Sports Medicine Applications Research Articles

A New Alpha Power Weibull Model for Analyzing Time-to-Event Data: A Case Study from Football

Statistical methodologies have wider applications in exercise science, sports medicine, sports management, sports marketing, sports science, and other related sciences. These methods can be used to predict the winning probability of a team or individual in a match, the number of minutes that an individual player will spend on the ground, the number of goals to be scored by an individual player, the number of red/yellow cards that will be issued to an individual player or a team, etc. Keeping in view the importance and applicability of the statistical methodologies in sport sciences, healthcare, and other related sectors, this paper introduces a novel family of statistical models called new alpha power family of distributions. It is shown that numerous properties of the suggested method are similar to those of the new Weibull-X and exponential type distributions. Based on the novel method, a special model, namely, a new alpha power Weibull distribution, is studied. The new model is very flexible because the shape of its probability density function can either be right-skewed, decreasing, left-skewed, or increasing. Furthermore, the new distribution is also able to model real phenomena with bathtub-shaped failure rates. Finally, the usefulness/applicability of the proposed distribution is shown by analyzing the time-to-event datasets selected from different football matches during 1964–2018.

Noninvasive direct assessment of the skeletal muscle function during neuromuscular electrical stimulation

Neuromuscular electrical stimulation (NMES) artificially activates skeletal muscle contraction by sending electrical pulses either to nerves or muscle belly. NMES has been used in various applications in rehabilitation and sports medicine. However, muscle function assessment has been limited to electrical activity measurements by an electromyography, indirect mechanical measurements using a force sensor, or ultrasound imaging that only provides anatomy and structure. In this paper, dynamic contractility of the targeted muscle in response to the NMES stimulation on human subjects is assessed using ultrafast plane wave imaging and speckle tracking. The change of the strain in the targeted muscle due to the continued NMES, resulting in muscle fatigue, was continually measured. By correlating the transient muscle strain with the force measurement as the direct gait function, it has been shown that muscle strain as measure of muscle contractility obtained by ultrasound elastography can be used as surrogate biomarker of muscle fatigue due to NMES. This technology can be used in several applications including NMES integrated exoskeletal for those who lost gait function as feedback to the motion control and NMES dose and monitoring the muscle strength and functional gain by NMES induced muscle treatment and training.

Epidermal Graphene Sensors and Machine Learning for Estimating Swallowed Volume

Assessment of liquid intake is necessary to obtain a complete picture of an individual’s hydration status. Measurements using state-of-the-art wearable devices have been demonstrated, but none of these devices have combined high sensitivity, unobtrusiveness, and automated estimation of volume, i.e., using machine learning. Such a capability would have immense value in a variety of medical contexts, such as monitoring patients with dysphagia or the performance of athletes. Here, an epidermal sensor platform is combined with machine learning to measure swallowed liquid volume based on signals obtained from the surface of the skin. The key component of the device is a composite piezoresistive sensor consisting of single-layer graphene decorated with metallic nanoislands and coated with a highly plasticized form of the conductive polymer poly(3,4-ethylenedioxythiophene):poly(styrenesuflonate) (PEDOT:PSS). Surface electromyography (sEMG) signals obtained with conventional electrodes are used in concert with the strain measurements. The use of strain and sEMG measurements together both (1) improve the accuracy of estimated volumes and (2) permit the differentiation of swallowing from motion artifacts. In a cohort consisting of 11 participants, the combined measurements of strain and sEMG—processed by the machine learning algorithm—were able to estimate unknown swallowed volumes cumulatively between 5 and 30 mL of water with greater than 92% accuracy. Ultimately, this system holds promise for numerous applications in sports medicine, rehabilitation, and the detection of nascent dysfunction in swallowing.

(Invited) Adding a New Sensing Dimension to Soft Electronics: From the Skin to below the Skin

Soft electronic devices that can noninvasively and continuously acquire vital signs from the human body represent an important trend for healthcare. Combined strategies of materials design and advanced microfabrication allow the integration of a variety of components and devices on a soft platform, resulting in functional systems with minimal constraints on the human body. In this presentation, I will demonstrate a wearable multichannel patch that can sense a collection of signals from the human skin in a wireless mode. Additionally, integrating high-performance ultrasonic transducers on the stretchable substrate adds a new third dimension to the detection range of conventional soft electronics. Ultrasound waves can penetrate the skin and noninvasively capture dynamic events in deep tissues, such as blood pressure and blood flow waveforms in central arteries and veins. This soft platform holds profound implications for a wide range of applications in consumer electronics, sports medicine, defense, and clinical practices. Figure 1

Experimental Evaluation of the Accuracy of Biped Model to Predict the Kinematics during Walking

Biped models (BMs) have extensive applications in structural vibration, robotics, and sports medicine, but the differences between the walking kinematics simulated by the BM model and those measured through an experiment have not been comprehensively recognized. This paper used wireless inertial measurement units (IMUs) to monitor the acceleration of center of masses (COMs) of 6 volunteers walking under the conditions of natural and fixed-knee gait. The observations were compared with the simulations from two typical BMs and also with the measurements from former research studies. The results show that when the step frequency is lower than 2.0 Hz, the peaks of acceleration simulated by BM are close to those observed in experiments and the errors are acceptable, while the step frequency is higher than 2.0 Hz, the discrepancy between the numerical and the experimental results is increasingly larger with higher step frequencies, and the errors can reach 60% at most. The comparison between numerical and experimental results indicates that the knee-fixing assumption of BMs may lead to overestimating the peaks of accelerations, but this assumption fails to explain the different increasing rates with respect to step frequency. Further research studies about the accuracy of BMs and relative modification methods are expected for civil engineering applications.

The Role of Collagen-Based Biomaterials in Chronic Wound Healing and Sports Medicine Applications.

Advancements in tissue engineering have taken aim at treating tissue types that have difficulty healing naturally. In order to achieve improved healing conditions, the balance of exogenous matrix, cells, and different factors must be carefully controlled. This review seeks to explore the aspects of tissue engineering in specific tissue types treated in sports medicine and advanced wound management from the perspective of the matrix component. While the predominant material to be discussed is collagen I, it would be remiss not to mention its relation to the other contributing factors to tissue engineered healing. The main categories of materials summarized here are (1) reconstituted collagen scaffolds, (2) decellularized matrix tissue, and (3) non-decellularized tissue. These three groups are ordered by their increase in additional components beyond simply collagen.

Autologous Bone Grafting

Autologous bone is the gold standard graft choice in the management of a range of orthopaedic and sports medicine pathologies. It has osteoinductive, osteoconductive, and osteogenic properties making it an excellent graft choice to both enhance biological healing and stabilize surrounding bony anatomy. Despite numerous attempts to synthetically manufacture bone graft substitutes with enhanced properties, autologous bone grafting remains the gold standard. Bone grafts can be divided into 3 types: autologous, allograft, and bone substitutes. In the treatment of sports injuries, the applications are diverse and include the management of fracture nonunions to address glenoid bone loss in the setting of revision anterior cruciate ligament reconstruction and to fill voids left following opening wedge osteotomies. The 4 main forms of autologous bone grafts are cancellous, cortical, corticocancellous, and vascularized grafts, and in some instances surgeons may combine grafts as a composite graft. Key advantages of autologous bone graft are that it is inexpensive, readily available and easily accessible. Donor site morbidity and restriction on the total volume which can be harvested are the principal limitations. In this review, we outline the 4 principal forms of autologous bone graft preparations (cortical, cancellous, corticocancellous, and vascularized) and describe the characteristics and advantages/disadvantages of each. We summarize the current literature on clinical outcomes evaluating autologous bone graft for sports medicine applications.

Narrative Review: Botulinum Toxin Applications in Sports Medicine

Intramuscular injections of botulinum toxin (BoNT) induce muscle relaxation by blocking acetylcholinesterase at the neuromuscular junction by cleavage of synaptosomal associated protein 25 kDa (SNAP-25)

Autologous platelet concentrates in maxillofacial regenerative therapy.

Platelet concentrates have emerged as innovative autologous blood products that enhance tissue healing and regeneration in regenerative therapy. A common feature of these products is their higher than baseline platelet concentration, which improves wound healing and tissue repair. Four main categories of products can be easily defined, based on their leukocyte content and fibrin architecture: pure platelet-rich plasma, such as Cell Separator PRP or Anitua' PRGF; leukocyte- and platelet-rich plasma (L-PRP), such as PCCS or Ace PRP; pure platelet-rich fibrin (P-PRF), such as Fibrinet PRFM; and leukocyte- and platelet-rich fibrin (L-PRF), such as Choukroun's PRF. Two families contain significant concentrations of leukocytes: L-PRP and L-PRF. These four families of products have different biological signatures and mechanisms and obviously different clinical applications. An L-PRF membrane releases growth factors and matrix proteins over a period longer than 7 days, whereas a PRP gel matrix releases and disperses its growth factors in a relatively quick download. In the near future, simple and inexpensive products such as L-PRF are expected to have applications in oral-maxillofacial surgery, periodontal surgery, plastic surgery, orthopedic surgery, and sports medicine. Leukocytes substantially affect the intrinsic biology and properties of platelet concentrates, not only because they enhance immune function and antibacterial potential, but also because they have essential roles in the wound healing process. Unfortunately, their impact has been almost completely neglected in the literature. Improved understanding of the effects of leukocytes in wound healing is essential for development of new clinical applications of platelet concentrates.

Multifunctional Electronic Textiles Using Silver Nanowire Composites.

Textiles represent an appealing platform for continuous wearable applications due to the exceptional combination of compliance, water vapor permeability, and comfortableness for long-term wear. We present mechanically and electrically robust integration of nanocomposites with textiles by laser scribing and heat press lamination. The simple and scalable integration technique enables multifunctional E-textiles without compromising the stretchability, wearability, and washability of textiles. The textile-integrated patterns exhibit small line width (135 μm), low sheet resistance (0.2 Ω/sq), low Young's modulus, good washability, and good electromechanical performance up to 50% strain, which is desirable for wearable and user-friendly electronic textiles. To demonstrate the potential utility, we developed an integrated textile patch comprising four dry electrophysiological electrodes, a capacitive strain sensor, and a wireless heater for electrophysiological monitoring, motion tracking, and thermotherapy, respectively. Beyond the applications demonstrated in this paper, the materials and methods presented here pave the way for various other wearable applications in health care, activity tracking, rehabilitation, sports medicine,and human-machine interactions.

Shock wave therapy applications in Sports Medicine

Shock wave therapy applications in Sports Medicine

Correlation of PROMIS Physical Function, Pain Interference, and Depression in Pediatric and Adolescent Patients in the Ambulatory Sports Medicine Clinic.

Background:Recently, interest has increased in incorporating the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes into clinical and research applications in sports medicine. The PROMIS forms have not been studied in pediatric and adolescent sports medicine patients.Purpose/Hypothesis:The goal of this study was to determine the correlation between PROMIS Computer Adaptive Test (CAT) forms measuring physical function, pain interference, and depression in pediatric and adolescent patients seen in the ambulatory sports medicine clinic. We hypothesized that there would be a negative correlation between physical function and pain interference as well as depression, as has been demonstrated in adult patient populations.Study Design:Cross-sectional study; Level of evidence, 3.Methods:All patients aged 8 to 17 years seen by 3 shoulder and sports medicine providers were included in this study. Patients completed a series of PROMIS CAT forms at clinic visits, including the PROMIS-PF and PROMIS-UE (Physical Function and Upper Extremity; depending on the nature of the complaint), PROMIS-PI (Pain Interference), and PROMIS-Depression subscales. Pearson correlation coefficients were calculated between the PROMIS forms as well as with other patient demographic data.Results:A total of 236 patient visits (152 patients) were included in the study, comprising 712 total PROMIS CAT forms. A negative correlation was found between PROMIS-PF and both PROMIS-Depression (R = –0.34) and PROMIS-PI (R = –0.76). These correlations with PROMIS-Depression and PROMIS-PI were –0.21 and –0.75, respectively, when considering the PROMIS-UE CAT. Patient demographic information had minimal impact on PROMIS scores as well as on correlations between scores.Conclusion:Correlations between physical function, pain interference, and depression were found to be similar in pediatric patients as they are in adult patients, as measured by PROMIS CAT forms.

Wearable sensor works without a battery

A sticker-like wearable sensor measures glucose, chloride, and other biomarkers in sweat—without the need for a battery (Sci. Adv. 2019, DOI: 10.1126/sciadv.aav3294). With further clinical testing, the sweat sensor may find applications in sports medicine or as a glucose monitor for people with diabetes. Researchers have been developing implantable or wearable skin-like electronics for about 15 years and have made many demonstrations of potential clinical applications. These technologies are beginning to mature, says John Rogers, a materials scientist at Northwestern University. But powering them in a user-friendly way remains challenging. Most demonstrations of wearable devices—especially those that collect biochemical data—require bulky batteries or tether the user to an external power source. The Northwestern team tackled this by developing self-powered sensing elements and a set of compact electronics to transmit data and receive power. They added these components to a disposable microfluidic sticker that passively sops up sweat on a person’s

Современные аспекты применения плазмы, обогащенной растворимыми факторами тромбоцитов, в лечении травм и заболеваний опорно-двигательного аппарата

The review of literature presents the new direction in the treatment of sports injuries and diseases of the musculoskeletal system – using of autologous platelet-rich plasma/plasma enriched in soluble platelet factors (PRP/PORFT). PRP/PORFT reveals anti-inflammatory, analgesic, anticatabolic and regenerative effects after local injection to affected area. Technology of preparation and clinical application of PRP/PORFT were under consideration. There were described the results of clinical studies on PRP/PORFT application in sports medicine and damage of musculoskeletal system. It was shown the clinical efficacy of 2-3 injections of PRP/PORFT into the area of muscle, ligaments, joints injury. Most effective use of PRP/PORFT was shown for therapy of lateral epicondylitis and osteoarthritis. There were no yet evidences for its efficacy in therapy of patients with damaged Achilles tendon. The best clinical effects of PRP/PORFT use was demonstrated in patients with trauma and damage of musculoskeletal system at the initial stages of treatment, and also as a part of rehabilitation courses.

Increasing the Robustness of the automatic IMU calibration for lower Extremity Motion Analysis

Abstract With the advances of IMU-based human motion tracking, joint angle tracking in an home environment has become a realistic goal. Achieving it, could enable novel applications in rehabilitation and sports medicine. However, in existing systems the process of aligning the mounted sensors with the body coordinate system is either not robust enough or to complicated for fully unsupervised usage. In this publication the performance of a promising existing algorithm is evaluated with a range of different calibration motions. Further, an extension to this implementation is proposed, aiming to improve its stability when only non-ideal calibration data is available. It could be validated that the modification of the algorithm can increase the stability and reduce the dependency of the calibration on specific calibration motions. Based on these results, we recommend the proposed extension of the algorithm as a drop-in replacement for the existing implementation.

Feasibility Testing of Hydrophobic Carbon Electrodes for Acquisition of Underwater Surface Electromyography Data.

Underwater surface electromyography (sEMG) signals are especially of interest for rehabilitation and sports medicine applications. Silver/silver chloride (Ag/AgCl) hydrogel electrodes, although the gold standard for sEMG data collection, require waterproofing for underwater applications. Having to apply waterproof tape over electrodes impedes the deployment of sEMG in immersed conditions. As a better alternative for underwater applications, we have developed carbon black/polydimethylsiloxane (CB/PDMS) electrodes for collecting sEMG signals under water. We recruited twenty subjects to collect simultaneous recordings of sEMG signals using Ag/AgCl and CB/PDMS electrodes on biceps brachii, triceps brachii, and tibial anterior muscles. The Ag/AgCL electrodes were covered in waterproof tape, and the CB/PDMS electrodes were not. We found no differences in sEMG signal amplitudes between both sensors, for the three muscles. Moderate mean correlation between Ag/AgCl and CB/PDMS electrodes was found on the linear envelopes (≥ 0.7); correlation was higher for power spectral densities (≥ 0.84). Ag/AgCl electrodes performed better in response to noise, whilst the CB/PDMS electrodes were more sensitive to myoelectric activity in triceps and tibialis, and exhibited better response to motion artifacts in the measurements on the triceps and tibialis. Results suggest that sEMG signal collection is possible under water using CB/PDMS electrodes without requiring any waterproof or adhesive tape.

Reporting of Mesenchymal Stem Cell Preparation Protocols and Composition: A Systematic Review of the Clinical Orthopaedic Literature

Background: Mesenchymal stem cells (MSCs) are increasingly being used in the treatment of a wide variety of sports-related conditions. Despite this enthusiasm, the biological properties of MSCs and their effects on musculoskeletal tissue healing remain poorly understood. MSC-based strategies encompass cell populations with heterogeneous phenotypes isolated from multiple tissues and using different methods. Therefore, comprehensive reporting of the source, preparation methods, and characteristics of MSC strategies is essential to enable interpretation of results. Purpose: To perform a systematic review of levels of reporting of key variables in MSC preparation and composition for clinical studies evaluating MSC-based therapies in the treatment of musculoskeletal conditions. Study Design: Systematic review. Methods: A systematic review of the clinical orthopaedic and sports medicine literature from 2002 to 2017 was performed. The following inclusion criteria were used: human clinical trials, published in the English language, involving the administration of MSC-based therapies for orthopaedic or sports medicine applications. In vitro or ex vivo studies, editorials, letters to the editor, and studies relating to cosmetic, neurological, or dental applications were excluded. Results: Of the 1259 studies identified on the initial search, 36 studies were found to satisfy the inclusion criteria for analysis on comprehensive review. Fifty-seven percent of studies evaluated bone marrow–derived MSCs, 41% evaluated adipose-derived MSCs, and 2% evaluated synovium-derived MSCs. Considerable deficiencies in the reporting of key variables, including the details of stem cell processing, culture conditions, and the characteristics of cell populations delivered, were noted. Overall, studies reported only 52% (range, 30%-80%) of variables that may critically influence outcome. No study provided adequate information relating to all of these variables. Conclusion: All existing clinical studies evaluating MSCs for orthopaedic or sports medicine applications are limited by inadequate reporting of both preparation protocols and composition. Deficient reporting of the variables that may critically influence outcome precludes interpretation, prevents others from reproducing experimental conditions, and makes comparisons across studies difficult. We encourage the adoption of emerging minimum reporting standards for clinical studies evaluating the use of MSCs in orthopaedics.

Design of wearable and wireless multi-parameter monitoring system for evaluating cardiopulmonary function

The 6-minute walking test (6MWT) is the test most commonly used to evaluate cardiopulmonary function in patients with respiratory or heart disease. However, there was previously no integrated monitoring system available to simultaneously record both the real-time cardiopulmonary physiological parameters and the walking information (i.e., walking distance, speed, and acceleration) during the 6MWT. In this study, then, a wearable and wireless multi-parameter monitoring system was proposed to simultaneously monitor oxygen saturation (SpO2), heart rhythm, and the walking information during the 6MWT. A multi-parameter detection algorithm was also designed to estimate the heart rate effectively. The results of the study indicate that this system was able to reveal the dynamic changes and differences in walking speed and acceleration during the 6MWT. As such, the system has the potential to provide a more integrated approach to monitoring cardiopulmonary parameters and walking information simultaneously during the 6MWT. The proposed system warrants further investigation as an assistive assessment tool in evaluating cardiopulmonary function and may be widely applied in cardiopulmonary-related and sports medicine applications in the future.

Tissue engineering in orthopaedic sports medicine: current concepts

Tissue engineering (TE) has been revolutionising the concepts and therapeutic approaches for the treatment of different sports injuries. To overcome the drawbacks of the current treatments, TE-based strategies provided new possibilities, either in the treatment of defects, which were previously considered unrecoverable, but also in what concerns to the decrease of recovery time. Supported in three mainstream concepts, TE uses the combination of scaffolds, cells and biological factors to pursue a better functional regenerative process. Aware of the limitations of today's treatments, the scientific and medical communities have made great effort to apply, in the safest and most efficient manner, the panoply of new TE tools. However, it is important to understand that there is still a long way to go until these new approaches turn out to be the 'gold standard' treatment in the clinics. This review aims to overview the current concepts of TE applications in orthopaedic sports medicine under preclinical and clinical research applied to growth factors, scaffolds and stem cells.

Interprofessional Collaboration in Sports Medicine: Findings from a Scoping Review

BACKGROUND Sports medicine has grown from a special interest area in healthcare to an established profession in its own right. Containing many specialties and a range of professional inputs there are complex dynamics at work which often dictate the provision of care. Whilst interprofessional interventions have been successfully applied in more mainstream healthcare contexts there has been no equivalent application in sports medicine. PURPOSE We seek to map the literature to explore interprofessional collaboration, interaction and tension in sports medicine. METHOD The study utilised a scoping review methodology followed by a thematic analysis. DISCUSSION & CONCLUSIONS The review located 13 studies which provided an insight into a number of key themes which affect interprofessional collaboration (IPC) in a variety of athletic contexts. All of these themes relate to IPC. The structured introduction of interprofessional education programmes for sports medicine professionals and others, will enable a response to the numerous challenges identified in the review.