Feasibility of neuromuscular training in patients with severe hip or knee OA: The individualized goal-based NEMEX-TJR training program

<p>Abstract</p> <p>Background</p> <p>Although improvements are achieved by general exercise, training to improve sensorimotor control may be needed for people with osteoarthritis (OA). The aim was to apply the principles of neuromuscular training, which have been successfully used in younger and middle-aged patients with knee injuries, to older patients with severe hip or knee OA. We hypothesized that the training program was feasible, determined as: 1) at most acceptable self-reported pain following training; 2) decreased or unchanged pain during the training period; 3) few joint specific adverse events related to training, and 4) achieved progression of training level during the training period.</p> <p>Methods</p> <p>Seventy-six patients, between 60 and 77 years, with severe hip (n = 38, 55% women) or knee OA (n = 38, 61% women) underwent an individualized, goal-based neuromuscular training program (NEMEX-TJR) in groups for a median of 11 weeks (quartiles 7 to 15) prior to total joint replacement (TJR). Pain was self-reported immediately after each training session on a 0 to 10 cm, no pain to pain as bad as it could be, scale, where 0-2 indicates safe, > 2 to 5 acceptable and > 5 high risk pain. Joint specific adverse events were: not attending or ceasing training because of increased pain/problems in the index joint related to training, and self-reported pain > 5 after training. The level of difficulty of training was registered.</p> <p>Results</p> <p>Patients with severe OA of the hip or knee reported safe pain (median 2 cm) after training. Self-reported pain was lower at training sessions 10 and 20 (p = 0.04) and unchanged at training sessions 5 and 15 (p = 0.170, p = 0.161) compared with training session 1. There were no joint specific adverse events in terms of not attending or ceasing training. Few patients (n = 17, 22%) reported adverse events in terms of self-reported pain > 5 after one or more training sessions. Progression of training level was achieved over time (p < 0.001).</p> <p>Conclusions</p> <p>The NEMEX-TJR training program is feasible in patients with severe hip or knee OA, in terms of safe self-reported pain following training, decreased or unchanged pain during the training period, few joint specific adverse events, and achieved progression of training level during the training period.</p

ACL injury prevention, more effective with a different way of motor learning?

What happens to the transference of learning proper jump-landing technique in isolation when an individual is expected to perform at a competitive level yet tries to maintain proper jump-landing technique? This is the key question for researchers, physical therapists, athletic trainers and coaches involved in ACL injury prevention in athletes. The need for ACL injury prevention is clear, however, in spite of these ongoing initiatives and reported early successes, ACL injury rates and the associated gender disparity have not diminished. One problem could be the difficulties with the measurements of injury rates and the difficulties with the implementation of thorough large scale injury prevention programs. A second issue could be the transition from conscious awareness during training sessions on technique in the laboratory to unexpected and automatic movements during a training or game involves complicated motor control adaptations. The purpose of this paper is to highlight the issue of motor learning in relation to ACL injury prevention and to post suggestions for future research. ACL injury prevention programs addressing explicit rules regarding desired landing positions by emphasizing proper alignment of the hip, knee, and ankle are reported in the literature. This may very well be a sensible way, but the use of explicit strategies may be less suitable for the acquisition of the control of complex motor skills (Maxwell et al. J Sports Sci 18:111-120, 2000). Sufficient literature on motor learning and it variations point in that direction

Political Belonging in a Neoliberal Era: The Struggle of the Sans-Papiers

This article argues that political belonging should be understood in the context of diverse spatial imaginaries which encompass but are not confined to the state. Engin Isin's approach to citizenship provides a theoretical grounding for this claim. By way of demonstration, the article focuses on the spatially reconfigured practices of the neoliberal state in relation to irregular migration. It shows how the policing of irregular migration sustains a logic of political belonging based on connections between state, citizen and territory. This logic is simultaneously compromised by transnational state practices including the exploitation of irregular migrant labour. Irregular migrants are contesting their positioning within these multidimensional statist frameworks that posit them as outsiders even while they are integrated into local sites of a global political economy. The struggle of the Sans-Papiers, a collective of irregular migrants in France, provides an example in this context. Their claims to entitlement also mobilize multiple dimensions of political belonging and provide insight into transitions in political community, identity and practice

How to break the people smugglers&#039; real business model

THE federal government claims that its new asylum seeker policy – the PNG solution – breaks the people smugglers’ business model. Anyone smuggled by boat to Australia will be removed to Papua New Guinea for processing and won’t be resettled in Australia. People smugglers will no longer be able to sell their product – the prospect of living in Australia – to prospective customers. Without a product to sell, the smuggling will stop, and so will the tragic deaths at sea. Many commentators have accepted this logic, even if they differ on the rights and wrongs of leaving asylum seekers stranded in Papua New Guinea. But is the logic sound? The policy rests on a misunderstanding of the product being sold. The product that asylum seekers want and that people smugglers offer is passage to a place where real protection is possible. By real protection, I mean the chance to live somewhere – anywhere – free from persecution and able to rebuild a dignified life. This is not necessarily the same as seeking a life in Australia. The problem is that Australia, at present, is one of the few countries in the region where real protection is possible… Read the full articl