Static balance tests are conducted in various clinics for diagnosis and treatment adjustment. As a result of population aging, the accessibility of these tests should be increased, in the clinic, and ...for remote patient examination. A number of publications have already conducted static balance evaluations using the sensors embedded in a smartphone. This study focuses on the applicability of using smartphone-based balance assessment on a large scale while considering ease of use, safety, and reliability. The Mon4t
app was used to acquire the postural motion using different smartphone devices, different smartphone locations, and various standing postures. The signals derived from the app were compared to the center of pressure displacement derived from a force plate. The results showed moderate to high agreement between the two methods, particularly at the tandem stance (0.69 ≤
≤ 0.91). Preliminary data collection was conducted on three healthy participants, followed by 50 additional healthy volunteers, aged 65+. The results demonstrated that the Mon4t app can serve as an accessible and inexpensive static balance assessment tool, both in clinical settings and for remote patient monitoring, which is key for enabling telehealth.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract
Background
Optimal application of the recently updated World Health Organization (WHO) guidelines for exercise in advanced age necessitates an accurate adjustment for the age-related ...increasing variability in biological age and fitness levels, alongside detailed recommendations across a range of motor fitness components, including balance, strength, and flexibility. We previously developed and validated a novel tool, designed to both remotely assess these fitness components, and subsequently deliver a personalized exercise program via smartphone.
We describe the design of a prospective randomized control trial, comparing the effectiveness of the remotely delivered personalized multicomponent exercise program to either WHO exercise guidelines or no intervention.
Methods
Participants (
n
= 300) are community dwelling, healthy, functionally independent, cognitively intact volunteers aged ≥65 at low risk for serious fall injuries, assigned using permuted block randomization (age/gender) to intervention, active-control, or control group. The intervention is an 8-week program including individually tailored exercises for upper/lower body, flexibility, strength, and balance (dynamic, static, vestibular); active-controls receive exercising counselling according to WHO guidelines; controls receive no guidance. Primary outcome is participant fitness level, operationalized as 42 digital markers generated from 10 motor fitness measures (balance, strength, flexibility); measured at baseline, mid-trial (4-weeks), trial-end (8-weeks), and follow-up (12-weeks). Target sample size is 300 participants to provide 99% power for moderate and high effect sizes (Cohen’s f = 0.25, 0.40 respectively).
Discussion
The study will help understand the value of individualized motor fitness assessment used to generate personalized multicomponent exercise programs, delivered remotely among older adults.
Trial registration
ClinicalTrials.gov
Identifier:
NCT04181983
Individuals suffering from patello-femoral pain syndrome (PFPS) exhibit altered gait parameters compared with healthy individuals. As soldiers carry heavy equipment, the extra load might further ...alter gait pattern. The aim of this study was to investigate the effect of load carrying on kinetic and kinematic variables in soldiers with PFPS compared with controls. The sample comprised 23 active-duty infantry soldiers (10 with bilateral/13 without bilateral PFPS, mean age: 20.4 (±0.5) years, height 179 (±5.8) cm, weight 76 (±6.9) kg). The participants walked barefoot on a 10 m walkway with and without loading equipment. The equipment added 50% to each participant’s body mass. Gait kinematic and kinetic variables were assessed by the VICON three-dimensional motion analysis system and two force plates. Weight carrying increased joint maximal angles, mean peak moments and double support and decreased single support and walk speed in both groups, without differences between groups (p > 0.05). The only difference between groups was in the hip adduction angle without a load (p < 0.05); no difference was observed while carrying the load. Kinematic and kinetic differences in gait were detected between weight and non-weight conditions, yet there was no effect of PFPS. Further studies with subjects performing different tasks are essential to examining the effect of PFPS and load among soldiers.
Background:
Long-term maintenance of sports participation is important for young men undergoing anterior cruciate ligament (ACL) reconstruction. Identifying biomechanical characteristics in patients ...who achieve this goal can assist in elaborating rehabilitation programs and in identifying successful recovery, but this has rarely been investigated.
Purpose:
To test the association between maintenance of sports participation at 5 to 10 years after ACL reconstruction and measures of force production and landing biomechanics in men.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A total of 30 men who underwent isolated ACL reconstruction were examined. At 5- to 10-year follow-up, associations were tested between reported outcomes of sports maintenance and objective biomechanical measures. The biomechanical tests included isokinetic knee torque and lower limb kinetics and kinematics during landing tasks. Measurements for each limb were conducted separately, and side-to-side symmetry indices (SI) were calculated. Subgroups included SI greater than +10% (ie, extreme positive), SI lower than –10% (ie, extreme negative), and SI between –10% and +10% (ie, symmetric).
Results:
At follow-up, concentric knee torque in the operated limb correlated with Tegner and Marx scores (r = 0.42-0.47; P ≤ .05). Regarding the SI of knee torque, the highest Tegner, Marx, and KOOS (Knee injury and Osteoarthritis Outcome Score) results were associated with symmetry, as opposed to patients with extreme positive or extreme negative SIs (P < .05). As for landing kinematics, Tegner score negatively correlated with knee range of motion (ROM) in the operated limb (r = –0.38; P ≤ .05). With regard to SI, hip and knee ROM correlated with Tegner, IKDC, and KOOS scores (r = 0.41-0.51; P ≤ .05). Specifically, the highest sports participation levels were associated with achieving symmetric hip and knee ROM but also with extreme positive SIs, as opposed to patients with extreme negative SIs (P < .03), indicating substantially higher ROM in the uninjured limb as compared with the operated limb.
Conclusion:
At 5 to 10 years after ACL reconstruction, maintenance of sports participation was associated with symmetric side-to-side concentric knee torque and with producing greater attenuation of hip and knee ROM during the drop jump landing in the operated limb. Therefore, eccentric load programs that can improve attenuation-phase kinematics during landing tasks may be valuable in addition to concentric training and may facilitate enhanced long-term outcomes.
This study aimed to assess the effects of core stability training on lower limbs' muscular asymmetries and imbalances in team sport. Twenty footballers were divided into two groups, either core ...stability or control group. Before each daily practice, core stability group (n = 10) performed a core stability training programme, while control group (n = 10) did a standard warm-up. The effects of the core stability training programme were assessed by performing isokinetic tests and single-leg countermovement jumps. Significant improvement was found for knee extensors peak torque at 3.14 rad · s
−1
(14%; P < 0.05), knee flexors peak torque at 1.05 and 3.14 rad · s
−1
(19% and 22% with P < 0.01 and P < 0.01, respectively) and peak torque flexors/extensors ratios at 1.05 and 3.14 rad · s
−1
(7.7% and 8.5% with P < 0.05 and P < 0.05, respectively) only in the core stability group. The jump tests showed a significant reduction in the strength asymmetries in core stability group (−71.4%; P = 0.02) while a concurrent increase was seen in the control group (33.3%; P < 0.05). This study provides practical evidence in combining core exercises for optimal lower limbs strength balance development in young soccer players.
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BFBNIB, FSPLJ, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK
Background: In the past, several studies provided anecdotal descriptions of high-arched feet in individuals sustaining proximal fifth metatarsal stress fractures. This relationship has never been ...supported by scientific evidence. Our objective was to examine whether athletes who sustained this injury had an exceptional static foot structure or dynamic loading pattern. Materials and Methods: Ten injured professional soccer players who regained full professional activity following a unilateral proximal fifth metatarsal stress fracture and ten control soccer players were examined. Independent variables included static evaluation of foot and arch structure, followed by dynamic plantar foot pressure evaluation. Each variable was compared between injured, contra-lateral uninjured, and control feet. Results: Static measurements of foot and arch structure did not reveal differences among the groups. However, plantar pressure evaluation revealed relative unloading of the fourth metatarsal in injured and uninjured limbs of injured athletes compared with control, while the fifth metatarsal revealed pressure reduction only in the injured limbs of injured athletes. Conclusion: Athletes who sustained proximal fifth metatarsal stress fracture were not characterized by an exceptional static foot structure. Dynamically, lateral metatarsal unloading during stance may either play a role in the pathogenesis of the injury, or alternately represent an adaptive process. Clinical Relevance: Footwear fabrication for previously injured athletes should not categorically address cushioning properties designed for high-arch feet, but rather focus on individual dynamic evaluation of forefoot loading, with less attention applied to static foot and arch characteristics.
Level of Evidence: III, Retrospective Comparative Study
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background:
Distal metatarsal osteotomy has been used to alleviate plantar pressure caused by anatomic deformities. This study’s purpose was to examine the effect of minimally invasive floating ...metatarsal osteotomy on plantar pressure in patients with diabetic metatarsal head ulcers.
Methods:
We performed a retrospective case series of prospectively collected data on 32 patients with diabetes complicated by plantar metatarsal head ulcers without ischemia. Peak plantar pressure and pressure time integrals were examined using the Tekscan MatScan prior to surgery and 6 months following minimally invasive floating metatarsal osteotomy. Patients were followed for complications for at least 1 year.
Results:
Peak plantar pressure at the level of the osteotomized metatarsal head decreased from 338.1 to 225.4 kPa (P < .0001). The pressure time integral decreased from 82.4 to 65.0 kPa·s (P < .0001). All ulcers healed within a mean of 3.7 ± 4.2 weeks. There was 1 recurrence (under a hypertrophic callus of the osteotomy) during a median follow-up of 18.3 months (range, 12.2-27). Following surgery, adjacent sites showed increased plantar pressure and 4 patients developed transfer lesions (under an adjacent metatarsal head); all were managed successfully. There was 1 serious adverse event related to surgery (operative site infection) that resolved with antibiotics.
Conclusion:
This study showed that the minimally invasive floating metatarsal osteotomy successfully reduced local plantar pressure and that the method was safe and effective, both in treatment and prevention of recurrence.
Level of Evidence:
Level III, retrospective case series of prospectively collected data.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
This study was aimed at exploring the transferability of short range of motion (RoM) isokinetic conditioning on quadriceps performance inside and outside the trained range.
Fifty-five women were ...randomly assigned to one of four groups: G1 (N = 14) and G2 (N = 14) trained concentrically at 30 and 90degrees x s(-1), respectively, whereas G3 (N = 13) and G4 (N = 14) trained similarly but using the eccentric mode. All four groups trained within 30-60degrees of knee flexion. The training paradigm consisted of 4 sets of 10 maximal repetitions, 3x wk(-1) for a total period of 6 wk. Before the training period and 2 d after its termination, the isokinetic work output (Wisk) was assessed within three angular RoM: 85-60degrees (R1), 60-30degrees (R2), and 30-5degrees (R3). Isometric peak extension moment (PM) and rate of force development (RFD) were evaluated at 10degrees, 45degrees and 80degrees.
Significant increases were observed in the isometric output (at all three angles), Wisk (in R1 and R2), and the RFD (45degrees). The PM increased significantly more in G3 and G4 compared with G1 and G2, evidencing specificity of contraction mode.
These findings point out to the potential benefits of short RoM conditioning, particularly in those cases where, during specific phases of rehabilitation, a wider RoM may be contraindicative.
This study was aimed at exploring the carryover effect of short range of motion (RoM) isokinetic conditioning on vastus medialis (VM) motor unit recruitment (MUR) across the full RoM. Fifty-five ...women were randomly assigned to one of four groups: G1 (
n
=
14) and G2 (
n
=
14) trained concentrically at 30 and 90°/s, respectively whereas G3 (
n
=
13) and G4 (
n
=
14) trained similarly but using the eccentric mode. All 4 groups trained within 30–60° of knee flexion. The training protocol consisted of 4 sets of 10 maximal repetitions, 3 times a week for 6 weeks. sEMG was recorded from the VM for analysis of mean frequency of the EMG power spectrum prior to the training period and 2 days after its termination. The EMG assessments took place during dynamic contractions within 3 angular RoM’s: 85–60° (R1), 60–30° (R2) and 30–5° (R3). In addition MUR was evaluated during isometric contractions at 10°, 45° and 80°. Significant increases were observed in the MUR at R1, R2, and R3 during dynamic contractions as well as in all 3 angles during isometric contractions. These findings applied equally regardless of the mode of contraction and motion speed during training. The fact that MUR increased significantly within untrained RoM’s may point out to the potential benefits of short RoM conditioning, particularly in those cases where, during specific phases of rehabilitation, a wider RoM may be contraindicative.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
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