Calculation of Resistive Loads for Elastic Resistive Exercises

Context: What is the correct resistive load to start resistive training with elastic resistance to gain strength? This question is typically answered by the clinician\u27s best estimate and patient\u27s level of discomfort without objective evidence. Objective: To determine the average level of resistance to initiate a strengthening routine with elastic resistance following isometric strength testing. Design: Cohort. Setting: Clinical. Participants: Thirty-four subjects (31±13yrs, 73±17kg, 170±12cm). Interventions: The force produced was measured in Newtons (N) with an isometric dynamometer. The force distance was the distance from center of joint to location of force applied was measured in meters to calculate torque that was called Test Torque for the purposes of this report. This torque data was converted to Exercise Load in pounds based on the location where the resistance was applied, specifically the distance away from the center of rotation of the exercising limb. The average amount of exercise load as percentage of initial Test Torque for each individual for each exercise was recorded to determine what the average level of resistance that could be used for elastic resistance strengthening program. Main Outcome Measures: The percentage of initial test torque calculated for the exercise was recorded for each exercise and torque produced was normalized to body weight. Results: The average percentage of maximal isometric force that was used to initiate exercises was 30 ± 7% of test torque. Conclusions: This provides clinicians with an objective target load to start elastic resistance training. Individual variations will occur but utilization of a load cell during elastic resistance provides objective documentation of exercise progression

Nonoperative Management of Shoulder Instability

Non-operative management following a shoulder dislocation or subluxation remains a challenging and complex task. Accurate diagnosis of the condition, and shared decision-making regarding operative and non-operative management, as well as timing of return to play is required. This clinical concept paper introduces a shoulder instability framework that addresses these fundamental clinical dilemmas. Valid clinical prognostic tools which can predict recurrent shoulder instability are reviewed. The process of shared decision-making within the realm of shoulder instability is also presented. Finally, a framework for progressive rehabilitation that addresses deficits in motor control, strength, and endurance in scapula and shoulder musculature is presented to guide patients from an initial instability event, through to return to play

The role of the stratospheric polar vortex for the austral jet response to greenhouse gas forcing

Future shifts of the austral midlatitude jet are subject to large uncertainties in climate model projections. Here we show that, in addition to other previously identified sources of inter-model uncertainty, changes in the timing of the stratospheric polar vortex breakdown modulate the austral jet response to greenhouse gas forcing during summertime (December-February). The relationship is such that a larger delay in vortex breakdown favors a more poleward jet shift, with an estimated 0.7-0.8-degree increase in jet shift per 10 days delay in vortex breakdown. The causality of the link between the timing of the vortex breakdown and the tropospheric jet response is demonstrated through climate modeling experiments with imposed changes in the seasonality of the stratospheric polar vortex. The vortex response is estimated to account for about 30% of the inter-model variance in the shift of the summertime austral jet, and about 45% of the mean jet shift

Effectiveness of a Home-Based Eccentric-Exercise Program on the Torque-Angle Relationship of the Shoulder External Rotators: A Pilot Study

Context: The role of the rotator cuff is to provide dynamic stability to the glenohumeral joint. Human and animal studies have identified sarcomerogenesis as an outcome of eccentric training indicated by more torque generation with the muscle in a lengthened position. Objective: The authors hypothesized that a home-based eccentric-exercise program could increase the shoulder external rotators’ eccentric strength at terminal internal rotation (IR). Design: Prospective case series. Setting: Clinical laboratory and home exercising. Participants: 10 healthy subjects (age 30 ± 10 y). Intervention: All participants performed 2 eccentric exercises targeting the posterior shoulder for 6 wk using a home-based intervention program using side-lying external rotation (ER) and horizontal abduction. Main Outcome Measures: Dynamic eccentric shoulder strength measured at 60°/s through a 100° arc divided into 4 equal 25° arcs (ER 50–25°, ER 25–0°, IR 0–25°, IR 25–50°) to measure angular impulse to represent the work performed. In addition, isometric shoulder ER was measured at 5 points throughout the arc of motion (45° IR, 30° IR, 15° IR, 0°, and 15° ER). Comparison of isometric and dynamic strength from pre- to posttesting was evaluated with a repeated-measure ANOVA using time and arc or positions as within factors. Results: The isometric force measures revealed no significant differences between the 5 positions (P = .56). Analysis of the dynamic eccentric data revealed a significant difference between arcs (P = .02). The percentage-change score of the arc of IR 25–50° was found to be significantly greater than that of the arc of IR 0–25° (P = .007). Conclusion: After eccentric training the only arc of motion that had a positive improvement in the capacity to absorb eccentric loads was the arc of motion that represented eccentric contractions at the longest muscle length

The Effectiveness of Cervical Traction and Exercise in Decreasing Neck and Arm Pain for Patients With Cervical Radiculopathy: A Critically Appraised Topic

Clinical Question: Is there evidence to suggest intermittent cervical traction with cervical and scapular strengthening exercises is more effective in decreasing neck and arm pain when compared with cervical and scapular strengthening exercises alone in nonoperative patients with cervical radiculopathy? Clinical Bottom Line: There is currently inconsistent, high-quality evidence that suggests that the use of intermittent cervical traction in addition to strengthening exercises is more effective at decreasing pain in nonoperative patients with cervical radiculopathy when compared with strengthening alone. Future research should continue to examine long-term outcomes associated with cervical radiculopathy patients who use intermittent cervical traction as an intervention

An Electromyography Study of Muscular Endurance during the Posterior Shoulder Endurance Test

The primary purpose was to determine if there is a difference between the median frequency slopes of 5 posterior shoulder muscles during the initial portion of the Posterior Shoulder Endurance Test (PSET) at the 90° and 135° shoulder abduction positions. Fifty-five healthy volunteers (31 females) participated. The median frequency of the posterior deltoid (PD), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and infraspinatus (INF) was measured during the PSET at 90° and 135° of shoulder abduction. External torque of 13 ± 1 Nm was used for females and 21 ± 1 Nm for males. A fixed effect multi-variable regression model was used to investigate the median frequency slopes. Males and females were analyzed separately. Median frequency slopes demonstrated fatigue in all 5 of the muscles. The PD fatigued greater than the UT in males (p = 0.0215) and greater than the LT in females (p = 0.008). The time to task failure (TTF) was greater at 90° than 135° for females and males (p = 0.016; p = 0.0193) respectively. The PSET causes fatigue in all of the muscles that were tested, with the PD fatiguing at a greater rate compared to one muscle for each sex. This investigation supports using TTF as a clinical measure of shoulder girdle endurance at 90° shoulder abduction

Return to Swimming Protocol for Competitive Swimmers: A Post-Operative Case Study and Fundamentals

A large percentage of swimmers report shoulder pain during their swimming career. Shoulder pain in swimmers has been attributed to duration of swim practice, total yardage, and break down in stroke technique. Rehabilitation programs are generally land-based and cannot adequately address the intricacies of the swimming strokes. Return to swimming protocols (RTSP) that address progression of yardage are scarce, yet needed. The purpose of this clinical commentary is to familiarize the clinician with the culture and vernacular of swimming, and to provide a suggested yardage based RTSP for high school and collegiate level swimmers. LEVEL OF EVIDENCE: 5

A Quantitative Comparison of Arm Activity between Women with Breast Cancer and Healthy

Purpose: Survivors of breast cancer (BC) on the non-dominant side have more persistent deficits than those with cancer on the dominant limb. What is not known is whether those with BC use their involved upper limbs more, less, or at the same level as women without BC. Accelerometer use offers a quantifiable method to measure activity levels of upper limbs. The purpose of this study was to quantify the activity levels of the non-dominant involved limb among survivors of BC and compare these values to their dominant limb, as well as the non-dominant limb of a control group. Methods: Participants (n = 30) were women with unilateral BC on the non-dominant limb, diagnosed between 6 and 24 months prior to data collection, and a matched healthy group of women as controls. Participants completed the following questionnaires: medical and demographics, Brief Fatigue Inventory, Brief Pain Inventory – Short form, Disabilities of the Arm, Shoulder and Hand (DASH), and Beck Depression Index. Participants wore an accelerometer on each wrist during waking hours for 7 days. Arm activity was measured using vector magnitude activity counts extracted from the accelerometers. Results: There were no significant differences in total vector magnitude activity counts between groups for either limb. Within group dominant to non-dominant comparison was significantly different (p ≤ 0.001). No significant difference in pain was present but significant differences for fatigue (p = 0.002), depression (p = 0.004), and DASH scores (p = 0.035) were present. Conclusions: Women with non-dominant BC use their involved limb similar to healthy controls but less than their dominant limb

ICF Linking of Patient-Reported Therapy Goals for Children with Acquired Upper Extremity Impairment

BACKGROUND: Patient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy. PURPOSE: To determine the desired treatment outcomes of children with acquired upper extremity impairments. STUDY DESIGN: Descriptive case series METHODS: Two raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of the linked codes. RESULTS: Following consensus, two independent raters linked 894 meaningful concepts to the study population\u27s 501 goals derived from the Canadian Occupational Performance. Ninety-two unique ICF codes were linked to these 894 meaningful concepts. Twenty-three ICF codes account for 77.2% of the most frequently linked codes. For these top 23 codes, the greatest proportion (51.4%) of ICF codes are in the d4 mobility chapter representing specific constructs of hand and arm use. The second largest proportion (14.2%) of linked codes are in the d9 Community, society and civic life chapter aligning with participation in sports, music, performing arts and play. Within the d5 self-care chapter, the study population\u27s top priorities included hair care, fitness and drinking. The primary concerns within the b body functions domain are reduced pain, improved joint mobility and strength. CONCLUSION: The study population\u27s top priorities align with specific dimensions of hand and arm use and participation in sports and fitness, performing arts, and play. Further research may elucidate alignment of these patient-desired outcomes and the item banks of commonly used patient reported outcome measurement scales in this population

Highly-Individualized Physical Therapy Instruction beyond the Clinic Using Wearable Inertial Sensors

Musculoskeletal conditions, often requiring rehabilitation, affect one-third of the U.S. population annually. This paper presents rehabilitation assistive technology that includes body-worn motion sensors and a mobile application that extends the reach of a physical rehabilitation specialist beyond the clinic to ensure that home exercises are performed with the same precision as under clinical supervision. Assisted by a specialist in the clinic, the wearable sensors and user interface developed allow the capture of individualized exercises unique to the patient’s physical abilities. Beyond the clinical setting, the system can assist patients by providing real-time corrective feedback to repeat these exercises through a correct and complete arc of motion for the prescribed number of repetitions. An inertial measurement unit (IMU) is used on the body part to be exercised to capture its pose. In this paper, we present a kinematics data processing approach to defining custom exercises with flexibility in terms of where it is worn and the nature of the exercise, as well as real-time corrective feedback parameters. The system is tested on two exercises performed by a healthy individual to demonstrate the feasibility and accuracy of the approach. We demonstrate how it can improve exercise adherence by assisting users in reaching the full prescribed range of motion and stay on the ideal plane of motion and improve hold time. Preliminary results from an ongoing clinical trial are presented