Background. Australian inpatient rehabilitation facilities are increasingly integrating rehabilitation technologies to support patient recovery. However, little is known about patient perceptions of rehabilitation technologies and the intensity of therapy able to be facilitated. This study aimed to quantify the amount of practice being achieved by patients in an Australian inpatient rehabilitation setting and explore their perceptions of upper limb rehabilitation technologies. Methods. A multimethod study design was used to investigate the perceptions and use of rehabilitation technologies (i.e. InMotion, Fourier ArmMotus, SaeboReJoyce and Touch Accessible Platform for Interactive Technology) by adult inpatients. Semi-structured interviews and the System Usability Scale were completed. Observations of routine therapy sessions were undertaken to quantify the amount and intensity of technology-based practice. Results. Ten participants were recruited (50% male, mean age 62 years). A total of 15 sessions were observed across all participants using robot-assisted therapy and Touch Accessible Platform for Interactive Technology at an average duration of 35 min/session; of which 29 min was active therapy. Most participants described their experiences with rehabilitation technologies positively, highlighting benefits for recovery, enjoyability and easy usability. Participants rated the technologies highly on the System Usability Scale, with total scores ranging between 65 and 100 for usability, and a minimum rating of 'good' for user-friendliness. Conclusion. Rehabilitation technologies were well received by adults undergoing inpatient rehabilitation and with application for a range of impairments. The technologies facilitated enjoyment of daily therapy, and participants were comfortable with limited therapist input when using the devices. Additionally, participants were able to engage in highly intensive practice using the technologies.

Background: Caseload management is a core component of physiotherapy practice and a required competency for professional registration. However, there is limited understanding of how it is navigated during clinical practice placements and to what extent current practices prepare students for new graduate practice. Aims: To investigate how clinical practice placements prepare physiotherapy students for caseload management, focusing on experiences and perceptions of students and clinical educators. Methods: A qualitative research design employing reflexive thematic analysis was utilised to analyse data gathered from six semi-structured focus groups comprising pre-registration physiotherapy students in clinical practice placements (n=19) and semi-structured one-on-one clinical educator interviews (n=19). Results: Four key themes were generated: 1. Variable interpretations of caseload management; 2. Navigating the complexities of caseload management; 3. Realising caseload management matters; and 4. Preparation prior to clinical practice placements is crucial. Conclusion: This study provides insights into caseload management opportunities during clinical practice placements, from clinical educator and student perspectives. Exposure to caseload management varies significantly, often contextual and opportunistic, shaped by educators' perception of individual student capabilities. Findings emphasise the need for physiotherapy training to ensure equitable learning and exposure to practice, fostering core competencies required for new graduates in caseload management.

OBJECTIVES:Deficits in vestibulo-ocular function have been reported in athletes following concussion and in healthy developing adolescent athletes. There is a known increase in injury risk in athletes returning to sport following concussion; however, the relationship between vestibulo-ocular dysfunction in adolescents and injury risk is unknown. The aim of this study was to determine i) the prevalence of vestibulo-ocular dysfunction and ii) the relationship between vestibulo-ocular dysfunction and playing season injuries in adolescent rugby union players. DESIGN:Cross-sectional. METHOD:Seventy-one male adolescent rugby union players were recruited from four schools in Queensland, Australia. In the preseason, clinical assessments of oculomotor and vestibular function were conducted. 'Time-loss' injuries were recorded during the season. Statistical analysis was conducted using Pearson's chi-square test with significance set at p < 0.05. RESULTS:In preseason assessment, 40 players (57 %) had one or more, and of these, 18 players (25.7 %) had two or more positive vestibular and oculomotor findings indicating vestibulo-ocular dysfunction. There were 39 injuries sustained by 33 players during the season. No between group differences for vestibulo-ocular function were found between players who did and did not sustain an in-season injury (p = 0.55). CONCLUSION:Vestibulo-ocular dysfunction is common in male adolescent rugby union players and positive findings should include comparison with baseline function or symptom profile. The wider impact of vestibulo-ocular dysfunction on sporting performance in adolescents is unknown.

Background: Clinical practice placements play an important role in preparing students for challenging areas of clinical practice. Little is known about student learning needs for working with patients with complex needs during clinical practice placements, and clinical educator decision-making that underpins this exposure. Purpose: To explore the perspectives of physiotherapy students and clinical educators on exposing students to working with and learning from patients with complex needs during clinical practice placements across Queensland and New South Wales, Australia. Methods: Six semi-structured focus groups with pre-registration physiotherapy students undertaking clinical practice placements (n = 19) and semi-structured one-on-one interviews with clinical educators (n = 20). Data were analyzed using reflexive thematic analysis. Results: Four overarching themes were generated following analysis: 1) Complexity is challenging; 2) Tension between student exposure and patient care; 3) Variance in expectations; and 4) Readiness for complexity. Conclusion: Physiotherapy students and clinical educators recognize the challenges and importance of exposure to patients with complex needs. Student learning experiences are influenced by clinical educator decision-making, which is often unclear, leading to varying opportunities. This study highlights the need for enhanced support from clinical educators to prepare students for working with patients with complex needs.

Objective Fostering a research culture and enhancing research capacity within the workforce is essential for any health service aiming to provide evidence-based care. This study aims to explore the research culture and capacity in a community health service setting and provide a comparison to previous published research in other health service settings. Methods Participants were invited to complete a survey consisting of demographics and the Research Capacity and Culture (RCC) tool. Median and interquartile ranges were calculated for each RCC item and compared to three Australian and one international comparison. Results A total of 73 staff members from Metro North Community and Oral Health service participated. The team-level scores for the RCC were overall the lowest. Comparison to previously published research using the RCC indicated marginally higher scores for individual-level items in our study across all domains. Individual-level items were very weak to weakly correlated with the team and organisation-level RCC items. Strong to very strong correlations were found between a majority of the team and organisation-level items. Conclusions Team-level scores were substantially lower when compared to individual and organisational levels. The item 'team leaders that support research' was positively correlated with various organisation-level items, indicating that if the respondent perceived the team leader as a low supporter of research the respondent perceived several organisation items also poorly. As an important stakeholder in enabling research in a health service, organisations should investigate the challenges experienced by team leaders in facilitating research and the support or training they may need.

BACKGROUND:Traumatic life experiences (TLE) are common and can affect a person's physical being and health-related behaviors, including those related to oral health. This scoping review aimed to identify evidence exploring the implementation and provision of trauma-informed care (TIC) in oral health services delivery. METHODS:Arksey and O'Malley's framework with enhancements proposed by Levac et al. and Peters et al. was used. Studies were selected based on a preset inclusion and exclusion criteria and the population/concept/context framework. Primary charting of descriptive data was conducted, followed by thematic analysis to identify ideas common within the included literature. Searches were conducted in Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases. Google Scholar and ProQuest were used to identify grey literature. RESULTS:The search identified 251 records, with fifteen records meeting the inclusion criteria. Limited models, frameworks, and recommendations for trauma-informed practices in oral health services were identified. Recommendations for TIC practices were identified, and clinical practice adjustments for dental practitioners were described to improve service delivery for patients who may have experienced trauma. Avenues for future research were identified. CONCLUSIONS:Limited evidence exists to guide trauma-informed practice in oral health service delivery. This scoping review highlights the need for further research into approaches and practices of TIC for oral health services delivery to assess their efficacy and the need to develop evidence-based TIC frameworks to meet the unique needs of oral health service providers and populations.

Introduction A prior study examining perceptions of Allied Health Professions (AHP) telehealth services at a metropolitan hospital highlighted multiple issues impacting service uptake, operationalisation, and delivery. Concept mapping methodology was utilised to address these issues and prioritise actionable telehealth service improvements. Methods Representatives (n = 22) from seven AHP departments and consumers generated statements addressing the question: ‘What do we need to do to enhance and sustain telehealth services?’ Statements were synthesised and then clinicians and managers sorted them into similar groups and assigned each statement a ranking of perceived (a) importance and (b) changeability. Multivariate and multidimensional scaling was undertaken to develop a final prioritised set of goals for change. Results Ninety-six unique statements were generated as actionable goals for change. Statements were grouped into 13 clusters relating to improvements in staff support, infrastructure, consumer support and organisational processes. All clusters were rated >50% for importance (range 3.3–2.4 out of 4) and changeability (range 2.6–2.1 out of 4). Twenty-six statements were ranked highest for importance and changeability. Key prioritised areas were staff training, consumer advocacy and engagement, telehealth operations and workflow. Conclusion Concept mapping was an effective process for generating a prioritised list of actions to enhance AHP telehealth services.

Background: The pathophysiology of concussion is complex. Altered sensorimotor function post-concussion may contribute to the wide range of symptoms and impairments reported. There is currently limited evidence documenting changes in sensorimotor function during the recovery period. The aim of this study was to investigate the effect of concussion on the sensorimotor system in adolescents post-concussion using a multifaceted approach. Study design: Prospective nested case-control study. Methods: A total of 285 male adolescent rugby players underwent assessment of sensorimotor function during preseason. Players who sustained a concussion during the season and control players, matched for age and playing position, were assessed in the subacute period (3-5 days) and after return-to-sport (3 weeks). Tests of sensorimotor function included balance, cervical spine and vestibulo-ocular function, and measurement of the size and contraction of lumbopelvic muscles (ultrasound imaging). Results: Twenty-three players (8%) sustained a concussion. Of these, 20 players were assessed during the subacute period and 17 players following return-to-sport. The prevalence of vestibulo-ocular dysfunction increased from 38.9% to 72.2% during the subacute period and dysfunction was present in 83.3% of players after return-to-sport (p = 0.01). Changes in lumbar multifidus muscle size (p = 0.002) and thickness (p = 0.05) at the L5 vertebral level were observed. No statistically significant changes in balance, cervical spine proprioception, or contraction of lumbopelvic muscles were found (p > 0.05). Conclusion: Changes in sensorimotor function were observed in the subacute period post-concussion, with some persisting after return-to-sport. Using symptom-based criteria for return-to-sport may not adequately reflect the sequelae of concussion on the sensorimotor system.

CONTEXT Aquatic plyometric training may provide benefits due to reduced joint loading compared with land plyometric training; however, the reduced loading may also limit performance gains. OBJECTIVE To systematically review the effect of aquatic plyometric training on strength, performance outcomes, soreness, and adverse events in healthy individuals. EVIDENCE ACQUISITION Five databases were searched from inception to June 2020. Quality assessment and data extraction were independently completed by 2 investigators. When similar outcome measures were used, standardized mean differences were calculated. EVIDENCE SYNTHESIS A total of 19 randomized controlled trials with 633 participants (mean age, range 14-30 y) were included. Aquatic plyometric training was most commonly performed in waist to chest deep water (12/19 studies), 2 to 3 times per week for 6 to 12 weeks (18/19 studies), with final program foot contacts ranging from 120 to 550. Meta-analyses were not completed due to the clinical and statistical heterogeneity between studies. Compared with land plyometric training, aquatic plyometric training exercises and dosage were replicated (15/16 studies) and showed typically similar performance gains (3/4 knee extensor strength measures, 2/4 leg extensor strength measures, 3/4 knee flexor strength measures, 7/10 vertical jump measures, 3/3 sprint measures). In total, 2 of 3 studies monitoring muscle soreness reported significantly less soreness following training in water compared with on land. Compared with no active training (no exercise control group or passive stretching), most effect sizes demonstrated a mean improvement favoring aquatic plyometric training (23/32 measures). However, these were not significant for the majority of studies measuring isokinetic knee strength, vertical jump, and sprinting. The effect sizes for both studies assessing leg press strength indicated that aquatic plyometric training is significantly more effective than no training. CONCLUSION Aquatic plyometric training appears similarly effective to land plyometric exercise for improving strength, jumping, and sprinting and may be indicated when joint impact loading needs to be minimized. However, the low quality of studies limits the strength of the conclusions.

The patient, clinician and administration staff perspectives of telehealth (specifically videoconferencing) services provided by Allied Health Professions (AHP) at a large quaternary hospital were explored. The purpose was to understand stakeholders’ perceptions of the service during initial COVID-19 restrictions and examine factors that influenced the implementation and sustained use of telehealth. A sequential mixed-methods approach was undertaken. Stage 1 involved surveys completed by patients (n = 109) and clinicians (n = 66) who received and provided care via telehealth, respectively, across six AHP departments. Stage 2 involved focus groups with clinicians (n = 24) and administrative staff (n = 13) to further examine implementation and sustainability factors. All participant groups confirmed that telehealth was a valid service model and valued the benefits it afforded, particularly during COVID-19 restrictions. Both patients and clinicians reported that not all AHP services could be delivered via telehealth and preferred a blended model of telehealth and in-person care. Increased administrative staff assistance was needed to support growing telehealth demand. Main factors to address are the need to expand AHP telehealth models and workforce/patient training, improve workflow processes and enhance technical support. Despite rapid implementation, telehealth experiences were overall positive. Study findings are being used to generate solutions to enhance and sustain AHP telehealth services.

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Objectives: To determine the typical proportions of diagnoses for patients presenting with dizziness or vertigo based on clinical speciality and to assess the change in proportions of diagnoses over time. Data Sources: Following PRISMA guidelines, systematic searches of PubMed and CINAHL databases and follow-up reference searches were performed for articles published in English up to October 2016. Study Selection: Analysis of searches yielded 42 studies meeting the criteria of case series of adult patients with dizziness and/or vertigo presenting to general practice, emergency departments or specialist outpatient clinics. Data Extraction: Data comprising demographics, diagnostic cases, and the total number of cases were recorded and independently tested, followed by a risk of bias analysis. Data Synthesis: Sample size weighted proportions expressed as percentages with confidence intervals were calculated and compared using χ 2 analysis and a reference proportion formed by the combination of Ear Nose and Throat and Neurotology case series published between 2010 and 2016. Analysis of diagnostic trends over time used Poisson regression with consideration for overdispersion. Conclusions: This systematic review of case series demonstrated significant differences in the proportions of diagnoses for patients presenting with dizziness or vertigo, depending on the specialty making the diagnosis. ENT proportions were dominated by BPPV, Psychogenic and Menière's disease diagnostic categories, whereas emergency proportions were dominated by Other, Cardiac, and Neurological categories. Analysis of case series proportions over time revealed increases in diagnoses such as Benign Paroxysmal Positional Vertigo and Vestibular Migraine, and a corresponding decrease in the diagnoses of Menière's disease.

Objective To investigate differences in sensorimotor function in players with and without a history of concussion. Design Cross-sectional. Setting Australian secondary schools. Participants 214 male adolescent (13–18 years old) rugby union. Interventions (or Assessment of Risk Factors) Sensorimotor function assessment included testing of cervical spine function (proprioception), measurement of size and contraction of lumbopelvic muscles (ultrasound imaging) and balance testing (sway velocity). Outcome Measures Players were allocated into two groups: no history of concussion in the last 12 months (n=165), and concussion in the last 12 months (n=49). Main Results Players with a history of concussion had significantly larger lumbopelvic muscles than players without a history of concussion. The largest mean differences occurred for the quadratus lumborum muscle (8.3% larger; 7.42 and 6.85 cm2 in players with and without a history of concussion respectively) (ES=0.41; p=0.01) and for the lumbar multifidus muscle at L5 vertebral level (6.6% larger; 8.13 and 7.63 cm2 in players with and without a history of concussion respectively) (ES=0.43, p=0.02). The results also indicated that players with a history of concussion had a 24% larger lumbar multifidus muscle contraction at the L2/3 zygapophyseal joint level (ES=0.34; p=0.04). There were no significant differences between groups for the other measures (p>0.05). Conclusions This study demonstrated residual changes in the sensorimotor system 12 months after concussion. Changes in lumbopelvic muscle size and function may indicate residual effects of concussion, which may reflect altered movement strategies such as splinting and over-holding of trunk muscles. This novel finding may possibly help identify contributing risk factors for subsequent injuries in athletes returning to sport after concussion.

Background: Closed kinetic chain and plyometric exercises are commonly used in aquatic rehabilitation because they are believed to reduce joint loading whilst replicating functional tasks. However, the forces and relationship to land-based functional movement is unknown. This study aims to compare vertical ground reaction force during squats, calf raises and jumping in older adults with and without knee osteoarthritis on land and in water. Methods: Forty one participants (Healthy n = 21; Knee osteoarthritis n = 20; Age 68.5 (4.4) years) completed squats and calf raises at slow, medium and maximal speeds and jumping at maximal speed on land and in waist and chest depth water. Vertical ground reaction force and pain rating was measured in each environment. Results: Force in all exercises was significantly greater on land than in chest depth water (p < 0.005). Peak force was significantly greater at maximal speed compared to slow speed (p < 0.001). The pattern of force in squats at slow speed in water was different to on land, with force highest at the start and end of the exercise and decreasing in the central phase. Pain ratings were significantly lower (p < 0.001) in water compared to on land in squats. Conclusions: Closed kinetic chain exercises offer inherently different loading in an aquatic environment. Body weight squats and calf raises in water could be defined as either neuromotor or low load, high velocity training. Maximal speed exercise in water produces higher relative load compared to slow speed and minimal pain providing an opportunity for clinicians to use greater speed to address power deficits. (C) 2018 Elsevier B.V. All rights reserved.

Widespread use of electromyography (EMG) as an assessment and biofeedback method may be limited by costly commercial systems. Low-cost devices are available; however their validity is unknown. This study determined the concurrent validity of a low-cost EMG on a microchip compared with a commercially available system during isometric and dynamic muscle contractions. Inter-tester, intra-session reliability of manual data extraction during data processing compared to a simple, automatic thresholding method using the Teager-Kaiser energy operator (TKEO) was also evaluated. 10 healthy women (age 28.1 +/- 6.8 yrs, height 162.1 +/- 6.8 cm, mass 60.3 +/- 10.2 kg) were assessed simultaneously with a commercially available EMG system (Telemyo DTS) and a custom low-cost EMG system (Myoware Muscle Sensor) during voluntary isometric contractions, knee extension, squatting, stepping and jumping. Two surface electrode sets (connected to the low-cost and the commercial system) were placed end to end along the same Vastus Lateralis muscle fibre line. Peak and mean contraction intensity, and contraction duration were analysed. Overall the relative agreement between systems was excellent for peak muscle activation (ICC 0.77-0.96) and modest to excellent for mean muscle activation (ICC 0.68-0.95) and contraction duration (ICC 0.65-0.99). Inter-tester, intra-session reliability was excellent for peak contraction intensity (ICC > 0.99) and modest to excellent for mean contraction intensity, with the TKEO method primarily recording stronger agreement than the manual method. Poor to excellent inter-tester reliability occurred for contraction duration. Our findings indicate that a low-cost EMG system is comparable to a commercial system for assessing muscle activation, and that using the TKEO improved the reliability of timing related variables.

Introduction: Symptoms experienced by athletes following concussion vary considerably. A multifaceted approach to the assessment of the sensorimotor system may provide greater understanding of the specific deficits seen post-concussion. Thorough assessment may inform and guide physiotherapy interventions aimed at promoting safe player return-to-sport. Our study aimed to investigate the changes in sensorimotor function in adolescent Rugby players in the acute and return-to-sport period following a concussion.

Objectives: Sport-related concussions are common in adolescent contact sports. Vestibulo-ocular dysfunction has been reported in athletes post-concussion. There is a lack of research on vestibulo-ocular function in sporting adolescents, and the influence of previous concussions on the vestibular system in this population. The aim of this study was to investigate vestibulo-ocular function in a cohort of adolescent rugby players with and without a history of concussion during pre-season assessment. Design: Cross-sectional cohort. Methods: 213 male adolescent (13-18 years old) rugby players were recruited from six schools in Queensland, Australia. Vestibulo-ocular assessments were conducted during the preseason and included clinical assessment of oculomotor function and the vestibulo-ocular reflex (VOR) using the clinical and video-Head Impulse Test (HIT). Players were allocated into two groups: no history of concussion in the last 12 months (n = 165); and concussion in the last 12 months (n = 48). Results: There were no between group differences in vestibulo-ocular function for players with and without a history of concussion (p = 0.65). However, vestibulo-ocular dysfunction was reported in 69 (32.7%) of the players tested, who had either abnormal oculomotor control or VOR function. Conclusions: The high prevalence of vestibulo-ocular dysfunction in adolescent rugby players suggests that positive clinical findings post-concussion need to be interpreted carefully in the absence of baseline or pre-concussion assessments.

Objectives: There is a high incidence of injuries in rugby union due to the physical nature of the game. There is a lack of large-scale injury surveillance data reported for school level rugby players of different ages. Our study aimed to investigate the frequency and nature of injuries being sustained during an Australian school level rugby union season.Design: Prospective observational study.Methods: Injury surveillance was conducted on 3585 rugby players from all 8 schools participating in an interschool rugby competition in Queensland, Australia. Match injury data were collected using paper based injury recording forms during the season using a 'medical-attention' injury definition for each age group from opens (17 and 18 year olds) through to year 5 teams (9-10 year olds).Results: There were 332 injuries recorded over 14,029 player hours during the season. The overall rate of injury was 23.7/1000 player hours (95% CI, 21.2-26.3). The incidence of upper and lower limb injuries were 6.3 and 5.6 injuries/1000 player hours respectively (95% CI, 5.1-7.8 and 4.5-7.0). The incidence of suspected concussion injuries was 4.3/1000 player hours (95% CI, 3.6-5.5). Injuries differed across age groups and tackling was the most common mechanism of injury.Conclusions: The injury patterns observed in this large sample of players could be used to guide injury prevention programs in school level rugby union. Injury prevention programs should include age appropriate interventions and focus on improving the techniques used during the contact phase of rugby. (C) 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Objective: To investigate the effectiveness of aquatic exercise in improving lower limb strength in people with musculoskeletal conditions. Data Sources: A systematic search used 5 databases, including MEDLINE, CINAHL, Embase, SPORTDiscus, and The Cochrane Library. Study Selection: Randomized controlled trials evaluating aquatic exercise with a resistance training component for adults with musculoskeletal conditions compared with no intervention or land-based exercise were identified. Fifteen studies from the initial yield of 1214 met these criteria. Data Extraction: Data related to participant demographics, study design, and methods, interventions, and outcomes, including numerical means and SDs, were extracted independently by 2 reviewers. Data Synthesis: Nine of the 15 studies were of high quality, scoring at least 6 on the Physiotherapy Evidence Database Scale. Limited consideration of the prescription of resistance in the aquatic exercise and application of resistance training principles existed. Low- or very low-quality evidence indicates there was no difference in average effect between aquatic exercise and no exercise in improving hip abductor strength (standardized mean difference [SMD], .28; 95% confidence interval [CI], -.04 to.59), knee extensor strength (SMD, .18; 95% CI, -.03 to.40), knee flexor strength (SMD, .13; 95% CI, -.20 to.45), or lower limb endurance (SMD, .35; 95% CI, -.06 to.77). Low-quality evidence indicates no difference in average effect between aquatic and land exercise for knee extensor (SMD, -.24; 95% CI, -.49 to.02) or flexor strength (SMD, -.15; 95% CI, -.53 to.22). Conclusions: It is likely that the inadequate application of resistance in water is a significant contributor to the limited effectiveness of aquatic exercise interventions in improving hip and knee muscle strength in people with musculoskeletal conditions. Future research is needed to quantify resistance with aquatic exercises and to determine if using opportunities for greater resistance in aquatic rehabilitation and appropriate resistance training principles can be more effective in improving muscle strength. (C) 2016 by the American Congress of Rehabilitation Medicine

BACKGROUND:Exercises replicating functional activities are commonly used in aquatic rehabilitation although it is not clear how the movement characteristics differ between the two environments. A systematic review was completed in order to compare the biomechanics of gait, closed kinetic chain and plyometric exercise when performed in water and on land. METHODS:Databases including MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane library were searched. Studies were included where a functional lower limb activity was performed in water and on land with the same instructions. Standardized mean differences (SMD) and 95% confidence intervals were calculated for spatiotemporal, kinematic, force and muscle activation outcomes. FINDINGS:28 studies included walking or running (19 studies), stationary running (three), closed kinetic chain exercise (two), plyometric exercise (three) and timed-up and go (one). Very large effect sizes showed self-selected speed of walking (SMD >4.66) and vertical ground reaction forces (VGRF) (SMD >1.91) in water were less than on land, however, lower limb range of movement and muscle activity were similar. VGRF in plyometric exercise was lower in water when landing but more similar between the two environments in propulsion. Maximal speed of movement for walking and stationary running was lower in water compared to on land (SMD>3.05), however was similar in propulsion in plyometric exercise. INTERPRETATION:Drag forces may contribute to lower self-selected speed of walking. Monitoring speed of movement in water assists in determining the potential advantages or limitations of aquatic exercise and the task specificity to land-based function.