Bonnie Van Lunen

Real-Time Intersession and Interrater Reliability of the Functional Movement Screen

Onate, JA, Dewey, T, Kollock, RO, Thomas, KS, Van Lunen, BL, DeMaio, M, and Ringleb, SI. Real-time intersession and interrater reliability of the functional movement screen. J Strength Cond Res 26(2): 408–415, 2012—The purpose of this study was to examine the real-time intersession and interrater reliability of the functional movement screen (FMS). The overall study consisted of 19 volunteer civilians (12 male, 7 female). The intersession reliability consisted of 12 men and 7 women, whereas 10 men and 6 women participated in the interrater reliability test session. Two raters (A and B) were involved in the interrater reliability aspect of this study. The FMS includes 7 tests: deep squat (DS), hurdle step (HS), in-line lunge (IL), shoulder mobility (SM), active straight leg raise (ASLR), trunk stability push-up (TSPU), and rotary stability (RS). Researchers analyzed the data via intraclass correlation (ICC). To determine the reliability of the intersession scoring of the FMS and the intrasession interrater scoring of the FMS a 2-way mixed effects model intraclass correlation coefficient (ICC3,1) was used for the continuous data, whereas a weighted Cohens kappa (κ) was used for the categorical data. The dependent variables were FMS total score (0–21 scale) and associated tests were DS, HS, IL, SM, ASLR, TSPU, and RS. Intersession reliability (ICC, SEM) and κ were as follows: FMS total score (0.92, 0.51), DS (κ = 0.69), HS (κ = 0.16), IL (κ = 0.69), SM (κ = 0.84), ASLR (κ = 0.69), TSPU (κ = 0.77), and RS (no covariance). Interrater reliability (ICC, SEM) and κ were as follows: FMS total score (0.98, 0.25), DS (κ = 1.0), HS (κ = 0.33), IL (κ = 0.88), SM (κ = 0.90), ASLR (κ = 0.88), TSPU (κ = 0.75), and RS (no covariance). The FMS total scores displayed high intersession and interrater reliabilities. Finally, with the exception of HS, all tasks displayed moderate to high intersession reliability and good to high interrater reliability.

Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.

UNLABELLED Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects. OBJECTIVE To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke. DESIGN A before-after comparison of a single group with BWSTT intervention. SETTING University research laboratory. PARTICIPANTS A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study. INTERVENTION Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback. MAIN OUTCOME MEASURES Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed. RESULTS One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s. CONCLUSIONS A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.

Two Different Fatigue Protocols and Lower Extremity Motion Patterns During a Stop-Jump Task

CONTEXT Altered neuromuscular control strategies during fatigue probably contribute to the increased incidence of noncontact anterior cruciate ligament injuries in female athletes. OBJECTIVE To determine biomechanical differences between 2 fatigue protocols (slow linear oxidative fatigue protocol [SLO-FP] and functional agility short-term fatigue protocol [FAST-FP]) when performing a running-stop-jump task. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A convenience sample of 15 female soccer players (age = 19.2 ± 0.8 years, height = 1.67 ± 0.05 m, mass = 61.7 ± 8.1 kg) without injury participated. INTERVENTION(S) Five successful trials of a running-stop-jump task were obtained prefatigue and postfatigue during the 2 protocols. For the SLO-FP, a peak oxygen consumption (Vo(2)peak) test was conducted before the fatigue protocol. Five minutes after the conclusion of the Vo(2)peak test, participants started the fatigue protocol by performing a 30-minute interval run. The FAST-FP consisted of 4 sets of a functional circuit. Repeated 2 (fatigue protocol) × 2 (time) analyses of variance were conducted to assess differences between the 2 protocols and time (prefatigue, postfatigue). MAIN OUTCOME MEASURE(S) Kinematic and kinetic measures of the hip and knee were obtained at different times while participants performed both protocols during prefatigue and postfatigue. RESULTS Internal adduction moment at initial contact (IC) was greater during FAST-FP (0.064 ± 0.09 Nm/kgm) than SLO-FP (0.024 ± 0.06 Nm/kgm) (F(1,14) = 5.610, P = .03). At IC, participants had less hip flexion postfatigue (44.7° ± 8.1°) than prefatigue (50.1° ± 9.5°) (F(1,14) = 16.229, P = .001). At peak vertical ground reaction force, participants had less hip flexion postfatigue (44.7° ± 8.4°) than prefatigue (50.4° ± 10.3°) (F(1,14) = 17.026, P = .001). At peak vertical ground reaction force, participants had less knee flexion postfatigue (-35.9° ± 6.5°) than prefatigue (-38.8° ± 5.03°) (F(1,14) = 11.537, P = .001). CONCLUSIONS Our results demonstrated a more erect landing posture due to a decrease in hip and knee flexion angles in the postfatigue condition. The changes were similar between protocols; however, the FAST-FP was a clinically applicable 5-minute protocol, whereas the SLO-FP lasted approximately 45 minutes.

Health-Related Quality of Life in Individuals With Chronic Ankle Instability

CONTEXT Individuals with chronic ankle instability (CAI) have reported decreased global and regional function. Despite the identification of functional deficits in those with CAI, more research is required to determine the extent to which CAI influences the multidimensional profile of health-related quality of life. OBJECTIVE To determine whether global, regional, and psychological health-related outcomes differ between individuals with and without CAI. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-five participants with CAI (age = 21.9 ± 2.5 years, height = 170.8 ± 8.6 cm, mass = 69.8.0 ± 11.7 kg) were sex- and limb-matched to 25 healthy participants (age = 22.0 ± 2.1 years, height = 167.4 ± 9.1 cm, mass = 64.8 ± 11.2 kg). MAIN OUTCOME MEASURE(S) Both groups completed the Disablement in the Physically Active Scale, the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport, the Tampa Scale of Kinesiophobia-11, and the Fear-Avoidance Beliefs Questionnaire. Dependent variables were scores on these instruments, and the independent variable was group. RESULTS Compared with healthy individuals, those with CAI reported decreased function on the Disablement in the Physically Active Scale, FAAM, and FAAM-Sport (P < .001) and increased fear of reinjury on the Tampa Scale of Kinesiophobia-11 and Fear-Avoidance Beliefs Questionnaire (P < .001). In the CAI group, the FAAM and FAAM-Sport demonstrated a significant relationship (r = 0.774, P < .01). CONCLUSIONS Individuals with CAI reported decreased function and increased fear of reinjury compared with healthy control participants. Also, within the CAI group, there was a strong relationship between FAAM and FAAM-Sport scores but not between any other instruments. These findings suggest that health-related quality of life should be examined during the rehabilitation process of individuals with CAI.

Pivot task increases knee frontal plane loading compared with sidestep and drop-jump

Abstract The purpose of this study was to assess kinematic and kinetic differences between three tasks (drop-jump, sidestep cutting, and pivot tasks) commonly used to evaluate anterior cruciate ligament risk factors. Nineteen female collegiate soccer athletes from a Division I institution participated in this study. Participants performed a drop-jump task, and two unanticipated tasks, sidestep cutting and pivot. Repeated-measures analyses of variance were conducted to assess differences in the kinematic and kinetic parameters between tasks. The pivot task had lower knee flexion (−41.2 ± 8.8°) and a higher valgus angle (−7.6 ± 10.1°) than the sidestep (−53.9 ± 9.4° and −2.9 ± 10.0°, respectively) at maximum vertical ground reaction force. The pivot task (0.8 ± 0.3 multiples of body weight) had higher peak posterior ground reaction force than the drop-jump (0.3 ± 0.06 multiples of body weight) and sidestep cutting (0.3 ± 0.1 multiples of body weight), as well as higher internal varus moments (0.72 ± 0.3 N · m/kg · m) than the drop-jump (0.14 ± 0.07 N · m/kg · m) and sidestep (0.17 ± 0.5 N · m/kg · m) at peak stance. During the pivot task, the athletes presented a more erect posture and adopted strategies that may place higher loads on the knee joint and increase the strain on the anterior cruciate ligament.

Knee and hip sagittal and transverse plane changes after two fatigue protocols

UNLABELLED Fatigue has been shown to alter the biomechanics of lower extremity during landing tasks. To date, no study has examined the effects of two types of fatigue on kinetics and kinematics. OBJECTIVES This study was conducted to assess biomechanical differences between two fatigue protocols [Slow Linear Oxidative Fatigue Protocol (SLO-FP) and Functional Agility Short-Term Fatigue Protocol (FAST-FP)]. DESIGN Single-group repeated measures design. METHODS Fifteen female collegiate soccer players had to perform five successful trials of unanticipated sidestep cutting (SS) pre- and post-fatigue protocols. The SLO-FP consisted of an initial VO(2peak) test followed by 5-min rest, and a 30-min interval run. The FAST-FP consisted of 4 sets of a functional circuit. Biomechanical measures of the hip and knee were obtained at different instants while performing SS pre- and post-fatigue. Repeated 2 × 2 ANOVAs were conducted to examine task and fatigue differences. Alpha level set a priori at 0.05. RESULTS During the FAST-FP, participants had increased knee internal rotation at initial contact (IC) (12.5 ± 5.9°) when compared to the SLO-FP (7.9 ± 5.4°, p<0.001). For hip flexion at IC, pre-fatigue had increased angles (36.4 ± 8.4°) compared to post-fatigue (30.4 ± 9.3°, p=0.003), also greater knee flexion during pre-fatigue (25.6 ± 6.8°) than post-fatigue (22.4 ± 8.4°, p=0.022). CONCLUSION The results of this study showed that hip and knee mechanics were substantially altered during both fatigue conditions.

Functional performance following an ice bag application to the hamstrings.

Fischer, J, Van Lunen, BL, Branch, JD, and Pirone, JL. Functional performance following an ice bag application to the hamstrings. J Strength Cond Res 23(1): 44-50, 2009-This study examined the immediate and short-term (20 minute) effects of 3- and 10-minute ice bag applications to the hamstrings on functional performance as measured by the cocontraction test, shuttle run, and single-leg vertical jump. Forty-two (25 women, 17 men) recreational or collegiate athletes who were free of injury in the lower extremity 6 months before testing and who did not suffer from allergy to cryotherapy were included. Time to completion was measured in seconds for the cocontraction and the shuttle run test. Single-leg vertical jump was measured on the Vertec (Sports Imports, Columbus, Ohio) in centimeters. The 10-minute ice bag application reduced immediate postapplication vertical jump performance and increased immediate post and 20-minute post shuttle run time (p ≤ 0.05). A decrease in cocontraction time was observed at 20 minutes post compared with preapplication during the control condition in which no ice bag was applied. Power and functional performance are affected by short-term cryotherapy application. Power and functional performance was impaired immediately and 20 minutes after 10-minute ice bag application to the hamstrings, whereas a shorter duration of ice application had no effect on these tasks.

A Feedback Inclusive Neuromuscular Training Program Alters Frontal Plane Kinematics

Abstract Greska, EK, Cortes, N, Van Lunen, BL, and Oñate, JA. A feedback inclusive neuromuscular training program alters frontal plane kinematics. J Strength Cond Res 26(6): 1609–1619, 2012—Anterior cruciate ligament (ACL) neuromuscular training programs have demonstrated beneficial effects in reducing ACL injuries, yet further evaluation of their effects on biomechanical measures across a sports team season is required to elucidate the specific factors that are modifiable. The purpose of this study was to evaluate the effects of a 10-week off-season neuromuscular training program on lower extremity kinematics. Twelve Division I female soccer players (age: 19.2 ± 0.8 years, height: 1.67 ± 0.1 m, weight: 60.2 ± 6.5 kg) performed unanticipated dynamic trials of a running stop-jump task pretraining and posttraining. Data collection was performed using an 8-camera Vicon system (Los Angeles, CA, USA) and 2 Bertec (Columbus, OH, USA) force plates. The 10-week training program consisted of resistance training 2 times per week and field training, consisting of plyometric, agility, and speed drills, 2 times per week. Repeated measures analyses of variance (ANOVAs) were used to assess the differences between pretraining and posttraining kinetics and kinematics of the hip, knee, and ankle at initial contact (IC), peak knee flexion (PKF), and peak stance. Repeated measures ANOVAs were also used to assess isometric strength differences pretraining and posttraining. The alpha level was set at 0.05 a priori. The training program demonstrated significant increases in left hip extension, left and right hip flexion, and right hip adduction isometric strength. At IC, knee abduction angle moved from an abducted to an adducted position (−1.48 ± 3.65° to 1.46 ± 3.86°, p = 0.007), and hip abduction angle increased (−6.05 ± 4.63° to −10.34 ± 6.83°, p = 0.007). Hip abduction angle at PKF increased (−2.23 ± 3.40° to 6.01 ± 3.82°, p = 0.002). The maximum knee extension moment achieved at peak stance increased from pretraining to posttraining (2.02 ± 0.32 to 2.38 ± 0.75 N·m·kg−1, p = 0.027). The neuromuscular training program demonstrated a potential positive effect in altering mechanics that influence the risk of incurring an ACL injury.

The Reliability of Portable Fixed Dynamometry During Hip and Knee Strength Assessments

CONTEXT Insufficient lower extremity strength may be a risk factor for lower extremity injuries such as noncontact anterior cruciate ligament tears. Therefore, clinicians need reliable instruments to assess strength deficiencies. OBJECTIVE To assess the intrarater, interrater, intrasession, and intersession reliability of a portable fixed dynamometer in measuring the strength of the hip and knee musculature. DESIGN Crossover study. SETTING Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS Three raters (A, B, C) participated in this 2-phase study. Raters A and B tested 11 healthy college graduate students (2 men, 9 women) in phase 1. Raters A and C tested 26 healthy college undergraduate students (7 men, 19 women) in phase 2. MAIN OUTCOME MEASURE(S) The dependent variables for the study were hip adductor, hip abductor, hip flexor, hip extensor, hip internal rotator, hip external rotator, knee flexor, and knee extensor peak force. RESULTS The phase 1 intrasession intraclass correlation coefficients for sessions 1, 2, and 3 ranged from 0.88 to 0.99 (SEM = 0.08-3.02 N), 0.85 to 0.99 (SEM = 0.26-3.88 N), and 0.92 to 0.96 (SEM = 0.52-2.76 N), respectively. Intraclass correlation coefficients ranged from 0.57 to 0.95 (SEM = 1.72-13.15 N) for phase 1 intersession values, 0.70 to 0.94 (SEM = 1.42-9.20 N) for phase 2 intrarater reliability values, and 0.69 to 0.88 (SEM = 1.20-8.50 N) for phase 2 interrater values. CONCLUSIONS The portable fixed dynamometer showed good to high intrasession and intersession reliability values for hip and knee strength. Intrarater and interrater reliability were fair to high, except for hip internal rotation, which showed poor reliability.

An Assessment of Burnout in Undergraduate Athletic Training Education Program Directors

CONTEXT Athletic training education program directors (ATEPDs) often manage their time among students, program administration, and patient care. OBJECTIVE To assess the level of burnout in ATEPDs and to determine the relationship between burnout and various demographics of ATEPDs. DESIGN Cross-sectional study. SETTING Public and private colleges and universities nationwide. PATIENTS OR OTHER PARTICIPANTS Two hundred forty-nine ATEPDs of undergraduate athletic training education programs accredited by the Commission on Accreditation of Athletic Training Education. INTERVENTION(S) We administered the Maslach Burnout Inventory (MBI) to all participants. MAIN OUTCOME MEASURE(S) The MBI consisted of 21 items assessing 3 characteristics of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Another component of the survey requested demographic information about the ATEPDs. We used univariate, multivariate, and factorial analyses of variance with the alpha level set a priori at .05. We also calculated Pearson product moment correlation coefficients. RESULTS Women had greater emotional exhaustion than men (20.67 +/- 9.43 and 16.47 +/- 9.64, respectively) (P = .001). The difference between tenure-status groups for emotional exhaustion was significant (P = .014), with tenure-track ATEPDs scoring higher on emotional exhaustion than tenured ATEPDs. Pearson product moment correlation coefficients revealed a weak negative relationship among emotional exhaustion and age (r = -0.263, P < .001), years of program director experience (r = -0.157, P = .013), and years at current job (r = -0.162, P = .010), indicating that as ATEPDs aged, gained more experience, and stayed in their current jobs, their emotional exhaustion scores decreased. There was also a weak negative relationship between age and depersonalization (r = -0.171, P = .007). There was a weak positive relationship between years at current job and personal accomplishment (r = 0.197, P = .002). CONCLUSIONS We found that ATEPDs experienced a moderate form of emotional exhaustion burnout and low depersonalization and personal accomplishment burnout, with women experiencing greater emotional exhaustion than males. Additionally, ATEPDs in tenure-track positions experienced greater emotional exhaustion than tenured ATEPDs. The ATEPDs need to obtain healthy coping strategies early within their directorships to manage components related to burnout.