Pressure pain hypersensitivity and referred pain from muscle trigger points in elite male wheelchair basketball players

BackgroundShoulder injuries are common in individuals who use wheelchairs.ObjectivesThis study investigated the presence of mechanical pain hypersensitivity and trigger points in the neck-shoulder muscles in elite wheelchair basketball players with/without shoulder pain and asymptomatic able-bodied elite basketball players.MethodsEighteen male wheelchair basketball players with shoulder pain, 22 players without shoulder pain, and 20 able-bodied elite male basketball players were recruited. Pressure pain thresholds were assessed over C5-C6 zygapophyseal joint, deltoid muscle, and second metacarpal. Trigger points in the upper trapezius, supraspinatus, teres minor, infraspinatus, teres major, latissimus dorsi, subscapularis, pectoralis minor, pectoralis major and deltoid muscles were also examined.ResultsWheelchair basketball players with shoulder pain showed lower pressure pain thresholds over the C5-C6 joint and second metacarpal than elite wheelchair basketball players without pain (between-groups differences: 1.1, 95%CI 0.4, 1.8 and 1.8, 95%CI 0.8, 2.8, respectively) and able-bodied basketball players without pain (between-groups differences: 0.8, 95%CI 0.4, 1.2; 1.6, 95%CI 0.8, 2.4, respectively). The mean number of myofascial trigger points for wheelchair basketball players with unilateral shoulder pain was 4.8 ± 2.7 (2 ± 1 active, 2.9 ± 2.2 latent). Wheelchair basketball players and able-bodied basketball players without shoulder pain exhibited a similar number of latent trigger points (2.4 ± 2.0 and 2.4 ± 1.8, respectively). Wheelchair basketball players with shoulder pain exhibited higher number of active myofascial trigger points than those without pain (either with or without wheelchair), but all groups had a similar number of latent trigger points (P < 0.05).ConclusionsThe reported mechanical pain hypersensitivity suggests that active trigger points may play a role in the development of shoulder pain in elite male wheelchair basketball players.     

Reduced version of the Activity Measure for Post-Acute Care (AM-PAC) for inpatients, “6-clicks”: Brazilian-Portuguese cross-cultural adaptation and measurement properties

BackgroundThe “6-clicks” is the reduced version of the Activity Measure for Post-Acute Care for inpatients that assesses limitations in basic mobility, daily activity, and applied cognitive, simply and quickly.ObjectiveCross-culturally adapt the “6-clicks” into Brazilian-Portuguese and verify its measurement properties.MethodsCross-cultural adaptation followed recommendations from international guidelines. Reliability indices, standard error of measurement and minimum detectable difference were calculated. Participants included 13 professionals, 13 patients and 13 companions. Test of measurement properties involved 101 patients’ of both sexes, hospitalized in the infirmary, under physical therapy care, able to understand and respond to commands and with no discharge expectation. Their 30 companions were also included.ResultsMinor changes implemented to the original version. The three domains showed adequate internal consistency (α > 0.65). Inter-rater reliability (n = 50) and test–retest reliability, when administer to patients (n = 51) and to companions (n = 30), showed good for basic mobility domain (ICC_2.1 = 0.81, 0.83 and 0.82, respectively), good to moderate for daily activity (ICC_2.1 = 0.78 and ICC_3.1 = 0.71 and 0.82, respectively) and moderate to poor for applied cognitive (ICC_2.1 = 0.64, 0.36 and ICC_3.1 = 0.63), respectively. The highest agreements among patients/companions were also in basic mobility. Standard error of measurement ranged from 2.03 to 2.64 while the minimum detectable difference ranged from 5.63 to 7.32.ConclusionTranslated and adapted Brazilian version of the “6-clicks” showed acceptable measurement properties. The functional data provided by the instrument could be used to enhance care and help treatment follow-up.     

Comparison of shoulder strength in males with and without myofascial trigger points in the upper trapezius

BackgroundThis study was conducted in order to compare the strength of scapular elevator and shoulder abductor with and without restricted scapular elevation between male subjects with and without myofascial trigger points in the upper trapezius.MethodsIn total, 15 male subjects with myofascial trigger points, and 15age- and weight-matched male subjects without myofascial trigger points in the upper trapezius. Each subject was measured in the strength of maximum isometric scapular elevation and shoulder abduction with and without restricted scapular elevation. Maximum isometric contractions were measured using the Smart KEMA strength measurement system. Independent t-tests were used to compare shoulder strength values between the myofascial trigger points and non- myofascial trigger points groups.FindingThe results showed that shoulder abductor strength in the group with myofascial trigger points (5.64 kgf) was significantly lower than in the group without myofascial trigger points (11.96 kgf) when scapular elevation was restricted (p < 0.05). However, there was no significant difference in the strength of the scapular elevator or shoulder abductor between groups (p > 0.05).InterpretationThese findings suggest that decreased strength in the shoulder abductor with restricted scapular elevation should be considered in evaluating and treating individuals with myofascial trigger points of the upper trapezius.     

Inter-day reliability of the Upper Body Test for shoulder and pelvic girdle stability in adults

BackgroundThere are a limited number of tests for the assessment of shoulder and pelvic girdle stability. Reliable instruments are important to evaluate movement dysfunction at these joints in order to provide more objective parameters.ObjectiveTo evaluate the inter-day reliability of the Upper Body Test in young adults.MethodsA reliability study was carried out with three assessments of the shoulder and pelvic girdle stability within 48-h intervals (Monday, Wednesday, and Friday). The OctoBalance® platform was used to perform the Upper Body Test in 31 active young adults (24.5 ± 8 years). Intraclass Correlation Coefficient (ICC_2,2) two-way mixed model, Coefficient of Variation, and Bland–Altman plots were used to verify the reliability of the test. The standard error of measurement (SEM) and the minimum detectable difference (MDD_95%) were calculated for clinical applicability.ResultsThe Intraclass Correlation Coefficient ranged from 0.87 to 0.94 – Featuring a mean difference of 0.89 (95%CI = −0.19–1.97) to left and 0.95 (95%CI = −0.38–2.27) for the right side, with a low variation coefficient (3.31–5.91%) between the second and third days of assessment. There was a statistically significant difference between the first assessment day and the other test sessions. The Bland–Altman analyses revealed low bias with scores within the limits of agreement. Minimum detectable difference scores were between 4.02 and 5.10, and standard error of measurement between 1.75 and 2.72, depending on the movement side.ConclusionThe Upper Body Test presented good inter-day reliability for assessing the stability of the shoulder and pelvic girdle in young active healthy adults.     

The scale for retropulsion: Internal consistency,reliability and construct validity

BackgroundRetropulsion is an impairment of body orientation against gravity in the sagittal plane. In a Delphi study, the Scale for Retropulsion (SRP) was developed with a high level of expert agreement.ObjectiveTo assess the clinimetric properties of the German SRP in patients with neurological disorders.MethodsThe SRP was applied to 70 hospitalized patients with neurological disorders (stroke, critical illness neuropathy and/or myopathy, Parkinson syndromes). Internal consistency was determined with the Cronbach ɑ. Test–retest and interrater reliabilities were evaluated with the weighted kappa, intraclass correlation coefficient (ICC), and Bland–Altman plots. The construct validity was evaluated with Spearman correlation.ResultsThe median (interquartile range) SRP score was 5 (3–8) and ranged from 0 to 22 (total scale range: 0 to 24). The SRP had excellent internal consistency (Cronbach ɑ = 0.875) and good to excellent test–retest reliability (weighted kappa = 0.957, ICC = 0.957) and interrater reliability (weighted kappa = 0.837, ICC = 0.837). Analysis of construct validity resulted in good correlations with other clinical balance scales (r_Sp > 0.80), and fair to moderate correlations with posturographic measures (r_Sp = 0.27–0.56) and the subjective postural vertical error in the sagittal plane (r_Sp = ?0.325, P = 0.012) as well as the range in the frontal plane (r_Sp = 0.359, P = 0.007). The SRP discriminated between patients classified with and without retropulsion by an independent clinical expert (P < 0.001).ConclusionThe SRP provides a valid and reliable bedside test to quantify retropulsion in individuals with neurological disorders.     

Implant impingement during internal rotation after reverse shoulder arthroplasty. The effect of implant configuration and scapula anatomy: A biomechanical study

BackgroundInternal rotation after reverse shoulder arthroplasty is essential to perform fundamental daily living activities. The purpose of this study was to examine the impact of anatomical and implant related factors on impingement-free internal rotation of the glenohumeral joint.MethodsCT-scans of 13 human shoulder specimens with implanted reverse shoulder prostheses were carried out and scapula neck length, lateral pillar angle, and implantation height of the metaglene were measured. Internal rotation testing of all specimens was performed by the use of a robot assisted shoulder simulator. Biomechanical variables were analyzed using a three-way ANOVA. Spearman's rank correlations were performed to determine the relationship between biomechanical and anatomical data.FindingsThe maximum internal rotation angle for a 38 mm centric glenosphere and a standard onlay was 93.4(SD 34.9°). The change of the diameter of the glenosphere resulted in no significant increase of the maximum rotation angle (P = 0.16), while change of the glenosphere type from concentric to eccentric (P = 0.005) as well as the change of the onlay type from standard to a more shallow one (P = 0.002) both had a significant effect on the internal rotation.The distance between the inferior rim of the metaglene and the inferior aspect of the glenoid (P = 0.21), scapula pillar angle (P = 0.13) as well as the scapula neck length (P = 0.81) showed no significant correlation with the maximum internal rotation angle.InterpretationImplant component selection shows strong influence on the impingement-free internal rotation. The use of an eccentric glenosphere and a shallow humeral cup may improve internal rotation after reverse shoulder arthroplasty.     

Isokinetic strength differences between patients with primary reverse and total shoulder prostheses: Muscle strength quantified with a dynamometer

BackgroundRange of motion after total shoulder arthroplasty is better than after reverse shoulder arthroplasty, however with similar clinical outcome. It is unclear if this difference can only be found in the different range of motion or also in the force generating capacity. Questions: (1) are isokinetically produced joint torques of reverse shoulder arthroplasty comparable to those of total shoulder arthroplasty? (2) Does this force-generating capacity correlate with functional outcome?MethodsEighteen reverse shoulder arthroplasty patients (71 years (SD 9 years)) (21 shoulders, follow-up of 21 months (SD 10 months)) were recruited, 12 total shoulder arthroplasty patients (69 years (SD 9 years)) (14 shoulders, follow-up of 35 months (SD 11 months)). Pre- and post-operative Constant–Murley scores were obtained; two isokinetic protocols (ab-/adduction and ex-/internal rotations) at 60°/s were performed.FindingsTwelve of 18 reverse shoulder arthroplasty patients generated enough speed to perform the test (13 shoulders). Mean ab-/adduction torques are 16.3 Nm (SD 5.6 Nm) and 20.4 Nm (SD 11.8 Nm). All total shoulder arthroplasty patients generated enough speed (14 shoulders). Mean ab-/adduction torques are 32.1 Nm (SD 13.3 Nm) and 43.1 Nm (SD 21.5 Nm). Only 8 reverse shoulder arthroplasty patients (9 shoulders) could perform ex-/internal rotation tasks and all total shoulder arthroplasty patients. Mean ex-/internal rotation torques are 9.3 Nm (SD 4.7 Nm) and 9.2 Nm (SD 2.1 Nm) for reverse shoulder arthroplasty, and 17.9 Nm (SD 7.7 Nm) and 23.5 Nm (SD 10.6 Nm) for total shoulder arthroplasty. Significant correlations between sub-scores: activity, mobility and strength and external rotation torques for reverse shoulder arthroplasty. Moderate to strong correlation for sub-scores: strength in relation to abduction, adduction and internal rotation torques for total shoulder arthroplasty.InterpretationShoulders with a total shoulder arthroplasty are stronger. This can be explained by the absence of rotator cuff muscles and (probably) medialized center of rotation in reverse shoulder arthroplasty. The strong correlation between external rotation torques and post-operative Constant–Murley sub-scores demonstrates that external rotation is essential for good clinical functioning in reverse shoulder arthroplasty.     

Shoulder muscle atrophy and its relation to strength loss in obstetrical brachial plexus palsy

BackgroundTreatment/prevention of shoulder muscle strength imbalances are major therapeutic goals for children with obstetrical brachial plexus palsy. The study aims were to characterize muscle atrophy in children/adolescents with unilateral obstetrical brachial plexus palsy, to quantify the agonist-antagonist muscle volume balance and the association between muscle volume and strength.MethodsEight boys and four girls (age = 12.1, standard deviation = 3.3) participated in this case-control study. Three-dimensional magnetic resonance images of both shoulders were acquired. The unimpaired shoulder served as a reference. Volumes of deltoid, pectoralis major, supraspinatus, infraspinatus, teres major, subscapularis were calculated based on 3D models, derived through image segmentation. Maximal isometric torques were collected in six directions.FindingsAll the major muscles studied were significantly atrophied. The teres major demonstrated the biggest difference in atrophy between groups (51 percentage points), the pectoralis major was the least atrophied (23 percentage points). The muscle volume distribution was significantly different between shoulders. Muscle volume could predict maximal voluntary isometric torques, but the regression coefficients were weaker on the impaired side (72% to 91% of the strength could be predicted in the uninvolved side and 24% to 90% in the involved side and external rotation strength could not be predicted).InterpretationThis study demonstrates muscle atrophy varied across all the main shoulder muscles of the glenohumeral joint, leading to significant muscle volume imbalances. The weaker coefficients of determination on the impaired side suggest that other variables may contribute to the loss of strength in addition to atrophy.     

Quantifying acromiohumeral distance in elite male field hockey players compared to a non-athletic population

BackgroundShoulders of elite field hockey players are loaded continuously during play. Frequent high shoulder loading is known to influence certain shoulder variables, such as acromiohumeral distance. However, the influence of elite field hockey play on acromiohumeral distance is not examined yet.ObjectiveTo examine the acromiohumeral distance in elite male field hockey players compared to a non-athletic control group.DesignCross-sectional study.MethodsFifty male participants were included; 25 elite field hockey players (age: 24.0 ± 2.72 years; weight: 77.2 ± 5.29 kg; height; 180.5 ± 5.37 cm) and 25 age- and gender matched non-athletes (23.0 ± 2.29 years; weight: 75.7 ± 9.53 kg; height: 181.8 ± 5.52 cm). A Telemed-Colormaster-128 EXT-IZ device was used to bilaterally obtain ultrasound acromiohumeral distance images at 3 different angles of shoulder abduction in the frontal plane.ResultsField hockey players showed a bilateral larger acromiohumeral distance at 45° (mean difference: 1.46 mm [95% CI 0.46; 2.46]; p = 0.005) and 60° (mean difference: 1.07 mm [95% CI 0.21; 1.93]; p = 0.016) compared to controls. In both groups, a significant but clinically less relevant, side difference was established for the acromiohumeral distance at 60° (mean difference: 0.79 mm [95% CI 0.21; 1.34]; p = 0.009).ConclusionWith active shoulder abduction, elite field hockey players show a larger acromiohumeral distance in comparison to non-athletic participants. This may be a protective sport-specific adaptation, to better guard the shoulder from injury. Thus, acromiohumeral distance measurement may help physical therapists/coaches decide which athletes could benefit from specific, additional exercises aimed at enlarging the subacromial space.     

Gender difference of shoulder-pelvic kinematic integration for trunk rotation directions in healthy older adults

BackgroundThe trunk coordination pattern has been extensively studied, and there is a higher pain prevalence and asymmetry in female older adults. However, there is a lack of investigation of different directions of trunk rotation and asymmetrical compensatory strategies of motor control between genders. The purpose of this study was to investigate shoulder and pelvic ranges of motion (ROM) as well as relative phases (RP) for the different directions of trunk rotation between genders in healthy older adults.MethodsThere were 62 right hand dominant older adults in this study (31 female subjects (68.4 [5.62] years) and 31 male subjects (68.7 [5.68] years)). The participants performed trunk axial rotation from the left to the right direction (RP1) and then returned to the left side (RP2), three times repeatedly in standing. The measurements included shoulder and pelvic ROM, RP1, and RP2. The RP was defined as the average absolute relative phase, which was the difference between the phase angle of the shoulder and the phase angle of the pelvis during trunk rotation.FindingsThe female group demonstrated significantly greater pelvic rotation compared to the male group (98.64 [24.67] vs. 86.96 [18.97]; t = 2.09, p = 0.04) during trunk rotation. The pelvic ROM demonstrated a significant positive correlation with shoulder ROM in both genders; however, the RP was negatively correlated with the pelvis. For pelvic rotation, the male group demonstrated a negative correlation with RP1 (r = − 0.68, p < 0.01) and RP2 (r = − 0.60, p < 0.01) while the female group demonstrated a negative correlation with RP2 (r = − 0.53, p < 0.01). The ageing factor demonstrated negative correlations with ROM for the shoulder and pelvis in both genders.InterpretationAlthough no gender difference was indicated on the direction of RP, the pelvic ROM was significantly lesser in the male group. The male group demonstrated lesser pelvic rotation in both directions of rotation; however, the female group showed lesser pelvic rotation in RP2. The male group demonstrated stiffened pelvic rotation and greater shoulder rotation in both directions while the female group demonstrated pelvic stiffness only in the direction from right to left rotation. Clinicians need to consider this directional asymmetry of trunk rotation to enhance integrated shoulder-pelvic coordination in female older adults.Mini abstractA coordinative pattern of different directions of trunk rotation was investigated in healthy older adults. The pelvic range of motion was lesser in the male group compared with the female group. The female group demonstrated pelvic stiffness only in the direction from right to left rotation, while the male group demonstrated pelvic stiffness in both directions. Clinicians need to understand the gender difference of directional coordination as integrated coordination in female older adults.     

Stability and intra-tester reliability of an in vivo measurement of thoracic axial rotation using an innovative methodology

The aim of this study was to evaluate the stability and intra-tester reliability of an innovative approach to measure active thoracic spine axial rotation. Ultrasound imaging of a thoracic vertebra in conjunction with Polhemus motion analysis of the transducer was used to measure axial thoracic spine rotation in a functional position. The range of motion in a convenience sample of asymptomatic subjects (n = 24) was calculated across ten repetitions of a single trial to evaluate stability. The protocol was repeated the same day and 7–10 days later to provide data for within and between day intra-tester reliability. Mean total range of axial rotation was 85.15 degrees across a single trial with SD = 14.8, CV = 17.4, SEM = 3.04. SEM ranged 0.63–3.37 for individual subjects and 2.60–3.64 across repetitions. Stability of performance occurred at repetitions 2–4. Intra-tester reliability (ICC_2,1) was excellent within day (0.89–0.98) and good/excellent between days (0.72 0.94). Bland–Altman plots however suggest that agreement may range from 0 to 10% for within day measures and from 0 to 15% for between day measures. Whether this combined approach has sufficient precision and accuracy as a clinical research tool has yet to be fully evaluated.     

Isometric muscle strength in children and adolescents using Handheld dynamometry: reliability and normative data for the Brazilian population

Objective

Isometric muscle strength measured by Handheld dynamometer indicates physical ability. There is no normative data for the Brazilian population. This study aims (a) to describe the development of isometric muscle strength in healthy children and adolescents 5–15 years of age; (b) to evaluate Handheld dynamometer inter and intra-rater reliability.

Does trunk and hip muscles strength predict performance during a core stability test?

BackgroundA better understanding about the relationship between trunk and hip muscles strength and core stability may improve evaluation and interventions proposed to improve core stability.ObjectivesTo investigate if trunk and hip muscles strength predict pelvic posterior rotation during the bridge test with unilateral knee extension.MethodsThis is a cross-sectional study. Sixty-one healthy individuals of both sexes (age, 28 ± 6.4 years, weight, 66.5 ± 10.9 kg, height, 167 ± 9.5 cm) performed the bridge test with unilateral knee extension. The pelvic posterior rotation during the bridge test was obtained with two-dimensional video analysis. Isometric strength of the trunk extensors and rotators, and hip abductors, external and internal rotators and extensors were measured with a hand-held dynamometer. Multiple linear regression analysis was performed to identify if the strength variables could explain the pelvic posterior rotation during the test.ResultsMuscle strength predicted pelvic posterior rotation during the bridge test (r = 0.54; p = 0.003). Strength of the trunk rotators (p = 0.045) and hip internal rotators (p = 0.015) predicted reduced magnitude of pelvic posterior rotation during the bridge test, and strength of the hip extensors (p = 0.003) predicted increased magnitude of pelvic posterior rotation.ConclusionsTrunk rotators and hip internal rotators and extensors strength predict 29% of the performance during the bridge test with unilateral knee extension. The strength of these muscles should be evaluated in individuals with increased pelvic posterior rotation during the bridge test with unilateral knee extension.     

Scapular asymmetry in participants with and without shoulder impingement syndrome; a three-dimensional motion analysis

BackgroundThis study analyzed the dynamic three-dimensional scapular kinematics and scapular asymmetry in participants with and without shoulder impingement syndrome.MethodsTwenty-nine participants with shoulder impingement syndrome, have been suffering from unilateral shoulder pain at the dominant arm lasting more than six weeks and thirty-seven healthy controls participated in the study. Scapular kinematics was measured with an electromagnetic tracking device during shoulder elevation in the sagittal plane. Data for bilateral scapular orientation were analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. The symmetry angle was calculated to quantify scapular asymmetry throughout shoulder elevation.FindingsStatistical comparisons indicated that the scapula was more downwardly rotated (p < 0.001) and anteriorly tilted (p = 0.005) in participants with shoulder impingement syndrome compared to healthy controls. Side-to-side comparisons revealed that the scapula was more anteriorly tilted on the involved side of participants with shoulder impingement syndrome (p = 0.01), and the scapula was rotated more internally (p = 0.02) and downwardly (p = 0.01) on the dominant side of healthy controls. Although there were side-to-side differences in both groups, symmetry angle calculation revealed that the scapular movement was more asymmetrical for scapular internal and upward rotation in individuals with shoulder impingement syndrome when compared with healthy controls (p < 0.05).InterpretationThe findings of the study increase our knowledge and understanding of scapular alterations in symptomatic and asymptomatic populations, which creates biomechanical considerations for shoulder assessment and rehabilitation.     

Translation of the short version of the Smartphone Addiction Scale into Brazilian Portuguese: cross-cultural adaptation and testing of measurement properties

BackgroundSmartphone use has been constantly increasing. Smartphone addiction can lead to changes in the emotional state and musculoskeletal system of users. To identify smartphone addicts, the Smartphone Addiction Scale-Short Version was developed; however, this scale has not been translated into Brazilian Portuguese and tested for its measurement properties.ObjectiveTo translate and cross-culturally adapt the Smartphone Addiction Scale-Short Version into Brazilian Portuguese; to assess the internal consistency, reliability and construct validity of the scale among university students.MethodsThe cross-cultural adaptation was performed following the guidelines for cross-cultural adaptation of self-report measures, and data were collected via online surveys administered to 59 university students over 18 years of age for test–retest. To test the measurement properties of the final version of the Smartphone Addiction Scale-Short Version, a convenience sample including 130 university students was used.ResultsThe Smartphone Addiction Scale-Short Version showed good reliability for test–retest scores (ICC_3,1 = 0.82; 95% CI = 0.70–0.89) and good internal consistency considering all 10 items (Cronbach's alpha = 0.95). The construct validity was calculated comparing the Smartphone Addiction Scale-Short Version score to data from a questionnaire prepared by the authors of this study, including frequency per day (r = 0.35; p < 0.001), leisure time on the smartphone (r = 0.33; p < 0.001), and time working on the smartphone (r = 0.18; p = 0.04) that were significantly positively associated with higher Smartphone Addiction Scale-Short Version scores. The results show a high prevalence of smartphone addiction among university students (33.1%).ConclusionIt can be concluded that the Brazilian Portuguese version of the Smartphone Addiction Scale-Short Version is a reliable and valid tool for screening smartphone addiction in university students.     

Assessment of bimanual performance in 3-D movement analysis: Validation of a new clinical protocol in children with unilateral cerebral palsy

BackgroundThe “Be an Airplane Pilot” (BE-API) protocol is a novel 3-D movement analysis (3DMA) protocol assessing the bimanual performance of children during a game.ObjectiveThis study aimed to investigate the reliability and validity of this protocol in children with unilateral cerebral palsy (uCP).MethodsAngular waveforms (WAVE), maximum angles (MAX) and range of motion (ROM) of the trunk, shoulder, elbow and wrist joints were collected in children with uCP and in typically developing children (TDC) during 4 tasks of the BE-API protocol designed to explore specific degrees of freedom (DoF). The inter-trial reliability for children with uCP was assessed with the coefficient of multiple correlation (CMC) for WAVE and the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for MAX and ROM. Clinical performance-based measures, including the Assisting Hand Assessment (AHA) and ABILHAND-Kids scores, were used to explore correlations between clinical measures and kinematic parameters in children with uCP.Results20 children with uCP (13 boys; mean age 12.0 [SD 3.2] years) and 20 TDC (11 boys; mean age 11.9 [SD 3.4] years) were included. In children with uCP, most kinematic parameters showed high reliability (WAVE: CMC ≥ 0.82; MAX and ROM: ICC ≥ 0.85, SEM ≤ 4.7°). Elbow extension, forearm supination, and wrist adduction were reduced and wrist flexion was increased for children with uCP versus TDC (P < 0.01). In children with uCP, MAX and ROM values were moderately correlated with clinical assessments (AHA score: r = 0.48–0.65; ABILHAND-Kids score: r = 0.48–0.49).ConclusionsThe BE-API protocol is a 3DMA-bimanual performance-based assessment that is highly reliable in children with uCP. Children with uCP and TDC significantly differed in some clinically relevant kinematic parameters. The BE-API is a promising playful tool, helpful for better understanding upper-limb motor movement abnormalities in bimanual conditions and for tailoring treatments to individual deficits.     

Accuracy of modified 30-s chair-stand test for predicting falls in older adults

BackgroundPostural stability during sit-to-stand (STS) movements depends on visual and somatosensory information. A modification of the 30-sec chair-stand test (30s-CST) with visual and somatosensory alteration (m30CST) may improve the ability to identify fall status.ObjectiveThis study aimed to investigate the accuracy of the m30CST in predicting falls in older adults.MethodsThis prospective cohort study recruited a convenience sample of 73 individuals from Kao Kilo community, Chonburi, Thailand. Eligibility criteria were age ≥ 65 years and independent STS ability. All participants performed the 30s-CST and m30CSTs (i.e., eyes closed and a foam surface and eyes closed and a foam surface). The fall incidence during a 6-month follow-up was recorded. The area under the receiver operating characteristic curve (AUC) was calculated. Twenty participants were designated for reliability and validity analyses using the 30s-CST and the Fullerton Advanced Balance (FAB) Scale, estimating intraclass correlation coefficients (ICCs).ResultsWe included 37 fallers and 36 non-fallers. All tests showed excellent accuracy in classifying fallers (AUC = 0.77–0.91). The m30CST with eyes closed and a foam surface had the highest AUC (0.91), with a cutoff score of 9.25 repetitions, sensitivity 92%, and specificity 81%. The m30CSTs presented excellent inter-rater reliability (ICC = 0.93–0.96) and test–retest reliability (ICC = 0.90–0.96), good to excellent correlation with the 30s-CST (r = 0.90–0.98), and moderate to good correlation with the FAB Scale (r = 0.64–0.73).ConclusionsThe m30CST could be used as an alternative evaluation for predicting the risk of falls in community-dwelling older adults, with excellent accuracy.     

Lean muscle volume of the thigh has a stronger relationship with muscle power than muscle strength in women with knee osteoarthritis

BackgroundThigh lean muscle and intramuscular fat have been implicated in the impairment of physical function observed in people with knee osteoarthritis. We investigated the relationships of quadriceps and hamstrings intramuscular fat fraction and lean muscle volume with muscle power and strength, controlling for neuromuscular activation, and physical performance in women with knee OA.MethodsWomen (n = 20) 55 years or older with symptomatic, radiographic knee osteoarthritis underwent a 3.0T magnetic resonance imaging scan of the thigh of their most symptomatic knee. Axial fat-separated images were analyzed using software to quantify intramuscular fat and lean muscle volumes of the quadriceps and hamstrings. To quantify strength and power of the knee extensors and flexors, participants performed maximum voluntary isometric contraction and isotonic knee extensions and flexions, respectively. Electromyography of the quadriceps and hamstrings was measured. Participants also completed five physical performance tests.FindingsQuadriceps and hamstrings lean muscle volumes were related to isotonic knee extensor (B = 0.624; p = 0.017) and flexor (B = 1.518; p = 0.032) power, but not knee extensor (B = 0.001; p = 0.615) or flexor (B = 0.001; p = 0.564) isometric strength. Intramuscular fat fractions were not related to isotonic knee extensor or flexor power, nor isometric strength. No relationships were found between intramuscular fat or lean muscle volume and physical performance.InterpretationMuscle power may be more sensitive than strength to lean muscle mass in women with knee osteoarthritis. Thigh lean muscle mass, but neither intramuscular nor intermuscular fat, is related to knee extensor and flexor power in women with knee osteoarthritis.     

Prediction equation of hip external rotators maximum torque in healthy adults and older adults using the measure of hip extensors maximum torque

BackgroundThe use of predictive equation of muscular torque can reduce physical effort and time spent during evaluation.ObjectivesTo establish, validate, and test the accuracy of a prediction equation to estimate the hip external rotators (HER) torque in adults and older adults by means of hip extensors (HEX) torque measurement.MethodsEighty-three healthy adults (development set) were assessed to test the association of HEX and HER torques and to establish the prediction equation. A separate 36 adults and 15 older adults (validation sets) were assessed to test the ability of the equation to estimate HER torque. Hip isometric strength was assessed by a handheld dynamometer.ResultsSimple linear regression analysis revealed that HEX torque was associated with HER torque (r = 0.80; p < 0.0001), resulting in the following prediction equation: HER_torque= −0.02 + (0.58 * HEX_torque). Paired t-test revealed no difference between directly measured and predicted values of HER torque in adults (mean difference = 0.02; 95% CI = −0.115, 0.072) and older adults (mean difference = 0.05; 95% CI = −0.02, 0.12).ConclusionThe HEX and HER torques were strongly correlated. The prediction equation was valid, accurate, and can be used to estimate HER muscle strength in healthy adults and older adults, requiring only the direct measurement of HEX torque.