Physical assessment to improve the identification of modifiable physiological fall risk factors in healthy community-dwelling older adults

As the population aged >60 years grows, the number of people falling and subsequent injury increases. Falls have a devastating effect on older adults living in the community in terms of morbidity, mortality, and loss of independence. In general, a positive answer to falls screening questions, or opportunistic identification of fall risk through primary care pathways, establishes an older adult as being at risk of a fall and warrants further investigation using multifactorial fall risk assessments (MFRA). At the MFRA stage, standardised fall risk assessment tools are directed at identifying the presence of physiological impairments and risk of falling in older adults. Although these tools identify which intervention domain a person needs, information from these assessments does not inform the health professional of the underlying causes of poor physical function and performance. Therefore, the purpose of this project was to develop an assessment tool that may potentially identify modifiable fall risk factors in this population. A conceptual framework for objectively measuring modifiable physical impairments and a novel assessment procedure (Performance Deficit Test for Community-dwelling older adults (PDT-Com)) were introduced (Chapter 2). This was followed by a brief description of the scoring criteria of the PDT-Com assessment and discussion of the validity of its contents (Chapters 3 and 4). Chapter 5 reviewed current literature on falls prevention guidelines and assessment procedures which identified a need to better detect modifiable risk factors. The first study was a systematic review examining the objective measurement of lower-extremity muscle strength in community-dwelling older adults (Chapter 6). The second study was another systematic review (Chapter 7) examining current assessment tools which are used to identify modifiable functional status and fall risk factors in this population. The results further supported the need for a newly designed assessment tool that can objectively measure modifiable physical impairments to better inform the contents of an exercise intervention. The first experimental study (Chapter 7) was carried out to determine reference values of strength for ten lower-extremity muscle actions using hand-held dynamometry in a small cohort of community-dwelling older adults. These data were used to develop an objective scoring system. A second experimental study (Chapter 8) investigated intra- and inter-rater reliability of the PDT-Com in community-dwelling older adults. Assessment of movement competency is reliable and can confidently be applied by suitably trained individuals when a standardised procedure is used. A final experimental study examined the effect and feasibility of a three-month home and group exercise intervention directed by initial assessment using the PDT-Com. For the experimental group, a corrective exercise programme was prescribed based on each person’s PDT-Com score. The mean total PDT-Com scores for the exercise group were significantly improved compared to baseline scores. Conversely, mean PDT-Com scores in the control group marginally decreased over time from baseline scores. Between groups differences in mean PDT-Com scores were observed between groups suggesting that those subjects receiving an individualised exercise programme improved their physical function compared to the control group. This new assessment tool is a promising but untested approach to reducing falls and falls-related injury through the identification, and possible causes, of modifiable fall risk factors at the MFRA stage. A physiological assessment paradigm serves to promote a primary preventative approach to the management of falls in active community-dwelling older adults

The development and evaluation of virtual reality-based training on performance and rehabilitation outcomes

Sports injuries are types of injuries that usually occur during sports, training, or exercise. Sports injuries often result from poor training methods, inappropriate equipment, lack of fitness, insufficient warm-up, and trauma (Salerno, 2009). Knee injuries are considered one of the most common injuries in athletes and include a large part of the cost of medical care for sports injuries (Loes et al., 2000; Sancheti et al., 2010). The ACL is the most common knee ligament injury in rugby, soccer, ski, volleyball, gymnastics, and basketball players due to quick deceleration movements such as landing, pivoting, cutting, and changing direction in these sports. Despite increased knowledge of ACL injury mechanisms, rehabilitation programmes and surgical techniques, the rates of return-to-sport (RTS) and the subsequent ACL re-injury after ACL reconstruction (ACLR) are not optimal (Buckthorpe, 2019). Therefore, rehabilitation plays a significant role in helping athletes return to sports activities, and inappropriate rehabilitation can even devastate a satisfactory ACLR (Wright et al., 2015). This dissertation consists of two studies, including a systematic review in Chapter 2 that explores the research conducted on the application of immersive technologies for improving the outcome of the rehabilitation phases after ACL reconstruction and examines the correlation between virtual reality, rehabilitation, exercise therapy, and sport-related ACL injuries in patients. The second study in Chapter 3 validates the Microsoft Azure Kinect camera for body tracking of dynamic movements against the gold standard Qualisys system. The findings indicated that VR-based systems could be a considerable alternative to real-world training to improve certain aspects of athletic performance because immersive technologies effectively offer a tool to control virtual environmental features. Finally, immersive technologies and VR-based systems are still in their infancy and will need considerable improvements in the future. Therefore, further research needs to be conducted in a theoretical frame to acknowledge the profitability of VR interventions in sports performance and rehabilitation programmes. The triple Azure Kinect system provides a consistent track of the joint centres' displacements with good to excellent agreement in the vertical and AP direction during the squat exercise in all joints except the ankles, particularly in upper joints such elbow and shoulder. However, future investigations must be conducted to acknowledge the Azure Kinect's profitability in the assessment of abnormal clinical conditions and the limits of Kinect's accuracy in various movements and planes of motion. In conclusion, the markerless triple Azure Kinect motion capture system may be a considerable alternative to a gold standard Qualisys marker-based system for specific applications such as human activities in the frontal plane. However, future investigations must be conducted to acknowledge the Azure Kinect's profitability in the assessment of abnormal clinical conditions and the limits of Kinect's accuracy in various movements and planes of motion

Correlations Between the Functional Movement Screen (FMS), the Balance Error Scoring System (BESS), and Injury

Men’s ice hockey is a fast and exciting sport that draws elite athletes into its rink. The demands of the sport place athletes at an exceptionally high risk for musculoskeletal injury if they are not properly conditioned. Determining at risk athletes during pre-season screenings is of particular importance to the medical staff, and any opportunity to provide prophylactic treatment is sought after. The purpose of this study was to investigate a potential correlation between a) total FMS scores and total BESS scores, b) total FMS scores and the incidence of injury, c) total BESS scores and the incidence of injury, d) scores on the rotary stability screen and total BESS scores, and e) scores on the inline-lunge screen and total BESS scores. Data were collected using participants from one selected East Coast Hockey League (ECHL) team. Athletes completed the FMS and the BESS shortly after reporting for training camp and injuries were reported from the head athletic trainer from October through February of the 2014-2015 hockey season. Results indicated that no significant correlations were found between the FMS and the BESS; one screen could not predict scores or ability on the other. Neither the FMS nor the BESS were successful at identifying at risk athletes for potential injury and although the rotary stability and the in-line lunge screen require a great amount of balance and core stability, neither were significantly correlated, or able to predict ability on the BESS