Faculty Bibliography

INTRODUCTION/BACKGROUND:The purpose of this study was to characterize using MRI the effects of a 10-week supervised exercise program on lower extremity skeletal muscle composition, nerve microarchitecture, and metabolic function in individuals with diabetic peripheral neuropathy (DPN). RESEARCH DESIGN AND METHODS/METHODS:) and once following intervention to measure relaxation times (T1, T1ρ, and T2), phosphocreatine recovery, fat fraction, and diffusion parameters. RESULTS:and postintervention MRI metrics were: calf adipose infiltration -2.6%±6.4%, GM T1ρ -4.1%±7.7%, GM T2 -3.5%±6.4%, and gastrocnemius lateral T2 -4.6±7.4%. Insignificant changes were observed in gastrocnemius phosphocreatine recovery rate constant (p>0.3) and tibial nerve fractional anisotropy (p>0.6) and apparent diffusion coefficient (p>0.4). CONCLUSIONS:The 10-week supervised exercise intervention program successfully reduced adiposity and altered resting tissue properties in the lower leg in DPN. Gastrocnemius mitochondrial oxidative capacity and tibial nerve microarchitecture changes were not observed, either due to lack of response to therapy or to lack of measurement sensitivity.

PURPOSE/OBJECTIVE: METHODS:measured using TB-SL MRF in Bloch simulations, model agar phantoms, and in vivo experiments to those with a self-compensated spin-lock preparation module (SC-SL). The TB-SL MRF repeatability was evaluated in maps acquired in the lower leg skeletal muscle of 12 diabetic peripheral neuropathy patients, scanned two times each during visits separated by about 30 days. RESULTS:= 31.7 ± 3.2 ms in skeletal muscle across patients. Bland-Altman analysis demonstrated low bias between TB-SL and SC-SL MRF and between TB-SL MRF maps acquired in two visits. The coefficient of variation was less than 3% for all measurements. CONCLUSION/CONCLUSIONS:

Research Objectives: To compare interlimb asymmetries of athletes post anterior cruciate ligament reconstruction (ACLR) to healthy athletes during return to sport (RTS) testing. Secondary objectives investigated correlations between interlimb asymmetries and survey-scores of self-confidence, perceived risk, and injury-emotions (ACL-RSI). Understanding interlimb differences and athlete psychology may help prevent reinjury.
Design(s): Cross-sectional.
Setting(s): Hospital-based orthopedic/sports clinic.
Participant(s): 12 Athletes, 9-12months post-ACLR (6 female; 25.4+/-5.8y/o) and 21 healthy athletes (10 female; 27.9+/-3.5y/o) were recruited. Participants reported moderate/high activity-level (IPAQ). Athletes post-ACLR were painfree and cleared for RTS testing.
Intervention(s): N/A.
Main Outcome Measure(s): Testing included: single-leg drop-landing (30cm), knee isokinetic testing (Biodex, 60degree/sec), and single-leg hop tests (single/triple/crossover distance, 6m-timed). Single-leg landing interlimb differences in peak knee flexion (PKF), frontal plane projection angle (FPPA), peak forward/lateral trunk flexion were calculated (2-dimensional analysis, 100Hz). Peak torque and hop test limb symmetry indices (LSIs) were computed (post-ACLR:100*Surgical/Non-surgical; healthy:100*Non-dominant/Dominant). MANOVA (p < 0.05) compared outcomes between groups. Pearson correlations (r) were calculated between tests and ACL-RSI.
Result(s): Significantly greater interlimb differences between groups in single-leg landing PKF (p=0.01) were observed post-ACLR (9.2+/-8.2degree; healthy:1.0+/-8.7degree). FPPA was greater (p=0.005) in post-ACLR non-surgical limbs (11.1+/-8.7degree; healthy dominant limbs:3.7+/-5.4degree) and nearly significant (p=0.06) in post-ACLR surgical limbs (8.6+/-5.5degree; healthy non-dominant limbs:4.5+/-6.1degree). For peak torque LSI, knee extension was lower (p=0.003) post-ACLR (82.8+/-16.8%; healthy:98.2+/-10.6%) and knee flexion was higher (p=0.006) post-ACLR (106.7+/-17.2%; healthy:93.5+/-8.3%). ACL-RSI was significantly lower (p < 0.0001) post-ACLR (71.3+/-12.7%; healthy:95.0+/-8.5%). ACL-RSI negatively correlated to PKF interlimb differences (r=-0.53) and positively correlated to crossover-hop (r=0.53) and peak extension torque LSIs (r=0.60).
Conclusion(s): Interlimb asymmetries in strength and knee mechanics present 9-12months post-ACLR and can be biomarkers to evaluate RTS readiness. Given the relationships between strength, kinematics, and ACL-RSI, clinicians should consider connections between athlete self-perceptions and performance. Author(s) Disclosures: None. Keywords: Anterior Cruciate Ligament Reconstruction, Physical Functional Performance, Psychology, Sports, Physical Therapy Specialty, Muscle Strength
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Aims: Children with idiopathic toe walking (ITW) gait are increasingly referred to physical therapists. The purpose of this study was to evaluate the intra-rater and inter-rater reliability of the Clinical Gait Assessment Scale (CGAS), a newly developed observational rating scale.Methods: Four raters evaluated videos of four children. Foot, arm and head/trunk movement was scored as children walked over four surfaces. Intra-class correlation coefficients (ICC), model (3,k) were calculated to determine intra-rater and inter-rater reliability of each dependent variable.Results: The key findings of this study indicate robust intra- and inter-rater reliability, particularly of the foot (Inter-rater reliability, ICC (3,2)=0.9) and head and trunk (Inter-rater reliability, ICC (3,2)=1.0) subsections. Arm movements were more challenging to rate and showed moderate reliability (Inter-rater reliability, ICC (3,2)=0.7). Highest total impairment score; the highest value occurred while walking on the obstacle course (38 ± 29).Conclusions: Overall, the CGAS showed adequate/acceptable reliability across different surfaces (linoleum, textured surface, narrow base, obstacle), however the obstacle surface was most challenging surface to the rater.

BACKGROUND:A growing body of literature supports the promising effect of real-time feedback to re-train runners. However, no studies have comprehensively assessed the effects of foots trike and cadence modification using different forms of real-time feedback provided via wearable devices. RESEARCH QUESTION/OBJECTIVE:The purpose of the present study was to determine if a change could be made in foot strike pattern and plantar loads using real-time visual, auditory and combined feedback provided using wearable devices. METHODS:Visual, auditory and combined feedback were provided using wearable devices as fifteen recreational runners ran on a treadmill at self-selected speed and increased cadence. Plantar loads and location of initial contact were measured with a flexible insole system. Repeated measures ANOVAs with Bonferroni adjusted pair-wise comparisons were used to assess statistical significance. RESULTS AND SIGNIFICANCE/CONCLUSIONS:A significant effect of condition was noted on location of center of pressure (p < 0.01). Bonferroni-adjusted post-hoc comparisons showed that feedback conditions differed from baseline as well as the new cadence conditions, however did not differ from each other. A significant interaction effect (region x feedback) was found for plantar loads (maximum force P < 0.001). Significant effects of feedback were noted at the heel (P < 0.001), medial midfoot (P < 0.001), lateral midfoot (P < 0.001), medial forefoot (P = 0.003), central forefoot (P = 0.003), and great toe (P = 0.004) but not at the lateral forefoot (P = 0.6) or lateral toes (P = 0.507). SIGNIFICANCE/CONCLUSIONS:The unique findings of our study showed that an anterior shift of the center of pressure, particularly when foot strike modification was combined with 10% increased cadence. We found lower heel and midfoot loads along with higher forefoot and great toe loads when foot strike modification using real-time feedback was combined with increased cadence. Our findings also suggest that auditory feedback might be more effective than visual feedback in foot-strike modification.

BACKGROUND: Wrist-Worn Activity Monitors(WWAMs) are low-cost, user-friendly devices which have become popular for monitoring physical activity. Their reliability and validity need investigation for accurate physical activity monitoring. We examined between-sessions and inter-device reliability of the WWAMs. In addition, we examined the criteria-related validity of the WWAMs against two gold standards, an Ankle-Worn Activity monitor (AWAM) and video. METHODS: Twenty volunteers participated in two sessions, one week apart. In each session, participants walked on a treadmill for five minutes at each of the three speeds: 0.89 m/s (slow),1.12 m/s (moderate) and 1.33 m/s (fast). Total step counts at each speed were obtained using one AWAM (stepWatch), three-WWAMs (Fitbit Flex) and video. The Intraclass Correlation Coefficient (ICC) was calculated to determine the reliability and validity of the WWAMs. RESULTS: The WWAMs exhibited moderate to excellent between-sessions reliability (ICC = 0.69-0.90). The WWAMs demonstrated excellent inter-device reliability at each speed across both sessions (ICC = 0.91-0.98). The criteria-related validity ofWWAMscompared to theAWAM, and video recording showed moderate to excellent agreement (ICC = 0.67-0.85) at each speed. CONCLUSIONS:WWAMs recorded steps consistently between-sessions and between-devices for treadmillwalking among healthy adults at each speed but exhibited limited agreement for recording steps at each speed compared to AWAMand video.

Wounds of the foot challenge reconstructive surgeons to manage multiple factors: sensibility, stability, and durability. In this article, we focus on the insensate foot, which poses challenges to wound prevention with its propensity to develop pressure ulceration. The authors present the innovative use of a pressure-sensing smart insole system (SurroSense Rx, Orpyx Medical Technologies Inc., Calgary, Canada) in the management of the insensate foot in a patient following foot reconstruction. The pressure-sensing smart insole system provided unique feedback to both patient and provider in ways that contributed to the prevention of pressure ulcer recurrence, as well as highlight the importance of prescribed footwear in both the affected and unaffected foot. Wearable real-time monitoring and feedback faces the challenge of patient adherence. Future studies are indicated to examine the specific behaviors that are associated with favorable outcomes and long-term behavior changes.

BACKGROUND: The flexibility of the first metatarsophalangeal (MTP) joint in patients with hallux rigidus (HR) has not been studied. Compared to measuring range of motion alone, measures of joint flexibility provide additional information that may prove useful in the assessment of HR. The purpose of this study was to assess the flexibility of the hallux MTP joint in patients with HR compared to controls using a novel flexibility device. METHODS: Fifteen patients with Coughlin stage II or III HR and 20 healthy controls were recruited prospectively. Using a custom flexibility jig, each of 2 raters performed a series of seated and standing tests on each subject. Dorsiflexion angle and applied torque were plotted against each other to generate 5 different parameters of flexibility. Differences between (1) HR patients and controls and (2) the sitting and standing testing positions were assessed with t tests. Intrarater test-retest reliability, remove-replace reliability, and interrater reliability were assessed with intraclass correlation coefficients (ICCs). RESULTS: Patients in the HR group were older than patients in the control group ( P < .001) and had lower maximum dorsiflexion ( P < .001). HR patients were less flexible as measured by 3 of the 5 flexibility parameters: early flexibility (first 25% of motion; P = .027), laxity angle ( P < .001), and torque angle ( P = .002). After controlling for age, only laxity angle differed significantly between HR patients and controls ( P < .001). Generally, patients were more flexible when seated compared to standing, with this effect being more marked in HR patients. All parameters had good or excellent intra- and interrater reliability (ICC >/= 0.60). CONCLUSIONS: Hallux MTP joint flexibility was reliably assessed in HR patients using a flexibility device. Patients with HR had decreased flexibility of the hallux MTP joint compared to control patients. LEVEL OF EVIDENCE: Level II, prospective comparative study.

It has been suggested that foot type consider not only foot structure (high, normal, low arch), but also function (over-pronation, normal, over-supination) and flexibility (reduced, normal, excessive). Therefore, this study used canonical regression analyses to assess which variables of foot structure, function, and flexibility can accurately discriminate between clinical foot type classifications. The feet of 61 asymptomatic, healthy adults (18-77 years) were classified as cavus (N=24), rectus (N=54), or planus (N=44) using standard clinical measures. Custom jigs assessed foot structure and flexibility. Foot function was assessed using an emed-x plantar pressure measuring device. Canonical regression analyses were applied separately to extract essential structure, flexibility, and function variables. A third canonical regression analysis was performed on the extracted variables to identify a combined model. The initial combined model included 30 extracted variables; however five terminal variables (malleolar valgus index, arch height index while sitting, first metatarsophalangeal joint laxity while standing, pressure-time integral and maximum contact area of medial arch) were able to correctly predict 80.7% of foot types. These remaining variables focused on specific foot characteristics (hindfoot alignment, arch height, midfoot mechanics, Windlass mechanism) that could be essential to discriminating foot type.