Effect of Wheelchair Stroke Pattern on Upper Extremity Muscle Fatigue

Shoulder dysfunction is common in persons with spinal cord injury (SCI) with an incidence of up to 63%1. Dysfunction is a result of muscle imbalances, specifically denervated rotator cuff muscles that are repetitively used during manual wheelchair propulsion.

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The effects of tongue pressure strength and accuracy training on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia: a preliminary randomized clinical trial

Tongue pressure strength and accuracy training (TPSAT) has been proposed as an intervention to improve dysphagia. However, the effects of TPSAT on dysphagia in subacute stroke patients remain unclear. The aim of this study was to investigate the effects of TPSAT on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia. Sixteen subacute stroke patients were assigned randomly to two groups: the TPSAT group (n=8) or the control group (n=8). In the former, both TPSAT and traditional dysphagia therapies were performed for 30 min each per day; in the latter, only traditional dysphagia therapy was performed for 30 min twice a day. Both groups performed each daily intervention five times per week for 8 weeks. To assess the tongue pressure strength, maximum isometric tongue pressures (MIPs) of the anterior and posterior tongue using the Iowa Oral Performance Instrument were measured before and after the intervention. Mann Assessment of Swallowing Ability (MASA) and Swallowing-Quality of Life (SWAL-QOL) were also used to assess the swallowing function and quality of life, respectively. TPSAT with traditional dysphagia therapy significantly improved MASA, SWAL-QOL, and MIPs both anteriorly and posteriorly, and traditional dysphagia therapy significantly increased MASA, SWAL-QOL, and MIPs anteriorly (P

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Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study

Abstract

Background

Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide.

Methods

This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days.

Results

4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45).

Conclusion

A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments.

Trial registration: NCT02179112.

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Biomechanical properties of the patellar tendon in children with heritable connective tissue disorders

Abstract

Purpose

Hereditary connective tissue disorders (HCTDs), such as classic Ehlers–Danlos syndrome (cEDS) and Marfan syndrome (MS) share overlapping features like hypermobility and tissue fragility. In clinical practice it remains a challenge to distinguish children and adolescents with HCTD from healthy children. The purpose of this study was to investigate the biomechanical properties of the patellar tendon and joint laxity (Beighton score) in children with HCTDs (n = 7) compared to healthy controls (n = 14).

Methods

The mechanical properties of the patellar tendon were assessed using simultaneous force and ultrasonographic measurements during isometric ramp contractions. Ultrasonography was also used to measure tendon dimensions. The HCTD children were matched with 2 healthy controls with regard to age, body mass index (BMI), sex and physical activity level.

Results

The HCTD children had a greater degree of joint laxity (P < 0.01). Although, the patellar tendon dimensions did not differ significantly between the two groups, the HCTD children showed a tendency toward a larger patellar tendon cross-sectional area (CSA) (35%, P = 0.19). Moreover, stiffness did not differ between the two groups, but secant modulus was 27% lower in children with a HCTD (P = 0.05) at common force and 34% lower at maximum force (P = 0.02).

Conclusions

The present study demonstrates for the first time that children with HCTDs have lower material properties (modulus) of their patellar tendon, which may be indicative of general impairment of connective tissue mechanics related to their increased joint laxity.

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A Longitudinal Study of the Effect of Organized Physical Activity on Free Active Play

Purpose The relationship between organized sport participation and positive youth development is well established. However, over-involvement in sport and organized physical activity (e.g., dance) has been identified as having a potentially negative impact. Over-scheduling and its impact on free play is one concern, given the importance of free play to overall health and development. Currently, it is not known if greater participation in organized sport has a positive or negative effect on discretionary free play in children and youth. Methods The Physical Health and Activity Study Team (PHAST) study was a five-year, longitudinal cohort study that followed 2278 fourth grade children (ages 9 to 10 years). Organized sport and free play was assessed at in the fall of each school year from fifth to eighth grade using self-report questionnaires. Results Using mixed effects modeling, we found that higher participation in organized sport was associated with increased participation in free play over time (Coef = 0.20, p<.001 while this effect was independent of age and socioeconomic status we did find that boys with high levels organized participation reported the highest free play overall. conclusion possible explanations for association are related to role sport might in supporting physical literacy development fundamental movement skills allowing children participate more active pursuits. it also be case simply seek out both unorganized activity opportunities during developmental period. limitations implications further research policy discussed. corresponding author: john cairney faculty kinesiology education university toronto harbord st on canada m5s tel.: e-mail address: john.cairney authors declare they have no competing interests. results study presented clearly honestly without fabrication falsification or inappropriate data manipulation. present do not constitute endorsement by acsm. supported canadian institutes health no. american college sports medicine>

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Mental Fatigue and Soccer: Current Knowledge and Future Directions

Abstract

Fatigue is a complex state with multiple physiological and psychological origins. However, fatigue in soccer has traditionally been investigated from a physiological perspective, with little emphasis on the cognitive demands of competition. These cognitive demands may induce mental fatigue, which could contribute to the fatigue-related performance decrements observed during and after soccer matches. Recent research investigating the relationship between mental fatigue and soccer-specific performance supports this suggestion. This leading article provides an overview of the research in this emerging field, outlining the impact of mental fatigue on soccer-specific physical, technical, decision-making, and tactical performances. The second half of this review provides directions for future research in response to the limitations of the existing research. Emphasis is placed on translating the current body of knowledge into practical applications and developing a greater understanding of the mechanisms underpinning the negative impact of mental fatigue on soccer performance. A conceptual model is presented to help direct this future research.

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Injury Risk (Burden), Risk Matrices and Risk Contours in Team Sports: A Review of Principles, Practices and Problems

Abstract

The aim of this review was to provide insights into and a critical assessment of injury burden, risk matrices and risk contours in the context of team sports. Injury burden is the product of injury incidence and mean severity, and is normally reported as days' absence/1000 player-hours. An important feature of injury burden is that equal values can reflect quite different numerical combinations of injury incidence and severity. The timeframe over which injury burden affects a team depends on the incidence and severity values of the injuries sustained. Injury burden is evaluated through the use of risk matrices and risk contours. The main benefits of using risk matrices, and the reasons for their widespread acceptance, are the minimal data inputs required, the ease of understanding the visual data presentation, the transparent nature of the evaluation criteria and the simplicity with which the conclusions can be communicated to stakeholders. Injury burden is most often used for the identification of injuries that cause the greatest loss of time for players, ranking the importance of injury risk factors and prioritising injury prevention plans. Although risk matrices are commonly used for evaluating risks during the risk assessment process, there is little evidence to demonstrate that they improve decision-making, as they have a number of limitations, including potential inconsistencies and discrepancies when evaluating and ranking risks. These limitations suggest that physicians, physiotherapists and sports scientists should only use injury burden, risk matrices and risk contours when they fully understand their strengths and weaknesses.

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