Weight-Bearing Dorsiflexion Range of Motion and Landing Biomechanics in Individuals With Chronic Ankle Instablity

Context: People with chronic ankle instability (CAI) exhibit less weight-bearing dorsiflexion range of motion (ROM) and less knee flexion during landing than people with stable ankles. Examining the relationship between dorsiflexion ROM and landing biomechanics may identify a modifiable factor associated with altered kinematics and kinetics during landing tasks. Objective: To examine the relationship between weight-bearing dorsiflexion ROM and single-legged landing biomechanics in persons with CAI. Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: Fifteen physically active persons with CAI (5 men, 10 women; age = 21.9 ± 2.1 years, height = 168.7 ± 9.0 cm, mass = 69.4 ± 13.3 kg) participated. Intervention(s): Participants performed dorsiflexion ROM and single-legged landings from a 40-cm height. Sagittal-plane kinematics of the lower extremity and ground reaction forces (GRFs) were captured during landing. Main Outcome Measure(s): Static dorsiflexion was measured using the weight-bearing–lunge test. Kinematics of the ankle, knee, and hip were observed at initial contact, maximum angle, and sagittal displacement. Sagittal displacements of the ankle, knee, and hip were summed to examine overall sagittal displacement. Kinetic variables were maximum posterior and vertical GRFs normalized to body weight. We used Pearson product moment correlations to evaluate the relationships between dorsiflexion ROM and landing biomechanics. Correlations (r) were interpreted as weak (0.00–0.40), moderate (0.41–0.69), or strong (0.70–1.00). The coefficient of determination (r2) was used to determine the amount of explained variance among variables. Results: Static dorsiflexion ROM was moderately correlated with maximum dorsiflexion (r = 0.49, r2 = 0.24), ankle displacement (r = 0.47, r2 = 0.22), and total displacement (r = 0.67, r2 = 0.45) during landing. Dorsiflexion ROM measured statically and during landing demonstrated moderate to strong correlations with maximum knee (r = 0.69–0.74, r2 = 0.47–0.55) and hip (r = 0.50–0.64, r2 = 0.25–0.40) flexion, hip (r = 0.53–0.55, r2 = 0.28–0.30) and knee (r = 0.53–0.70, r2 = 0.28–0.49) displacement, and vertical GRF (−0.47– −0.50, r2 = 0.22–0.25). Conclusions: Dorsiflexion ROM was moderately to strongly related to sagittal-plane kinematics and maximum vertical GRF during single-legged landing in persons with CAI. Persons with less dorsiflexion ROM demonstrated a more erect landing posture and greater GRF

The Effectiveness of Prophylactic Ankle Braces in Reducing the Incidence of Acute Ankle Injuries in Adolescent Athletes: A Critically Appraised Topic

Clinical Scenario: Ankle injuries constitute a large number of injuries sustained by adolescent athletes participating in high school athletics. Prophylactic ankle bracing may be an effective and efficient method to reduce the incidence of ankle injuries in adolescent athletes in the secondary-school setting. Clinical Question: Do prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes? Summary of Key Findings: Two of the three included studies reported that prophylactic ankle braces reduced the incidence of ankle injuries compared with no ankle bracing. Clinical Bottom Line: There is moderate evidence to support the use of prophylactic ankle braces in adolescent athletes, particularly those who participate in football and basketball, to reduce the incidence of acute ankle injuries. Strength of Recommendation: Grade B evidence exists that prophylactic ankle braces reduce the incidence of acute ankle injuries in adolescent athletes

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Trauma and parenting: Considering humanitarian crisis contexts

This chapter uses a risk and resilience framework to examine three humanitarian crisis contexts (natural disasters, war exposure, and forced displacement) that represent potentially traumatic events in the lives of children around the world. For each context, the existing research relating to: adverse child mental health outcomes; risk and protective factors (at the level of the individual child/youth, parent/family, and community); and parenting interventions is reviewed. Although parenting interventions are frequently recommended for families in each of the three settings, very little empirical research has been conducted to date. Across the three humanitarian crisis contexts, common risk factors for adverse child outcomes include exposure to trauma for children and parents, parental mental health, changes in parenting behaviors, hardships and financial stress, domestic and community violence, and a lack of accessible services. Equally important, common protective factors include stable supportive parental relationships, strong family connectedness, and sustainable resources available to support families. The importance of parents—in terms of both risk and resilience—is clear. Few culturally appropriate and sustainable parenting interventions exist, with even less published research evaluating these interventions. Strengthening families is an empirically supported means of buffering or protecting children from exposure to disaster, conflict, and forced displacement; and must be the focus of future endeavors

Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy

International audienceBACKGROUND Nusinersen is an antisense oligonucleotide drug that modulates pre-messenger RNA splicing of the survival motor neuron 2 (SMN2) gene. It has been developed for the treatment of spinal muscular atrophy (SMA). METHODS We conducted a multicenter, double-blind, sham-controlled, phase 3 trial of nusinersen in 126 children with SMA who had symptom onset after 6 months of age. The children were randomly assigned, in a 2: 1 ratio, to undergo intrathecal administration of nusinersen at a dose of 12 mg (nusinersen group) or a sham procedure (control group) on days 1, 29, 85, and 274. The primary end point was the least-squares mean change from baseline in the Hammersmith Functional Motor Scale-Expanded (HFMSE) score at 15 months of treatment; HFMSE scores range from 0 to 66, with higher scores indicating better motor function. Secondary end points included the percentage of children with a clinically meaningful increase from baseline in the HFMSE score (>= 3 points), an outcome that indicates improvement in at least two motor skills. RESULTS In the prespecified interim analysis, there was a least-squares mean increase from baseline to month 15 in the HFMSE score in the nusinersen group (by 4.0 points) and a least-squares mean decrease in the control group (by -1.9 points), with a significant between-group difference favoring nusinersen (least-squares mean difference in change, 5.9 points; 95% confidence interval, 3.7 to 8.1; P< 0.001). This result prompted early termination of the trial. Results of the final analysis were consistent with results of the interim analysis. In the final analysis, 57% of the children in the nusinersen group as compared with 26% in the control group had an increase from baseline to month 15 in the HFMSE score of at least 3 points (P< 0.001), and the overall incidence of adverse events was similar in the nusinersen group and the control group (93% and 100%, respectively). CONCLUSIONS Among children with later-onset SMA, those who received nusinersen had significant and clinically meaningful improvement in motor function as compared with those in the control group. (Funded by Biogen and Ionis Pharmaceuticals; CHERISH ClinicalTrials. gov number, NCT02292537.