Differences in gait kinetics and kinematics between patients with rotating hinge knee and cruciate-retaining prostheses : A cross-sectional study

東京都立大学Tokyo Metropolitan University博士（理学療法学）doctoral thesi

Movement patterns of the functional reach test do not reflect physical function in healthy young and older participants

東京都立大学Tokyo Metropolitan University博士（理学療法学）doctoral thesi

The difference of ground reaction force during anterior step motion in collegiate male long-distance runners between with or without a history of medial tibial stress syndrome

本研究は代表的なランニング障害の一つである内側脛骨過労性骨膜炎（MTSS）を発症したアスリートのリハビリテーションや再発予防の一助とするために、MTSSの既往がある男子長距離ランナーにおける前方ステップ動作中の着地衝撃パターンを明らかにすることを目的とした。対象は大学男子長距離ランナー15名とした。自記式アンケートを用いて基本属性に関する情報を得た。最大一歩幅の距離をステップ幅とした前方ステップ時の片脚着地動作（前方ステップ動作）を行わせ、最大垂直床反力（pVGRF）、初期接地からpVGRFまでの時間、loading rate 、およびfree moment（FM）を計測、算出した。対象をMTSS既往あり群（4名6脚）とMTSS既往なし群（13名24脚）に分け、床反力パラメータを群間で比較した。MTSS既往なし群と比較してMTSS既往あり群のpVGRFとFMは有意に小さかった。省スペースで動作の評価が可能な前方ステップ動作において、MTSSの既往がある男子長距離ランナーと既往がない男子長距離ランナーの前方ステップ動作中の床反力パターンに違いがみられた。このことはMTSSの発症予防に向けた動作指導に役立つ可能性があるが、本研究の結果がMTSSの発症要因となるか、MTSSを発症した結果生じた動作戦略であるかは不明である。東京都立大学学位論乙第254号　副論文journal articl

Injury-related fear in athletes returning to sports after anterior cruciate ligament reconstruction - A quantitative content analysis of an open-ended questionnaire

Background/objective: Injury-related fear during sport activities are major psychological factors inhibiting a person’s return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR). Currently, there are no studies that quantitatively analyse the open-ended questionnaire for knee injury-related fear in post-ACLR athletes.The purpose of this study was to identify knee injury-related fear in athletes who return to ball-centric sports via the use of an open-ended questionnaire. We aimed to determine the main concepts of injury-related fear according to sex, type of sport, and participation level. Methods: In this study, a quantitative analysis of an open-ended questionnaire was used to examine the type of fear athletes experience after returning to ball-centric sports. The RTS and fear questionnaire collected open-ended questionnaire to knee injury-related fear during sport activities; this questionnaire was completed at the outpatient visit post-RTS. Quantitative content analysis was performed to extract frequently occurring words from the responses to the questionnaire to create a co-occurrence network. The resulting co-occurrence network and extracted words were used to create concepts regarding knee injury-related fear. The relationship between each concept and subject demographics (sex, returned sports events, and participation level) were analysed using the chi-squared test. Results: Fifty-four athletes (30 females and 24 males) aged 16–45 [median age: 21.2; interquartile range (IQR): 11.0] years with an average RTS of 8.0 (IQR: 3.3) months from ACLR participated in the study. A total of 79 responses were included in the analysis. The knee injury-related fear can be summarized as follows: (1) Quick response to the opponent; (2) Ball-related play; (3) Jump-landing; (4) Contact; (5) Loss of balance; and (6) Athletic movement. Chi-squared tests showed that athletes participating in sport events with potential contact with an opponent (soccer, futsal, basketball, handball, lacrosse, and ultimate (frisbee)) were more likely to experience fear in quick response to the opponent (P < 0.01, adjusted residual = 2.943, ϕ = 0.301). Conclusion: The knee injury-related fear can be summarized into six concepts. Post-ACLR athletes participating in ball-centric sports need to assess fear in situations such as quick responses to the opponent’s movements and ball-related play, in addition to simple movements such as jumping, cutting, and contact

Development of a Wearable Mouth Guard Device for Monitoring Teeth Clenching during Exercise

Teeth clenching during exercise is important for sports performance and health. Recently, several mouth guard (MG)-type wearable devices for exercise were studied because they do not disrupt the exercise. In this study, we developed a wearable MG device with force sensors on both sides of the maxillary first molars to monitor teeth clenching. The force sensor output increased linearly up to 70 N. In four simple occlusion tests, the trends exhibited by the outputs of the MG sensor were consistent with those of an electromyogram (EMG), and the MG device featured sufficient temporal resolution to measure the timing of teeth clenching. When the jaw moved, the MG sensor outputs depended on the sensor position. The MG sensor output from the teeth-grinding test agreed with the video-motion analysis results. It was comparatively difficult to use the EMG because it contained a significant noise level. Finally, the usefulness of the MG sensor was confirmed through an exercise tolerance test. This study indicated that the developed wearable MG device is useful for monitoring clenching timing and duration, and the degree of clenching during exercise, which can contribute to explaining the relationship between teeth clenching and sports performance

Characteristics of landing impact in athletes who have not returned to sports at the pre-injury competition level after anterior cruciate ligament reconstruction

Background: Most patients with anterior cruciate ligament (ACL) injury undergo ACL reconstruction (ACLR) with the expectation of being able to return to sport (RTS) at the same level of the competition as before the injury. The magnitude and asymmetry of landing impact are important post-ACLR functional variables related to increased ACL strain and poor athletic performance. However, the association between the RTS status and landing impact in post-ACLR patients is unknown. Objective: To investigate the association between RTS status and landing impact during single-leg landing in post-ACLR patients. Methods: Forty-four patients after primary, unilateral ACLR participated in this study. They had already participated in sports post-ACLR. Questionnaires were used to assess whether the participants achieved the same competitive level of RTS as before the injury. The magnitude and symmetry of the peak vertical ground reaction force (pVGRF) were collected and analysed during single-leg jump landings. Additionally, knee functions (range of motion, laxity, effusion, strength, and single-leg hop distance) were measured. Results: A total of 28 (64%) patients reported RTS at their pre-injury competition levels. The no-RTS group had a lower pVGRF magnitude on the operated side than the yes-RTS group (P = .019). The no-RTS group had a higher rate of pVGRF asymmetry (50%) than the yes-RTS group (18%) (P = .040). Logistic regression analysis revealed that pVGRF magnitude and asymmetry were significantly associated with the RTS status. Logistic regression analysis adjusted for knee function revealed that the pVGRF magnitude was significantly associated with the RTS status. Conclusion: In patients who are unable to RTS at their pre-injury competition level after ACLR, the pVGRF is lower and more likely to be asymmetrical than in those able to RTS at their pre-injury competition level

Effects of differences in femoral anteversion and hip flexion angle on hip abductor muscles activity during clam exercise in females.

This study aimed to determine differences in the hip abductor muscle activity during clam exercise at different hip flexion and femoral anteversion angles. Thirty healthy females were divided into two groups based on the femoral anteversion angle: the excessive femoral anteversion group and the normal group. Clam exercise was performed at three different hip flexion angles (60°, 45°, and 30°). Tensor fascia latae, gluteus medius, and superior portion of gluteus maximus activities were measured during the exercise, and the results were normalized to the activity during maximum voluntary isometric contraction to calculate the gluteal-to-tensor fascia latae muscle activation index. The superior portion of gluteus maximus activities at a hip flexion of 60° and 45° were greater than that at 30°. The excessive femoral anteversion group had a lower gluteal-to-tensor fascia latae muscle activation index than the normal group; the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° was higher than that at 45°, and the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° and 45° were higher than that at 30°. Therefore, the femoral anteversion angle and hip joint position were related to the activity of the hip abductor muscles during clam exercise. These findings may provide a rationale for instructing exercises to maximize the activity of the hip abductor muscles in individuals with an excessive femoral anteversion angle

Comparison of foot kinetics and kinematics during gait initiation between young and elderly participants

[Purpose] To investigate the differences in foot kinetics during gait initiation between young and elderly participants using a modified multi-segment foot model. [Participants and Methods] Twelve young (23.3 ± 2.4 years) and 12 elderly participants (73.3 ± 3.9 years) were included in this study. Gait initiation was measured using a three-dimensional motion analysis system. We calculated the kinetic and kinematic values using our modified multi-segment foot model and compared those values with the values calculated using Bruening et al.’s multi-segment foot model. Modified gait initiation values were also compared between the elderly and young participants. [Results] Our modified multi-segment foot model, created using the Software for Interactive Musculoskeletal Modeling, showed similar values to those reported by Bruening et al. When we compared gait initiation between the elderly participants and their younger counterparts, the elderly exhibited lower torque and power values in the ankle, tarsometatarsal, and metatarsophalangeal joints. Additionally, the elderly exhibited a lower torque ratio in the distal joint than in the proximal joint (torque ratio: ankle joint >tarsometatarsal joint >metatarsophalangeal joint). [Conclusion] The elderly participants had less speed, stride, foot joint movement, moment, and power than the young participants. Moreover, the ratio of joint moment was smaller in the elderly participants. In elderly patients whose walking speed has decreased, consideration of the kinetics of the foot is important when deciding physiotherapy intervention.東京都立大学学位論文甲第1239号　副論文論文発表時氏名：佐藤 義尚journal articl