The relevance of posture as a constituent of physical health varies depending on one's explanatory framework of disease. Contrasting perspectives within this discussion refer to optimal biomechanics, but often without consistent meaning. The resulting theoretical confusion presents challenges both for applied research and clinical practice. We studied joint angle drift tendencies and sway-stabilizing synergy as indicators of optimality in relaxed bipedal standing. Sixteen subjects completed a series of 4-min bipedal standing trials under varying foot positions. Kinematic time series were segmented on the basis of multivariate changepoint location to quantify directional tendencies associated with slow, unintentional joint angle drifts. Subsequently, time series were segmented into shorter epochs and synergy indices describing center of mass stabilizing joint coordination were quantified for each epoch. Paired t-tests were used to assess the tendency of observed drifts to approximate common endpoints and "Random Effects Within Between" models were used to assess the relationship between synergy indices and Euclidean distance from individually defined drift targets. Our analyses suggest that 1) joint angles in relaxed bipedal standing tend to drift toward specific endpoints, and 2) greater deviation from these drift endpoints associates with greater COM-stabilizing coordinative synergy. We interpret these findings as supporting the presence of latent cost functions associated with individual sagittal joint angle configuration. We discuss our work in the context of the ongoing theoretical and clinical dialogue concerning optimal movement and the relevance of biomechanics in physical health.

Background and aims: In the recent years creatine has been shown promising results in patients with neurodegenerative diseases, myopathies and dystrophies. Cardiovascular diseases could be another pathology that can benefit from creatine supplementation, considering the influence on the risk factors associated with the development of cardiovascular diseases including reduction in chronic inflammation, and improved control of hyperglycemia and dyslipidemia The aim of the present study was to investigate the impact of short-term creatine supplementation on cardiac and vascular health in older adults. Methods: Males between the ages of 55-80 were randomly assigned to three groups: creatine, placebo and control. Creatine or placebo was provided for 7-day supplementation, at a dose of 20 g/day. Testing was performed at the same time of the day at baseline and on the eighth day. Vascular responses were assessed using an arterial pulse wave velocity equipment, while cardiac assessment was performed using an impedance cardiography device. Results: The placebo group was older (71.1 +/- 8.2 yr) compared to creatine (61.4 +/- 5.2 yr) and control (62.5 +/- 7.1 yr). Cardio-ankle vascular index improved just in the creatine group (8.7 +/- 0.5 to 8.2 +/- 0.5, p = 0.03). While the upstroke time of the placebo and control groups did not change after 7 days, the creatine group had a nonsignificant reduction, 178.9 +/- 26.5 ms to 158.4 +/- 28.6 ms, p = 0.07. Similar tendency was seen with the systolic blood pressures, while the placebo and control did not change, the creatine group showed nonsignificant improvement, especially on the right, 144.0 +/- 12.7 mmHg to 136.1 +/- 13.4 mmHg, p = 0.08. All three groups had similar responses in stroke volume (p = 0.61), contractility index (p = 0.64) and ejection fraction (p = 0.72). Conclusions: In older adults, acute creatine supplementation can positively affect vascular parameters of arterial stiffness and atherosclerosis. Creatine supplementation has the potential to serve as a potent adjuvant in the management of CVD for older adults. Clinical trial registration: clinicaltrials.gov; ID: NCT053294 80. Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism.

RATIONALE AND OBJECTIVES:Diagnostic momentum refers to ruling in a particular diagnosis without adequate evidence. As the field of physical therapy continues to transition more towards autonomous practitioners with direct access, there is a need to identify the effect of a physician diagnosis on a therapist's examination and treatment. The purpose of this study was to identify if diagnostic momentum exists in physical therapy and whether this phenomenon could affect the ability of the therapist to identify clinical red flags.METHODS:An online survey with randomized case scenarios was completed by 75 licensed practicing physical therapists. Participants received one of two scenarios: a case vignette where the patient was referred to physical therapy for left shoulder pain and presented with 'red flags' indicative of myocardial infarction, or a similar vignette with additional results from an exercise stress test that ruled out myocardial infarction. The subjects were asked if they would 'treat' or 'refer' to another healthcare provider and the reason behind their decision. Independent t-tests and χ2 analyses were conducted to understand the differences between the groups. A thematic analysis was used to explore the therapists' responses regarding the reasoning for their decision.RESULTS:There was no significant difference in clinical decision making based on age, gender, years of experience, advanced certification, primary caseload or primary practice setting. Among those who received the case without the stress test, 31.4% of participants indicated that they would refer, compared to 12.5% of the participants that had the additional stress test result included within their case. The presence of the negative stress test was indicated as the main reason for choosing to treat without referral by 65.7% of the subjects that received the additional stress test result.CONCLUSION:This study suggests that practicing physical therapists may be influenced by diagnostic decisions made by other clinicians, causing them to overlook signs and symptoms of possible myocardial infarction.

Older individuals have a higher risk for developing cardiovascular diseases, mainly from the age-related alterations in vascular wall structure and baroreceptor reflex sensitivity. A single bout of exercise has been demonstrated to improve vascular function, however most of the studies tested the effects after various protocols lasting 15 minutes or longer, while the acute effects were determined at 15 or 30 minutes after the exercise. PURPOSE: To examine the immediate effect of walking on vascular health of older males. METHODS: Arterial stiffness was determined using cardio-ankle vascular index (CAVI) measurements obtained from 19 non-smoker individuals (age: 65.6 ± 7.4 yr., BMI: 26.2 ± 2.8 kg/m2). Using pulse wave velocity, indication of atherosclerosis was determined from analyzing the upstroke time (UT) values. Oscillometric blood pressure (BP) values were also collected. All these variables were measured at baseline and after 10 and 20 minutes following a 10-minute walk on a treadmill at 6 km/h and 5% grade. RESULTS: Systolic BP changed from baseline (140.7 ± 16.5 mmHg) to 10 minutes (137.4 ± 15.9 mmHg) and 20 minutes (138.5 ± 16.4 mmHg) after exercise, p = 0.2. Diastolic BP was almost unchanged; 87.4 ± 10.4 mmHg at baseline, to 86.8 ± 10.4 mmHg and 87.7 ± 9.7 mmHg at 10 and 20 minutes, p = 0.7. CAVI continued to decrease after exercise, 8.0 ± 0.9 at 10 minutes, and 7.8 ± 0.9 at 20 minutes, from a baseline of 8.6 ± 0.9, p = 0.00003. UT fallowed the same trend as CAVI, decreasing to 170.5 ± 42.1 ms at 10 minutes, and 161.6 ± 42.4 ms at 20 minutes, from a baseline of 190.6 ± 44.6 ms, p = 0.01. CONCLUSION: A short bout of moderate aerobic exercise elicit acute changes in parameters of systemic arterial stiffness and atherosclerosis in older males. Long term and consistent performance of these aerobic sessions may cause reversible changes on the structural alterations of the vascular system caused by the aging process.

Background The Selective Functional Movement Assessment (SFMA) is a whole-body movement classification system that identifies non-optimal movement performance requiring further assessment. There needs to be more evidence specifying the training time required to obtain SFMA reliability for entry-level health care practitioners. Purpose The primary intent of this study was to determine SFMA inter-rater reliability between two third-year physical therapy students following an in-person three-hour training and one-hour follow-up training with a certified SFMA physical therapist. The secondary purpose was to compare rater scores of the composite criterion 50-point checklist and rater categorization using the top-tier movements in real-time assessments of healthy participants. Study Design Inter-rater reliability study. Methods Two novice raters received training on assessing movement using the SFMA. Participants included non-pregnant healthy adults screened for general exercise, participants were excluded for history of orthopedic surgery within the prior six months. Three independent raters, including two novice and one SFMA-certified rater, individually assessed the top-tier movements in separate rooms in real-time. Participants were randomly assigned a start location, and raters were blinded to each other’s criterion 50-point checklist and categorical scoring. Statistical analysis included a paired t -test, a repeated measures ANOVA, and a two-way, mixed absolute agreement ICC. Results Twenty-five participants (23.4 years ± 1.9; 72% female) completed the SFMA top-tier movements. Significant differences were identified with novice raters identifying fewer non-optimal movement patterns than the certified clinician. The intraclass correlation coefficient (ICC 2,1 ) was moderate (0.60, p <0.001) for all three raters on the 50-point criterion checklist scoring. Conclusion Third year physical therapy students were able to demonstrate moderate inter-rater reliability assessing healthy individuals using the 50-point criterion checklist. Variation between novice raters may reflect the amount of previous exposure assessing movement and suggests that some may require more time learning and practicing in order to identify non-optimal movement patterns that may require further assessment. Level of Evidence 3b

Creatine has been widely investigated for its bioenergetic role, however, recent research demonstrated its benefits for patients with neurodegenerative diseases, myopathies and dystrophies. In addition, creatine has been shown to impact risk factors associated with the development of cardiovascular diseases including reduction in chronic inflammation, and improved control of hyperglycemia and dyslipidemia PURPOSE: To investigate the impact of short-term creatine supplementation on vascular health in older males. METHODS: Nineteen subjects between the ages of 55-80 participated in the measurements if they did not report creatine use in the previous 3 months or any history of kidney disease. Vascular responses were assessed using a non-invasive arterial pulse wave velocity equipment. The study was double blinded with subjects randomized in three groups: creatine, placebo and control. Creatine or placebo was provided for 7-day supplementation, at a dose of 20 g/day. Testing was performed at the same time of the day at baseline and on the eighth day. Effect of creatine was calculated using analysis of covariance, with the baseline values as the covariate. RESULTS: The placebo group was older (70.1 ± 8.2 yr.) compared to creatine (62.4 ± 5.3 yr.) and control (64.5 ± 7.2 yr.). The BMI was lower in the placebo group (24.0 ± 2.5 kg/m2) compared to creatine (28.2 ± 1.9 kg/m2) and control (26.9 ± 2.1 kg/m2). Cardio-ankle vascular index improved just in the creatine group (8.7 ± 0.4 to 8.3 ± 0.5, p = 0.03). There was no difference in change of ABI between the groups, p = 0.9. While the upstroke time of the placebo and control groups did not change after 7 days, in the creatine group trended toward improvement, 179.7 ± 41.4 ms to 155.3 ± 36.0 ms, p = 0.08. Similar tendency was seen with the systolic and diastolic blood pressures; while the placebo and control did not change, the creatine group showed non-statistical improvement, 143.7 ± 11.7 mmHg to 139.7 ± 18.6 mmHg, p = 0.3, and 91.2 ± 7.6 mmHg to 88.2 ± 11.0 mmHg, p = 0.6. CONCLUSIONS: In older individuals, 7 days of creatine supplementation seems to positively affect vascular parameters of arterial stiffness and atherosclerosis. Creatine supplementation has the potential to serve as an effective antioxidant, reducing the vascular remodeling that contributes to atherosclerosis.

Clinicians frequently assess and intervene on postural alignment; however, notions of what constitutes good postural alignment are variable. Furthermore, the majority of current evidence appeals either to population norms or defines good postural alignment as the negation of what has been observed to correlate with pathology. The purpose of this study was to identify affirmative indicators of good postural alignment in reference to motor control theory. Electromyography (anterior leg, posterior leg, and trunk muscles) and motion capture data were acquired from 13 participants during 4 min bipedal standing trials in 4 conditions: control, − 10%, + 30%, and + 60% of subject-specific anterior limits of stability. Synergistic kinematic coordination was quantified via the uncontrolled manifold framework, and correlated neural drive was quantified in posture-relevant muscle groups (anterior, posterior, and trunk) via intermuscular coherence. Multilevel models assessed the effects of sagittal plane alignment on both outcomes. We observed a within-subjects fixed effect in which kinematic synergistic coordination decreased as subjects became more misaligned. We also observed within-subjects fixed effects for middle- and high-frequency intermuscular coherence in the posterior group (increased coherence with increased misalignment) and for trunk intermuscular coherence across all frequency bands (decreased coherence with increased misalignment). Our findings indicate that it may be possible to describe healthy postural alignment in light of referent control theory. Greater misalignment with respect to vertical is associated with compromises in synergistic control of posture and increased corticospinal drive to specific muscle groups. These results suggest that postural alignment may not simply be an empirical phenomenon.

The aim of the study was to determine the effects of proprioceptive training (PT) on balance, strength, agility and dribbling in adolescent soccer players. In this research, we included an experimental (n = 48) and a control (n = 48) group (CG) with 14 years old players. The experimental group (EG) participated in an 8 week PT program, with four 30 min sessions per week. The experimental program included 12 bosu ball exercises to improve balance, stability and strength which were grouped into two subprograms: the first not using the soccer ball, the second subprogram using the soccer ball. The subprograms were implemented alternately during 16 proprioceptive training sessions, on two types of firm and foam surfaces. Pre- and post-tests included the static balance [Balance Error Scoring System (BESS)], vertical, horizontal, and lateral jumping, and the completion of agility (“arrowhead”) and dribbling (“short dribbling”) tests. Regarding the total BESS score, the CG has demonstrated progress between the pre- and the post-test, with 0.780 ± 0.895, fewer errors, while the EG had 5.828 ± 1.017 fewer errors. The difference between the two groups was of 5.148 fewer errors for the EG who had practiced the proposed program of proprioceptive training. The highest difference registered between the pre- and the post-test was at the test “single-leg forward jump with the right leg”, with a result of 1.083 ± 0.459 cm for the CG and of 3.916 ± 0. 761 cm for the EG. Through the analysis of average differences between the pre- and the post-tests, we observe that, regarding the “Agility right side test”, the EG has progressed with 0.382 s in comparison with the CG; regarding the “Agility left side test”, the EG has progressed with 0.233 s compared to the CG; regarding the “Agility right and left side test”, the EG has progressed with 0.196 s compared to the CG; in the “Short dribbling test”, the EG has progressed with 0.174 s compared to the CG. The highest progress was made at the “Agility right side test”, of 0.402 s for the EG, while the CG registered 0.120 s. Most of the results in all tests for both experimental groups show an effect size ranging from small to medium. The progress made by the experimental group in all tests was statistically significant, while in the control group the progress was mostly statistically insignificant for p < 0.05. The results suggest that a PT program performed at about 14 years of age could be successfully implemented in the training regime of soccer players to improve components of fitness along with dribbling skills. The results of the study revealed that sports training on the foam surfaces determined a superior progress of the development of proprioception compared to the increased training on the firm surfaces.

Purpose: Fatigue may mimic suboptimal brain functioning seen after a concussion and lead to false-positive King-Devick (K-D) scores and decreased balance. The purpose of this study was to investigate if whole-body fatigue has an effect on K-D scores or postural sway. Method: A total of 38 healthy participants (20 females; age = 23.5 +/- 2.63 y; height = 170 +/- 0.1 cm; mass = 75.2 +/- 10.3 kg) volunteered for the study. Participants completed the King-Devick (K-D) test and the modified Clinical Test of Sensory Interaction of Balance (mCTSIB) on the Biodex BioSway(TM) Portable Balance System prior to and immediately following the completion of a fatigue protocol on a Concept2 Rower. Results: Half of the participants demonstrated a positive K-D test post-fatigue. Balance scores were poorer post-fatigue. No difference was found between participants based on history of concussion. Among the participants that had a positive post-fatigue K-D test, 71% had also a worse composite sway index score (chi(2) = 6.3, p = .02). Conclusions: Whole-body fatigue may negatively impact a person's ability to perform the K-D test and balance assessments. It is recommended that the athlete is allowed a period of time to accommodate for the acute effects of fatigue before administering these assessments following a suspected concussion.

Female gymnastic injuries range 2.2-2.5 per 1000 athletic exposures and usually involve lower extremities, specifically the ankle. Intrinsic risk factors include prior injury, age, and body mass index. Fear of injury or re-injury, often measured by the TSK-11, negatively impacts performance and contributes to poor rehabilitation potential. PURPOSE: To explore the impact of leg injury history on indices of ankle health in female gymnasts. METHODS: Female subjects 12-18 years old (n=30, age=13.03 ± 1.88 yr.) completed the Ankle Instability Instrument (AII) to assess perception of functional instability and the Tampa Scale for Kinesiophobia (TSK-11) to assess fear of re-injury/movement. Ankle flexibility was determined using dorsiflexion lunge test. Hip abductor strength was assessed for both legs in a side-lying position using a hand-held dynamometer. Participants were separated into two groups: those with leg injury history (n=17) and those without (n=13). Ankle (47%), knee (23%) and foot (18%) injuries were the most commonly reported. RESULTS: There was no difference in age (13.4 ± 1.8 yr. vs 12.6 ± 1.8, p=0.29) and BMI (18.1 ± 2.6 yr. vs 17.6 ± 2.9, p=0.62) between groups. Of gymnasts reporting a history of leg injury, 71.4% perceived a functional instability compared to 12.5% of those who did not report an injury, p=0.03. The two groups were similar on their TSK-11, 22.7 ± 6.1 vs 18.8 ± 6.0, p=0.23. Additionally, there was no difference in hip abduction strength (p=0.86 for right, p=0.96 for left) or ankle flexibility (p=0.45 for right, p=0.46 for left) between groups. CONCLUSION: Female gymnasts with a history of leg injury may perceive a functional instability; however, this does not translate to an increased fear of movement. Moreover, performance in outcome measures related to ankle stability is not affected by those injuries. Gymnastics may be a sport in which regular exposure to leg injuries does not cause residual symptoms affecting ankle performance. It could also be possible that the TSK-11 is not sensitive enough to measure fear of reinjury in young female gymnasts.

The lower quarter Y-balance test (YBT) assesses dynamic postural control in three reach directions. Deficits in dynamic performance have been shown to increase the risk for sustaining injuries. Larger hip abductor muscle strength (HAbd) has been related to reach distance performance in females 25-80 years; however, no studies have assessed associations between HAbd and YBT performance in female gymnasts. PURPOSE: To investigate the association between HAbd and dynamic balance in young female gymnasts. METHODS: Thirty competitive female gymnasts (age = 13.03 ± 1.88 yr; years of practice = 8.9 ± 2.5 yr) were tested during off season. Isometric strength of the hip abductors was assessed in a side-lying position for both legs using a hand-held dynamometer. Dynamic balance was determined using the YBT with subjects reaching as far as possible in the anterior, posteromedial and posterolateral directions. RESULTS: There was no correlation between bilateral hip abduction strength and YBT values (composite or various directions). Age was the only significant predictor for right or left hip abduction strength, R2 = 0.33, p = 0.001, and R2 = 0.36, p = 0.0002, respectively. Further analysis was conducted on two groups which were created based on an average menarche age of 12. Older girls (14.3 ± 1.5 yr.) had greater HAbd (right = 38.2 ± 12.1 vs. 28.8 ± 5.7, p = 0.01; left = 38.2 ± 11.8 vs. 29.8 ± 5.3, p = 0.009) than younger girls (11.3 ± 0.6 yr). YBT values were similar between young and old gymnasts. In the younger group, right HAbd was correlated with YBT right composite (r = 0.5, p = 0.05), with a trend towards correlation between left hip abduction strength and YBT left composite (r = 0.5, p = 0.09). CONCLUSION: In gymnasts, there may be a minimum degree of HAbd required to support dynamic balance performance. For younger ages, HAbd seems to play a greater role in dynamic balance performance; however, beyond a certain level, further increases in HAbd do not confer additional benefits to dynamic balance. This group-specific effect could be related to varying levels of gymnastics skill, puberty-associated changes in proportional strength and/or muscle mass, or both. It is also possible that YBT is not sensitive enough to asses dynamic balance challenges in a sport that requires consistent specialized balance training.

[Purpose] Determine if female adolescent soccer players with a history of concussion, impaired K-D scores, and pre-season subjective complaints of neck pain, dizziness, and headache were predisposed to additional risk of musculoskeletal or concussive injury during 10-weeks of competitive play. [Participants and Methods] Twenty-three female high school soccer athletes provided concussion history and reported pre-season subjective complaints. K-D testing was performed pre and postseason. During the 10-week season, all injuries, preventing participation in practice or game, were recorded. [Results] Six reported a history of concussion. Of those six, three injuries were reported, including two concussions and a hamstring strain. Baseline K-D scores were worse in athletes that had two or more pre-season subjective factors compared to those that did not have any. Moderate positive correlations were found between a history of concussion and the number of injuries and a history of concussion and K-D post-test scores. [Conclusion] Findings indicate that pre-season subjective factors of neck pain, dizziness and headache, history of concussion, and K-D potentially increased injury risk. Combining pre-season metrics both at baseline and during the course of the season may assist in better injury risk screening in-season or indicate suboptimal function due to cumulative effects.

Aim This study investigated the effects of upper extremity muscle fatigue on dynamic and static balance in young and old populations.Methods Static and dynamic balance was assessed in 20 males before and after an upper extremity (UE) fatigue protocol. Fatigue was achieved using an arm crank ergometer protocol, which consisted of 3-minute intervals of UE exercise, increasing by 25 watts in a range of 70-80 rpms, until exhaustion.Results The UE fatigue protocol did not negatively impact dynamic or static balance levels in either young or old populations. In fact, UE fatigue was shown to have a positive influence on dynamic balance in the posterolateral direction in the young population.Conclusion Although old population demonstrated preexisting balance impairments, UE exercise does not appear to further impair balance. Additionally, the influence on dynamic balance after UE fatigue in the young population may indicate a possible priming effect.

Currently there is no cure for the progressive movement disorders associated with Parkinson's Disease (PD). Pharmacological management of movement disorders in PD are associated with significant negative side effects. Exercise improves the efficacy of anti-parkinsonian medication, but does not ameliorate the side effects. Consensus on the optimal mode of exercise training or dosing to improve motor function for individuals with PD is lacking. The new concept of forced exercise is gaining traction in the literature as a mode of exercise which has the potential to improve motor function in individuals with PD. The purpose of this article is to review the effects of forced exercise on specific components of motor function that would help guide clinical decision making and exercise prescription for the PD patient population. Collectively, the evidence provided in this review suggests that forced exercise may be safely added as an ancillary therapy to the medical management of PD.

PURPOSE: Ankle sprains are common injuries which can progress to chronic ankle instability (CAI) and balance impairments. While objective data guide treatment for individuals with CAI, the patient’s subjective experience is often overlooked and not counted in the adoption of plan of care. Individual perception of ankle instability is an important factor and has the potential to influence presentation of sensorimotor impairments either through neuromotor or fear-avoidance mechanisms. The purpose of this study was to explore the contribution of perception of unilateral and bilateral CAI on a dynamic balance test. METHODS: Subjects were males and females 18-35 years old (n=25, age= 23.8 ± 1.8 yr.). All subjects completed the Cumberland Ankle Instability Tool (CAIT) to measure perceived ankle instability (lower CAIT scores are associated with greater perceived instability). Dynamic balance was assessed using 3 repetitions in each direction (anterior, postero-medial, and postero-lateral) of the Y-Balance Test (YBT). Asymmetries in CAIT scores and reach distances were calculated by subtracting right leg values from left leg values. Further comparisons were analyzed between groups of bilaterally highest (>80%) and lowest (<20%) combined CAIT scores. RESULTS: There was a significant positive moderate correlation between CAIT asymmetries and asymmetries in the anterior reach (r=0.526, p=0.007) and the posteromedial reach scores (r= 0.554, p=0.004). Significant differences were found between participants with the highest (n=5) and lowest (n=5) bilateral CAIT scores in right posteromedial reach (101.60 ± 9.91 vs 86.80 ± 5.89, p=0.02), right posterolateral reach (96.40 ± 7.70 vs 76.80 ± 4.87, p=0.001), and right composite score (89.96 ± 5.93 vs 78.44 ± 3.85, p=0.007). CONCLUSION: Subjects reporting increased perceived ankle instability demonstrated decreased YBT performance on the side of perceived instability. Decreased reach distances may be attributable to neuromuscular consequences of ankle injury, changes in movement strategy associated with apprehension, or both. In fact, the larger the perceived asymmetries the greater the performance deficits. These findings may help clinicians contextualize sensorimotor assessment results in patients with a history of ankle sprain.

BACKGROUND:The Modified Star Excursion Balance Test (MSEBT) and the Y-Balance Test- Lower Quarter (YBT-LQ) are utilized to assess dynamic postural stability. These assessments cannot be used interchangeably secondary to kinematic variations and performance differences. A Modified Y-Balance Test-Lower Quarter (MYBT-LQ) was developed to determine if a modification allows performance scores to be directly compared to the MSEBT.PURPOSE:The purpose of this research was to determine if reach distances were similar for young, healthy individuals between three different balance tests: the YBT-LQ, the MYBT-LQ, and the MSEBT.STUDY DESIGN:Repeated measures, descriptive cohort study.METHODS:Twenty-eight participants (17 males, 11 females) were recruited from a convenience sample of young, healthy adults. Participants completed all testing within a single session and performed three trials in each direction, on each leg, for all balance tests. Scoring performance was calculated for each balance test using the average normalized reach distance in the anterior, posterolateral, and posteromedial directions. A one-way ANOVA was used to compare between-subject posteromedial and posterolateral scores, while anterior scores were analyzed using a Kruskal Wallis test. The intraclass correlation coefficient (ICC) was used to determine within-subject participant performance reliability.RESULTS:Analyses indicated significant differences in the posterolateral and posteromedial reach directions between the YBT-LQ and MSEBT and between the MYBT-LQ and MSEBT, while no significant difference was found between the YBT-LQ and MYBT-LQ in any direction. No anterior reach differences were noted between any of the tests. Within-subject ICCs showed a very strong level of agreement between right and left anterior and right posteromedial reaches between all three tests, while only the YBT-LQ and MYBT-LQ demonstrated very strong agreement in all directions.CONCLUSION:Reach performance on the MSEBT differed from the performance on the YBT-LQ and MYBT-LQ in the anterior, posteromedial and posterolateral directions in this population. These findings further support the difference in motor control strategies used during these tests.LEVELS OF EVIDENCE:2c.

PURPOSE: Dual-tasking refers to concurrent performance of two physical or mental tasks. Considering the critical role of dual-tasking in daily life, it is important to develop interventions to improve its efficiency or slow down its decline with age or disease. The specific purpose of this research was to study the effects of single bouts of a moderate-intensity (MI) or high-intensity interval training (HIIT) exercise on the efficiency of the extended cognitive Timed Up and Go (ETUGcog) test, which involves concurrent performance of physical and mental tasks. METHODS: 17 males and females aged 23-35 years underwent two different single bouts of exercise sessions, a HIIT and a MI, on separate occasions, based on established protocols. Each session began with ETUGcog prior to exercise as pre-test. ETUGcog involves simultaneous performance of an extended version of Timed Up & Go test (the physical task), while counting backwards by sevens starting from a given number (the mental task). The post-tests were administered immediately after the exercise when the subject cooled down to 10% above resting HR (10%HR), and 24 hours later. The test parameters that were recorded are the number of correct responses while counting backwards until test completion, and time to complete test. RESULTS: Correct responses after a HIIT session were significantly higher than pre-test responses when tested at 10%HR (5.18 + 1.43 vs 4.24 + 1.82, p=0.02), and 24 hours later (5.82 + 2.24 vs 4.24 + 1.82, p=0.002). No such improvements were seen after a MI session, as correct post-test responses at 10%HR (5.18 + 2.98) and 24 hours later (5.06 + 2.75) were similar to pre-test responses (4.79 + 2.47), with p>0.05 in both paired comparisons. Also, the times to complete ETUGcog tests were not significantly different when comparing the pre-test to both post-test times, with p>0.05, in both types of exercise sessions. CONCLUSIONS: A single bout of high-intensity, but not moderate intensity exercise, might improve dual-tasking efficiency by increasing cognitive processing speeds, without delaying activity completion times, and improvements can last a full day. This could be due to neuroplastic improvements in brain’s cognitive areas in the prefrontal cortex, caused by blood flow increases sufficient with high intensity, but not with lower intensity exercise.

PURPOSE: The Sensory Organization Test (SOT) assesses impairments in postural control following acute concussion. Head Shake Sensory Organization Test (HS-SOT) is a superior test that challenges the vestibular system to help detect more subtle deficits missed by SOT. The purpose of this study was to assess the accuracy of the HS-SOT in identifying residual impairments of postural control in individuals with self-reported history of concussion. METHODS: The Ohio State University-Traumatic Brain Injury Identification Method (OSU TBI-ID) determined self-reported history of concussion while NeuroCom was used to perform HS-SOT. Twenty-nine subjects were included (11 males and 18 females, mean age 25.2 ± 3.7; history of concussion: n= 14, 5 males and 9 females, mean age 25.7±3.5; no concussion: n= 15, 6 males and 9 females, mean age 24.8±4.0). Independent T-Tests were completed to determine performance differences based on history of concussion. RESULTS: HS-SOT fixed surface equilibrium ratio was similar (p = 0.988) between those without a history of concussion (0.998 ± 0.024) and those with a history of concussion (0.998 ± 0.026). Furthermore, HS-SOT sway reference surface equilibrium ratio was also similar (p = 0.431) between those without a history of concussion (0.871 ± 0.128) and those with a history of concussion (0.9136 ± 0.160). Within subjects with a history of concussion, younger subjects (23.4 ± 0.8) had a lower sway index compared to older (30.3 ± 3.6) individuals (0.85 ± 0.11 vs 1.09 ± 0.16, p=0.021). In addition, the younger group trended toward a more recent history of a concussive event (4.7 ± 4.8 vs. 8.0 ± 3.4, p=0.25). CONCLUSIONS: There was no difference in HS-SOT in subjects with or without a history of concussion demonstrating an inability to detect performance impairments. Of those with a concussion, the HS-SOT significantly identified subtle performance deficiencies in younger individuals, suggesting that time from concussion tends to normalize sub-clinical deficits. This indicates that postural control impairments initially persist but resolve over time, which may place individuals at risk for injury during this window of recovery.

Ankle sprains are a common injury, with affected individuals often experiencing recurrent symptoms that can progress to chronic ankle instability (CAI). Balance impairments are routinely present in subjects with CAI. Changes in tissue structure of the anterior talofibular ligament (ATFL) and superior extensor ankle retinaculum (SEAR) may occur after an ankle sprain, and may contribute to impaired balance through altered proprioception. PURPOSE: To determine if ATFL/SEAR thicknesses were related to dynamic balance in individuals with CAI. METHODS: Subjects were 14 males and 15 females (Age= 24.52 ± 3.46 years). Ankle instability was assessed using the Cumberland Ankle Instability Tool (CAIT), with a cut-off score of 25 to define two groups: those with and without CAI. Real-time ultrasound was used to assess ATFL and SEAR thicknesses. Dynamic balance was measured with the Y Balance Test (YBT) and the NeuroCom® motor control and adaptation tests. For subjects with CAI, we analyzed stable versus unstable ankles; for those without CAI, we analyzed right versus left ankles. RESULTS: There was no difference in mean ATFL thickness (0.24 ± 0.03 vs. 0.22 ± 0.04 cm, respectively, p=0.21) or in SEAR thickness (0.09 ± 0.01 vs. 0.10 ± 0.02 cm, respectively, p=0.19) between the stable and unstable ankles in those with CAI. For those without CAI, there was also no difference between the right and left ATFL thickness (0.22 ± 0.06 vs. 0.20 ± 0.04 cm, p=0.14) or SEAR thickness (0.09 ± 0.01 vs. 0.09 ± 0.01 cm, p=0.95). There was no difference in YBT scores in those with or without CAI (p=0.21, p=0.89 respectively). Additionally, sway energy for upward or downward forces was comparable between those with and without CAI, (p=0.15, p=0.36). Similarly, composite latencies were also no different (p= 0.68). CONCLUSIONS: There was no relationship between ligament thickness and balance, supporting a multifactorial CAI rather than dependency upon tissue changes alone. Central nervous system sensory integration, neuromuscular control compensations, or psychosomatic reactions may be the ones affecting the balance more. Likewise, subject perception of ankle instability may not coincide with impaired dynamic balance. Finally, tests used to assess dynamic balance may not be sensitive enough to identify differences caused by CAI.