An investigation of made-to-measure compression garments and their utility during running

The effects of wearing made-to-measure compression garments on exercise performance and recovery has not been extensively examined. Most of the published research literature has opted to use ‘off the shelf’ standard sized compression garments (i.e., small, medium and large), which may not provide optimal fitting and consequently may not elicit the expected pressures. The research presented within this thesis was undertaken to examine the effect of wearing made-to-measure compression garments, developed using 3D scanning, on running biomechanics and thermal responses. The research within the thesis also presents novel methodologies for measuring compression garment pressures and examines the reliability and validity of 3D scanning. The purpose of the first study was to develop a novel method to examine compression garment pressures and to determine the pressure profile (peak pressure and pressure gradient) on different aspects of the leg. Fifteen males volunteered to participate (age 24.6 ± 2.0 years, stature 178.9 ± 4.5 cm, body mass 77.4 ± 6.5 kg, mean ± standard deviation). Garment pressures were assessed from the malleolus to the gluteal fold using a Kikuhime pressure monitoring device which consists of a pressure transducer attached to a sensor that transmits pressure readings to the transducer with a typical error of measurement of ±1 mmHg. The sensor was pulled up the leg in 5 cm increments. Three-dimensional motion capture was used simultaneously with pressure measurements to quantify the measurement locations. Pressure assessment was performed on the anterior, posterior, lateral and medial aspects of the right leg. Pressure assessment was also performed at the anatomical locations used in previous research, defined as the established method (three medial lower leg, and three anterior upper leg locations; Brophy-Williams et al., 2014; Brophy-Williams et al., 2015). The main findings from the study were that peak pressure at the ankle was typically higher when measurements were made on the posterior (18.3 to 27.5 mmHg) and anterior (16.6 to 27.6 mmHg) compared to the lateral (12.4 to 21.2 mmHg) and medial (12.2 to 23.0 mmHg) aspects of the upper, lower and whole leg. The pressure gradient was steeper when measurements were made on the posterior (-21.7 to -26.9 mmHg) and anterior (-22.1 to -23.2 mmHg) compared to the lateral (-11.0 to -15.3 mmHg) and medial (-13.9 to - 19.3 mmHg) aspects of the upper, lower and whole leg. The root mean squared difference was smaller for pressure measurements made on the posterior (1.8 ± 0.4 mmHg) compared to the lateral (2.7 ± 0.5 mmHg), anterior (3.1 ± 1.1 mmHg) and medial (3.2 ± 1.1 mmHg) aspects of the whole leg, when pressure measurements were made using the novel method. When comparing the novel method to the established method, the peak pressure at the ankle was higher when using the novel method (27.5 ± 2.2 mmHg) compared to the established method (19.8 ± 3.0 mmHg), when pressures were measured over the whole leg. The pressure gradient was also steeper using the novel method (-21.7 ± 2.9 mmHg) compared with the established method (-11.2 ± 4.5 mmHg). The measured pressure profile (peak pressure and pressure gradient) of a compression garment is significantly influenced by the aspect of the leg, and the posterior aspect showed the smallest variation of pressure. Therefore, pressure III measurements should be made using the posterior aspect of the whole leg using the novel method which provides more pressure measurements compared to the established method which allows a more informative reflection of the elicited pressure across the whole leg. The purpose of the second study was to make made-to-measure compression garments that elicit pressures within and below clinical standards and establish whether pressures and gradients could be replicated between participants in different garment conditions. Ten males volunteered to participate (age 24.3 ± 4.6 years, stature 181.5 ± 1.8 cm, body mass 75.7 ± 3.8 kg, mean ± standard deviation). Based on three-dimensional scans of the participants’ lower body, three different made-to-measure garments were manufactured: control, high gradient and asymmetrical. The control garment was designed to elicit pressure below clinical standards (< 14 mmHg) with no pressure gradient. The high gradient garment was designed to elicit pressure within clinical standards (14 – 35 mmHg) and to include a linear pressure gradient from distal to proximal (graduated compression). The asymmetrical garment was designed to elicit control conditions in the left leg and high gradient garment conditions in the right leg. Garment pressures were assessed using the method developed in study one (posterior). A root mean squared difference analysis was used to calculate the in-vivo linear graduation parameters. Linear regression showed that peak pressure at the ankle in the left and right leg were: control garment, 13.5 ± 2.3 and 12.9 ± 2.6; asymmetrical garment, 12.7 ± 2.5 and 26.3 ± 3.4; high gradient garment, 27.7 ± 2.2 and 27.5 ± 1.6 (all mmHg, mean ± standard deviation). The pressure reduction from the ankle to the gluteal fold in the left and right leg were: control garment, 8.9 ± 3.5 and 7.4 ± 3.0; asymmetrical garment, 7.8 ± 3.9 and 21.9 ± 3.2; high gradient garment, 25.0 ± 4.1 and 22.3 ± 3.6 (all mmHg, mean ± standard deviation). The results demonstrated that made-to-measure compression garments can be made to elicit pressures within and below clinical standards, and to elicit equivalent pressures and gradients in different participants and between participants’ legs. The purpose of the third study was to examine the reliability (test-retest, intra- and inter-day) and validity of 3D scanning to measure leg volume. Fifteen males volunteered to participate (age 24.6 ± 2.0 years, stature 178.9 ± 4.5 cm, body mass 77.4 ± 6.5 kg, mean ± standard deviation). The volume of the lower and upper legs was examined using two consecutive 3D scans and water displacement (criterion) at baseline, 1 hour post baseline (intra-day) and 24 hours post baseline (inter-day). Reliability (test-retest, intra- and inter-day) and validity of the 3D scanner were compared to the water displacement criterion method, using Bland and Altman limits of agreement, Pearson’s product moment correlations, and paired samples t-tests. The 3D scanner method provided better test-retest reliability than the water displacement method as the 3D scanner had smaller systematic bias and limits of agreement (±1-1%, and 3-5% respectively) compared to the water displacement method (1-2% and 4- 7% respectively), for lower leg and upper leg volume measurements. The intra- and inter-day reliability was also better for the 3D scanner evidenced by narrower limits of agreement for intra-day reliability (3D scanner: 4-7%, and water displacement: 8-20%) and inter-day reliability (3D scanner: 5-6%, and IV water displacement: 9-16%). The 3D scanner was also found to be a valid method for measuring upper leg volume as the systematic bias and limits of agreement were within 10% of volume measurements made using the criterion water displacement method. The results suggest that the use of 3D scanning may be a reliable and valid method to measure leg volume. The purpose of the fourth study was to examine the effect of border removal and region of interest size on skin temperature outputs of thermal images (thermograms) using a sensitivity analysis, before and after exercise. Ten males volunteered to participate (age 23.5 ± 2.8 years, stature 181.9 ± 4.8 cm, body mass 76.2 ± 5.3 kg, mean ± standard deviation). Participants performed a 30-minute submaximal run on a treadmill and thermograms were captured of the upper and lower, anterior and posterior legs, before and after exercise using an infrared thermal imaging camera. Temperature data was extracted from the thermograms using a custom MATLAB® program which performed 2% increments of border removal from the unadjusted border, and 5% reductions of the region of interest size (length reduction) from the unadjusted length. A sensitivity analysis was performed to examine the influence of border removal and region of interest size on skin temperature. The sensitivity analysis showed that overall, the mean and maximum skin temperature had no to small sensitivity to the removal of the border and region of interest size on the thermograms. However, it was found that the inclusion of the region of interest border reduced skin temperature outputs between 0.14-0.24°C, at baseline and post exercise. The results suggest that the border of a thermogram should be removed when selecting a region of interest for analysis. Furthermore, regions of interest should be carefully selected over the specific area under investigation to reduce the influence of hot and cold areas within the thermogram caused by underlying tissues (muscle and bone). The purpose of the fifth study was to examine the effect of wearing made-to-measure compression garments, with different pressure profiles, on thermal responses and comfort perception before and after exercise. Ten males volunteered to participate (age 23.5 ± 2.8 years, stature 181.9 ± 4.8 cm, body mass 76.2 ± 5.3 kg, mean ± standard deviation). Participants performed a 30-minute submaximal run on a treadmill whilst wearing four made-to-measure compression garments that differed in pressure and pressure gradient. The garment conditions were: 1) control garment which was designed to elicit pressure below clinical standards ( 0.05) and mean skin temperature change from baseline to post run ranged between 1.4 – 2.0°C, 1.1 – 1.5°C, 1.6 – 1.8°C and 1.2 – 1.7°C for the lower anterior and posterior, and the upper anterior and posterior leg segments respectively, in all four compression garment conditions. General comfort was lower for the left leg and right leg in the medium gradient garment (left: 7.9 ± 2.7, and right: 8.0 ± 2.7) compared to the control (left: 12.7 ± 1.8, and right: 12.8 ± 1.6), and asymmetrical (left: 12.1 ± 1.9, and right: 11.6 ± 2.2) garment conditions (P 35°C). However, compression garments with higher pressures may provide greater discomfort, thus, there must be an optimal balance between wearer comfort and elicited pressures. The purpose of the sixth study was to examine the effect of wearing made-to-measure compression garments, with different pressure profiles, on running biomechanics. Nine males volunteered to participate (age 22.9 ± 2.1 years, stature 182.0 ± 5.1 cm, body mass 76.4 ± 5.6 kg, mean ± standard deviation). Participants performed a 30-minute submaximal run on an instrumented treadmill whilst wearing made-to-measure compression garments that differed in pressure and pressure gradient. The garment conditions were identical to those of study five which were: control, high gradient, medium gradient and asymmetrical garments. Kinematics, kinetics and heart rate were measured during the run. Principal component analysis (PCA) was conducted to compare running kinematic and the kinetic variables of ground reaction force, joint powers, joint moments, joint angles and joint angular velocities, between compression garment conditions. The PCA results showed no differences between compression garment conditions for kinematic and kinetic variables, evidenced by a lack of data clustering. Heart rate was lower in the high gradient (128 ± 32 bpm) and medium gradient (127 ± 32 bpm) garments compared to the control (133 ± 33 bpm) garment condition (P = 0.039 and P = 0.011 respectively). The lower heart rate suggests that made-to-measure compression garments do not effect running kinematics and kinetics but may provide a cardiovascular benefit during submaximal running. Overall, made-to-measure compression garments can be developed to elicit the same prescribed pressure profiles between participants. Moreover, the application of 3D scanning used to support the manufacture of the made-to-measure garments may also be used to reliably measure leg volume. Furthermore, when worn during submaximal running at 20.5 ± 0.8°C, made-to-measure compression garments with different pressure profiles do not elevate skin temperature to temperatures associated with performance decrements (i.e., > 35°C), and do not influence running biomechanics but may provide cardiovascular benefits as evidenced by reduced heart rate

THE EFFECTS OF ENHANCED SENSORI-MOTOR REHABILITATION ON INDICES OF FUNCTIONAL PERFORMANCE IN PATIENTS UNDERGOING TOTAL KNEE REPLACEMENT

The primary aim of this thesis addressed a knowledge gap regarding whether sensori-motor training (SMT) stimuli implemented early post-surgery are capable of targeting persisting sensori-motor and neuromuscular deficits in TKR patients’ performance. Therefore, the effects of early enhanced sensori-motor training (ESMET) on self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities of patients undergoing total knee replacement (TKR) were investigated. In order to assess the effects of SMT on patients’ functional mobility and sensori-motor function, as well as indirectly investigating the mechanism underpinning any observed effects, relevant outcome measures used in the literature were reviewed for their clinimetric properties. Indices of functional performance, as reflected by the Timed Up and Go Test (as primary outcome), balance-related performance, sensori-motor performance, neuromuscular performance, muscle size and knee ROM, as well as patient-reported measures (PROMs), were selected on the basis of their clinimetric utility to best reflect the outcome of the SMT intervention. A clinical survey of Greek physiotherapists’ perspectives revealed that contemporary usual care management of TKR-related rehabilitation incorporated in the majority of cases home-based exercises with emphasis on knee ROM and muscle strengthening (Moutzouri et al, 2016b). A first systematic review including studies with IIc-IV level of evidence (Moutzouri et al, 2016c), revealed that patients undergoing TKR surgery experience persisting deficits in static and dynamic balance and incidence of falls remain within the pre-surgery levels. In parallel, a second systematic review evaluating preliminary effects of contemporary functional physiotherapy programmes being augmented by SMT in TKR clinical population, revealed statistically significant greater effects for balance performance but not for functional capabilities. However, the number of studies that had met inclusion criteria was small (n = 5) and the nature of their designs, which had been as pilot studies in the majority of cases, precluded conclusive findings. Following preliminary investigations of reproducibility of measurement and related clinimetric characteristics of outcomes, the main aspect of the thesis reported on the findings of a novel randomised control trial (Moutzouri et al,2017), in which the effects of a newly formulated time-matched sensori-motor exercise training programme [ESMET] was compared with those from a functional exercise training programme [FET] (representing the control condition and usual care practice, and which have been characterised by the findings of the aforementioned clinical survey) during rehabilitation following TKR. Participants (n= 52) were allocated to 12-week programmes of rehabilitation, initiated in the second week post-surgery, and assessed at pre-surgery (0 weeks), 8 weeks post-surgery, and at 14 weeks post-surgery on outcomes which included indices of self-reported and objective measures of physical function, sensori-motor, neuromuscular, and musculoskeletal performance capabilities. The findings revealed significant advantages for the new sensori-motor focused rehabilitation on several outcomes (relative effect size range at 14 weeks post-surgery ~ 0.5 to 2.1), including a significant group by time interaction (F(1.7,82.5)GG = 11.0; p <0.005) for the study’s primary outcome (Timed Up and Go Test), favouring ESMET over FET by ~ 35 %. However, the study’ findings need to be interpreted with caution due to the single-blind nature of the study. Key words: total knee replacement; knee osteoarthritis, Rehabilitation; Balance; sensori-motor trainin

Muscle activation patterns in shoulder impingement patients

Introduction: Shoulder impingement is one of the most common presentations of shoulder joint problems 1. It appears to be caused by a reduction in the sub-acromial space as the humerus abducts between 60o -120o – the 'painful arc'. Structures between the humeral head and the acromion are thus pinched causing pain and further pathology 2. Shoulder muscle activity can influence this joint space but it is unclear whether this is a cause or effect in impingement patients. This study aimed to observe muscle activation patterns in normal and impingement shoulder patients and determine if there were any significant differences. Method: 19 adult subjects were asked to perform shoulder abduction in their symptomatic arm and non-symptomatic. 10 of these subjects (age 47.9 ± 11.2) were screened for shoulder impingement, and 9 subjects (age 38.9 ± 14.3) had no history of shoulder pathology. Surface EMG was used to collect data for 6 shoulder muscles (Upper, middle and lower trapezius, serratus anterior, infraspinatus, middle deltoids) which was then filtered and fully rectified. Subjects performed 3 smooth unilateral abduction movements at a cadence of 16 beats of a metronome set at 60bpm, and the mean of their results was recorded. T-tests were used to indicate any statistical significance in the data sets. Significance was set at P<0.05. Results: There was a significant difference in muscle activation with serratus anterior in particular showing a very low level of activation throughout the range when compared to normal shoulder activation patterns (<30%). Middle deltoid recruitment was significantly reduced between 60-90o in the impingement group (30:58%).Trends were noted in other muscles with upper trapezius and infraspinatus activating more rapidly and erratically (63:25%; 60:27% respectively), and lower trapezius with less recruitment (13:30%) in the patient group, although these did not quite reach significance. Conclusion: There appears to be some interesting alterations in muscle recruitment patterns in impingement shoulder patients when compared against their own unaffected shoulders and the control group. In particular changes in scapula control (serratus anterior and trapezius) and lateral rotation (infraspinatus), which have direct influence on the sub-acromial space, should be noted. It is still not clear whether these alterations are causative or reactionary, but this finding gives a clear indication to the importance of addressing muscle reeducation as part of a rehabilitation programme in shoulder impingement patients

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations

Bio-Inspired Soft Artificial Muscles for Robotic and Healthcare Applications

Soft robotics and soft artificial muscles have emerged as prolific research areas and have gained substantial traction over the last two decades. There is a large paradigm shift of research interests in soft artificial muscles for robotic and medical applications due to their soft, flexible and compliant characteristics compared to rigid actuators. Soft artificial muscles provide safe human-machine interaction, thus promoting their implementation in medical fields such as wearable assistive devices, haptic devices, soft surgical instruments and cardiac compression devices. Depending on the structure and material composition, soft artificial muscles can be controlled with various excitation sources, including electricity, magnetic fields, temperature and pressure. Pressure-driven artificial muscles are among the most popular soft actuators due to their fast response, high exertion force and energy efficiency. Although significant progress has been made, challenges remain for a new type of artificial muscle that is easy to manufacture, flexible, multifunctional and has a high length-to-diameter ratio. Inspired by human muscles, this thesis proposes a soft, scalable, flexible, multifunctional, responsive, and high aspect ratio hydraulic filament artificial muscle (HFAM) for robotic and medical applications. The HFAM consists of a silicone tube inserted inside a coil spring, which expands longitudinally when receiving positive hydraulic pressure. This simple fabrication method enables low-cost and mass production of a wide range of product sizes and materials. This thesis investigates the characteristics of the proposed HFAM and two implementations, as a wearable soft robotic glove to aid in grasping objects, and as a smart surgical suture for perforation closure. Multiple HFAMs are also combined by twisting and braiding techniques to enhance their performance. In addition, smart textiles are created from HFAMs using traditional knitting and weaving techniques for shape-programmable structures, shape-morphing soft robots and smart compression devices for massage therapy. Finally, a proof-of-concept robotic cardiac compression device is developed by arranging HFAMs in a special configuration to assist in heart failure treatment. Overall this fundamental work contributes to the development of soft artificial muscle technologies and paves the way for future comprehensive studies to develop HFAMs for specific medical and robotic requirements

Life Sciences Program Tasks and Bibliography

This document includes information on all peer reviewed projects funded by the Office of Life and Microgravity Sciences and Applications, Life Sciences Division during fiscal year 1995. Additionally, this inaugural edition of the Task Book includes information for FY 1994 programs. This document will be published annually and made available to scientists in the space life sciences field both as a hard copy and as an interactive Internet web pag

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require