Search Results (632)

Background/Objectives: Peak force (PF) reflects maximal strength, while early rate of force development (RFD; 0–100 ms) indicates explosive neuromuscular output. The Athletic Shoulder (ASH) test is gaining popularity in overhead athlete profiling, but its use for assessing explosive strength in various shoulder positions is underexplored. This study compared PF and RFD at shoulder abductions of 180° (ASH-I), 135° (ASH-Y), and 90° (ASH-T) in baseball players. Methods: Seventeen male athletes (age 22.7 ± 4.2 years; height 186.3 ± 7.3 cm; body mass 83.9 ± 10.1 kg) performed isometric ASH tests with the dominant arm. PF, PF relative to body mass (PF/BM), and early RFD were analysed. Results: ASH I showed 25% significantly higher PF (182 ± 41 N), PF/BM (2.15 ± 0.39 N/kg), and 40% higher RFD (545 N/s) than ASH Y or T (all p < 0.001), which did not differ significantly. PF showed excellent reliability (ICC = 0.86–0.93); RFD showed moderate-to-good reliability (ICC = 0.75–0.81). Smallest worthwhile changes were ~5% for PF and ~15% for RFD. Conclusions: Maximal isometric shoulder strength and explosiveness were highest at 180° abduction in baseball athletes, with no significant difference between 135° and 90°. PF demonstrated excellent reliability, while early RFD showed moderate to good reliability and higher variability, highlighting the need for repeated measures. These findings provide specific position reference values and support the inclusion of multiple abduction angles in shoulder strength assessment to detect neuromuscular deficits and monitor training adaptations in baseball athletes. Full article

Population aging intensifies the demand for rehabilitation services, which are already suffering from staff shortages. In response to this challenge, the implementation of new technologies in physiotherapy is needed. For such a task, rehabilitation exoskeletons can be used. While designing such tools, their functionality and safety must be ensured. Therefore, simulations of their strength and kinematics must meet set criteria. This paper aims to present a methodology for simulating the dynamics of rehabilitation exoskeletons during activities of daily living and determining the reactions in the construction’s joints, as well as the required driving torques. The methodology is applied to the SmartEx-Home exoskeleton. Two versions of a multibody model were developed in the Matlab/Simulink environment—a rigid-only version and one with deformable components. The kinematic chain of construction was reflected with the driven rotational joints and modeled passive sliding open bearings. The simulation outputs include the driving torques and joint reaction forces and the torques for various input trajectories registered using IMU sensors on human participants. The results obtained in the investigation show that in general, to mobilize shoulder flexion/extension or abduction/adduction, around 30 Nm of torque is required in such a lightweight exoskeleton. For elbow flexion/extension, around 10 Nm of torque is needed. All of the reactions are presented in tables for all of the characteristic points on the passive and active joints, as well as the attachments of the extremities. This methodology provides realistic load estimations and can be universally used for similar structures. The presented numerical results can be used as the basis for a strength analysis and motor or force sensor selection. They will be directly implemented for the process of mass minimization of the SmartEx-Home exoskeleton based on computational optimization. Full article

STEM ideologies provoke environmental destruction from which deaf, disabled, and Indigenous people are uniquely targeted. Our analysis counteracts harms caused by governmental, industrial, and educational agents who weaponize STEM ideologies against downstream people, animals, plants, environments, and biogeochemical entities. We explore two research questions via a theoretical framework about biocultural deaf gains and deaf/Indigenous languacultures to center the arts in STEAM. As a result, we synthesized a conceptual framework called Deaf and Indigenous Curricula and Eco-pedagogies (DICE), which are multimodal, multilingual approaches to STEAM education emphasizing place-based ecology and the arts, including knowledge emanating from Indigenous Deaf Cultures, Indigenous sign languages, and epistemologists who are deaf, disabled, women, and Indigenous (singly or in combination). DICE is designed to reinvigorate communities and ecologies at risk of destruction from colonialism and runnamok capitalism. Within and across Indigenous and Deaf lifeworlds, our model explores: collaboration, mutualism, and symbiosis. These are situated in examples drawn from the research, abductive reasoning, our life histories, and the creative works of Deaf Indigenous scientists and artists. In sum, alongside uprising Indigenous voices, deaf hands shall rise in solidarity to aid Earth’s defense. Full article

Background: Anal squamous cell carcinoma is a rare disease strongly associated with the human papillomavirus (HPV) and preceded by the premalignant anal squamous intraepithelial lesion (ASIL). High-resolution anoscopy (HRA) using a colposcope is considered the gold standard for detecting and managing ASIL. Despite being recommended in current guidelines for anal cancer screening, HRA availability remains limited. Although generally well tolerated, concerns about follow-up adherence persist. We have developed an endoscopic technique using high-resolution flexible endoscopes for detection, resection, and screening of ASIL. Our previous research suggests that this method is effective and gentle, but patients’ experiences of this approach remain underexplored. The aim of this study was to explore patients’ experiences of endoscopic detection, treatment, and screening of anal squamous intraepithelial lesions. Method: A qualitative approach was used involving semi-structured interviews and abductive qualitative content analysis. The 32-item COREQ checklist guided the reporting of the study. All participants followed a standardized protocol for treatment and follow-up. Results: Analysis of 16 interviews (female n = 7, male n = 9, age 19–72 years) yielded four categories: a comforting encounter in an exposed situation (with four subcategories); impact on intimate relationships (with one subcategory); living with uncertainty (with four subcategories); and physical discomfort (with two subcategories). Conclusions: High-resolution endoscopy is a well-tolerated and effective diagnostic and therapeutic modality for ASIL. However, the psychological impact of HPV-related conditions highlights the need for appropriate psychosocial support. These findings underscore the importance of integrating patient-centered care principles into the implementation of novel diagnostic and therapeutic technologies. Full article

Objective: Head-to-head evidence comparing closed-kinetic-chain (CKC) and open-kinetic-chain (OKC) training on balance in middle-aged women with knee osteoarthritis (KOA) is limited. Purpose: To compare 10-week hip abduction/external rotation-focused CKC versus OKC on static and dynamic balance. Methods: Twenty-two women with KOA were randomized to CKC (n = 11) or OKC (n = 11) and trained twice weekly for 10 weeks. The primary outcome was the center of pressure (COP) during single-leg stance (AP/ML range, excursion, velocity, and RMS); the secondary outcome was the Y-Balance Test (YBT) composite score. Results: CKC produced significant within-group reductions across all COP variables and significant YBT increases for both affected and unaffected limbs (p < 0.05). OKC showed only small changes in select COP indices and no meaningful change in YBT. Post-intervention between-group comparisons consistently favored CKC for AP/ML and total COP excursion/velocity and for the YBT composite score (p < 0.05). Conclusions: Under weight-bearing conditions, a hip-focused CKC program that promotes multi-joint coordination and co-contraction yields broader and more consistent improvements in postural stability and dynamic balance than OKC in middle-aged women with KOA. These findings support prioritizing CKC when rehabilitation aims include gait and functional stability. Full article

The barbell back squat, a prevalent lower-limb resistance exercise characterized by a closed kinetic chain and multi-joint movement, results in the greatest knee joint range of motion. Variations in thigh and shank lengths and their ratios may influence knee joint mechanics. This study investigated the effects of thigh and shank lengths and their ratios on knee kinematics and kinetics during the barbell back squat. Fifty resistance-trained adult men participated. Kinematic and kinetic data were collected using an eight-camera motion capture system and two force plates. Correlation and simple linear regression analyses were conducted to evaluate the relationships between thigh and shank length parameters and knee joint mechanics. Greater thigh length was significantly associated with increased anterior knee displacement and knee extension moment. Additionally, longer shank length and a higher shank-to-thigh ratio were associated with greater knee abduction and internal rotation angles. Consequently, increased thigh length may contribute to greater anterior knee displacement, while increased shank length may be associated with increased knee abduction and internal rotation. Accordingly, trainers and trainees should evaluate individual thigh and shank lengths. For participants with relatively longer shank and thigh segments, compensatory knee movements should be closely monitored to mitigate the risk of musculoskeletal injuries. Full article

The assessment of shoulder stability is a great challenge in sports medicine. There is a lack of objective tools to assess functional shoulder stability in sports with high demands on the upper limb. This cross-sectional study recruited twenty healthy adults to analyze the use of a force platform in a push-up analysis as a valid tool for estimating glenohumeral stability. For this purpose, the subjects performed one strength task based on a maximum lateral abduction against a dynamometer. They also performed three variations of a push-up task on force plates with movements recorded by a 3D motion capture system. The results showed that healthy adults present similar movement patterns during push-ups, without differences in terms of stability between sexes, although males showed greater values in lateral abduction strength (left: 63.2 vs. 36.8; p < 0.001; right: 64.2 vs. 38.9; p < 0.001) and ground reaction force peak in the three push-up tasks (p < 0.005). Moreover, four prediction models were developed based on the use of force plate data to estimate kinematics concerning humerus acceleration (p < 0.001). In conclusion, this research demonstrated that force plates are a valid tool for upper-limb assessment with significant correlations with dynamometer and 3D motion capture measures. Full article

Background/Objectives: Although considerable progress has been made in understanding lateral ankle sprains (LAS) and chronic ankle instability (CAI), recurrent injury rates remain high. This highlights the need to explore additional contributors such as comprehensive lower-limb gait analysis, including multisegmented foot models and proximal joint kinematics and strength. This study aimed to assess multisegmented foot and lower-limb kinematics throughout the gait cycle in individuals with CAI compared to healthy controls. Additionally, associations between hip abductor strength and frontal plane ankle kinematics were examined. Methods: Fifty males (25 with CAI and 25 healthy controls) participated in this cross-sectional study. Gait analysis was conducted using a BTS SMART 3D motion capture system to assess multisegmented foot and proximal joint kinematics. Isometric hip strength was measured using a Biodex dynamometer. Statistical Parametric Mapping (SPM) was used to assess group differences, and correlations were calculated between hip abductor strength and ankle kinematics. Results: The CAI group demonstrated significantly greater calcaneus abduction relative to the shank in the transverse plane between 88% and 93% of the gait cycle (MD = −3.50°, 95% CI [−5.60, −1.40], d = −0.95, p = 0.037). No other statistically significant between-group differences in hip, knee, or foot segment kinematics were detected. Furthermore, correlations between hip abductor strength and ankle frontal plane kinematics were not significant. Conclusions: Males with CAI demonstrated altered rearfoot kinematics in the transverse plane during the terminal swing phase. The multisegmented foot model was valuable in detecting subtle deviations and emphasized the importance of including the swing phase. Hip abductor strength was not associated with ankle kinematics, suggesting that its potential role in CAI may involve other mechanisms. These findings may support clinical gait assessment and rehabilitation planning by highlighting the importance of evaluating all foot segments and the entire lower limb, rather than focusing solely on the ankle joint. Segment-specific deviations, particularly those emerging during the swing phase, may help guide targeted interventions aimed at improving foot positioning in males with CAI. Full article

Background: Blood Flow Restriction (BFR) training may be an alternative when traditional heavy-load training is unsuitable. This study compared BFR with light loads to traditional strength training for shoulder muscle development proximal to the occlusion site; Methods: A total of 22 healthy adults were randomized into Group A: BFR training (30% 1RM; n = 12) and Group B: Traditional strength training (70% 1RM; n = 10). Four-week protocol (2 sessions/week) included shoulder abduction and lateral rotation, and dumbbell overhead press. Arm circumference, Single Arm Seated Shot-Put Test (SAASPT), vertical lift strength (VLS) and Shoulder Endurance Test were assessed at baseline and at the end of the protocol. Cohen’s d effect size was calculated for significant outcomes; Results: Significant gains occurred in both groups across most parameters. The magnitude of effects was, in Group A, large on Arm circumference and SASSPT (Cohen’s d = 0.870 and 1.158, respectively) and very large in VLS and SET (Cohen’s d = 1.284 and 1.301, respectively). In Group B, the magnitude of effects was large in SASSPT and VLS (Cohen’s d = 0.962 and 0.922, respectively) and very large in SET (Cohen’s d = 1.238); Conclusion: BFR training with light loads effectively improved musculature proximal to the occlusion site, demonstrating comparable strength gains to heavy-load training in healthy individuals. Full article

Background: Hip migration is a common comorbidity in children with cerebral palsy (CP) and can progress to complete hip dislocation, resulting in a reduced quality of life. Structured surveillance programs designed to prevent complete hip dislocation have demonstrated success regarding the early identification of hip migration. The objectives of this study are to determine whether there is a correlation between hip abduction in flexion (AIF) and migration percentage (MP) and to determine if there are clear cutoff values for hip abduction in flexion that are associated with progressive hip migration. Methods: This retrospective study evaluated children at our neuromuscular clinic between 2018 and 2022. We included children diagnosed with spastic CP for whom hip radiographs and concurrent physical examinations were available. The outcomes were assessed using AIF as a measure of range of motion and migration percentage according to Reimers. Results: In total, 83 patients were included, with a mean MP of 30.7% and a median AIF of 40 degrees. Mixed-effects modeling revealed a significant correlation between MP and AIF (β = −0.51, p < 0.001). Using generalized linear mixed-effects models and ROC analysis, we established a cutoff value of 40 degrees for AIF in predicting MP above 30%, with a sensitivity of 94.5% and a specificity of 80%. Conclusions: A negative correlation between AIF and MP was found, indicating that as AIF decreases, MP increases. Furthermore, a distinct cutoff value of 40° for AIF in progressive hip migration was found, which can guide timely referrals and early imaging. Full article

(1) Background: Several tools have been proposed to measure elastic band tension and time under tension (TUT) during elastic band exercise performance. However, current methods are often indirect, non-objective, or expensive. The Elastic Force Evaluation Bracelet (EFEB) is a simple, wearable system designed to estimate both variables. Therefore, the aim of this study was to evaluate the concurrent validity and test–retest reliability of the EFEB as a portable measurement device for application in a therapeutic exercise context. (2) Methods: Thirty-five healthy volunteers were recruited. Exercises with elastic bands were performed on the dominant upper and lower limbs in two sessions with a one-week interval between them, and peak elastic force values were obtained. Validity was assessed in the first session by comparing the force values obtained simultaneously using a force gauge, and the TUT compared to a linear encoder. Test–retest reliability was examined by comparing the measurements obtained between the two sessions. (3) Results: EFEB showed excellent correlation with the force gauge for elastic force (r = 0.883 for shoulder abduction and r = 0.981 for knee extension) and with the linear encoder for TUTs (r = 0.873 and r = 0.883, respectively). EFEB showed good levels of reliability for all four of the following parameters measured: elastic force for shoulder abduction and knee extension (ICC = 0.880 and 0.855, respectively), and TUT in both movements (ICC = 0.768 and 0.765, respectively). (4) Conclusions: In conclusion, EFEB is a valid and reliable device for the measurement of TUT during shoulder abduction and knee extension exercises performed with elastic bands. Full article

Background: Subacromial impingement or pain syndrome (SAPS) is the most common diagnosis for chronic shoulder pain. Current surgeries do not reduce long-term pain, suggesting they miss the root etiology. Previously, we described the Human Disharmony Loop (HDL), where the unique lower trunk innervation to the pectoralis minor (PM) causes scapular dyskinesis and deforms its connections, including tugging the acromion down and impinging the subacromial structures. We hypothesize that SAPS patients who meet HDL criteria would benefit significantly from PM tenotomy with infraclavicular brachial plexus neurolysis (PM + ICN) alone. Methods: SAPS patients who met HDL diagnostic criteria were treated with PM + ICN, with secondary distal neurolysis if needed. Outcomes included pain and shoulder abduction ROM. Six-month follow-up minimum was required. Results: N = 140 patients were included. Median age was 49. Prior surgeries included 27% subacromial decompression/acromioplasty, 21% rotator cuff repair, 16% biceps tenodesis, 4% SLAP repair, 2% labral repair, 7% distal clavicle resection, 10% reverse total shoulder arthroplasty (rTSA), 1% rib resection with scalenectomy, 16% cervical spine fusion, 28% distal neurolysis. Median pain decreased from 8 to 2 and median shoulder ROM increased from 90 to 180 degrees. Positive impingement signs on exam decreased from 100% to 11%. (p < 0.01) Conclusions: In a large series of SAPS patients, evaluation and treatment for the HDL significantly reduced pain and restored motion. These findings suggest that in many patients SAPS may be a subset of the HDL: the ventral PM disturbing the scapula constitutes the anatomic basis and optimal surgical target behind SAPS. Full article

This study investigated the relationships between inspiratory performance (IP) and glenohumeral rotation in Division 1 Collegiate baseball players (D1CBP). Thirty D1CBP were recruited. The Test of Incremental Respiratory Endurance (TIRE) provides maximal inspiratory pressure (MIP), sustained maximal inspiratory pressure (SMIP), and inspiratory duration (ID). Right and left glenohumeral internal and external rotation (RGHIR, RGHER, LGHIR, and LGHER, respectively) were measured with the shoulder in 90 degrees(d) of abduction. Significant differences between position groups were observed. IP of the entire group was significantly correlated to height, weight, and negatively correlated to right total rotational motion (RTRM) (r = −0.41; p < 0.05). The IP of all pitchers was significantly negatively correlated to both RTRM and LTRM (r = −0.56 to −0.61; p < 0.05). IP of right-handed pitchers was significantly correlated negatively to RGHER (r = −0.83 to −0.93; p < 0.05). IP of left-handed pitchers was significantly correlated negatively to LGHER (r = −0.82; p = 0.04). GH motions are significantly related to the IP of D1CBP. This association may be explained by the involvement of overstretched internal rotators, which act as accessory inspiratory muscles. Full article

The treatment of shoulder dysplasia resulting from brachial plexus birth injury (BPBI) remains a matter of debate within pediatric orthopedic and neurosurgical communities. Various approaches have been proposed to address the muscular imbalance and joint incongruity that develop in affected children, with special attention paid to the roles of humeral head reduction and tendon transfers. Background/Objectives: These procedures aim to correct the disproportionate strength between internal and external rotators of the shoulder. However, the specific contribution of skeletal procedures such as glenoid osteotomy to restoring shoulder mechanics remains controversial. Glenoid osteotomy, a technique that involves surgically reorienting the glenoid cavity, is hypothesized to promote better containment of the humeral head and allow more physiological joint development. On one hand, altering the glenoid axis could enhance joint congruency and facilitate remodeling during growth. On the other hand, there is limited evidence supporting its efficacy and safety. Methods: This review aims to assess the available literature to determine whether glenoid osteotomy represents a safe and effective procedure for patients with BPBI-associated shoulder dysplasia. A comprehensive literature search yielded 1380 titles. After excluding studies focused on adults and those failing to meet inclusion criteria, only three studies were selected for final analysis. Due to the limited data and variability in study design, no statistical meta-analysis could be performed. Results: Findings suggest that glenoid osteotomy, particularly when combined with tendon transfers, may lead to improvements in shoulder abduction and external rotation. However, outcomes are often difficult to interpret in isolation, and the specific benefits attributable to the osteotomy remain unclear. The lack of standardized imaging, follow-up, and scoring systems limits the strength of current conclusions. Conclusions: Further multicenter, prospective studies are needed to evaluate the long-term efficacy of glenoid osteotomy, its role in skeletal remodeling, and its contribution to overall shoulder stability and function. Such studies would help clarify the true potential of this surgical technique in the broader context of BPBI treatment. Full article

Background/Objectives: This study investigates the benefits of incorporating stem cell therapy into arthroscopic rotator cuff repair by evaluating its impact on postoperative pain and functional recovery. Methods: A retrospective, comparative analysis was conducted with a small cohort of patients undergoing rotator cuff surgery, divided into two groups: one receiving adjunctive combined PRP and bursal stem cell therapy and the other undergoing standard arthroscopic repair alone. The outcomes were assessed using visual analog scale (VAS) scores for pain and the Constant–Murley score (CMS), which includes strength of abduction, VAS pain, limitation and range of motion, evaluated at baseline, 1, 2, 3 and 6 months postoperatively. Results: Patients in the stem cell group experienced significantly greater reductions in pain scores and more substantial improvements in functional scores at the follow-up points compared to the control group. A linear mixed-effects analysis showed that in the early postoperative period, the use of PRP and bursal stem cell therapy was associated with significantly reduced postoperative VAS pain scores (F 4.8, p = 0.045) and an increased CMS regarding postoperative pain (F 8.6, p = 0.01), alongside painless elevation level (F 6.5, p = 0.022), forward flexion (F 8.5, p = 0.01) and abduction scores (F 8.3, p = 0.011). The effect of PRP and bursal stem cell therapy remains constant during late follow-up, from the fourth to sixth postoperative month, with postoperative CMS regarding pain remaining statistically significantly higher in the stem cell therapy group (F 4.8, p = 0.008), alongside reduced night-time pain (F 7.4, p = 0.015), improved recreation ability (F 4.8, p = 0.044) and reduced activity restriction (F 5.8, p = 0.028). Conclusions: The findings suggest that the addition of stem cell therapy to arthroscopic rotator cuff repair may enhance postoperative recovery by alleviating pain and promoting functional gains. Full article