Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint

Context

 Decreased postural stability is a primary risk factor for lower limb musculoskeletal injuries. During athletic competitions, cryotherapy may be applied during short breaks in play or during half-time; however, its effects on postural stability remain unclear.

Objective

 To investigate the acute effects of a 15-minute ankle-joint cryotherapy application on dynamic postural stability.

Design

 Controlled laboratory study.

Setting

 University biomechanics laboratory.

Patients or Other Participants

 A total of 29 elite-level collegiate male field-sport athletes (age = 20.8 ± 1.12 years, height = 1.80 ± 0.06 m, mass = 81.89 ± 8.59 kg) participated.

Intervention(s)

 Participants were tested on the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the Star Excursion Balance Test before and after a 15-minute ankle-joint cryotherapy application.

Main Outcome Measure(s)

 Normalized reach distances; sagittal-plane kinematics of the hip, knee, and ankle joints; and associated mean velocity of the center-of-pressure path during performance of the ANT, PL, and PM reach directions of the Star Excursion Balance Test.

Results

 We observed a decrease in reach-distance scores for the ANT, PL, and PM reach directions from precryotherapy to postcryotherapy (P < .05). No differences were observed in hip-, knee-, or ankle-joint sagittal-plane kinematics (P > .05). We noted a decrease in mean velocity of the center-of-pressure path from precryotherapy to postcryotherapy (P < .05) in all reach directions.

Conclusions

 Dynamic postural stability was adversely affected immediately after cryotherapy to the ankle joint.Key Words: postural balance, lower limb, kinetics

Key Points

• A 15-minute cryotherapy application to the ankle joint decreased cutaneous temperature recorded over the anterior talofibular ligament and deltoid ligament.
• Reach distances in the anterior, posterolateral, and posteromedial directions of the Star Excursion Balance Test and center-of-pressure mean velocity decreased after cryotherapy.
• A 15-minute cryotherapy application negatively influenced dynamic postural-stability performance.
• Elite-level field-based athletes should undergo a rewarming period before returning to participation after cryotherapy to the ankle joint to ensure they are not predisposed to injury due to decreased dynamic postural stability.

Cryotherapy is a treatment modality that clinicians commonly use to promote quicker recovery from soft tissue injury in athletes to expedite return to participation. It has been described as the application of cold therapy to living tissues that results in a lower tissue temperature^1,2 and often is used as an immediate treatment method to relieve the acute pain of soft tissue injuries.¹The proposed physiologic benefits of cryotherapy for injury have been widely reported. Cryotherapy facilitates edema reduction, produces analgesia,^2,3–6 reduces muscle temperature,⁷ and reduces injury-induced inflammation.^8,9 If an athlete incurs a mild sprain or contusion to the ankle joint in a game, the accepted practice during a break in participation (eg, during a half-time period) is to apply cryotherapy to the affected area.In contrast to the aforementioned positive physiologic effects, Bleakley et al¹⁰ reported in a recent literature review that cryotherapy application negatively affected at least 1 of the following outcomes: vertical-jump height, sprint time, or agility performance. These tasks are integral components of field-based sports, and any decrement in performance could predispose individuals to injury during participation. Pritchard and Saliba¹¹ suggested that athletic performance may be adversely affected when athletes return to participation immediately after cryotherapy. Furthermore, Costello and Donnelly¹² reported that cryotherapy negatively affects knee-joint positional sense. Uchio et al¹³ observed that a 15-minute cryotherapy application increased knee-joint stiffness and decreased knee-joint position sense acuity. Stal et al¹⁴ reported that ankle-joint sensorimotor control as quantified by static postural stability was negatively affected by a 20-minute cooling procedure known as hypothermic anesthesia, which is similar to a cryotherapy application.Postural stability refers to the ability to control the center of mass in relation to the base of support to prevent falls¹⁵ and is considered a fundamental component required for performing movement skills.¹⁶ Dynamic postural stability can be defined and measured as an assessment of an individual''s ability to maintain balance while transitioning from a dynamic to a static state.¹⁷ It is an essential part of an athlete''s physical attributes, especially for field sports, given their dynamic nature.¹⁸ Both static and dynamic postural stability result from the complex coordination of central processing from visual, vestibular, and somatosensory pathways, as well as the resultant efferent response.¹⁹Static-standing balance ability decreases after cryotherapy application. Cross et al²⁰ reported that after cryotherapy to the lower extremity, study participants had difficulty maintaining their balance on the treated extremity. More recently, Kernozek et al²¹ reported a deficit in mediolateral (ML) ground reaction force variability on the test leg immediately after a 20-minute cryotherapy application to the ankle joint, with a mean difference of 0.48 N relative to precryotherapy measures (P < .001; d = 1.20). At the 10-minute and 20-minute measurements postcryotherapy, participants continued to exhibit deficits in static-standing balance. However, traditional laboratory measures of postural stability, including static single-legged stance on instrumented force plates, may not be sensitive enough to detect postural-stability deficits associated with lower limb injury.²² Furthermore, Hrysomallis et al²³ indicated that postural-stability performance in static positions cannot be extrapolated to dynamic postural-stability performance, concluding that it is not advisable to infer the latter based on the former. Douglas et al²⁴ reaffirmed this conclusion, postulating that measures of dynamic standing balance may better represent the demands of the lower extremity during functional tasks and, therefore, may be a more appropriate assessment than static standing balance. In addition, Hrysomallis²⁵ showed that Australian Rules football players with an increased ML center-of-pressure (COP) excursion incurred at least twice as many ankle-ligament injuries as players with average or good postural stability. Kernozek et al²¹ and Douglas et al²⁴ observed that cryotherapy debilitated dynamic postural stability, potentially increasing the risk of lower limb injury.Considering the potential shortcomings of static postural-stability testing, our contention was that further investigations of the effects of cryotherapy application to the ankle joint on dynamic postural-stability performance are warranted. One potential method to investigate the influence of ankle-joint cryotherapy application on dynamic postural-stability performance is to use the Star Excursion Balance Test (SEBT) as a primary assessment, supplemented by lower limb sagittal-plane motion analysis and force-plate–derived kinetic assessment. Therefore, the purpose of our study was to evaluate the acute influence of a 15-minute cryotherapy application to the ankle joint on dynamic postural stability as quantified by performance on selected reach directions of the SEBT, associated lower limb sagittal-plane kinematic profiles, and kinetic measures of postural stability. We hypothesized that a 15-minute cryotherapy application to the ankle joint would result in decreased reach distances on the selected directions of the SEBT and altered sagittal-plane ankle-joint kinematics and kinetic measures of postural stability.     

Plantar-Plate Disruptions: “The Severe Turf-Toe Injury.” Three Cases in Contact Athletes

Objective:

To present 3 cases of plantar-plate rupture and turf-toe injury in contact athletes at 1 university and to discuss appropriate diagnosis and treatment algorithms for each case.

Background:

Turf toe is a common injury in athletes participating in outdoor cutting sports. However, it has been used as an umbrella term to describe many different injuries of the great toe. In some cases, the injury can be so severe that the plantar plate and sesamoid apparatus may be ruptured. These patients may be better managed with surgery than with traditional nonoperative interventions.

Differential Diagnosis:

Turf toe, plantar-plate disruption, sesamoid fracture.

Treatment:

For stable injuries in which the plantar plate is not completely disrupted, nonoperative treatment with casting or a stiff-soled shoe, gradual weight bearing, and rehabilitation is the best practice. Unstable injuries require surgical intervention and plantar-plate repair.

Uniqueness:

Turf toe and injury to the first metatarsophalangeal joint are relatively common injuries in athletes, but few researchers have detailed the operative and nonoperative treatments of plantar-plate disruption in these patients. We examine 3 cases that occurred over 4 seasons on a collegiate football team.

Conclusions:

Turf toe represents a wide array of pathologic conditions involving the first metatarsophalangeal joint. Stress and instability testing are key components to assess in determining whether surgical intervention is warranted to restore optimal function. Stiffer-soled shoes or shoes with steel-plate insertions may help to prevent these injuries and are useful tools for protection during the rehabilitation period.Key Words: metatarsophalangeal joint, great toe, football playersTurf toe is a common injury in athletes participating in outdoor cutting sports. Clanton and Ford¹ reported that injury to the foot was the third leading cause of missed athletic participation. Damage to the metatarsophalangeal joint (MTPJ) represents a large percentage of those injuries. However, since Bowers and Martin² coined the term turf toe, it has been a poorly studied topic of substantial controversy. They originally described turf toe as a sprain to the first MTPJ, but in many instances, the injury has been attributed incorrectly to various pathologic conditions involving the first ray.² Turf toe historically has been managed nonoperatively with a stiff-soled shoe or short walking boot. Yet in severe cases, the plantar plate may be ruptured and disrupted. These injuries are easy to overlook on physical examination. Therefore, the purpose of our study was to review 3 cases of injury to the plantar plate of the first MTPJ in contact athletes and to focus on diagnosis and treatment of the more severe toe injuries.     

Detection and phasing of single base de novo mutations in biopsies from human in vitro fertilized embryos by advanced whole-genome sequencing

Currently, the methods available for preimplantation genetic diagnosis (PGD) of in vitro fertilized (IVF) embryos do not detect de novo single-nucleotide and short indel mutations, which have been shown to cause a large fraction of genetic diseases. Detection of all these types of mutations requires whole-genome sequencing (WGS). In this study, advanced massively parallel WGS was performed on three 5- to 10-cell biopsies from two blastocyst-stage embryos. Both parents and paternal grandparents were also analyzed to allow for accurate measurements of false-positive and false-negative error rates. Overall, >95% of each genome was called. In the embryos, experimentally derived haplotypes and barcoded read data were used to detect and phase up to 82% of de novo single base mutations with a false-positive rate of about one error per Gb, resulting in fewer than 10 such errors per embryo. This represents a ∼100-fold lower error rate than previously published from 10 cells, and it is the first demonstration that advanced WGS can be used to accurately identify these de novo mutations in spite of the thousands of false-positive errors introduced by the extensive DNA amplification required for deep sequencing. Using haplotype information, we also demonstrate how small de novo deletions could be detected. These results suggest that phased WGS using barcoded DNA could be used in the future as part of the PGD process to maximize comprehensiveness in detecting disease-causing mutations and to reduce the incidence of genetic diseases.Worldwide, more than 5 million babies (Ferraretti et al. 2013) have been born through in vitro fertilization (IVF) since the birth of the first in 1978 (Steptoe and Edwards 1978). Exact numbers are difficult to determine, but it has been estimated that currently 350,000 babies are born yearly through IVF (de Mouzon et al. 2009, 2012; Centers for Disease Control and Prevention 2011; Ferraretti et al. 2013). That number is expected to rise, as advanced maternal age is associated with decreased fertility rates and women in developed countries continue to delay childbirth to later ages. In 95% of IVF procedures, no diagnostic testing of the embryos is performed (https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0). Couples with prior difficulties conceiving or those wishing to avoid the transmission of highly penetrant heritable diseases often choose to perform preimplantation genetic diagnosis (PGD). PGD involves the biopsy of one cell from a 3-d embryo or the recently more preferred method, due to improved implantation success rates (Scott et al. 2013b), of up to 10 cells from a 5- to 6-d blastocyst-stage embryo. Following biopsy, genetic analysis is performed on the isolated cell(s). Currently this is an assay for translocations and the correct chromosome copy number (Hodes-Wertz et al. 2012; Munne 2012; Yang et al. 2012; Scott et al. 2013a; Yin et al. 2013), a unique test designed and validated for each specific heritable disease (Gutierrez-Mateo et al. 2009), or a combination of both (Treff et al. 2013). Importantly, none of these approaches can detect de novo mutations.Advanced maternal age has long been associated with an increased risk of producing aneuploid embryos (Munne et al. 1995; Crow 2000; Hassold and Hunt 2009) and giving birth to a child afflicted with Down syndrome or other diseases resulting from chromosomal copy number alterations. Conversely, children of older fathers have been shown to have an increase in single base and short multibase insertion/deletion (indels) de novo mutations (Kong et al. 2012). Many recent large-scale sequencing studies have found that de novo variations spread across many different genes are likely to be the cause of a large fraction of autism cases (Michaelson et al. 2012; O’Roak et al. 2012; Sanders et al. 2012; De Rubeis et al. 2014; Iossifov et al. 2014), severe intellectual disability (Gilissen et al. 2014), epileptic encephalopathies (Epi4K Consortium and Epilepsy Phenome/Genome Project 2013), and many other congenital disorders (de Ligt et al. 2012; Veltman and Brunner 2012; Yang et al. 2013; Al Turki et al. 2014). Additionally rare and de novo variations have been suggested to be prevalent in patients with schizophrenia (Fromer et al. 2014; Purcell et al. 2014), and Michaelson et al. (2012) found that single base de novo mutations affect conserved regions of the genome and essential genes more often than regions of unknown function. Current targeted approaches to PGD would miss many of these important functional changes within the embryonic DNA sequence, and even a whole-genome sequencing (WGS)–based carrier screen of both parents would not enable comprehensive preimplantation or prenatal diagnoses due to de novo mutations. As more parents delay childbirth into their mid-30s and later, these studies suggest we should try to provide better diagnostic tests for improving the health of newborns. In this study, we demonstrate the use of an advanced WGS process that provides an accurate and phased genome sequence from about 10 cells, allowing highly sensitive and specific detection of single base de novo mutations from IVF blastocyst biopsies.     

A human-oriented framework for developing assistive service robots

Purpose: Multipurpose robots that can perform a range of useful tasks have the potential to increase the quality of life for many people living with disabilities. Owing to factors such as high system complexity, as-yet unresolved research questions and current technology limitations, there is a need for effective strategies to coordinate the development process.

Method: Integrating established methodologies based on human-centred design and universal design, a framework was formulated to coordinate the robot design process over successive iterations of prototype development.

Results: An account is given of how the framework was practically applied to the problem of developing a personal service robot. Application of the framework led to the formation of several design goals which addressed a wide range of identified user needs. The resultant prototype solution, which consisted of several component elements, succeeded in demonstrating the performance stipulated by all of the proposed metrics.

Conclusions: Application of the framework resulted in the development of a complex prototype that addressed many aspects of the functional and usability requirements of a personal service robot. Following the process led to several important insights which directly benefit the development of subsequent prototypes.

• Implications for Rehabilitation

• This research shows how universal design might be used to formulate usability requirements for assistive service robots.

• A framework is presented that guides the process of designing service robots in a human-centred way.

• Through practical application of the framework, a prototype robot system that addressed a range of identified user needs was developed.

     

Full-participation of students with physical disabilities in science and engineering laboratories

Purpose: To conduct a literature review identifying barriers and facilitators students with physical disabilities (SwD-P) may encounter in science and engineering (S&E) laboratories.

Method: Publications were identified from 1991 to 2015 in ERIC, web of science via web of knowledge, CINAHL, SCOPUS, IEEEXplore, engineering village, business source complete and PubMed databases using search terms and synonyms for accommodations, advanced manufacturing, additive manufacturing, assistive technology (AT), barriers, engineering, facilitators, instructor, laboratory, STEM education, science, students with disabilities and technology.

Results: Twenty-two of the 233 publications that met the review’s inclusion criteria were examined. Barriers and facilitators were grouped based on the international classification of functioning, disability and health framework (ICF). None of the studies directly found barriers or facilitators to SwD-P in science or engineering laboratories within postsecondary environments. The literature is not clear on the issues specifically related to SwD-P.

Conclusion: Given these findings, further research (e.g., surveys or interviews) should be conducted to identify more details to obtain more substantial information on the barriers that may prevent SwD-P from fully participating in S&E instructional laboratories.

• Implications for Rehabilitation

• Students with disabilities remain underrepresented going into STEM careers.

• A need exist to help uncover barriers students with disabilities encounter in STEM laboratory.

• Environments.

• Accommodations and strategies that facilitate participation in STEM laboratory environments are promising for students with disabilities

     

The impact of test loads on the accuracy of 1RM prediction using the load-velocity relationship

Background

Numerous methods have been proposed that use submaximal loads to predict one repetition maximum (1RM). One common method applies standard linear regression equations to load and average vertical lifting velocity (V_mean) data developed during squat jumps or three bench press throw (BP-T). The main aim of this project was to determine which combination of three submaximal loads during BP-T result in the most accurate prediction of 1RM Smith Machine bench press strength in healthy individuals.

Methods

In this study combinations of three BP-T loads were used to predict 1RM Smith Machine bench press strength. Additionally, we examined whether regression models developed using peak vertical bar velocity (V_peak), rather than V_mean, provide the most accurate prediction of Smith Machine bench press 1RM. 1RM Smith Machine bench press strength was measured directly in 12 healthy regular weight trainers (body mass?=?80.8?±?5.7 kg). Two to three days later a linear position transducer attached to the collars on a Smith Machine was used to record V_mean and V_peak during BP-T between 30 and 70% of 1RM (10% increments).

Results

Repeated measures analysis of variance testing showed that the mean values for slope and ordinate intercept for the regression models at each of the load ranges differed significantly depending on whether V_mean or V_peak were used in the prediction models (P?<?0.001). Conversely, the abscissa intercept did not differ significantly between either measure of vertical bar velocity at each load range. The key finding in this study was that 1RM Smith Machine bench press strength can be determined with high relative accuracy by examining V_mean and V_peak during BP-T over three loads, with the most precise models using V_peak during loads representing 30, 40 and 50% of 1RM (R ² ?=?0.96, SSE?=?4.2 kg).

Conclusions

These preliminary findings indicate that exercise programmers working with normal healthy populations can accurately predict Smith Machine 1RM bench press strength using relatively light load Smith Machine BP-T testing, avoiding the need to expose their clients to potentially injurious loads.

     

Speech perception in children with cochlear implants for continua varying in formant transition duration

Purpose: To examine the developmental course of labial and alveolar manner of articulation contrasts, and to determine how that course may be different for typically developing (TD) children with cochlear implants (CI).

Method: Eight young adults, eight TD 5–8 year-old children, and seven 5–8 year-old children with CIs participated. Labial /ba/–/wa/ and alveolar /da/–/ja/ continua stimuli were presented, with each continuum consisting of nine synthetic stimuli varying in F2 and F3 transition duration. Participants were asked to label the stimuli as either a stop or glide, and responses were analysed for phonetic boundaries and slopes.

Result: For the /ba/–/wa/ contrast, children with CIs required longer transition durations compared to TD children or adults to cross from one phoneme category to another. The children with CIs demonstrated less confidence in labelling the stimuli (i.e. less steep slopes) than the TD children or the adults. For the /da/–/ja/ contrast, the children with CIs showed less steep slope values than adults.

Conclusion: These results suggest that there are differences in the way TD children and children with CIs develop and maintain phonetic categories, perhaps differences in phonetic representation or in linking acoustic and phonetic representations.