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Purpose: Lymphedema is a common late effect of head and neck cancer treatment that causes various symptoms, functional impairment, and poor quality of life. We completed a pilot, prospective, single-arm clinical trial to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema. In this study, we report patients' perceived treatment experience of PBM therapy and provide suggestions to better understand head and neck cancer survivors' experience of PBM therapy. Methods: Head and neck cancer patients who underwent PBM therapy completed face-to-face semi-structured interviews. Interviews were audio-recorded and then transcribed verbatim. Qualitative content analysis was used to analyze the transcriptions from the interviews. Results: Among 12 participants who consented for the study, 11 (91.7%) completed the PBM therapy. Participants described positive experiences and unique benefits about the PBM therapy, for example, decreased swelling, reduced tightness, increased range of motion, increased saliva production, and improved ability to swallow. Some participants ( n  = 5, 45.5%) delineated challenges related to traffic, travel time, and distance from study location. Many participants proposed suggestions for future research on PBM therapy, for example, research on internal edema and its relationship with swallowing, and indicated patients with severe lymphedema and fibrosis may be more likely to benefit. Conclusions: Findings from this study suggested the potential benefits of PBM therapy in treatment of chronic head and neck lymphedema. Rigorously designed clinical trials are needed to evaluate the effect of PBM therapy for head and neck cancer-related lymphedema. Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.

Purpose: Lymphedema is a common debilitating late effect among patients post-head and neck cancer (HNC) treatment. Head and neck lymphedema was associated with symptom burden, functional impairment, and decreased quality of life. The objective of this study was to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema, symptom burden, and neck range of motion among HNC survivors., Methods: This was a single-arm, pre- and post-design clinical trial. Eligible patients included those with lymphedema after completion of complete decongestive therapy (CDT) and 3 to 18 months after completion of cancer therapy. The intervention included PBM therapy 2 times a week for 6 weeks for a total of 12 treatments. Lymphedema, symptom burden, and neck range of motion were measured at baseline, end-of-intervention, and 4-week post-intervention., Results: Of the 12 patients enrolled in the study, 91.7% (n = 11) completed the study intervention and assessment visits, and no adverse events were reported. When comparing the baseline to 4-week post-intervention, we found statistically significant improvements in the severity of external lymphedema, symptom burden, and neck range of motion (all P  < .05)., Conclusion: PBM therapy was feasible and potentially effective for the treatment of head and neck lymphedema. Future randomized controlled trials are warranted to examine the efficacy of PBM therapy for HNC-related lymphedema., Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.

Children with cleft lip and/or palate (CL ± P) undergo several surgical procedures from birth to adulthood to achieve functional, aesthetic, and psychosocial normalcy. Although children with CL ± P have normal physical development apart from their CL ± P, they face increased risk for emotional, social, behavioral, and academic concerns. In this article, we discuss how the psychology team helps support children with CL ± P and their families. We also explore how the child's overall functioning is evaluated through interview and assessment tools. Throughout, we validate the need for specialized considerations related to having a CL ± P such as increased risk for peer victimization as well as readiness for medical and surgical procedures. By examining the psychology team's role across a child's lifespan, we hope to show that our goal is to advocate for the child and to encompass the child's voice throughout the treatment process.

The objective of this technical paper is to demonstrate how graphing kinematic data to represent body segment coordination and control can assist clinicians and researchers in understanding typical and aberrant human movement patterns. Aberrant movements are believed to be associated with musculoskeletal pain and dysfunction. A dynamical systems approach to analysing movement provides a useful way to study movement control and coordination. Continuous motion angle-angle and coupling angle-movement cycle graphs provide information about coordinated movement between body segments, whereas phase-plane graphs provide information about neuromuscular control of a body segment. Examples demonstrate how a dynamical systems approach can be used to represent (1) typical movement patterns of the lumbopelvic and shoulder regions; (2) aberrant coordination in an individual with low back pain who presented with altered lumbopelvic rhythm; and (3) aberrant control of shoulder movement in an individual with observed scapular dysrhythmia. Angle-angle and coupling angle-movement cycle graphs were consistent with clinical operational definitions of typical and altered lumbopelvic rhythm. Phase-plane graphs illustrated differences in scapular control between individuals having typical scapular motion and an individual with scapular dysrhythmia. Angle-angle, coupling angle-movement cycle, and phase-plane graphs provide information about the amount and timing of segmental motion, which clinicians assess when they observe movements. These approaches have the potential to (1) enhance understanding of typical and aberrant movement patterns; (2) assist with identifying underlying movement impairments that contribute to aberrant movements: and (3) improve clinicians' ability to visually assess and categorize functional movements., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Collegiate football is a high-demand sport in which shoulder injuries are common. Research has described the incidence of these injuries, with little focus on causative factors or injury prevention., Hypothesis: Football athletes who score lower on preseason strength and functional testing are more likely to sustain an in-season shoulder injury., Study Design: Prospective, cohort study., Level of Evidence: Level 2., Methods: Twenty-six collegiate football players underwent preseason testing with a rotational profile for shoulder range of motion, isometric strength of the rotator cuff at 90° elevation and external rotation in the 90/90 position, fatigue testing (prone-Y, scaption, and standing cable press), and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). Data collected postseason included the type of shoulder injury and the side injured. Logistic regression was used to determine if the testing measures predicted injury, and a receiver operating characteristic curve was constructed to examine the relationship of CKCUEST to injury., Results: Six athletes sustained shoulder injuries during the season. Predictor variables could significantly predict whether that player would sustain an injury during the season for both the right and left shoulders (P < 0.05). The variables that were significantly correlated with injury of the right side were forward elevation strength, prone-Y to fatigue, and the CKCUEST (P < 0.05); on the left, only the CKCUEST was significant (P < 0.05). The area under the receiver operating characteristic curve for the CKCUEST was 0.86 (ϵ = 0.87, P = 0.01). Using a score of 21 touches, the CKCUEST had a sensitivity of 0.83, a specificity of 0.79, and an odds ratio of 18.75 in determining whether a player sustained a shoulder injury., Conclusion: For this sample, the combination of preseason strength, fatigue, and functional testing was able to identify football players who would sustain a shoulder injury during the season., Clinical Relevance: Using a battery of strength, fatigue, and functional testing may be helpful in identifying football players during preseason who are at a higher risk for sustaining a shoulder injury. This information can be used to optimize preseason testing and implementation of injury prevention programs.

Scapulothoracic muscle activity is essential for normal scapulothoracic motion. While previous research has furthered the understanding of scapulothoracic motion and muscle activity during the raising phase of motion, a gap exists with respect to the lowering phase. The purpose of this study was to compare scapulothoracic motion and scapulothoracic muscle activity between the raising and lowering phases of an overhead reaching task. Twenty healthy subjects volunteered to participate in the study. Three-dimensional scapulothoracic motion was collected using an electromagnetic device. Surface electromyography (EMG) was used to assess muscle activity from the upper trapezius, lower trapezius, and serratus anterior muscles. Overall scapulothoracic motion was similar for the raising and lowering phases of the overhead reaching task. However, significantly lower EMG amplitude values existed during the lowering phase across all muscles. Less muscle activity during the lowering phase may reflect differing neuromuscular control strategies between arm raising and lowering. These findings suggest that scapulothoracic muscle activation levels during eccentric contractions may be closer to an activation threshold below which their ability to control scapulothoracic motion may be compromised subsequently leading to altered scapulothoracic motion (scapular dyskinesis). This provides a possible explanation for why scapular dyskinesis is more notable during the lowering phase of motion., (2009 Elsevier Ltd. All rights reserved.)