Wendy E. Huddleston

Work-Related Musculoskeletal Disorders and Injuries: Differences Among Older and Younger Occupational and Physical Therapists

Introduction Occupational and physical therapists are at significant risk of work-related musculoskeletal disorders and injuries. As the therapy workforce ages, and shortages of therapists are predicted, it is important to evaluate differences in injuries and injury behaviors between older and younger therapists. Methods Half of all occupational and physical therapists practicing in Wisconsin were randomly selected for a cross sectional study examining the relationship between aging and characteristics of self-reported work injuries and musculoskeletal symptoms. Results Data from a sample of 1,158 therapists revealed older workers to have similar injury incidence rates, however, days away from work due to injury were higher among older workers. Overall, older and younger therapists were more similar than different, especially in regards to work behaviors. Older therapists tended to report more severe pain symptoms than younger therapists and were two and a half times more likely to report that they changed jobs due to their pain symptoms. Conclusions Older and younger therapists have similar work-related injury experiences. Older workers may be more vulnerable to lost work time and may experience more severe pain symptoms. Many interventions exist to prevent work-related injuries to therapists and more guidance in the best way to integrate these interventions (e.g., mechanical lift devices) into therapy practice is needed.

Anticipatory effects on anterior cruciate ligament loading during sidestep cutting

BACKGROUND A key to understanding potential anterior cruciate ligament injury mechanisms is to determine joint loading characteristics associated with an injury-causing event. However, direct measurement of anterior cruciate ligament loading during athletic tasks is invasive. Thus, previous research has been unable to study the association between neuromuscular variables and anterior cruciate ligament loading. Therefore, the purpose of this study was to determine the influence of movement anticipation on anterior cruciate ligament loading using a musculoskeletal modeling approach. METHODS Twenty healthy recreationally active females were recruited to perform anticipated and unanticipated sidestep cutting. Three-dimensional kinematics and kinetics of the right leg were calculated. Muscle, joint and anterior cruciate ligament forces were then estimated using a musculoskeletal model. Dependent t-tests were conducted to investigate differences between the two cutting conditions. FINDINGS ACL loading significantly increased during unanticipated sidestep cutting (p<0.05). This increase was primarily due to a significant increase in the sagittal plane ACL loading, which contributed 62% of the total loading. Frontal plane ACL loading contributed 26% and transverse plane ACL loading contributed 12%. INTERPRETATION These results suggest that anterior cruciate ligament loading resulted from a multifaceted interaction of the sagittal plane shear forces (i.e., quadriceps, hamstrings, and tibiofemoral), as well as the frontal and transverse plane knee moments. Additionally, the results of this study confirm the hypothesis in the current literature that unanticipated movements such as sidestep cutting increase anterior cruciate ligament loading.

Reduced hamstring strength increases anterior cruciate ligament loading during anticipated sidestep cutting.

BACKGROUND Dynamic knee stability is considered a critical factor in reducing anterior cruciate ligament loads. While the relationships between hamstring force production and anterior cruciate ligament loading are well known in vitro, the influence of hamstring strength to anterior cruciate ligament loading during athletic maneuvers remains unknown. Therefore, the purpose of this study was to determine the influence of hamstring strength on anterior cruciate ligament loading during anticipated sidestep cut. METHODS Seventeen recreationally active females were recruited to perform sidestep cutting maneuvers pre/post an acute hamstring strength reduction protocol. Kinematics and kinetics were calculated during the cut and a musculoskeletal model was used to estimate muscle, joint, and anterior cruciate ligament loads. Dependent t-tests were conducted to investigate differences between the two cutting conditions. FINDINGS Anterior cruciate ligament loading increased by 36% due to reduced hamstring strength. This was mostly due to a 44% increase in sagittal plane loading and a 24% increase in frontal plane loading. Post strength reduction sidestep cuts were also performed with decreased anterior tibiofemoral shear force, an outcome that would theoretically reduce anterior cruciate ligament loading. However, the overall decrease in hamstring force production coupled with a more axial hamstring line of action yielded a net increase in anterior cruciate ligament loading. INTERPRETATION These results suggest that decreased hamstring strength significantly increases anterior cruciate ligament loading during anticipated sidestep cutting. Additionally, these results support the premise that preseason screening programs should monitor hamstring strength to identify female athletes with potential deficits and increased injury risk.

Hip Muscle Activity During 3 Side-Lying Hip-Strengthening Exercises in Distance Runners

CONTEXT Lower extremity overuse injuries are associated with gluteus medius (GMed) weakness. Understanding the activation of muscles about the hip during strengthening exercises is important for rehabilitation. OBJECTIVE To compare the electromyographic activity produced by the gluteus medius (GMed), tensor fascia latae (TFL), anterior hip flexors (AHF), and gluteus maximus (GMax) during 3 hip-strengthening exercises: hip abduction (ABD), hip abduction with external rotation (ABD-ER), and clamshell (CLAM) exercises. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty healthy runners (9 men, 11 women; age = 25.45 ± 5.80 years, height = 1.71 ± 0.07 m, mass = 64.43 ± 7.75 kg) participated. INTERVENTION(S) A weight equal to 5% body mass was affixed to the ankle for the ABD and ABD-ER exercises, and an equivalent load was affixed for the CLAM exercise. A pressure biofeedback unit was placed beneath the trunk to provide positional feedback. MAIN OUTCOME MEASURE(S) Surface electromyography (root mean square normalized to maximal voluntary isometric contraction) was recorded over the GMed, TFL, AHF, and GMax. RESULTS Three 1-way, repeated-measures analyses of variance indicated differences for muscle activity among the ABD (F(3,57) = 25.903, P < .001), ABD-ER (F(3,57) = 10.458, P < .001), and CLAM (F(3,57) = 4.640, P = .006) exercises. For the ABD exercise, the GMed (70.1 ± 29.9%), TFL (54.3 ± 19.1%), and AHF (28.2 ± 21.5%) differed in muscle activity. The GMax (25.3 ± 24.6%) was less active than the GMed and TFL but was not different from the AHF. For the ABD-ER exercise, the TFL (70.9 ± 17.2%) was more active than the AHF (54.3 ± 24.8%), GMed (53.03 ± 28.4%), and GMax (31.7 ± 24.1%). For the CLAM exercise, the AHF (54.2 ± 25.2%) was more active than the TFL (34.4 ± 20.1%) and GMed (32.6 ± 16.9%) but was not different from the GMax (34.2 ± 24.8%). CONCLUSIONS The ABD exercise is preferred if targeted activation of the GMed is a goal. Activation of the other muscles in the ABD-ER and CLAM exercises exceeded that of GMed, which might indicate the exercises are less appropriate when the primary goal is the GMed activation and strengthening.

Effect of Patellofemoral Pain on Strength and Mechanics after an Exhaustive Run

PURPOSE To investigate the effects of an exhaustive run on trunk and lower extremity strength and mechanics in patients with and without patellofemoral pain (PFP), we hypothesized that strength would decrease and mechanics would change after the exhaustive run. METHODS Nineteen subjects with PFP and 19 controls participated (10 men and 9 women per group). Lower extremity and trunk mechanics during running, body mass-normalized strength, and pain assessments before and after an exhaustive run were quantified. A repeated-measures ANOVA was used to assess group differences and exhaustion-related changes (P < 0.05), with t-test post hoc analyses performed when significant interactions were identified (P < 0.0125). RESULTS Pain significantly increased with the exhaustive run in the PFP group (P = 0.021). Hip strength was reduced after the exhaustive run, more so in those with PFP (abduction: before = 0.384 ± 0.08, after = 0.314 ± 0.08, P < 0.001; external rotation: before = 0.113 ± 0.02, after = 0.090 ± 0.02, P < 0.001). Persons with PFP also demonstrated increased knee flexion (before = 41.6° ± 5.5°, after = 46.9° ± 7.5°, P < 0.001), hip flexion (before = 30.4° ± 6.8°, after = 42.5° ± 9.7°, P < 0.001), and anterior pelvic tilt (before = 7.2° ± 5.1°, after = 13.3° ± 6.7°, P = 0.001) after the exhaustive run compared to controls. Trunk flexion increased in both PFP (before = 13.09° ± 6.2°, after = 16.31° ± 5.3°, P < 0.001) and control (before = 1393° ± 4.7°, after = 15.99° ± 5.9°, P < 0.001) groups. Hip extension (before = -2.09 ± 0.49 N · m · kg(-1), after = -2.49 ± 0.54 N · m · kg(-1), P = 0.002) moments increased only in subjects with PFP. CONCLUSIONS Exhaustive running results in reduced hip strength in subjects with PFP; however, this did not result in changes to hip internal rotation or adduction kinematics. Kinematic and kinetic changes after the exhaustive run are more indicative of compensatory changes to reduce pain. Increasing trunk flexion during running might provide pain relief during running; however, reducing anterior pelvic tilt may also warrant attention during treatment.

Auditory and visual attention-based apparent motion share functional parallels

A perception of coherent motion can be obtained in an otherwise ambiguous or illusory visual display by directing ones attention to a feature and tracking it. We demonstrate an analogous auditory effect in two separate sets of experiments. The temporal dynamics associated with the attention-dependent auditory motion closely matched those previously reported for attention-based visual motion. Since attention-based motion mechanisms appear to exist in both modalities, we also tested for multimodal (audiovisual) attention-based motion, using stimuli composed of interleaved visual and auditory cues. Although subjects were able to track a trajectory using cues from both modalities, no one spontaneously perceived (“multimodal motion”) across both visual and auditory cues. Rather, they reported motion perception only within each modality, thereby revealing a spatiotemporal limit on putative cross-modal motion integration. Together, results from these experiments demonstrate the existence of attention-based motion in audition, extending current theories of attention-based mechanisms from visual to auditory systems.

Selective Age Effects on Visual Attention and Motor Attention during a Cued Saccade Task

Objective. Visual information is often used to guide purposeful movement. However, older adults have impaired responses to visual information, leading to increased risk for injuries and potential loss of independence. We evaluated distinct visual and motor attention contributions to a cued saccade task to determine the extent to which aging selectively affects these processes. Methods. Nineteen healthy young (18–28 years) and 20 older (60–90 years) participants performed a cued saccade task under two conditions. We challenged motor attention by changing the number of possible saccade targets (1 or 6). Results. Older adults had difficulty in inhibiting unwanted eye movements and had greater eye movement inaccuracy in the hard condition when compared to the younger adults and to the easy condition. Also, an inverse relation existed between performance on the visual and motor components of the task in older adults, unlike younger adults. Conclusions. Older adults demonstrated difficulty in both inhibiting irrelevant saccade targets and selecting correct saccade endpoints during more complex tasks. The shift in relations among attention measures between the younger and older participants may indicate a need to prioritize attentional resources with age. These changes may impact an older adults ability to function in complex environments.

Attentional resource allocation during a cued saccade task

Attentional selection of sensory information and motor output is critical for successful interaction with ones surroundings. However, organization of attentional processes involved in selection of salient visual information, decision making, and movement planning has not yet been fully elucidated. We hypothesized that attentional processes involved in these tasks can function independently and draw from separate resources. If true, challenging the capacity limit of one attentional process would not affect performance of others. Healthy participants performed a cued saccade task in which target cues were embedded in a central stream of letters in a Rapid Serial Visual Presentation (RSVP). Participants performed saccades as quickly and as accurately as possible to a peripheral target location based on cue presentation within the central letter stream. To challenge visual attention, we parametrically varied the duration at which each letter of the RSVP was presented (50-200ms). In a separate experiment we challenged motor attention by increasing the number of possible saccade trajectories (1-6 peripheral targets). As expected, increasing attentional load in one domain of the task negatively affected performance in that domain, while performance in other domains was unaffected. We interpret our results as support for the independent allocation of attentional resources, at least in the early stages of processing, required across components of a cued saccade task. Deciphering the contributions of attention during visuomotor tasks is a critical step to understanding how humans process information necessary to successfully interact with the environment.

Relations among Visual Strategies, Force Fluctuations, and Attention during a Force-Matching Task

Greater understanding of how people use visual information to minimize force fluctuations provides critical insight into visuomotor processing. Visual strategies were examined during a force-matching task with different feedback displays. When only vertical feedback was provided, young healthy participants (N = 20, 9 men) fixated their gaze centrally. When vertical and horizontal visual feedback was provided, participants performed saccades to maintain gaze near the leading edge of the force trace. Performance on a separate attention task assessed visual and motor attention capabilities in the same participants. Selecting the correct saccade trajectory on the attention task was positively correlated with measures predicting performance on the force-matching task. Optimal visual strategies, combined with motor attention, may contribute to minimizing pinch force variability at low force.

Altered visual strategies and attention are related to increased force fluctuations during a pinch grip task in older adults

The purpose of the study was to determine the visual strategies used by older adults during a pinch grip task and to assess the relations between visual strategy, deficits in attention, and increased force fluctuations in older adults. Eye movements of 23 older adults (>65 yr) were monitored during a low-force pinch grip task while subjects viewed three common visual feedback displays. Performance on the Grooved Pegboard test and an attention task (which required no concurrent hand movements) was also measured. Visual strategies varied across subjects and depended on the type of visual feedback provided to the subjects. First, while viewing a high-gain compensatory feedback display (horizontal bar moving up and down with force), 9 of 23 older subjects adopted a strategy of performing saccades during the task, which resulted in 2.5 times greater force fluctuations in those that exhibited saccades compared with those who maintained fixation near the target line. Second, during pursuit feedback displays (force trace moving left to right across screen and up and down with force), all subjects exhibited multiple saccades, and increased force fluctuations were associated (rs = 0.6; P = 0.002) with fewer saccades during the pursuit task. Also, decreased low-frequency (<4 Hz) force fluctuations and Grooved Pegboard times were significantly related (P = 0.033 and P = 0.005, respectively) with higher (i.e., better) attention z scores. Comparison of these results with our previously published results in young subjects indicates that saccadic eye movements and attention are related to force control in older adults.NEW & NOTEWORTHY The significant contributions of the study are the addition of eye movement data and an attention task to explain differences in hand motor control across different visual displays in older adults. Older participants used different visual strategies across varying feedback displays, and saccadic eye movements were related with motor performance. In addition, those older individuals with deficits in attention had impaired motor performance on two different hand motor control tasks, including the Grooved Pegboard test.