateral low-grade tears, and one had bilateral high- and low-grade tears of the levator ani muscles. All tears were focal at the pubis. Levator edema was present in all women on initial imaging and was resolved at follow-up. Six women had bone marrow edema, five with fracture line. None showed a pattern indicating nerve damage separate from muscle tears., Conclusion: MRI showed focal levator ani muscle tears at the pubis with bone marrow edema and fracture in patients at risk for pelvic floor injury.

Purpose: Concentric needle and current transurethral surface recording techniques are unlikely to accurately record electromyography activity of the male striated urethral sphincter during dynamic tasks. Thus, we developed a novel transurethral surface electrode that could be fixed to the urethral mucosa with optimal orientation to record striated sphincter electromyography., Materials and Methods: Four recording surfaces were placed at equal intervals circumferentially around the tip of a 6Fr pediatric urinary catheter. This configuration provides optimal electrode-to-muscle fiber orientation for differential amplification. The electrode was fixed by gentle suction via the urine ports. Intra-abdominal pressure was monitored with a gastric pressure transducer. Five healthy male subjects participated in the validation study. Electromyography recordings were made of voluntary and involuntary striated sphincter contractions to investigate the quality of recordings and electrode stability. Tasks included maximal voluntary contractions of the striated sphincter and intra-abdominal pressure, submaximal contractions, ramped intra-abdominal pressure efforts and voluntary coughs., Results: Data indicated high quality electromyography recordings. Energy in the frequency spectrum was between 50 and 500 Hz, typical of human striated muscle surface electromyography. The median signal-to-noise ratio was 16.1 db (range 11.9 to 18.6) for striated sphincter maximal voluntary contractions. Motor unit action potentials could be discriminated during gentle contractions. Overlaid motor unit action potentials showed consistent morphology. Energy associated with motion artifact during a cough was less when suction was applied, indicating improved electrode stability., Conclusions: The new electrode provides high quality surface electromyography recordings of the male striated sphincter during dynamic tasks, such as coughing.

Objective: The objective of the study was to determine the effect of aging and continence status on the structure and function of the external (EAS) and internal (IAS) anal sphincters, Study Design: Young (YC) and older (OC) continent women were compared with older women with fecal incontinence (OI). Patients completed the Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index and underwent anorectal manometry and transanal ultrasound., Results: Nine YC, 9 OC, and 8 OI women participated. Aging was associated with a thickening of the IAS. Older incontinent women had a thinner EAS, had decreased maximum squeeze pressures, and were hypersensitive to rectal distention with decreased tolerable rectal volumes and urge to defecate at lower volumes., Conclusion: Thickening of the IAS occurs with aging. Thinning of the EAS and a corresponding drop in squeeze pressure correlated with fecal incontinence but not aging. Rectal hypersensitivity was associated with fecal incontinence rather than aging and may play a role in the mechanism of fecal incontinence.

Objective: The aim of this study was to determine how hand space for manual insertion of flexible hoses is affected by insertion method and force., Background: Adequate space is needed during assembly tasks in which workers join parts together with their hands. Hose installations are an example of such a task. Hand clearance envelopes for insertion tasks that involve cylindrical objects, such as a hose, are currently unavailable in the literature., Methods: Participants inserted a flexible 25-mm rubber hose onto a stationary flange using simulated methods similar to those observed in field studies of automotive assembly tasks. Markers placed on the back of the hand and wrists were used to measure postures during the insertion task., Results: Hand clearance envelopes for high-force insertions were significantly larger across methods by an average of 15% for both male (p < .05) and female (p < .01) participants. Rocking insertions resulted in the largest hand clearance envelopes compared with other insertion methods. Rocking and twisting the hose resulted in mean increases in the cross-sectional area of the hand clearance envelopes of 35% and 24%, respectively, compared with the straight push. Differences were significant (p < .05) for male and female participants for both bead height conditions., Conclusion: Both required insertion force and method affect hand clearance envelopes during simulated insertions., Application: These methods can be used by engineers to determine if there is adequate clearance for the hand to grip selected objects.

The aim of the study was to determine the immediate effect of timing a pelvic muscle contraction with the moment of expected leakage (the Knack maneuver) to preempt cough-related stress incontinence. Women performed a standing stress test using three hard coughs without and then with the Knack maneuver. Volume of urine loss under both conditions was quantified with paper-towel test. Two groups of women were tested: nonpregnant women (n = 64) and pregnant women (n = 29). In nonpregnant women, wetted area decreased from a median (range) of 43.2 (0.2-183.7) cm2 without the Knack maneuver to 6.9 (range of 0 to 183.7 cm2) with it (p < 0.0001); while in pregnant women it decreased from 14.8 (0-169.7) cm2 to 0 (0-96.5) cm2, respectively (p = 0.001). This study confirms the effect from the Knack maneuver as immediate and provides a partial explanation for early response to widely applied pelvic muscle training regimens in women with stress incontinence.