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Employment status is considered a determinant of health, yet returning to work is frequently a challenge after lower limb amputation. No studies have documented if working after lower limb amputation is associated with functional recovery. The study's purpose was to examine the influence of full-time employment on functioning after lower limb amputation.Multisite, cross-sectional study of 49 people with dysvascular lower limb amputation. Outcomes of interest included performance-based measures, the Component Timed-Up-and-Go test, the 2-min walk test, and self-reported measures of prosthetic mobility and activity participation.Average participant age was 62.1 ± 9.7 years, 39% were female and 45% were persons of color. Results indicated that 80% of participants were not employed full-time. Accounting for age, people lacking full-time employment exhibited significantly poorer outcomes of mobility and activity participation. Per regression analyses, primary contributors to better prosthetic mobility were working full-time (This study offers novel evidence of associations between employment and performance-based mobility outcomes after dysvascular lower limb amputation. Further research is required to determine cause-effect directionalities. These results provide the foundation for future patient-centered research into how work affects outcomes after lower limb amputation. IMPLICATIONS FOR REHABILITATIONLower limb amputation can pose barriers to employment and activity participation, potentially affecting the quality of life.This study found that the majority of people living with lower limb amputation due to dysvascular causes were not employed full-time and were exhibiting poorer prosthetic outcomes.Healthcare practitioners should consider the modifiable variable of employment when evaluating factors that may affect prosthetic mobility.The modifiable variable of self-efficacy should be assessed by healthcare professionals when evaluating factors that may affect prosthetic mobility.

Making a prosthesis for an individual with limb loss is a highly personalized process. A currently unexplored area is whether there are tangible benefits in greater patient engagement during the cosmetic designing of their prostheses. We examined the current clinical practice of engaging patients in prosthetic cosmetic designing and identified factors associated with patient outcomes.One hundred and four prosthetists and 28 prosthesis users were surveyed in this cross-sectional study. The questionnaires covered aspects of prosthetic prescription and fabrication, users' perceived level of engagement, and self-reported outcomes. Regression analyses were used to examine the associations between patients' perceived levels of engagement during the design process, satisfaction, and other outcomes.Seventy-five percent of the prosthesis users reported being offered at least one cosmetic option during the making of their prostheses, which corroborated with 82.7% of the prosthetists reporting that they typically engage their patients in this aspect of their practices. Patients who were offered at least one cosmetic design option reported significantly greater satisfaction ( P = 0.027) than those who were not offered such an option. Patients' level of satisfaction regarding the look of their prostheses was significantly correlated with their perception that their prostheses empower them in daily activities (r = 0.415, P = 0.028).Engaging patients in the cosmetic designing of their prostheses is a widely accepted practice. Patients who are more satisfied with the look of their prostheses perceived higher levels of empowerment. Prosthetic practitioners should consider the potential outcome benefits of higher level engagement for users of prosthetic devices.

Background : The COVID-19 pandemic is expected to bring a surge of survivors in need of post-acute rehabilitation. Preliminary research and clinical guidelines suggest patients recovering from critical illness associated with COVID-19 will present compromised function similar to acute respiratory distress syndrome (ARDS) and ICU-acquired weakness (ICUAW). However, information regarding physical therapy and progressions of physiological and functional outcomes is currently limited. This case report describes the course of recovery of a patient without significant preexisting medical conditions. Case description : The patient RW (male, age 56) tested positive for COVID-19, and was admitted to ICU for 29 days. After weaning off mechanical ventilation after 2 months of hospitalization, he was transferred to our post-acute rehabilitation facility to recover from the residual effects. Physical therapy evaluation showed that while the patient was cognitively alert, he exhibited impaired general strength and activity intolerance due to severe exertional dyspnea. The patient received physical therapy aimed at improving his functional capacity. During his 16-day stay, the patient was able to significantly improve his capacities (i.e. 600% increase in 30-second chair stand test, 69.5% improvement in walking distance in 6-minute walk test, and 132.4% longer time to exhaustion during level ground ambulation). Dyspnea remained the main factor that limited his activities. Discussion : This case demonstrated that post-acute physical therapy appeared to be effective and safe in improving function after critical illness due to COVID-19 for this patient. Physical therapists are encouraged to closely monitor respiratory parameters such as heart rate, oxygen saturation, and levels of dyspnea during treatment for patient response and decisions regarding activity progression.

Indoor sport rock climbing has been increasing in popularity both recreationally and competitively. Despite this increase in popularity, the physiological responses to sport climbing as an exercise to specific muscle groups are not well defined. The purpose of this study was to quantify the change in handgrip strength over a 30-minute bout of continuous climbing, specifically in intermediate-level sport climbers. Ten intermediate rock climbers (age = 27 ± 2 years; climbing experience: 7.3 ± 1.5 years) completed baseline handgrip strength and forearm girth measurements. Each participant ascended one of two 5.9 difficulty routes as many times as possible in 30 minutes. After each ascent, heart rate was obtained, and handgrip strength and forearm girth were measured. Data were analyzed using repeated-measures ANOVA with significance set at α < 0.05. Dominant arm handgrip strength decreased by 22%, and non-dominant handgrip strength reduced by 23%. Dominant and non-dominant forearm girth increased by 4.5% and 4.4%, respectively. Weak but significant negative correlations were observed between handgrip strength and forearm girth in dominant (r = −0.311, p = 0.001) and non-dominant limbs (r = −.491, p = 0.001). These results indicate a relationship between increased forearm girth and decreases in muscular strength. Since handgrip strength decreases substantially during a 30-min climb in intermediate rock climbers, this population would be advised to carefully monitor recovery time between bouts.

PURPOSE OF REVIEW: People living with lower limb amputation are at an increased risk of falling compared with the healthy geriatric population. Factors of increased age and increased number of comorbidities could compound the already increased risk. The purpose of this article is to highlight recent research associated with fall risk in amputees and provide the reader with evidence to help guide clinical interventions. RECENT FINDINGS: Though research on the topic of falls in people with amputation is becoming more common, there is still a dearth of evidence regarding what contributes to increased fall risk and how to address it in this population. There are recent studies that have examined therapy and prosthetic interventions that could mitigate fall risk in people with amputation, yet there is not enough evidence to develop a consensus on the topic. More research is required to determine what contributes to increased fall rates in people with amputation, and what detriments to an amputee’s function or psyche may result after incurring a fall. SUMMARY: Borrowing from what is known about geriatric fall risk and combining the information with novel and existing approaches to fall mitigation in amputees can offer clinicians the opportunity to develop evidence-based programs to address fall risk in their patients with lower limb amputation.

Lower back pain is a debilitating condition common to individuals with lower limb amputation. It is unclear what risk factors contribute to the development of back pain. This study systematically reviewed and analyzed the available evidence regarding the clinical and biomechanical differences between individuals with amputation, with and without lower back pain.A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL databases in November 2020 and repeated in June 2021 and June 2022. Studies were included if they reported comparisons of demographic, anthropometric, biomechanical, and other clinical variables between participants with and without LBP. Study quality and potential for reporting bias were assessed. Meta-analyses were conducted to compare the two groups.Thirteen studies were included, with aggregated data from 436 participants (239 with LBP; 197 pain free). The median reporting quality score was 37.5%. The included studies enrolled participants who were predominantly male (mean = 91.4%, range = 77.8-100%) and with trauma-related amputation. Meta-analyses showed that individuals with LBP exhibited moderate (3.4 out of 10) but significantly greater pain than those without LBP. We found no between-group differences in age, height, weight, BMI, and time since amputation (p = 0.121-0.682). No significant differences in trunk/pelvic kinematics during gait were detected (p = 0.07-0.446) between the groups.Demographic, anthropometric, biomechanical, and simple clinical outcome variables may be insufficient for differentiating the risk of developing back pain after amputation. Investigators should be aware of the existing gender bias in sampling and methodological limitations, as well as to consider incorporating psychosocial measures when studying LBP in this clinical population.

Objective To examine how insertion and presence of intramuscular fine-wire electromyography electrodes (IFWEs) in lumbar multifidus affect paraspinal muscle strength, endurance, and activation in persons with and without recurrent lower back pain (RLBP) during activities that require high levels of muscle contraction. Design Case-control with randomization of conditions. Setting Clinical research laboratory. Participants Forty participants age 18 to 40 years were recruited (18 female; mean age = 25.5 years); 20 with a history of RLBP were compared to a matching control group of 20 without RLBP. Interventions Each participant was tested under three conditions over three sessions. On Session 1, the baseline condition, we assessed muscle performance without IFWE insertion. On Sessions 2 and 3, participants were randomly alternated between two experimental conditions: (1) wire-in, in which the IFWE was inserted and remained within the muscle during testing; and (2) wire-out, in which the IFWE was inserted and immediately removed. Main outcome measurements Lumbar spinal extensor peak strength, endurance, and normalized electromyography (EMG) amplitude during the endurance test. Results Individuals with RLBP showed a significant decrease in peak strength during conditions that involved IFWE insertion and tend to experience more pain during muscle testing. Both groups exhibited similar levels of performance and muscle activation during the endurance test. Conclusion Our findings indicate that individuals with RLBP exhibited reduced lumbar extensor strength in response to IFWE insertion to the deep paraspinal muscles. This behavior is different from those without RLBP. Researchers should carefully consider the use of IFWE in individuals with RLBP during high exertion activities.

The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between back pain and back-healthy control groups.Ninety-seven studies were included and reviewed. Two studies investigated acute pain and the rest investigated persistent pain. Nine studies investigated running gait. Of the studies, 20% had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent LBP walked slower (SMD = -0.59, 95% confidence interval (95%CI): -0.77 to -0.42)) and with shorter stride length (SMD = -0.38, 95%CI: -0.60 to -0.16). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups (SMD = -0.60, 95%CI: -0.90 to -0.30), and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles (SMD = 0.52, 95%CI: 0.23-0.80). There were no consistent differences in running biomechanics between groups.There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.

The current study aimed to investigate the long-term effects of receiving post-amputation physical therapy (PT) on individuals' self-reported functional outcomes and quality of life in middle-aged to older adults with lower limb amputation (LLA). Further, we qualitatively explored the patients' perception and experience of PT post-amputation. We assessed participants' functional outcomes using Short-Form Health Survey, Prosthetic Evaluation Questionnaire-Physical Mobility portion, and Fear of Falling Avoidance Behavior Questionnaire. Furthermore, participants' experience and perception to PT were assessed through in-person interviews guided by the custom Amputation Patient Perception Survey. Functional outcome scores were compared between participants who have (Yes-PT) and have not (No-PT) received PT following their amputations, controlling for age. Perception to PT was qualitatively analyzed. Out of the 70 participants, 56 had received PT (80%) following amputation. Functional outcome scores were not significantly different between Yes-PT and No-PT groups. Among participants in the Yes-PT group, 84% expressed overall positive perception toward their post-amputation PT care. Main positive and negative perceptions were related to outcome/benefits and unfulfilled needs/lack of benefits, respectively. Participants with LLA generally expressed a positive perception of PT. However, no significant long-term benefits were found. We recommend goal-directed intervention with patient engagement to improve care experience.

A patellar-tendon-bearing (PTB) bar is a common design feature used in the socket of trans-tibial prostheses to place load on the pressure-tolerant tissue. As the patellar tendon in the residual limb is subjected to the perpendicular compressive force not commonly experienced in normal tendons, it is possible for tendon degeneration to occur over time. The purpose of this study was to compare patellar tendon morphology and neovascularity between the residual and intact limbs in trans-tibial amputees and healthy controls. Fifteen unilateral trans-tibial amputees who utilized a prosthesis with a PTB feature and 15 age- and sex- matched controls participated. Sonography was performed at the proximal, mid-, and distal portions of each patellar tendon. One-way ANOVAs were conducted to compare thickness and collagen fiber organization and a chi-square analysis was used to compare the presence of neovascularity between the three tendon groups. Compared to healthy controls, both tendons in the amputees exhibited increased thickness at the mid- and distal portions and a higher degree of collagen fiber disorganization. Furthermore, neovascularity was more common in the tendon of the residual limb. Our results suggest that the use of a prosthesis with a PTB feature contributes to morphological changes in bilateral patellar tendons.

Lee, S-P, Gillis, CB, Ibarra, JJ, Oldroyd, DF, and Zane, RS. Heel-raised foot posture does not affect trunk and lower extremity biomechanics during a barbell back squat in recreational weight lifters. J Strength Cond Res 33(3): 606-614, 2019-It is claimed that weightlifting shoes with a raised heel may lead to a more upright trunk posture, and thus reduce the risk of back injuries during a barbell back squat. These proclaimed biomechanical effects have not been thoroughly investigated. The purpose of this study was to compare trunk and lower extremity biomechanics during barbell back squats in three foot postures. Fourteen recreational weight lifters (7 men and 7 women) between the ages of 18 and 50 years performed barbell back squats in three conditions (barefoot on a flat surface, barefoot on a heel-raised platform, and wearing heel-raised weightlifting shoes) at 80% of their 1 repetition maximum. Surface electromyography was used to assess the activation of the knee extensors and paraspinal muscles at L3 and T12 spinal levels. A 3D motion capture system and an electrogoniometer recorded the kinematics of the thoracic spine, lumbar spine, and knee during the back squat to a depth where the hip was at least at the same level to the knee. Results indicated that none of the heel-raised foot postures significantly affected trunk and lower extremity muscle activation (thoracolumbar paraspinal [p = 0.52], lumbar paraspinal [p = 0.179], knee extensor [p = 0.507]) or the trunk angles (thoracolumbar spine [p = 0.348], lumbar spine [p = 0.283]) during the squat. Our results demonstrated that during barbell back squats, heel-raised foot postures do not significantly affect spinal and knee extensor muscle activations, and trunk and knee kinematics. Heel-raised weightlifting shoes are unlikely to provide significant protection against back injuries for recreational weight lifters during the barbell back squat.

Objectives Previous studies showed that adopting forward trunk lean and forefoot strike patterns may reduce risk of running-related knee injuries. However, the process of learning such forms is unclear. The purpose of the study was to investigate the effects of a 4-week training using simple postural instructions to elicit these changes. Design Longitudinal intervention study. Setting A training included postural instructions: 1) lean your trunk forward, and 2) land on the front part of your feet. Participants Eighteen recreational runners. Main outcome measures Participants were assessed prior to training (PRE), immediately after the instructions (iPST), during training at 2 weeks (2WK) and 4 weeks (4WK), and 7–10 days after the conclusion of training (RET). Assessment consisted of running trials performed at self-selected and controlled speeds, during which the trunk and foot strike angles were assessed. Results Comparing to PRE, forward trunk angle significantly increased by approximately 3.5° and foot strike angle by approximately 7° at 2WK, 4WK and RET. Conclusions A 4-week training with simple postural instructions induced significant changes in trunk and foot strike patterns in recreational runners. Future study is needed to develop clinical therapeutic protocols for runners with and at risk of running-related knee injuries.

BACKGROUND: Age-related decline in vision may contribute to the development of fear of falling (FOF) behavior and reduced mobility, which are related to increased fall risk in older adults. PURPOSE: To investigate the inter-relationship between vision impairment, physical mobility performance, and FOF behavior in community-dwelling older adults. METHODS: A total of 400 participants from community centers (267 females; age = 74.8 (6.4), range = 65–97 years) participated in this cross-sectional study. Presence of age-related eye diseases (e.g. macular degeneration, cataracts, glaucoma, and retinopathy) and visual acuity (VA) was assessed. Physical mobility and FOF avoidance behavior were assessed using the Timed Up-and-Go (TUG) test and the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). The inter-relationships between parameters were analyzed using mediation model analysis. RESULTS: Significant decreases in mobility performance were observed in those with eye disease (eye disease = 9.56 [5.2] sec, no eye disease = 8.54 [2.75] sec; p = .037) and FOF avoidance behavior (avoiders = 12.87 [6.04] sec, non-avoiders = 8.51 [3.56] sec; p < .001). Furthermore, FOF behavior was found to significantly influence the inter-relationship between presence of eye disease and TUG performance (p = .004). VA alone had no significant effect on mobility (p = .69). CONCLUSION: The presence of eye disease and the associated FOF behavior was related to decreased mobility and potentially increased fall risk. We recommend clinicians to inquire about the presence of eye disease and FOF behavior to identify risk factors related to falls in older adults.

Wearable technology devices are used by millions of people who use daily step counts to promote healthy lifestyles. However, the accuracy of many of these devices has not been determined. The purpose was to determine reliability and validity of the Samsung Gear 2, FitBit Surge, Polar A360, Garmin Vivosmart HR+, and the Leaf Health Tracker when walking and jogging in free motion and treadmill conditions. Forty volunteers completed walking and jogging free motion and treadmill protocols of 5-minute intervals. The devices were worn simultaneously in randomized configurations. The mean of two manual steps counters was used as the criterion measure. Test-retest reliability was determined via Intraclass Correlation Coefficient (ICC). Validity was determined via a combination of Pearson’s Correlation Coefficient, mean absolute percent error (MAPE: free motion ≤ 10.0%, treadmill ≤ 5.00%), and Bland-Altman analysis (device bias and limits of agreement). Significance was set at p < 0.05. The Samsung Gear 2 was deemed to be both reliable and valid for the jogging conditions, but not walking. The Fitbit Surge was reliable and valid for all conditions except for treadmill walking (deemed reliable, ICC = 0.76; but not valid). The Polar A360 was found to be reliable for one condition (treadmill jog ICC = 0.78), but not valid for any condition. The Garmin Vivosmart HR+ and Leaf Health Tracker were found to be both reliable and valid for all situations. While each device returned some level of consistency and accuracy during either free motion or treadmill exercises, the Garmin Vivosmart HR+ and the Leaf Health Tracker were deemed to be reliable and valid for all conditions tested.

BACKGROUND: Socioeconomic status has been shown to be an important factor in the disparate prevalence and selected treatment of limb loss, but how personal financial difficulty affects patients’ health outcomes is currently unclear. OBJECTIVE: Examining how presence and experience of personal financial difficulty affects perceived health and wellbeing in individuals with lower limb loss. STUDY DESIGN: Cross-sectional study. METHODS: A total of 90 participants (68 males, mean age 58.7 ± 16.7 years) were recruited from local physical therapy and prosthetic and orthotic clinics, rehabilitation hospitals, and a regional amputee patient support group. All participants were community-dwelling, non-military adults with amputation involving at least one major lower limb joint. Participants were interviewed, and each completed a survey that included basic demographic/medical information, self-reported health and wellbeing (Short-Form Health Survey, SF-36v2), and a question to determine their financial situation after limb loss. Multiple regression analyses were used to examine the effect of financial difficulty on the eight subscales of SF-36v2 while accounting for age, gender, and amputation level. RESULTS: Experiencing financial difficulty significantly and negatively affected Role-Physical and Role-Emotional subscale scores (p < 0.01 and p = 0.02, respectively). Individuals with financial difficulty scored approximately 60% lower in these two specific subscales. CONCLUSION: Experiencing financial difficulty is a significant predictor for diminished work or daily activity participation due to physical and emotional stresses. Clinicians and health policy makers need to understand how socioeconomic factors may prevent individuals with lower limb loss from achieving higher levels of functional recovery and community re-integration after amputation. CLINICAL RELEVANCE: Our findings showed that presence or experience of financial difficulty was significantly associated with diminished community re-integration in community-dwelling, non-military adults with lower limb loss. It affects both physical and emotional aspects of wellbeing. Clinicians should be aware how socioeconomic factors may affect social re-integration after amputation.

Supplemental material, 10.1177_0309364620921756_Supplementary_material for Financial difficulty in community-dwelling persons with lower limb loss is associated with reduced self-perceived health and wellbeing by Szu-Ping Lee, Lung-Chang Chien, Tyler Chin, Heather Fox and Juan Gutierrez in Prosthetics and Orthotics International

Context: Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing. Objective: The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers. Data Sources: A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017. Study Selection: Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain. Results: The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain. Conclusion: Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers.

Background Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (ie, multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions. Objective To examine the effects of insertion and presence of fine-wire EMG electrodes in the lumbar multifidus on muscle strength, endurance, and activation profiles during high-exertion spinal extension muscle contractions. Design Single-blinded, repeated measures intervention trial. Setting University clinical research laboratory Participants Twenty individuals between the ages of 18-40 free of recent and current back pain. Methods Muscle performance was assessed during 3 conditions (with [WI] and without [WO] presence of intramuscular electrodes, and insertion followed by removal [IO]). Isometric spinal extension strength was assessed with a motorized dynamometer. Muscle endurance was assessed using the Sorensen test with neuromuscular activation profiles analyzed during the endurance test. Main Outcome Measurements Spinal extensor muscle strength, endurance, and activation. Results Our data showed no significant difference in isometric strength ( P = .20) between the 3 conditions. A significant difference in muscle endurance was found ( P = .03). Post hoc analysis showed that the muscle endurance in the IO condition was significantly higher than the WO condition (161.3 ± 58.3 versus 142.1 ± 48.2 seconds, P = .04), likely due to a learning effect. All 3 conditions elicited minimal pain (range 0-4/10) and comparable muscle activation profiles. Conclusion Our findings suggested the sonographically guided insertion and presence of fine-wire intramuscular EMG electrodes in the lumbar multifidus muscles had no significant impact on spinal extension muscle function. This study provides evidence that implementing intramuscular EMG does not affect muscle performance during high-exertion contractions in individuals with no current back pain. Level of Evidence II

Novel Eu2+-activated BaGa2SiS6 and Ba2Ga8SiS16 thiogallate phosphors were prepared by solid-state reaction route. The BaGa2SiS6:Eu2+ phosphor generated a green emission upon excitation at 405 nm, whereas the Ba2Ga8SiS16:xEu2+ phosphor could be tuned from cyan to green range with increasing Eu2+ concentration upon excitation at 365 nm. Additionally, the thermal luminescence properties of the thiogallate phosphors were investigated in the temperature range of 25 to 250 °C. A warm-white LED is fabricated using the combination of a 405 nm blue InGaN-based LED chip with the green-emitting BaGa2SiS6:0.01Eu2+ phosphor, and red-emitting Sr2Si5N8:Eu2+ commercial phosphor with the CRI value of ∼88 and the CCT of 4213 K.

Objectives To investigate the changes in lumbar kinematic and paraspinal muscle activation before, during, and after a 4-week minimalist running training. Design Prospective cohort study. Setting University research laboratory. Participants Seventeen habitually shod recreational runners who run 10–50 km per week. Main outcome measures During stance phases of running, sagittal lumbar kinematics was recorded using an electrogoniometer, and activities of the lumbar paraspinal muscles were assessed by electromyography. Runners were asked to run at a prescribed speed (3.1 m/s) and a self-selected speed. Results For the 3.1 m/s running speed, significant differences were found in the calculated mean lumbar posture (p = 0.001) during the stance phase, including a more extended lumbar posture after minimalist running training. A significant reduction in the contralateral lumbar paraspinal muscle activation was also observed (p = 0.039). For the preferred running speed, similar findings of a more extended lumbar posture (p = 0.002) and a reduction in contralateral lumbar paraspinal muscle activation (p = 0.047) were observed. Conclusion A 4-week minimalist running training program produced significant changes in lumbar biomechanics during running. Specifically, runners adopted a more extended lumbar posture and reduced lumbar paraspinal muscle activation. These findings may have clinical implications for treating individuals with running-related lower back pain.

Introduction: When comparing oral breathing versus nasal breathing, a greater volume of air can be transported through the oral passageway but nasal breathing may also have benefits at submaximal exercise intensities. Purpose: The purpose of this study was to determine breathing efficiency during increasing levels of submaximal aerobic exercise. Methods: Nineteen individuals (males N=9, females N=10) completed a test for maximal oxygen consumption (VO 2 max) and on separate days 4-min treadmill runs at increasing submaximal intensities (50%, 65%, and 80% of VO 2 max) under conditions of oral breathing or nasal breathing. Respiratory (respiration rate [RR], pulmonary ventilation [V E ]), metabolic (oxygen consumption [VO 2 ], carbon dioxide production [VCO 2 ]) and efficiency measures (ventilatory equivalents for oxygen [Veq×O 2 -1 ] and carbon dioxide [Veq×CO 2 -1 ] were obtained. Data were analyzed utilizing a 2 (sex) x 2 (condition) x3 (intensity) repeated measures ANOVA with significance accepted at p≤0.05. Results: Significant interactions existed between breathing mode and intensity such that oral breathing resulted in greater RR, V E , VO 2 , and VCO 2 at all three submaximal intensities (p

Novel Ce(3+)- and Eu(2+)-doped lanthanum bromothiosilicate La3Br(SiS4)2:Ce(3+)and La3Br(SiS4)2:Eu(2+) phosphors were prepared by solid-state reaction in an evacuated and sealed quartz glass ampule. The La3Br(SiS4)2:Ce(3+) phosphor generates a cyan emission upon excitation at 375 nm, whereas the La3Br(SiS4)2:Eu(2+) phosphor could be excited with extremely broad range from UV to blue region (300 to 600 nm) and generates a reddish-orange broadband emission centered at 640 nm. In addition, thermal luminescence properties of La3Br(SiS4)2:Ce(3+)and La3Br(SiS4)2:Eu(2+) phosphors from 20 to 200 °C were investigated. The combination of a 450 nm blue InGaN-based LED chip with the red-emitting La3Br(SiS4)2:Eu(2+) phosphor, and green-emitting BOSE:Eu(2+) commercial phosphor produced a warm-white light with the CRI value of ∼95 and the CCT of 5,120 K. Overall, these results show that the prepared phosphors may have potential applications in pc-WLED.

We have synthesized and investigated a series of yellow-emitting Sr3Ce(PO4)3:Eu2+ phosphors, showing an extreme broadband at around 535 nm (with a FWHM of ca. 200 nm/6760 cm−1) and a large Stoke shift (ca. 8265 cm−1), which is attributed to the 4f–5d transition of Eu2+ without the contribution from Ce3+ emission under excitation at long wavelengths (>370 nm). However, such broadband Eu2+ emission is rather surprising, considering that there is only one cation site for the Eu2+ luminescent center. Herein, we investigated the crystal structure by performing X-ray Rietveld refinement on the synchrotron X-ray diffraction data, and demonstrate that both cation and anion sites in Sr3Ce(PO4)3 are disordered in the host lattice. These unusual structural characters generate a variety of distinct Eu2+ sites, which is verified by decay lifetime analysis and electron paramagnetic resonance spectra, and thus result in astonishing broadband yellow-emission. Moreover, a white LED device with a color-rendering index of 86.5, a color temperature of 5996 K, and chromaticity coordinates of (0.32, 0.38) was obtained by combining a 405 nm near-UV LED chip and the phosphor blends of yellow-emitting Sr3Ce(PO4)3:Eu2+ and the commercial blue-emitting BaMgA10O17:Eu2+ phosphor. These results indicate that the as-prepared yellow-emitting Sr3Ce(PO4)3:Eu2+ phosphor has potential applications in the dual-color-phosphor-converted WLEDs.

Novel Eu

Supplemental material, 28951_Appendix for Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis by Jo Armour Smith, Andrew Hawkins, Marybeth Grant-Beuttler, Richard Beuttler and Szu-Ping Lee in Sports Health: A Multidisciplinary Approach

Cerebral palsy (CP) is the most common cause of motor disability among children. Limited evidence exists regarding the efficacy of traditional rehabilitation strategies on improving ambulatory function in this population. The purpose of the study was to investigate the feasibility and short-term effects of a novel large amplitude movement therapy on ambulatory functions in children with CP. Temporal-spatial gait characteristics were examined before and after a single intervention session, replicated over five children. Five children with CP (7.0 ± 1.0 years); Gross Motor Function Classification System Levels I-II, participated. Baseline gait parameters were obtained as the participant walked across an instrumented walkway at self-selected and fast speeds. Children then participated in a 20-30 min intervention focused on making body and limb movements as large as possible with gait assessment repeated immediately. All children tolerated testing and therapy with no adverse effects. Outcomes after one intervention included: significantly greater stride velocity; reduced double support time; and greater stride length after training for three of the five participants. Results for this pilot study suggested that the large amplitude movement therapy was feasible for children with CP. There is a need for a larger scale study to determine if the protocol can be effective at an appropriate clinical dose.

A novel reddish-orange-emitting BaLa2Si2S8:Eu(2+) thiosilicate was prepared in a sealed fused silica ampule and its crystal structure was refined using Rietveld methods. The BaLa2Si2S8:Eu(2+) phosphor is excitable over a broad range from UV to blue (350-450 nm) and generated a reddish-orange broadband emission peaking at 645 nm with a quantum efficiency of ∼24%. The thermal luminescence quenching of BaLa2Si2S8:Eu(2+) was investigated over the range 25 to 150 °C. This phosphor was utilized to incorporate with two commercially available phosphors, blue BaMgAl10O17:Eu(2+) and green (Ba,Sr)2SiO4:Eu(2+), and a near-UV LED chip (405 nm), a white light with Ra of ∼94 was obtained.

Aim To examine current evidence on use of active video gaming (AVG) to improve motor function in children with movement disorders including cerebral palsy, developmental coordination disorder, and Down syndrome. Method Scopus, MEDLINE, Cochrane Library, EMBASE, and CINAHL were searched. Included papers studied the use of AVG for improving movement-related outcomes in these populations. Parameters studied included health condition, strength of evidence, AVG delivery methods, capacity for individualizing play, outcomes addressed, effectiveness for achieving outcomes, and challenges/limitations. Results The 20 extracted articles varied in quality. Studies involved children with six different conditions using AVG in clinical, home, or school settings for 49 different motor outcomes. Dosage varied in frequency and duration. Choice of games played and difficulty level were therapist determined (n=6) or child controlled (n=14). The most common study limitations were small sample sizes and difficulty individualizing treatment. All articles showed improvement in outcomes with AVG, although differences were not consistently significant compared with conventional therapy. Interpretation Heterogeneity of measurement tools and target outcomes prevented meta-analysis or development of formal recommendations. However, AVG is feasible and shows potential for improving outcomes in this population. Additional investigations of dosing variables, utility as a home supplement to clinical care, and outcomes with larger sample sizes are merited.

Background:Foot pain and diminished functional capacity are characteristics of tibialis posterior tendon dysfunction (TPTD). This study tested the hypotheses that women with TPTD would have impaired performance of a unipedal standing balance test (USBT) and that balance performance would be related to the number of single limb heel raises (SLHR).Methods:Thirty-nine middle-aged women, 19 with early stage TPTD (stage I and II), were instructed to perform 2 tasks; a USBT and repeated SLHR. Balance success was defined as a 10-second stance. For those who were successful, center of pressure (COP) data in anterior-posterior (AP) and medial-lateral (ML) directions were recorded as a measure of postural sway. SLHR performance was divided into 3 bins (≤2; 3-9 and > 10 repetitions). The between-balance success on performing the SLHR test was analyzed using the Fisher’s exact test (2 × 3). Independent t tests were used to compare between-group differences in postural sway. Relationship of postural sway to the number of heel raises was assessed using Spearman’s rho.Results:The success rate of the USBT was significantly lower in women with TPTD than the controls (47% vs 85%, P = .041). In addition, women with TPTD who completed the USBT exhibited increased AP COP displacement (14.0 ± 7.4 vs 8.4 ± 1.3 mm, P = .008), and a strong trend of increased ML COP displacement (8.3 ± 4.5 vs 6.1 ± 1.2 mm, P = .050). The success rate of USBT was correlated with the number of SLHR ( P = .01). The AP and ML COP displacement were correlated with SLHR ( r = −.538 and .495), respectively.Conclusions:Women with TPTD have difficulty in performing the USBT. Performance of the USBT and SLHR are highly correlated and predictive of each other.Clinical Relevance:A unipedal balance test may be used as a proxy TPTD assessment tool to the heel raising test when pain prevents performance.Level of Evidence:Level III, case control study.

Anterior cruciate ligament (ACL) injury is a sports trauma that causes long-term disability. The function of the knee during dynamic activities can be severely limited even after successful surgical reconstruction. This study examined the effects of approach velocity during side-step cutting on knee joint mechanics in persons with reconstructed ACL (ACLR). 22 participants (11 with unilateral ACLR, 11 matched-controls) participated. Knee joint mechanics were tested in 3 approach conditions: counter-movement, one-step, and running. Dependent variables, including peak knee flexion, extension, valgus, varus, internal rotation, external rotation angles and corresponding peak joint moments, were assessed during the stance phase of cutting. Two 2×3 (“group” by “approach condition”) mixed MANOVA tests were used to examine the effects of ACLR and approach velocity on knee mechanics. ACLR participants exhibited higher knee internal rotator moment (0.22 vs. 0.13 Nm/kg, p =0.003). Inter-group comparisons revealed that the ACLR participants exhibited significantly higher abductor and internal rotator moments only in the running condition (1.86 vs. 1.16 Nm/kg, p =0.018; 0.28 vs. 0.17 Nm/kg, p =0.010, respectively). Our findings suggested that patients with ACLR may be at increased risk of re-injury when participating in high-demand physical activities. Task demand should be considered when prescribing progressive therapeutic interventions to ACLR patients.

A novel green-emitting Ce3+-doped CaY2Si2S8 thiosilicate phosphor was synthesized by using solid-state methods in a sealed silica ampoule. This compound could be excited over a broad range from UV to blue light (400–450 nm) and generated a broadband emission peaking at ∼495 nm, with a quantum efficiency of ∼57%, which is promising for solid-state lighting applications. Temperature-dependent optical measurements of CaY2Si2S8:Ce3+ from 25 to 225 °C were performed. In addition, a white LED device was fabricated by using the green-emitting CaY2Si2S8:Ce3+ phosphor and commercially-available red-emitting CaAlSiN3:Eu2+ pumped with a 450 nm blue chip. The CRI value and CCT were measured to be 91–95 and 3800–8600 K, respectively, showing promising potential for solid-state lighting applications. The preparation, spectroscopic characterization, quantum efficiency, decay lifetime, thermal stability, and related LED device data are also presented.

Introduction: Wearable Technology Devices are used to promote physical activity. It is unknown whether different devices measure heart rate and step count consistently during walking or jogging in a free motion setting and on a treadmill. Purpose: To compare heart rate and step count values for the Samsung Gear 2, FitBit Surge, Polar A360, Garmin Vivosmart HR+, Scosche Rhythm+ and the Leaf Health Tracker in walking and jogging activities. Methods: Forty volunteers participated. Devices were worn simultaneously in randomized configurations. 5-minute intervals of walking and jogging were completed in free motion and treadmill settings with matching paces. Heart rates at minutes 3, 4, and 5 were averaged for the devices along with the criterion measure, the Polar T31 monitor. Step count criterion measure was the mean of two manual counters. A 2x6 (environment vs device) repeated measures ANOVA with Bonferroni post-hoc was performed with significance set at p

Measurements, descriptive.To describe a weight-bearing method to assess bilateral hip abductor and external rotator muscle performance.The hip abductors and external rotators are important in maintaining lower extremity alignment during weight-bearing tasks. As such, there is a need for a method to assess hip muscle performance in weight bearing.The weight-bearing method of assessing hip muscle performance utilized a force transducer connected to a nonstretchable fabric strap positioned around the distal ends of both thighs (proximal to the lateral epicondyles). The force generation capacity was recorded with the participants in a semi-squat position (30° of hip flexion and 50° of knee flexion). To establish the reliability of the measurement, 20 participants were tested on 2 separate days, and intraclass correlation coefficient (model 3,1) and standard error of measurement were calculated to evaluate test-retest reliability and intersession consistency. The level of agreement between the muscle performance values obtained using the weight-bearing method and the traditional non-weight-bearing method of testing hip abduction in sidelying (dynamometer) was assessed using a linear correlation model.The weight-bearing method of assessing hip muscle performance was reliable (intraclass correlation coefficient = 0.99; 95% confidence interval: 0.97, 0.99) and consistent (standard error of measurement, 0.02 N/kg). The measured strength using the weight-bearing method was moderately associated with hip abduction strength values measured in non-weight bearing (r = 0.75, P.01).The proposed weight-bearing method of assessing hip abductor and external rotator muscle performance can be used as a simple, economic, and reliable method to assess hip muscle strength.

Objectives To investigate the effects of dance experience and movement instruction on lower extremity kinematics and muscle activation during a landing task. Design Cross-sectional case control. Setting Laboratory setting. Participants 27 female subjects (age 18–25) in 2 groups: dancers (n = 12) and non-dancers (n = 15). Main outcome measures Lower extremity biomechanics during drop landing were analyzed. Subjects performed drop landings after watching an instructional video without verbal instructions (NI), followed by repeat assessment after watching the same videos with specific verbal instructions (VI). Surface electromyography (EMG) was used to measure the activation of gluteus maximus and medius during the deceleration phase of landings. Peak knee and hip frontal plane angles during landing were acquired using a 3-D motion capture system. Results Compared to non-dancers, dancers demonstrated generally greater gluteus maximus activation and a decreased knee abduction (i.e. valgus) angle during drop landing. A significant interaction showed that instruction led to increased knee valgus angle in non-dancers but not dancers (p = .014). Conclusions Our findings suggest that experienced dancers demonstrate safer landing strategies compared to recreational athletes. Providing acute movement instruction was shown to disrupt the landing mechanics in those with no dance training experience.

Hip abductors play an important role in maintaining trunk and pelvis stability during unipedal tasks. The purpose of the study was to compare postural stability between individuals with patellofemoral pain (PFP) and pain-free controls. A secondary purpose was to evaluate the effect of a hip stabilizing brace on postural stability. Twenty females with PFP (27.3±6.3 years) and 19 controls (26.1±4.5 years) participated. Each subject performed a unipedal step-down balance task with the stance leg on a force platform from which center of pressure (COP) excursion was recorded. Quantitative COP excursion patterns (mean and peak displacements) were used as measures of postural stability. For subjects with PFP, postural stability also was quantified following the application of a hip stabilizing brace. Hip abductor strength was significantly lower in PFP group compared to the control group (1.39±0.4 vs. 1.62±0.26 N/kg-BW, p=0.046). Peak and mean medial-lateral COP displacements during the balance task were greater in the PFP group (39.8±6.7 vs. 24.3±3.8 mm, p

Background Although it is believed that genu varum increases loading on the medial knee during locomotion, the acute effect of increased loading on bone stress has not been determined. This study aimed to examine the effects of locomotion and lower extremity alignment on bone water content in middle-aged adults without knee osteoarthritis. Methods Five males and 5 females participated. Lower extremity alignment was defined as the angle between the midpoint of the anterior mid-thigh and the midpoint of the patellar tendon using the center of the patella as the fulcrum. A chemical-shift-encoded water-fat magnetic resonance imaging protocol was used to assess bone water content before and after a 30-minute fast walking session. Bone stress response was determined by quantifying water content within the weight-bearing regions of the medial and lateral compartments of the tibiofemoral joint. Paired t-tests were used to compare bone water content before and after fast walking. Pearson correlation coefficients were used to determine the associations between lower extremity alignment and changes in water content post-walking. Findings The paired t-tests revealed no changes in water content after fast walking within medial and lateral femur/tibia (P > 0.05). Pearson correlation analyses revealed a significant moderate correlation between increased bone water content of the medial femur and increased varus alignment (R = 0.688, P = 0.028). Interpretation Although there was no significant change in bone water content following locomotion, knee varus was associated with signs of bone stress in the medial femur.

OBJECTIVE: Lower-extremity external rotation, or turnout, is a fundamental skill in dance. Active standing turnout has previously been measured using low-friction turnout disks. Turnout is influenced by passive range of motion (ROM) and strength, with passive ROM a function of bony morphology and ligamentous/capsular restraints. PURPOSE: Our study explored the relationship between standing active turnout and femoral bony morphology, hip passive ROM, and strength among dancers and non-dancers. METHODS: Cross-sectional cohort study. Twenty-three female dancers and 13 female non-dancers aged 18 to 30 yrs were recruited. Standing active turnout on reduced-friction disks, ultrasound images of femoral version, supine passive turnout, and hip abductor and external rotator strength were collected. RESULTS: Dancers demonstrated greater standing turnout (107º±18º) than non-dancers (92º±28º), but the difference was not statistically significant (p=0.054). A significant difference was found for femoral version (p

A new Ce(3+)-activated thiosilicate phosphor, BaLa2Si2S8:Ce(3+), was synthesized by using solid-state methods in a fused silica ampule and found to crystallize in the structure type of La2PbSi2S8. The crystal structure has been characterized by synchrotron X-ray diffraction and refined with Rietveld methods. This novel cyan-emitting phosphor can be excited over a broad range from UV to blue light (380-450 nm) and generates a broadband emission peaking at 471 nm with a quantum efficiency of 36%. Nonradiative transitions between Ce(3+) ions in BaLa2Si2S8:Ce(3+) have also been demonstrated to be attributable to dipole-dipole interactions, and the critical distance was calculated to be 17.41 Å. When BaLa2Si2S8:Ce(3+) phosphor was utilized to incorporate with yellow-emitting (Sr,Ca)2SiO4:Eu(2+) phosphor and red-emitting CaAlSiN3:Eu(2+) phosphor on a 430 nm blue LED chip, a warm white light LED device with color rendering index of ∼96 was obtained. The results indicate that cyan-emitting BaLa2Si2S8:Ce(3+) can serve as a potential phosphor for incorporation in fabrication of solid-state lighting. The preparation, spectroscopic characterization, quantum efficiency, decay lifetime, thermal-quenching behavior, and related LED device data are also presented.

Coordinated control of the hip and ankle is important for maintaining postural stability. The purpose of the study was to compare postural stability between individuals with contrasting hip abductor strength during unipedal balance tasks and to determine whether diminished hip abductor strength results in greater utilization of the ankle strategy to maintain balance. Forty-five females (276±35 years) participated in the study. Participants were ranked based on their isometric hip abductor muscle strength. The top 33% of the participants were categorized as the strong group (n=15) and the lower 33% as the weak group (n=15). Each subject performed a static and a dynamic unipedal balance task, during which mean COP displacement, peak ankle invertor and evertor moments, and neuromuscular activation of the lower leg muscles were assessed. Two-way mixed analyses of variance tests with task as a repeated factor were performed to detect the effects of task and group on the variables of interest. When averaged across tasks, mean medial-lateral COP displacement was significantly greater in the weak group (136±117 vs. 98±60 mm, p=0.05). The weak group also exhibited greater peak ankle invertor and evertor moments (0.31±0.10 vs. 0.25±0.11 Nm/kg, p=0.03; 0.04±0.06 vs. -0.02±0.07 Nm/kg, p=0.01), and increased peroneus longus activation (46±12 vs. 36±15%, p

Previous studies have reported that diminished hip abductor muscle strength is associated with a loss of frontal plane postural stability and increased risk for ankle sprain. The purpose of this study was to determine whether hip abductor fatigue results in compensatory changes in neuromuscular activation of the peroneus longus (an important lateral stabilizer of the ankle) during a unipedal landing task.Thirty healthy females performed a unipedal landing task before and after completing a hip abductor fatigue protocol. Paired t-tests were used to assess changes in medial-lateral center of pressure displacement, and EMG (electromyographic) amplitude of the peroneus longus following hip abductor fatigue. Changes in peroneus longus onset timing also were assessed.Following the hip abductor fatigue protocol, participants exhibited increased mean center of pressure displacement (7.7 (1.5) vs. 9.2 (2.0) cm, P0.01), and increased EMG amplitude of peroneus longus (0.75 (0.18) vs. 0.86 (0.21), P0.01) during the deceleration phase of landing. Post-fatigue, significantly earlier peroneus longus onset timing prior to landing was observed (88.9 (24.9) vs. 121.9 (25.7) ms, P0.01).The increased EMG amplitude and earlier onset of the peroneus longus appears to be a protective compensatory adaptation to stabilize the ankle in response to frontal plane postural instability induced by hip abductor fatigue.