David L. Montgomery

Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial

BACKGROUND The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We did a randomised trial to assess the efficacy and side-effects of this form of therapy in children with cerebral palsy. METHODS 111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n=57) or slightly pressurised room air (n=54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 h in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurised air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech. FINDINGS For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurised air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was -0.40 (95% CI -1.69 to 0.90, p=0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p=0.004). INTERPRETATION In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurised air. The improvement seen in both groups for all dimensions tested deserves further consideration.

Physiology of Ice Hockey

SummaryIce hockey is characterised by high intensity intermittent skating, rapid changes in velocity and duration, and frequent body contact. The typical player performs for 15 to 20 minutes of a 60-minute game. Each shift lasts from 30 to 80 seconds with 4 to 5 minutes of recovery between shifts. The intensity and duration of a particular shift determines the extent of the contribution from aerobic and anaerobic energy systems. The high intensity bursts require the hockey player to develop muscle strength, power, and anaerobic endurance. The length of the game and the need to recover quickly from each shift demands a good aerobic system.Physical characteristics of elite players show that defensemen are taller and heavier than forwards probably due to positional demands. Hockey players are mesomorphic in structure. They are relatively lean since excess mass is detrimental to their skating performance. There is a large interindividual variability in V̇O2 during skating. Both the aerobic and anaerobic energy systems are important during a hockey game. Peak heart rates during a shift on the ice exceed 90% of HRmax with average on-ice values of about 85% of HRmax. Blood lactate is elevated above resting values confirming the anaerobic nature of the game.Glycogen depletion studies show a preferential utilisation of glycogen from the slow twitch fibres but also significant depletion from the fast twitch fibres. Elite hockey players display a muscle fibre composition similar to untrained individuals.Physiological profiles of elite hockey teams reveal the importance of aerobic endurance, anaerobic power and endurance, muscular strength and skating speed. Training studies have attempted to improve specific components of hockey fitness. Using traditional laboratory tests, a season of hockey play shows gains in anaerobic endurance but no change in aerobic endurance. On-ice tests of hockey fitness have been recommended as an essential part of the hockey player’s physiological profile.Existing training procedures may develop chronic muscular fatigue in hockey players. Lactic acidosis is associated with the onset and persistence of muscle fatigue. Muscle force output remains impaired throughout the hockey player’s typical cycle of practices and games. A supplementary programme of low-intensity cycling during the competitive phase of training was unsuccessful in altering V̇O2max Strength decrements during the hockey season are attributed to a lack of a specifically designed strength maintenance programmes. On-ice and off-ice training programmes should focus on the elevation of aerobic endurance, anaerobic power and endurance, muscular strength and skating speed.

Physiology of Alpine Skiing

SummaryPhysiological profiles of elite Alpine skiers reveal the importance of muscular strength, anaerobic power, anaerobic endurance, aerobic endurance, coordination, agility, balance, and flexibility. On-hill snow training and dryland training programmes should focus on the elevation of these fitness components.Physical characteristics of elite skiers reveal an average height and body mass. Today, successful skiers are taller and heavier than their predecessors. Slalom skiers tend to be leaner than skiers in other events while the downhill racers are the heaviest.Elite skiers have strong legs when peak torque is measured during isometric and isokinetic conditions involving knee extension, which may be a specific adaptation since the skier is in a crouched position for a prolonged period when racing. Leg strength correlates significantly with performance in the downhill and giant slalom events.The glycolytic contribution in the slalom and giant slalom events is about 40% of the total energy cost. Following a race, blood lactate concentration averages 9 to 13 mmol/L. A muscle lactate concentration of 24 mmol/kg wet muscle tissue has been reported. Elite skiers have higher lactate values than advanced or novice skiers.The aerobic demands of competitive Alpine skiing may approach (90 to 95%) of the athlete’s maximal aerobic power. Maximal heart rate is achieved during the latter part of the race. Elite skiers have a high V̇2max. This may reflect their training programme and not the actual demands of the sport. When turning, muscular activity acts to impede blood flow and oxygen delivery. As a consequence, anaerobic metabolism is increased.Glycogen studies show significant utilisation from both slow and fast twitch muscle fibres. Skilled and unskilled skiers differ with respect to glycogen utilisation. Skilled skiers have greater glycogen depletion in the slow twitch fibres compared to unskilled skiers. Muscle glycogen decreases by about 32 mmol/kg wet muscle tissue following a day of ski training. Glycogen depletion may contribute to the injury pattern which peaks toward the end of the ski day. The risk of injury has been estimated at 17 injuries per 1000 skier days. When the severity criterion was an injury causing the skier to miss 3 days of skiing or visit a physician, the risk was 2 injuries per 1000 skier-days.Field tests commonly used to assess the physiological fitness of Alpine skiers include the Wingate cycle ergometer test, hexagonal obstacle test, high box jump test and the 5-leg double jump test.

Neuropsychological effects of hyperbaric oxygen therapy in cerebral palsy

We conducted a double‐blind placebo study to investigate the claim that hyperbaric oxygen treatment (HBO2) improves the cognitive status of children with cerebral palsy (CP). Of 111 children diagnosed with CP (aged 4 to 12 years), only 75 were suitable for neuropsychological testing, assessing attention, working memory, processing speed, and psychosocial functioning. The children received 40 sessions of HBO2 or sham treatment over a 2‐month period. Children in the active treatment group were exposed for 1 hour to 100% oxygen at 1.75 atmospheres absolute (ATA), whereas those in the sham group received only air at 1.3 ATA. Children in both groups showed better self‐control and significant improvements in auditory attention and visual working memory compared with the baseline. However, no statistical difference was found between the two treatments. Furthermore, the sham group improved significantly on eight dimensions of the Conners’Parent Rating Scale, whereas the active treatment group improved only on one dimension. Most of these positive changes persisted for 3 months. No improvements were observed in either group for verbal span, visual attention, or processing speed.

The performance of the ice hockey slap and wrist shots: the effects of stick construction and player skill

The purpose of this study was to examine the interaction of players’ skill level, body strength, and sticks of various construction and stiffness on the performance of the slap and wrist shots in ice hockey. Twenty male and twenty female subjects were tested. Ten of each gender group were considered skilled and ten unskilled. In addition to general strength tests, each subject performed the slap and wrist shots with three stick shafts of different construction and stiffness. Shot mechanics were evaluated by simultaneously recording ground reaction forces from a force plate, stick movement and bending from high speed filming and peak puck velocity from a radar gun. Data were analysed with a 4-way repeated measures ANOVA for several dependent variables including peak puck velocity, peak Z (vertical) force, peak bending and stick to ground angles, peak angular deflection of the shaft, and hand placement on the stick. The results indicated that: 1) the slap shot was much faster than the wrist shot corresponding to greater vertical loading force, stick bending, and greater width of the hand placement; 2) the puck velocity was influenced by skill level and body strength but not stick type; and, 3) that skilled players were able to generate more vertical force and bend of the stick, in part, by adjusting their hand positions on the stick. Further studies are needed to address the specific influence of body strength and skill on the techniques of these shots and in relation to stick material and construction properties.

Pilot case study of the therapeutic potential of hyperbaric oxygen therapy on chronic brain injury.

BACKGROUND Recently, the effect of hyperbaric oxygen (HBO(2)) therapy was explored in the treatment of chronic TBI. It has been speculated that idling neurons in the penumbra zone remain viable several years after injury and might be reactivated by enhanced oxygenation. We studied the therapeutic potential of HBO(2) therapy in a 54-year-old man who had sustained traumatic brain injuries one year before testing that resulted in permanent neurological symptoms. METHODS Two treatment series separated by a one-year inter-session interval were administered. Treatment series consisted of 20 and 60 daily one-hour exposures to 100% oxygen at 2 ATA. Electrophysiological (event-related potentials), metabolic and behavioral (sensorimotor and neuropsychological) measurements were obtained to evaluate the effects of hyperbaric oxygen therapy on neurocognitive functioning. RESULTS Following the initial treatment, the patient showed improvements in sensorimotor functions, as well as enhanced P300 amplitude in the damaged hemisphere. Although most of these gains were no longer observed one year after treatment, these were reinstated with an additional series of 60 exposures. Neuropsychological improvements were also observed after the completion of the second series of treatments. CONCLUSION The present single-case study provides preliminary evidence of neuropsychological and electrophysiological improvements after series of 20 and 60 treatments, although the first dosage appeared to be insufficient to produce permanent benefits. Longitudinal studies using different treatment parameters should be conducted if we are to systematically investigate long-term improvements resulting from HBO(2) therapy.

Acute effects of intense interval training on running mechanics

The aims of this study were to determine if there are significant kinematic changes in running pattern after intense interval workouts, whether duration of recovery affects running kinematics, and whether changes in running economy are related to changes in running kinematics. Seven highly trained male endurance runners (VO 2max = 72.3 +/- 3.3 ml kg -1 min -1 ; mean +/- s) performed three interval running workouts of 10 X 400 m at a speed of 5.94 +/- 0.19 m s -1 (356 +/- 11.2 m min -1 ) with a minimum of 4 days recovery between runs. Recovery of 60, 120 or 180 s between each 400 m repetition was assigned at random. Before and after each workout, running economy and several kinematic variables were measured at speeds of 3.33 and 4.47 m s -1 (200 and 268 m min -1 ). Speed was found to have a significant effect on shank angle, knee velocity and stride length (P ≪ 0.05). Correlations between changes pre- and post-test for VO 2 (ml kg -1 min -1 ) and several kinematic variables were not significant (P > 0.05) at both speeds. In general, duration of recovery was not found to adversely affect running economy or the kinematic variables assessed, possibly because of intra-individual adaptations to fatigue.

Effect of intense interval workouts on running economy using three recovery durations

Abstract The purposes of this study were to determine whether running economy (RE) is adversely affected following intense interval bouts of 10 × 400-m running, and whether there is an interaction effect between RE and recovery duration during the workouts. Twelve highly trained male endurance athletes [maximal oxygen consumption; V˙O2max=72.5 (4.3) ml·kg−1·min−1; mean (SD)] performed three interval running workouts of 10 × 400 m with a minimum of 4 days between runs. Recovery duration between the repetitions was randomly assigned at 60, 120 or 180 s. The velocity for each 400-m run was determined from a treadmill V˙O2max test. The average running velocity was 357.9 (9.0) m · min−1. Following the workout, the rating of perceived exertion (RPE) increased significantly (P < 0.01) as recovery duration between the 400-m repetitions decreased (14.4, 16.1, and 17.7 at 180s, 120s, and 60 s recovery, respectively). Prior to and following each workout, RE was measured at speeds of 200 and 268 m · min−1. Changes in RE from pre- to post-workout, as well as heart rate (HR) and respiratory exchange ratio (R) were similar for the three recovery conditions. When averaged across conditions, oxygen consumption (V˙O2) increased significantly (P < 0.01) from pre- to post-test (from 38.5 to 40.5 ml · kg−1 · min−1 at 200 m · min−1, and from 53.1 to 54.5 ml · kg−1 · min−1 at 268 m · min−1, respectively). HR increased (from 124 to 138, and from 151 to 157 beats · min−1 respectively) and R decreased (from 0.90 to 0.78, and from 0.93 to 0.89, respectively) at 200 and 268 m · min−1, respectively (P < 0.01). This study showed that RE can be perturbed after a high-intensity interval workout and that the changes in V˙O2, HR and R were independent of the recovery duration between the repetitions.

Heart Rate Response and Lactic Acid Concentration in Squash Players

Abstract To determine whether the activity of playing squash is sufficiently intense to promote and/or maintain cardiovascular fitness, the heart rate response of ten male subjects (aged 20 to 53 years), was monitored continuously via radio telemetry for a 45-minute playing session. The mean heart rate for the total time of play was determined and intensity was calculated using the Karvonen method of potential heart rate. Maximum heart rate was determined with a continuous, graded bicycle ergometer test. Prior to and 5 minutes after squash play, fingertip blood samples were obtained for lactate analysis. The mean heart rate intensity of squash play was 77.2 ± 6.1 %. Intensities as high as 96% were recorded for 5-minute periods during the playing session. The average game heart rate was attained by the 10th minute of play. Thereafter, a heart rate fluctuation of only six beats was observed for the remaining 35 minutes. Postexercise lactate concentrations ranged from 11 to 57 mg% with a mean of 24.5 ± 13.8 ...

Stair stepping efficiency of mentally handicapped and nonhandicapped adult females

Net efficiency for stair stepping was compared between 15 mentally handicapped (MH) and 15 nonhandicapped (NH) women of comparable chronological age. Efficiency was computed as the percentage of the energy output divided by the energy expenditure. Energy expenditure was assessed by the performance of subjects on a double stair stepping apparatus, stepping at three work rates (14, 17, and 19 asc/min), repeated on four test days. Open-circuit spirometric techniques were used to measure oxygen uptake. The three-way (Group x Stepping Rates x Days) repeated measures ANOVA indicated that: (1) NH women stepped more efficiently than MH women (p less than 0.01). Mean stepping efficiency was 17.1% for the NH group, and 15.6% for the MH group; (2) MH women did not show improvement in stepping efficiency over the four days, although there was a 20% increase in the number of MH subjects capable of completing the fastest stepping rate over the four days; and (3) MH subjects were more efficient at 17 and 19 asc/min than at 14 asc/min.