Frontal Plane Knee Alignment: A Call for Standardized Measurement

Evaluations of knee alignment are useful in the diagnosis of arthritic conditions affecting the knee joint, serving also as a guide for conservative management and surgical planning. They are also fundamental to various aspects of musculo-skeletal research. Recently, there has been great interest in frontal plane alignment measures related to the pathogenesis of knee osteoarthritis (OA). Several approaches have been proposed over the years to describe and measure alignment, but the differences between them have made it difficult to compare or correlate the results of independent studies. Toward a standard approach to the measurement and reporting of alignment data that may be equally applicable to clinicians and researchers, we discuss a system of measurements based on geometric analysis of the femur, tibia, and knee joint surfaces. We also discuss a standardized methodology for measurement and computation of these parameters

Concussion Return to Play Protocols Effect on Athletes\u27 Reporting of Symptoms

When an athlete suffers a concussion, the standard return to play (RTP) guidelines are that they must sit out a minimum of a week as they go through a slow progression of exertional and neurocognitive tests once they are asymptomatic. This is a great improvement to concussion treatment in the past where athletes were often dangerously returned. However, because of this “blanket” 7-day minimum return policy, we believe the current RTP guidelines are potentially leading athletes to hide their symptoms more so they do not have to sit out. Fifty-three athletes were surveyed from soccer, basketball, lacrosse, and football teams from 3 universities in Southwest Ohio (ages 18-22, 34=male, 19=female). The survey contained questions about their demographics, concussion symptom knowledge, concussion history, potential reporting of concussions, and opinion on their university’s return to play policy. The results showed that 40% of athletes would be willing to hide their symptoms of a mild concussion and 21% believe that their university’s return to play policy affects this decision. While the results do not completely confirm our hypothesis, we still believe that the numbers we received in our study are enough to warrant a consideration of the current “blanket statement” return to play policy in favor of a very similar but more individualized version

Home Program of Hip Abductor Exercises: Effect on Knee Joint Loading, Strength, Function and Pain in Persons with Knee Osteoarthritis

Background Hip abductor muscle weakness may result in impaired frontal-plane pelvic control during gait, leading to greater medial compartment loading in people with knee osteoarthritis (OA). Objective This study investigated the effect of an 8-week home strengthening program for the hip abductor muscles on knee joint loading (measured by the external knee adduction moment during gait), strength (force-generating capacity), and function and pain in individuals with medial knee OA. Design The study design was a nonequivalent, pretest-posttest, control group design. Setting Testing was conducted in a motor performance laboratory. Patients An a priori sample size calculation was performed. Forty participants with knee OA were matched for age and sex with a control group of participants without knee OA. Intervention Participants with knee OA completed a home hip abductor strengthening program. Measurements Three-dimensional gait analysis was performed to obtain peak knee adduction moments in the first 50% of the stance phase. Isokinetic concentric strength of the hip abductor muscles was measured using an isokinetic dynamometer. The Five-Times-Sit-to-Stand Test was used to evaluate functional performance. Knee pain was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. Results Following the intervention, the OA group demonstrated significant improvement in hip abductor strength, but not in the knee adduction moment. Functional performance on the sit-to-stand test improved in the OA group compared with the control group. The OA group reported decreased knee pain after the intervention. Limitations Gait strategies that may have affected the knee adduction moment, including lateral trunk lean, were not evaluated in this study. Conclusions Hip abductor strengthening did not reduce knee joint loading but did improve function and reduce pain in a group with medial knee OA

The Effects of Square-Stepping Exercise on Risk of Falling and Balance in Senior Adults

As people age, their body systems gradually deteriorate. Muscle function and the vestibular system slowly deteriorate leading to lower body instability. Older adults who struggle with dizziness and imbalance are more prone to falling. Dizziness and imbalance cause falls, and falls are the leading cause of hospitalization and accidental death in older adults (Shinichi & Tatsuya, 2015). It is possible to prevent and reduce the risk of falls through balance training. It is crucial that older adults take the steps needed to improve their balance and therefore reduce their risk of falling. PURPOSE: To evaluate the effect of a 10-week Square-Stepping Exercise (SSE) program in older adults using the Biodex balance system. METHODS: Eleven adults over the age of 60 and involved in the Senior Jacket program at Cedarville University participated in this 10-week study (0 males, 11 females; mean age=76). Measurements taken prior to and after the intervention include Activities-specific Balance Confidence (ABC) Scale, Timed-Up-And-Go Test, 30-Second Chair Stand Test, Limits of Stability Test, and Fall Risk Test. A Repeated Measures ANOVA was used to determine changes in initial and final balance testing scores. RESULTS: The study revealed that significant differences were found for the functional fitness tests. SPSS indicated a significant difference in improvement from pretest to posttest for the Timed-Up-and-Go Test (P = .003) as well as the 30-Second Chair Stand Test (P = .043). For the Limits of Stability test, there was no significant change from pretest to posttest for the overall (P =0.162) or any of the 8 directions. The Fall Risk Test score also showed no significant change (P =0.831). The ABC Scale test did not show significant improvement either (P = 0.995). CONCLUSION: Overall, the results showed that the participants significantly benefited from the training program in areas of functional fitness. Unfortunately, there was no significant improvement with the Biodex balance system’s Fall Risk Test or Limits of Stability Test. Results may be due to the participants already having good balance as they were well below the normative data for risk of falling. It could also be because the training was not specific enough for improvements in the Fall Risk and Limits of Stability tests

Integration of the Saline Process on Holistic Patient Care to Improve Student Understanding of Interprofessional Team Roles, Values, and Ethics

Description of the Problem: Healthcare practitioner students currently report feeling underprepared to provide holistic and spiritual care to their patients upon transitioning into practice, and there is currently little data on the efficacy of holistic care-focused interventions on interprofessional outcomes. The goal of this research was to assess the impact of an interprofessional training session on holistic care on student perceptions of interprofessional 1) roles/responsibilities and 2) values/ethics. The Innovation: A live, interactive interprofessional training session to address holistic patient care was implemented in fall of 2017. Students’ pre- and post-training perceptions of their confidence in study outcomes were assessed using a survey instrument. Critical Analysis: Significant positive changes were seen in students’ perceived ability to participate in team discussions and clarify misconceptions regarding their role in healthcare following the training. Students had high confidence in interacting ethically at pre-test and sustained that confidence. Next Steps: Live, interactive educational interventions with skills practice and group discussions can help to increase students’ awareness of team roles and responsibilities, as well as expand their understanding of the values and ethics within healthcare professions

Sex matters during adolescence: Testosterone-related cortical thickness maturation differs between boys and girls

Age-related changes in cortical thickness have been observed during adolescence, including thinning in frontal and parietal cortices, and thickening in the lateral temporal lobes. Studies have shown sex differences in hormone-related brain maturation when boys and girls are age-matched, however, because girls mature 1-2 years earlier than boys, these sex differences could be confounded by pubertal maturation. To address puberty effects directly, this study assessed sex differences in testosterone-related cortical maturation by studying 85 boys and girls in a narrow age range and matched on sexual maturity. We expected that testosterone-by-sex interactions on cortical thickness would be observed in brain regions known from the animal literature to be high in androgen receptors. We found sex differences in associations between circulating testosterone and thickness in left inferior parietal lobule, middle temporal gyrus, calcarine sulcus, and right lingual gyrus, all regions known to be high in androgen receptors. Visual areas increased with testosterone in boys, but decreased in girls. All other regions were more impacted by testosterone levels in girls than boys. The regional pattern of sex-by-testosterone interactions may have implications for understanding sex differences in behavior and adolescent-onset neuropsychiatric disorders. © 2012 Bramen et al

The Biochemical and Cellular Basis for Nutraceutical Strategies to Attenuate Neurodegeneration in Parkinson’s Disease

Future therapeutic intervention that could effectively decelerate the rate of degeneration within the substantia nigra pars compacta (SNc) could add years of mobility and reduce morbidity associated with Parkinson’s disease (PD). Neurodegenerative decline associated with PD is distinguished by extensive damage to SNc dopaminergic (DAergic) neurons and decay of the striatal tract. While genetic mutations or environmental toxins can precipitate pathology, progressive degenerative succession involves a gradual decline in DA neurotransmission/synaptic uptake, impaired oxidative glucose consumption, a rise in striatal lactate and chronic inflammation. Nutraceuticals play a fundamental role in energy metabolism and signaling transduction pathways that control neurotransmission and inflammation. However, the use of nutritional supplements to slow the progression of PD has met with considerable challenge and has thus far proven unsuccessful. This review re-examines precipitating factors and insults involved in PD and how nutraceuticals can affect each of these biological targets. Discussed are disease dynamics (Sections 1 and 2) and natural substances, vitamins and minerals that could impact disease processes (Section 3). Topics include nutritional influences on α-synuclein aggregation, ubiquitin proteasome function, mTOR signaling/lysosomal-autophagy, energy failure, faulty catecholamine trafficking, DA oxidation, synthesis of toxic DA-quinones, o-semiquinones, benzothiazolines, hyperhomocyseinemia, methylation, inflammation and irreversible oxidation of neuromelanin. In summary, it is clear that future research will be required to consider the multi-faceted nature of this disease and re-examine how and why the use of nutritional multi-vitamin-mineral and plant-based combinations could be used to slow the progression of PD, if possible