Amanda M. Clifford

Neutral lumbar spine sitting posture in pain-free subjects

Sitting is a common aggravating factor in low back pain (LBP), and re-education of sitting posture is a common aspect of LBP management. However, there is debate regarding what is an optimal sitting posture. This pilot study had 2 aims; to investigate whether pain-free subjects can be reliably positioned in a neutral sitting posture (slight lumbar lordosis and relaxed thorax); and to compare perceptions of neutral sitting posture to habitual sitting posture (HSP). The lower lumbar spine HSP of seventeen pain-free subjects was initially recorded. Subjects then assumed their own subjectively perceived ideal posture (SPIP). Finally, 2 testers independently positioned the subjects into a tester perceived neutral posture (TPNP). The inter-tester reliability of positioning in TPNP was very good (intraclass correlation coefficient (ICC) = 0.91, mean difference = 3% of range of motion). A repeated measures ANOVA revealed that HSP was significantly more flexed than both SPIP and TPNP (p <0.05). There was no significant difference between SPIP and TPNP (p > 0.05). HSP was more kyphotic than all other postures. This study suggests that pain-free subjects can be reliably positioned in a neutral lumbar sitting posture. Further investigation into the role of neutral sitting posture in LBP subjects is warranted.

Dance for People With Parkinson Disease: What Is the Evidence Telling Us?

OBJECTIVES (1) To appraise and synthesize the literature on dance interventions for individuals with Parkinson disease (PD); (2) to provide information regarding the frequency, intensity, duration, and type of dance used in these programs; and (3) to inform the development of future studies evaluating dance interventions in this population. DATA SOURCES Eight databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature [CINAHL], the Allied and Complementary Medicine Database [AMED], SPORTDiscus, PubMed, PubMed Central, Sage, and ScienceDirect) were electronically searched in April 2014. The references lists from the included articles were also searched. STUDY SELECTION Studies retrieved during the literature search were reviewed by 2 reviewers independently. Suitable articles were identified by applying inclusion criteria. DATA EXTRACTION Data regarding participants and the frequency, intensity, duration, and type of dance form used were extracted. The effect that each dance program had on defined outcomes and the feasibility of each program were also reviewed. DATA SYNTHESIS Thirteen articles were identified. The quality of studies varied, and methodological limitations were evident in some. The evidence evaluated suggests that two 1-hour dance classes per week over 10 to 13 weeks may have beneficial effects on endurance, motor impairment, and balance. CONCLUSIONS Dance may be helpful for some people with PD. This article provides preliminary information to aid clinicians when implementing dance programs for people with PD. Higher-quality multicenter studies are needed to determine the effect of other dance genres and the optimal therapy volume and intensity.

Postural control in healthy individuals.

BACKGROUND The aim of rehabilitation is to optimize functional recovery and frequently following injury, the uninjured limb is used as measure to compare with the injured limb. This assumes that symmetry existed prior to the injury. The aim of this study was to examine postural control in a healthy sample to ascertain if differences exist between the functionally dominant compared to non-dominant limbs. METHODS Following ethical approval, 20 healthy active subjects (10 males and 10 females) mean age (SE) of 27.2 (1.4) years, with no previous history of lower-limb injury or pathology volunteered to participate in the study. Bilateral joint angle data was acquired to establish the amount of wobble and the strategies of movement used to maintain balance during single-leg stance. FINDINGS A greater proportion of non-dominant limbs used the ankle strategy, commonly modelled as an inverted pendulum, to maintain balance during unipedal stance (p>0.003) in the sagittal plane. No differences were found in the coronal plane or for wobble. INTERPRETATION A greater proportion of the healthy individuals were more pendular-like when balancing on the non-dominant limb. Thus an assessment of joint angle changes during single-leg stance may provide greater insight into the postural control strategies and capabilities of healthy active individuals, which may inform future rehabilitation programmes in order to optimize functional outcome.

Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle.

OBJECTIVE To identify the most effective components in an active exercise physiotherapy treatment intervention for chronic neck pain based on the frequency, intensity, time, and type (FITT) exercise method of tailoring physical activity recommendations to the individual needs and goals of patients. DATA SOURCES Databases, including the Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, SPORTDiscus, Biomedical Reference Collection, and Academic Search Premier, were searched for relevant articles. STUDY SELECTION Quantitative design studies that included active exercise as part of a multimodal or stand-alone approach were selected. Only studies scoring ≥6 on the Physiotherapy Evidence Database Scale were included in the review because this reflected a good level of evidence. DATA EXTRACTION Study methodologies and relevant outcome measures, including isometric strength, Neck Disability Index scores, and pain scores, were extracted from relevant articles and grouped together for appraisal and synthesis. DATA SYNTHESIS Evidence from selected articles was synthesized according to the FITT exercise principal to determine the most effective exercise type, frequency, and intensity in the treatment of chronic neck pain. CONCLUSIONS Physiotherapy interventions using a multimodal approach appear to produce more beneficial outcomes in terms of increased strength, improved function, and health-related quality of life and reduced pain scores. Active strengthening exercises appear to be beneficial for all of these outcomes; the inclusion of additional stretching and aerobic exercise components appear to enhance the benefits of an exercise intervention.

Aquatic Exercise Therapy for People With Parkinson Disease: A Randomized Controlled Trial

OBJECTIVE To evaluate the effects of aquatic exercise therapy on gait variability and disability compared with usual care for people with Parkinson disease (PD). DESIGN Single-blind randomized controlled trial. SETTING Community-based hydrotherapy pool. PARTICIPANTS Individuals with PD (Hoehn-Yahr stages I-III) (N=21). INTERVENTIONS Participants were randomly assigned to either an aquatic exercise therapy group (45min, twice a week for 6wk) or a group that received usual care. MAIN OUTCOME MEASURES The primary outcome measure was gait variability as measured using a motion capture system. Secondary outcomes were quality of life measured on the Parkinsons Disease Questionnaire-39 and freezing of gait and motor disability quantified by the Unified Parkinsons Disease Rating Scale. Feasibility was evaluated by measuring safety, adverse events, and participant satisfaction. RESULTS People in the aquatic therapy group and usual care group showed similar small improvements in gait variability. The aquatic therapy group showed greater improvements in disability than the usual care group (P<.01). No differences between groups or over time were identified for freezing of gait or quality of life. Aquatic therapy sessions were safe and enjoyable with no adverse events. CONCLUSIONS Aquatic therapy appears feasible and safe for some people in the early stages of PD.

Optimum gravity vector and vertical acceleration estimation using a tri-axial accelerometer for falls and normal activities

This study aims to determine an optimum estimate for the gravitational vector and vertical acceleration profiles using a body-worn tri-axial accelerometer during falls and normal activities of daily living (ADL), validated using a camera based motion analysis system. Five young healthy subjects performed a number of simulated falls and normal ADL while trunk kinematics were measured by both an optical motion analysis system and a tri-axial accelerometer. Through low-pass filtering of the trunk tri-axial accelerometer signal between 1Hz and 2.7Hz using a 1st order or higher, Butterworth IIR filter, accurate gravity vector profile can be obtained using the method described here. Results: a high mean correlation (≥0.83: Coefficient of Multiple Correlations) and low mean percentage error (≤2.06m/s2) were found between the vertical acceleration profile generated from the tri-axial accelerometer based sensor to those from the optical motion capture system. This proposed system enables optimum gravity vector and vertical acceleration profiles to be measured from the trunk during falls and normal ADL.

Predicting falls in community-dwelling older adults: A systematic review of task performance-based assessment tools

INTRODUCTION: Falls among community-dwelling older adults are a common yet often preventable occurrence. Clinicians frequently use task-based assessment tools to evaluate clients’ balance and mobility with the aim of predicting falls and providing targeted fall prevention interventions, but no consensus exists on the optimum tool(s) to use for this purpose. This review aims to identify the task-based assessment tools that can best predict falls among community-dwelling older adults. METHODS: Online databases Academic Search Complete, AMED, Biomedical Reference Collection: Expanded, CINAHL Plus, MEDLINE, General Science, and SPORTDiscus were searched from 1983 to 2013 to identify prospective studies assessing the performance of specific tasks in order to predict falls. Following screening, the methodological quality of studies included for review was appraised using a checklist based on the Critical Appraisal Skills Programme tool for cohort studies [1]. RESULTS: Thirty-seven studies, dating from 1996 to 2013 and largely of high methodological quality, were included in this review. A range of task performance-based assessment tools suitable for use in both clinical and laboratory settings were identified. CONCLUSIONS: Strong evidence in favour of using the Timed Up-and-Go test, Five Times Sit-to-Stand test and assessments of gait speed to predict falls among this population in clinical settings was found, along with weaker evidence for tests of standing balance and reaching task performance. Laboratory-based assessments of postural sway and gait variability were also found to predict falls. Incorporating the recommended assessment tools into comprehensive assessments of community-dwelling older clients can lead to improved falls prediction by clinicians.

The Effect of Patellar Taping on Squat Depth and the Perception of Pain in People with Anterior Knee Pain

Patellar taping is a treatment adjunct commonly used in the management of anterior knee pain. The aim of this cross sectional study was to investigate the effects of medial glide patellar taping on sagittal plane lower-limb joint kinematics and knee pain during a unilateral squat in a symptomatic population complaining of anterior knee pain. Ten participants with a history of unilateral or bilateral anterior knee pain were included in the study. Subjects were required to squat on the symptomatic leg under three conditions: placebo tape, patellar tape and no tape. Kinematic data was recorded using the CODA mpx64 motion analysis system and subjects’ pain was assessed using the Numerical Rating Scale. Patellar taping resulted in a significantly greater single-legged squat depth compared to placebo tape (p=0.008) and no tape (p=0.001) and a statistically significant reduction in pain during a squat compared to placebo tape (p=0.001) or no tape (p=0.001). Significant differences were not identified for maximum knee flexion in the patella taping compared to the no tape condition. This study may have significant clinical implications as participants reported less pain and alterations in sagittal plane movement following the application of patellar tape.

The reliability of the CODA motion analysis system for lumbar spine analysis: a pilot study

Background: Low bock pain (LBP)is 0 very common musculoskeletal disorder. Lumbar range of motion (ROM) and posture are parameters which are commonly assessed in LBP research. Reliable methods of measuring lumbar spine ROM and posture are needed. The CODA motion analysis system has several potential advantages over other motion analysis systems; however its reliability for lumbar spine analysis has not been examined. This study investigated the reliability of the CODA system for measuring lumbar spine sagittal plane ROM and posture. Methods: Twelve participants were tested by two investigators on two occasions. Ten trials of lumbar ROM and usual sitting posture were performed. The reliability of upper lumbar, lower lumbar, and pelvic sagittal plane motion was assessed using intra-closs correlation coefficients (ICC) and Blond and Altman methods, including evaluation of the mean diHerence and limits of agreement. Results: Levels of association were very good for ROM, for both intra-rater and inter-rater measurements (all ICC >0.7). However, agreement was more variable, with some lower lumbar and pelvic regions displaying large mean differences and wide limits of agreement. Overall, greater reliability was obtained for the upper lumbar region angles, and for intra-rater comparisons. Conclusion: Reliability of the CODA system varied from very good to fair, depending on the parameters assessed. While good association was found between most parameters, the level of agreement was only fair to moderate. Recommendations are mode to improve the protocol used to assess spinal motion, which may improve reliability.

Altered hamstring strength profile in Gaelic footballers with a previous hamstring injury

Hamstring injuries are common in many sports involving high-load eccentric hamstring activation, including Gaelic football. Eccentric hamstring peak torque (PT) and hamstring angle to peak torque (AngPT) have not been examined in previously injured Gaelic footballers. This study aimed to determine whether significant hamstring and quadriceps PT deficits were present in Gaelic footballers after a hamstring injury. Concentric hamstring and quadriceps PT at 60 and 180 degrees/second ( � /s) and eccentric hamstring PT at 30 � /s were measured using an isokinetic dynamometer in 18 male Gaelic footballers (nine previously injured, nine controls). Hamstring AngPT, as well as hamstring and quadriceps PT and PT ratios were analysed. For previously injured limbs, hamstring AngPT occurred at significantly sh orter muscle lengths (p = 0.038) than for the contralateral uninjured limbs in eccentric testing only. There were no other signific ant differences (p > 0.05) at any velocity, for within-subject or between-subject comparisons. The results showed that the previously injured hamstrings generated their eccentric ha mstring AngPT at significantly shorter muscle lengths than the contr alateral hamstrings. The results imply footballers with a p revious hamstring injury who have returned to full participation may remain at increased risk of re-injury because of an alterat ion in their eccentric hamstring AngPT.