Return To Sport Research Articles

Outcome comparison of meniscal allograft transplantation (MAT) and meniscal scaffold implantation (MSI): A systematic review.

Although numerous studies have reported successful clinical outcomes of Meniscal allograft transplantation (MAT) or Meniscal scaffold implantation (MSI), the difference between the outcome of MAT and MSI remains unclear. To compare the overall outcomes and survival rates of MAT and MSI, aiming to provide comprehensive evidence for determining the optimal treatment strategy for meniscal defects. A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of MAT or MSI were included according to the inclusion and exclusion criteria. The Lysholm score was chosen as the primary outcome measure, while secondary outcomes encompassed Patient-reported Outcome Measures (PROMs), Return to Sports (RTS) rates, survival rates, and complication rates. The outcomes were stratified into two groups: MAT group and MSI group, followed by statistical comparison (P<0.05). The quality of the included studies was assessed by the Cochrane Risk of Bias 2 (RoB2) assessment tool for randomized controlled trials (RCTs) and the Coleman Methodology Score (CMS) for non-randomized controlled trials. A total of 3932 patients (2859 MAT, 1073 MSI) in 83 studies (51 MAT, 32 MSI) had the overall significant improvement in all clinical scores. The group MSI had higher Lysholm score of both preoperative (P=0.002) and postoperative (P<0.001) than group MAT; however, the mean improvements were similar between the two groups (P=0.105). Additionally, MSI had higher improvements of IKDC (P<0.001), KOOS symptom (P=0.010), KOOS pain (P=0.036), and KOOS ADL (P=0.004) than MAT. Interestingly, MAT had higher preoperative (P=0.018) and less postoperative VAS pain (P=0.006), which was more improved in MAT (P<0.001). Compared with MAT, MSI had higher 10-year survival rate (P=0.034), similar mid-term survival rate MAT (P=0.964), and lower complication rate (P<0.001). Both MAT and MSI could have good clinical outcomes after surgery with the similar improvement in Lysholm score. MSI had higher 10-year survival rate and less complications than MAT. IV, systematic review.

Association between Gross Motor Competence and Physical Fitness in Chilean Children Aged 4 to 6 Years

The preschool period is considered critical for the development of motor competence, but as far as we know, no studies have investigated the association between motor competence and physical fitness in Chilean children. The aim of this study was to analyse the association between gross motor competence and physical fitness, controlling for possible confounding factors. A cross-sectional study was conducted with a sample of 144 preschool children (56.25% girls) with an average age of 5.3 years (4 to 6 years) from the Araucanía region, Chile. Motor competence was measured using the Children’s Movement Assessment Battery, 2nd Edition (MABC-2). Regarding physical fitness, the components of cardiorespiratory fitness, lower body muscle strength and speed/agility were evaluated using the Battery to Assess FITness in PREschool (PREFIT). Partial correlation models and analysis of variance (ANCOVA) were used to assess differences in physical fitness between motor competence categories, controlling for age and body mass index. The mean fitness scores for cardiorespiratory fitness, lower body muscle strength and speed/agility components were significantly higher in children with higher gross motor competence. In terms of effect size, large values were found for the lower body strength component in model 1 for boys and in model 2 for the total samples of girls and boys. The results of this study suggest that good levels of gross motor competence are associated with better physical fitness levels.

Return-to-Sport Testing in Young Athletes After Anterior Cruciate Ligament Reconstruction

Implementing return-to-sport (RTS) testing should be an integral component of rehabilitation for young athletes who have undergone anterior cruciate ligament (ACL) reconstruction, but there are no universally accepted standards for such testing. In this article, we highlight our institution’s use of a structured and evidence-based approach to guide RTS decision-making for athletes, coaches, surgeons, therapists, and parents, with an emphasis on reducing the likelihood of reinjury after ACL reconstruction surgery.

Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion

ABSTRACT Background In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage. Methods In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1. Results In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42–10.50), p = 0.01 and 2.86 (1.03–7.93), p = 0.04, respectively). Conclusions In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.

Evaluation of the Psychometric Properties of the Movement Assessment Battery Second Edition (M-ABC2): A Cross-Sectional Study

This cross-sectional study assessed the psychometric properties of the movement assessment battery for children second edition (M-ABC2) in Italian children with typical development, focusing on reliability and percentile rank establishment. The M-ABC2 is widely utilized but lacks validation in Italian populations. One hundred and eight children were recruited. Test-retest reliability was evaluated using intra-class correlation coefficients (ICCs), indicating good to excellent reliability across age groups, albeit with outliers requiring further scrutiny. Standard scores and percentile ranks were established, revealing age-related variations in motor performance. Noteworthy differences in completion times and error rates were observed among the age groups, highlighting the dynamic nature of motor development. While the findings provide valuable insights for clinicians and researchers, limitations such as sample size and geographic representation should be addressed in future studies. This study underscores the importance of employing reliable assessment tools for comprehensive understanding and effective intervention in pediatric motor development.

Association of Graft Maturity on MRI With Return to Sports at 9 Months After Primary Single-Bundle ACL Reconstruction With Autologous Hamstring Graft.

The relationship between graft maturity on magnetic resonance imaging (MRI) and return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction is unclear. To compare signal-to-noise quotient (SNQ) values and ACL graft T2* (gradient echo) values between patients who did RTS and those who did not RTS (NRTS) after ACL reconstruction and to evaluate the predictive value of T2* mapping for RTS after ACL reconstruction. Case-control study; Level of evidence, 3. At a minimum of 9 months after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendon graft, 82 patients underwent RTS assessment as well as MRI evaluation. The patients were classified into RTS (n = 53) and NRTS (n = 29) groups based on the results of the assessment. The SNQ values in the proximal, middle, and distal regions of the graft and the T2* values of the graft were measured on MRI. The correlation between T2* values and RTS was assessed using Spearman correlation analysis. Receiver operating characteristic curves were constructed to compare the diagnostic performance, and the optimal T2* cutoff value for detecting RTS was determined based on the maximum Youden index. At 9 months after ACL reconstruction, the proximal, middle, and mean SNQ values in the RTS group were significantly lower than those in the NRTS group (proximal: 17.15 ± 4.85 vs 19.55 ± 5.05, P = .038; middle: 13.45 ± 5.15 vs. 17.75 ± 5.75, P = .001; mean: 12.37 ± 2.74 vs 15.07 ± 3.32, P < .001). The T2* values were lower in the RTS group (14.92 ± 2.28 vs 17.69 ± 2.48; P < .001) and were correlated with RTS (r = -0.41; P = .02). The area under the curve of T2* was 0.79 (95% CI, 0.75-0.83), and the optimal cutoff value for T2* was 16.65, with a sensitivity and specificity for predicting failure to RTS of 67.9% and 88.2%, respectively. Study findings indicated that the SNQs (mean, proximal, and middle) and the T2* values of the graft in the RTS group were significantly lower than those in NRTS group. A T2* value of 16.65 was calculated to predict patients who failed RTS tests with a sensitivity of 67.9% and specificity of 88.2%.

Outcomes of Blood Flow Restriction Training After ACL Reconstruction in NCAA Division I Athletes.

Blood flow restriction training (BFRT) is a safe and potentially effective adjunctive therapeutic modality for postoperative rehabilitation related to various knee pathologies. However, there is a paucity of literature surrounding BFRT in high-performance athletes after anterior cruciate ligament reconstruction (ACLR). To (1) compare the overall time to return to sports (RTS) in a cohort of National Collegiate Athletic Association (NCAA) Division I athletes who underwent a standardized rehabilitation program either with or without BFRT after ACLR and (2) identify a postoperative time interval for which BFRT has the maximum therapeutic benefit. Cohort study; Level of evidence, 3. A total of 55 student-athletes who underwent ACLR between 2000 and 2023 while participating in NCAA Division I sports at a single institution were included in this study. Athletes were allocated to 1 of 2 groups based on whether they participated in a standardized postoperative rehabilitation program augmented with BFRT (BFRT group; n = 22) or completed the standardized protocol alone (non-BFRT group [control]; n = 33). Our primary outcome measure was time to RTS. The secondary outcome measure was handheld dynamometry quadriceps strength testing at various postoperative time points, converted to a limb symmetry index (LSI). Quadriceps strength was not tested between the BFRT and non-BFRT groups because of the limited amount of data on the control group. The mean age at the date of surgery was 18.59 ± 1.10 years for the BFRT group and 19.45 ± 1.30 years for the non-BFRT group (P = .011), and the mean RTS time was 409 ± 134 days from surgery for the BFRT group and 332 ± 100 days for the non-BFRT cohort (P = .047). For the BFRT group, the mean quadriceps strength LSI increased by 0.67% (95% CI, 0.53%-0.81%) for every week of rehabilitation, and there was a significantly positive rate of change in quadriceps strength in weeks 13-16 compared with weeks 9-12 (ΔLSI, 8.22%; P < .001). In elite NCAA Division I athletes, a statistically significant delay was observed in RTS with BFRT compared with standardized physical therapy alone after undergoing ACLR. There also appeared to be an early window during the rehabilitation period where BFRT had a beneficial impact on quadriceps strength.

AN INVESTIGATION OF SEX-BASED DIFFERENCES IN PHYSICAL AND PSYCHOLOGICAL RECOVERY, AND RETURN TO SPORT, FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

INTRODUCTION &amp; AIMS Despite the increasing rate of anterior cruciate ligament (ACL) tears and surgical reconstruction (ACLR), little is known about the post-operative recovery in males versus females. Understanding differences in the recovery between sexes will assist in better tailoring rehabilitation, return to sport (RTS) and counselling pathways. This study investigated sex-based differences in the physical and psychological recovery of both females and males after ACLR. METHODS This study recruited 104 patients (49 females, 55 males) undergoing ACLR. Patients were assessed pre-operatively and at 6, 12 and 24 months post-surgery, via patient-reported outcome measures (PROMs) including the International Knee Documentation Committee (IKDC) form, the Tegner Activity Scale (TAS) and the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score. Patients embarked on an assessment of peak isokinetic knee extensor (PKET) and flexor (PKFT) torque and a 4-hop performance battery. Limb Symmetry Indices (LSIs) were calculated. The incidence of RTS was investigated. RESULTS All PROMs significantly improved (p&amp;lt;0.05), though females reported significantly lower ACL-RSI (p=0.002) and IKDC (p=0.007) scores. While no sex-based differences were observed in hop test LSIs, males demonstrated significantly higher mean LSIs for PKET at 6 (p=0.037) and 24 (0.047) months, and PKFT at 6 (p=0.007) and 12 (p=0.002) months. At 24-months post-surgery, a significantly greater (p=0.030) percentage of male patients had returned to pivoting sports. CONCLUSION This study demonstrates the disparity between sexes in physical and psychological recovery, as well as RTS status, in community-level patients undergoing ACLR. The development and implementation of enhanced post-operative patient-centered care may be warranted tailored to sex, encompassing rehabilitation, education, and counseling after ACLR to promote increased engagement in rehabilitation.

LOWER LIMB PERFORMANCE AND KINETIC ASYMMETRIES IN PATIENTS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

INTRODUCTION AND AIM Analyses of functional performance and movement strategies at key clinical milestones during rehabilitation are critical to guide rehabilitation and return-to-sport (RTS) decisions post-anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate lower limb performance and kinetics during jumping and hopping in patients post-ACLR. METHODS Seventy-one patients (39 males, 32 females; mean age 27.0 years; height 1.74m; weight 76.5kg) underwent lower limb evaluation at 6.1 and 10-months post-ACLR. Patient-reported outcomes (IKDC-2000, ACL-RSI) were collected at both time points. Ground reaction forces during bilateral and unilateral countermovement jumps (CMJ) on dual force plates were recorded, alongside unilateral horizontal hops for distance (HHD). Paired sample t-tests examined between-limb differences in eccentric and concentric phases of the bilateral CMJ and jump heights and distances of the unilateral CMJ and HHD, respectively, at both time points. Differences in limb asymmetries between the unilateral CMJ and HHD were also examined. Chi square tests were performed to examine differences in meeting known RTS thresholds (&amp;gt;90% limb symmetry index [LSI]). RESULTS Moderate to large asymmetries were observed for concentric (effect size [ES] = -1.06, P&amp;lt;0.001) eccentric phases (ES = 0.54, p&amp;lt;0.001) during the bilateral CMJ at both time points. Greater limb asymmetry was observed in the unilateral CMJ compared to the HHD at 6-months (ES = -0.52; p≤0.001) and 10-months (ES = -0.56; p≤0.001). Significantly more participants “passed” a horizontal hop test versus a vertical hop test at 6 months (χ2=7.07, p=0.008) and at 10 months (χ2=7.52, p=0.006). CONCLUSION Vertical performance metrics can better identify between-limb asymmetries than HHD and should be included in RTS testing batteries following ACLR. Between-limb deficits in key eccentric and concentric phases of the bilateral CMJ are also apparent at 6- and 10-months after ACLR, suggesting a persistent offloading strategy even at the time of RTS.

A Clinically Guided Graph Convolutional Network for Assessment of Parkinsonian Pronation-Supination Movements of Hands

A Clinically Guided Graph Convolutional Network for Assessment of Parkinsonian Pronation-Supination Movements of Hands

Early detection of cerebral palsy with the Standardized Infant NeuroDevelopmental Assessment versus the General Movements Assessment: Is another assessment the way forward?

Early detection of cerebral palsy with the Standardized Infant NeuroDevelopmental Assessment versus the General Movements Assessment: Is another assessment the way forward?

Concurrent validity and test–retest reliability of VALD ForceDecks strength, balance, and movement assessment tests

ObjectivesTo evaluate the concurrent validity and test–retest reliability of common movement, strength, and balance tests using portable uniaxial dual force plates. DesignRepeated measures cross-sectional study. MethodsSixteen healthy individuals participated in two testing sessions, where they performed 12 different movement, strength, and balance tests. Vertical ground reaction force and center of pressure data were collected using the VALD ForceDecks simultaneously with ground-embedded laboratory force plates. Concurrent validity was assessed by quantifying the agreement between force plate systems using root mean square error for raw time-series data and Bland–Altman plots for discrete metrics. Test–retest reliability was assessed using intraclass correlation coefficients and minimal detectable changes. ResultsForceDecks recorded vertical ground reaction forces and center of pressure with high accuracy compared to laboratory force plates. The mean bias between systems was negligible (<2 N or 0.1 mm), with small limits of agreement (<5 N or 1 mm). Of all possible discrete force and center of pressure metrics, 530/674 (79 %) showed good or excellent validity (<10 % difference) and 611/773 (79 %) had good or excellent reliability (intraclass correlation coefficient > 0.75). ForceDecks reliability was similar to laboratory force plates (<0.07 intraclass correlation coefficient median difference for all metrics). ConclusionsPortable uniaxial force plates record highly accurate vertical ground reaction forces and center of pressure during a range of movement, strength, and balance tests. The VALD ForceDecks are a valid and reliable alternative to laboratory force plates when strict standardized testing and data analysis procedures are followed. Users should be aware of the validity and reliability characteristics of the tests and metrics they choose.

DOES MOTOR PROFICIENCY INFLUENCE SLEEP, PHYSICAL ACTIVITY AND MENTAL WELLBEING IN AUSTRALIAN CHILDREN?

INTRODUCTION Motor impairments such as poor timing, balance, sequencing, and dexterity often impact on the child’s quality of life, both physically and emotionally. Sleep and physical activity are modifiable behaviours that have a bi-directional association with mental health outcomes. However, there is very limited research on sleep in children with motor difficulties. The aim of this study is to examine if level of motor proficiency influences physical activity, sleep behaviour, and mental well-being. METHODS Children aged between 6 and 12 years attended one ∼90-minute testing session where they completed the Movement Assessment Battery for Children (MABC; 2nd edition), the Test of Gross Motor Development (TGMD; 3rd edition), and a brief physical activity assessment. Questionnaire were completed by the children and parents (Adolescents Motor Competence Questionnaire (AMCQ), Short Moods and Feelings, Kids Screen, Strength and Difficulties Questionnaire, Children’s Sleep Habits Questionnaire (CSHQ). RESULTS Currently, 15 children (9 males, mean age 9.2 ± 1.97 yrs) have completed the study. Preliminary results show a mean TGMD index of 104.93 ±1.97, suggesting motor skills performed to an average level. The MABC percentile rank was 56.93 ±27.05, one participant below 5th percentile (motor impairment). AMCQ mean 87.00±8.9, however four participants had perceived low motor competence. Interestingly mean sleep score suggests high sleep disturbance among the sample (CSHQ mean 42.33 ± 9.73) with 9 out of 15 participants identifying with a paediatric sleep disorder (three low motor competence and six high motor competence has a paediatric sleep disorder). CONCLUSION Results indicate some interesting findings with both high and low motor competence children demonstrating a sleep disorder. Further analysis looking at actigraph sleep data, sleep diary and physical activity collected over 7 days will be presented during the conference.

Anti-IgLON5 disease as a differential diagnosis of multiple system atrophy

IntroductionAnti-immunoglobulin-like cell adhesion molecule 5 (IgLON5) disease is a rare autoimmune encephalitis that can mimic progressive supranuclear palsy or corticobasal syndrome. Moreover, anti-IgLON5 disease can present with symptoms characteristic of multiple system atrophy (MSA), such as cerebellar ataxia and autonomic dysfunction. However, the clinical features of anti-IgLON5 disease resembling MSA have not been well established. MethodsWe enrolled 35 patients with suspected MSA for whom anti-IgLON5 antibody tests were requested. We evaluated immunoglobulin G (IgG) against IgLON5 using cell-based assays. We also summarized the clinical characteristics of patients who were positive for anti-IgLON5 antibodies. ResultsWe identified serum and cerebrospinal fluid anti-IgLON5 antibodies in three patients. These patients had many clinical features characteristic of MSA, including parkinsonism, cerebellar ataxia, severe orthostatic hypotension, acute respiratory failure, sleep parasomnia, vocal cord paralysis, and pyramidal tract signs. Clinical features atypical for MSA were myorhythmia, horizontal eye movement restriction, fasciculations, and painful muscle cramps. ConclusionAnti-IgLON5 disease may be an important differential diagnosis of MSA. A comprehensive physical examination, including assessments of eye movement, lower motor neuron signs, and atypical involuntary movements, is important to avoid misdiagnosis.

Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis.

Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate ligament reconstruction (ACLR). We therefore conducted a systematic review and meta-analysis to assess the potential association between passing of RTS and the risk of re-injury for patients after ACLR. This meta-analysis was registered in INPLASY with the registration number INPLASY202360027. The electronic databases MedLine, EmBase, and the Cochrane library were systematically searched to identify eligible studies from their inception up to September 2023. The investigated outcomes included knee injury, secondary ACL, contralateral ACL injury, and graft rupture. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the random-effects model. A total number of nine studies involving 1410 individuals were selected for the final quantitative analysis. We noted that passing RTS test was not associated with the risk of subsequent knee injury (OR: 0.95; 95% CI: 0.28-3.21; P = 0.929), secondary ACL injury (OR: 0.98; 95% CI: 0.55-1.75; P = 0.945), and contralateral ACL injury (OR: 1.53; 95% CI: 0.63-3.71; P = 0.347). However, the risk of graft rupture was significantly reduced (OR: 0.49; 95% CI: 0.33-0.75; P = 0.001). This study found that passing RTS test was not associated with the risk of subsequent knee injury, secondary ACL injury, and contralateral ACL injury, while it was associated with a lower risk of graft rupture. Thus, it is recommended that patients after ACLR pass an RTS test in clinical settings.

A new early warning criterion for landslides movement assessment: Deformation Standardized Anomaly Index

A new early warning criterion for landslides movement assessment: Deformation Standardized Anomaly Index

Open-wedge high tibial osteotomy with and without bone void filler: Allograft leads to faster bone union and weight bearing with comparable return to work and sports rates.

To compare the clinical and radiological outcome of open-wedge high tibial osteotomy (OWHTO) with allogenous bone chips to a control group without bone void filler. The focus was on the rates and timelines of return to work (RTW) and return to sports (RTS), given the significance of these factors for the satisfaction of young and active patients. One hundred and ninety-five cases of OWHTO (112 cases with allograft vs. 83 cases without graft) with a follow-up of 17 ± 4.8 months were included in this retrospective analysis. Various metrics were investigated, including time to return to full weight bearing, RTW and RTS rates and timelines, International Knee Documentation Committee (IKDC) Score, Cincinnati-Sportsmedicine and Orthopaedic Centre Scoreand Tegner Score. The time to bone union was determined on radiographs taken at 6, 16, 28 and 53 weeks. Patients returned to full weight bearing after 8.8 ± 4.8 weeks. RTW was possible for 92.8% after 13.7 ± 12.3 weeks. 96.2% returned to sports after 22.7 ± 8.3 weeks, but the number of disciplines and workouts per week diminished (p < 0.001, p = 0.006). A shift to low-impact and recreational sports was observed. Patients with allograft filling had earlier bone union (21 ± 12.3 vs. 31.9 ± 14.2 weeks, p < 0.001) and returned faster to full weight bearing (8.2 ± 4.5 vs. 9.8 ± 5 weeks, p = 0.013). There was no difference between groups in the IKDC Score (69 ± 17.2 vs. 69.9 ± 15.2, p = 0.834), Cincinnati-Sportsmedicine and Orthopaedic Centre Score (68 ± 18.3 vs. 69.4 ± 18.2, p = 0.698) and Tegner Score (3.8 ± 1.5 vs. 4 ± 1.5, p = 0.246). Allograft filling leads to faster bone union and return to full weight bearing but showed no significant advantage in terms of RTW/RTS, overall patient satisfaction and functional scores. The decision for or against filling the osteotomy gap, therefore, remainsa case-by-case decision. Level III, Retrospective cohort study.

Feasibility of Continuous Bronchoscopy During Exercise in the assessment of large airway movement in healthy subjects.

Excessive dynamic airway collapse (EDAC) is a recognized cause of exertional dyspnea arising due to invagination of the trachea and/ or main bronchi. EDAC is typically assessed by evaluating large airway movement with forced expiratory maneuvers. This differs from the respiratory response to exercise hyperpnea. We aimed to evaluate large airway movement during physical activity, with continuous bronchoscopy during exercise (CBE), in healthy subjects and compare findings with resting bronchoscopic maneuvers and imaging techniques. Twenty-eight individuals were recruited to complete two visits including treadmill-based CBE, to voluntary exhaustion and cine magnetic resonance imaging (MRI) with forced expiratory maneuvers at rest. 25 subjects (aged 29 (26 - 33) years, 52% female) completed the study (n=2 withdrew before bronchoscopy, and one was unable to tolerate insertion of bronchoscope). The majority (76%) achieved a peak heart rate of >90% predicted during CBE. The procedure was prematurely terminated in five subjects (n=3; elevated blood pressure and n=2; minor oxygen desaturation). The CBE assessment enabled adequate tracheal visualization in all cases. Excessive dynamic airway collapse (tracheal collapse ≥50%) was identified in 16 subjects (64%) on MRI, and in 6 (24%) individuals during resting bronchoscopy, but in no cases with CBE. No serious adverse events were reported, but minor adverse events were evident. The CBE procedure permits visualization of large airway movement during physical activity. In healthy subjects, there was no evidence of EDAC during strenuous exercise, despite evidence during forced maneuvers on imaging, thus challenging conventional approaches to diagnosis.

Removal of movement artifacts and assessment of mental stress analyzing electroencephalogram of non-driving passengers under whole-body vibration.

The discomfort caused by whole-body vibration (WBV) has long been assessed using subjective surveys or objective measurements of body acceleration. However, surveys have the disadvantage that some of participants often express their feelings in a capricious manner, and acceleration data cannot take into account individual preferences and experiences of their emotions. In this study, we investigated vibration-induced mental stress using the electroencephalogram (EEG) of 22 seated occupants excited by random vibrations. Between the acceleration and the EEG signal, which contains electrical noise due to the head shaking caused by random vibrations, we found that there was a strong correlation, which acts as an artifact in the EEG, and therefore we removed it using an adaptive filter. After removing the artifact, we analyzed the characteristics of the brainwaves using topographic maps and observed that the activities detected in the frontal electrodes showed significant differences between the static and vibration conditions. Further, frontal alpha asymmetry (FAA) and relative band power indices in the frontal electrodes were analyzed statistically to assess mental stress under WBV. As the vibration level increased, EEG analysis in the frontal electrodes showed a decrease in FAA and alpha power but an increase in gamma power. These results are in good agreement with the literature in the sense that FAA and alpha band power decreases with increasing stress, thus demonstrating that WBV causes mental stress and that the stress increases with the vibration level. EEG assessment of stress during WBV is expected to be used in the evaluation of ride comfort alongside existing self-report and acceleration methods.

Identifying Opportunities for Early Detection of Cerebral Palsy

This study aimed to evaluate assessment and referral practices for the early detection and diagnosis of children at risk for or with cerebral palsy (CP) by health care and education providers in Maryland and Delaware. A secondary aim was to identify barriers for using early detection tools and identify opportunities for change to support early diagnosis and improve care. Seventy-two participants answered ≥ 50% of the survey questions. Most were occupational or physical therapists (86%) working in early intervention (61%). Eighty-eight percent indicated awareness that CP can be diagnosed by 12 months. Though 86% stated they typically suspect a diagnosis of CP between 0 and 12 months, only 19% reported that their patients received a CP diagnosis &lt; 12 months. The Developmental Assessment of Young Children (73%) and the Peabody Developmental Motor Scales-2 (59%) were used most. Many respondents indicated never using magnetic resonance imaging (70%), the General Movements Assessment (87%), or the Hammersmith Infant Neurological Exam (69%). Participants identified clinical signs and symptoms prompting a referral for the diagnostic assessment of CP, most commonly stiffness in legs (95%), excessive head lag (93%), and persistent fisting (92%). Policy and organizational change, clinician education, and training are needed to support the implementation of CP early detection guidelines.