scholarly journals DEVELOPMENT OF A CONCISE LOWER EXTREMITY PHYSICAL PERFORMANCE TEST SET FOR A RETURN TO SPORT DECISION MAKING IN PEDIATRIC POPULATIONS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0017
Author(s):  
Trevor Lentz ◽  
John Magill ◽  
Heather Myers ◽  
Valentine Esposito ◽  
Emily Reinke ◽  
...  

Purpose/Hypothesis: Common physical performance tests (PPTs) used in return to sport decision-making include the Y-Balance LQ, stork balance, stork balance on BOSU, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, and triple crossover SLH. While each test assesses distinct characteristics of performance, the10-item battery is not practical in clinical settings. The aims of this study are to 1) define which primary components of physical performance these 10 PPTs assess, and 2) derive a reduced item set of PPTs that efficiently and accurately measures performance on each component. Number of Subjects: 63 Materials/Methods: Healthy volunteers ages 6-17 [10.7 ±3.2 years; 33 females (54.1%)] performed10 PPTs in the same order with randomized starting test and limb. For analysis, we developed a composite score for each test by averaging trials. All Y-Balance, and hop tests were normalized to leg length. Item reduction was performed using principal components analysis (PCA). Kaiser Criterion (eigenvalue > 1) and scree plot visualization determined the optimal number of components to extract. Items with loadings > 0.55 were considered for the reduced item test. Cross-loaded items with < 0.25 absolute difference in loading between components were dropped. If two or more factors loading on the same component were highly correlated (r > 0.7), we dropped the item(s) with the lowest factor loading. The reduced item set was evaluated for internal consistency (Cronbach a) among the principal components, with a minimum criterion of 0.7 considered satisfactory. Results: PCA extracted 2 components with a cumulative response variance of 67.7%. Component 1 (neuromuscular control) included all balance, SLS and quadrant hop tests. The two quadrant hop tests were highly correlated (r=0.94) and had the second and third lowest factor loadings (<0.78) and were not considered for the reduced-item set. The SLS had the lowest factor loading (0.69) and was also not considered. The Stork, Stork BOSU, and SLS BOSU had similar factor loadings (0.79, 0.90, and 0.88, respectively) and did not meet criteria for removal (all < 0.61). Component 2 (Power), forward SLH (0.94) and crossover SLH (0.79), demonstrated moderate correlation (r=0.56). Timed SLH and Y-balance did not meet the loading criterion and were not considered. The final 5-item set had a cumulative response variance of 76.0%. The Cronbach a of the 3-item Component 1 (0.80), 2-item Component 2 (0.72) and overall 5-item set (0.70) were all satisfactory. Conclusion: Neuromuscular control and power are most appropriately assessed with stork, stork BOSU, SLS BOSU, forward SLH and triple crossover SLH tests. Of these, the Stork BOSU and forward SLH may be most capable of evaluating components measured by the 10 PPTs. Clinical Relevance: These findings provide clinicians with efficient options for measuring lower extremity performance for the purposes of return to sport decision making in pediatric populations.

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0025
Author(s):  
Trevor A. Lentz ◽  
John Magill ◽  
Heather Myers ◽  
Valentine Esposito ◽  
Emily Reinke ◽  
...  

Objectives: Physical performance tests (PPT’s) are used to assess lower extremity function in pediatric populations. Common PPT’s include the lower quarter Y-balance, stork balance, stork balance on BOSU, single leg squat (SLS), SLS on BOSU, clockwise and counterclockwise quadrant single leg hop (SLH), forward SLH, timed SLH, and triple crossover SLH. Each of these tests assesses distinct performance characteristics, but administration of the full 10-item test battery is not practical. The aims of this analysis were to 1) define the primary underlying components of physical performance assessed by these 10 PPT’s, and 2) derive a reduced item set of PPTs that efficiently and accurately measures performance on each underlying component. Methods: This study included healthy, uninjured volunteers (n=61) between the ages 6 and 17 [mean age = 10.7 ±3.2 years; 33 females (54.1%)]. After a brief warm-up, subjects performed the 10 PPT’s in the same order (listed above), however we randomly assigned the starting test to avoid practice/fatigue effects. Subjects completed 2 trials on each leg for each test with the exception of the SLH tests, which were performed 3 times. We developed a composite score for each test by averaging trials across sides. Prior to item reduction, all Y-balance, and hop tests were normalized to leg length. Item reduction was performed using principal components analysis (PCA) with oblique rotation (Promax) on all 10 tests. We used the Kaiser criterion (eigenvalue > 1) to determine the optimal number of components. Items with loadings > 0.55 were considered for the reduced test item set. Cross-loaded items with < 0.25 absolute difference in loading between components were dropped. If two or more factors loading on the same component were highly correlated (r > 0.7), we dropped the item(s) with the lowest factor loading. Results: The PCA identified 2 components. Component 1 (neuromuscular control/balance) included all balance, single leg squat and quadrant hop test items. The 2 quadrant hop tests were highly correlated (r=0.94), had the second and third lowest factor loadings on the component (<0.78), and were dropped. The SLS test had the lowest factor loading (0.69) and was also dropped. The Stork, Stork BOSU, and SLS BOSU had similar factor loadings (0.79, 0.90, and 0.88, respectively) and did not meet the correlation criterion for removal (all < 0.61). Component 2 (Power) included the forward SLH and Crossover SLH. Each demonstrated high factor loadings (0.94 and 0.79, respectively) and only moderate correlation (r=0.56). The Timed SLH and lower quarter Y-balance did not meet the loading criterion and were dropped. The final 5-item PPT set had a cumulative response variance of 76.0%. The internal consistency (Cronbach α) of the 3-item Component 1 (0.80), 2-item Component 2 (0.72) and overall 5-item set (0.70) were all satisfactory (i.e., > 0.7). Conclusion: The 10 PPT’s measure 2 primary components of lower extremity performance: neuromuscular control/balance and power. These components are most appropriately assessed with the stork balance, stork BOSU, SLS BOSU, forward SLH and triple crossover SLH tests. Of these, the Stork BOSU and forward SLH are most capable of evaluating the 2 components. These findings provide clinicians with efficient options for measuring lower extremity performance in pediatric populations. Future studies should determine whether tests excluded from the reduced-item set provide important prognostic information for clinical outcomes. [Table: see text]


2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0005
Author(s):  
Elliot Greenberg ◽  
Miranda Dabbous ◽  
Anne Leung ◽  
Gabriella Marinaccio ◽  
Benjamin Ruley ◽  
...  

Background: The incidence of anterior cruciate ligament reconstruction (ACLR) in youth athletes is rising. Current rehabilitation guidelines recommend the use of a battery of single leg hop tests (SLHT) to assess performance and assist in return to sport (RTS) decision making. Although there is agreement on the use of SLHT, the level of required limb symmetry varies. Historically, values of 85-90% were acceptable; however, some experts are now advocating for more strict values of 95 to >100%. While higher performance thresholds are logical, and some data suggests reduced potential for reinjury using these more conservative criteria, previous literature shows that <25% of youth athletes can achieve =90% symmetry more than 1 year after ACLR. Furthermore, no studies have reported normal SLHT symmetry among youth athletes, making it difficult to compare post-rehabilitation values to non-injured peers. The purpose of this study was to report limb symmetry in SLHT performance in healthy youth athletes. Methods: This was a single episode cross-sectional study of youth athletes between the ages of 8-14 years-old. In order to be eligible for the study, all subjects had to be without any history of ACLR, no current lower extremity injuries, and presently participating in organized competitive sports. All data was collected on-site during practice or games. Consent, demographics, injury history, and sports participation information was obtained prior to testing. Each subject was instructed in a single hop (SH), triple hop (TrH), crossover hop (CH) and timed hop (TH) test and allowed 3-5 practice repetitions. (Figure 1) Successful trials required a controlled landing, with 2 second hold, as previously described. Distance from starting line to the heel was recorded in centimeters for the SH, TrH and CH. TH was recorded in seconds. Limb symmetry index (LSI) of non-dominant to dominant leg (self-reported kicking leg) was calculated for each hop. Descriptive statistics and frequency of pass/fail at 90% LSI threshold were calculated. The relationship between the different components of the SLHT were analyzed with Pearson Correlation Coefficient, while a two-way ANOVA was utilized to analyze whether age and sex affected LSI performance. Results: A total of 347 athletes were screened and met the inclusion criteria. After excluding those with incomplete data, a total of 340 subjects (54% male (n=184); mean age 10.9±1.5 years) were included in the analysis. The sample was heavily Caucasian (85%), with a mean height and weight of 146.6 cm ± 11.2 and 40.7 kg ± 10.8 respectively. Although most subjects identified as multisport athletes, the top self-reported primary sports were soccer (52%, n=178), basketball (22%, n=73), and baseball (10%, n=34). The mean LSI was >95% for each SLHT as follows (mean, standard error): SH=97.9% (0.7), TrH=96.6% (0.6), CH=96.8% (0.8), and TH=96.5% (0.6). When analyzed as a test battery, requiring the subject to achieve =90% LSI on all four components of the SLHT, only 45% of subjects were able to achieve this level of symmetry. (Figure 2) Pearson analysis revealed statistically significant (p<0.01) weak to moderate (r=0.342-0.520) correlations among all hop tests. (Table 1) There were no significant effects (p<0.05) for either age or sex on LSI for any of the individual hop tests. Conclusions/Significance: SLHT are commonly utilized as a battery, requiring an athlete to achieve a threshold of LSI (e.g. 90%) on each hop to satisfy RTS criteria. Although the mean LSI in our sample was >95% for each individual component of the SLHT, subject performance across all SLHT components varied, such that less than half of healthy athletes could achieve a standard of 90% LSI when applied as a test battery. These results question the validity of requiring >90% LSI on the SLHT battery in youth athletes after ACLR and highlights the need for further research into the use and interpretation of SLHT during RTS decision making. Tables and Figures: [Figure: see text][Figure: see text][Table: see text]


2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0005
Author(s):  
Heather Myers ◽  
John Magill ◽  
Valentine Esposito ◽  
Michael Messer ◽  
Trevor Lentz ◽  
...  

Purpose/Hypothesis: Return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction in children is associated with a much higher risk (˜30%) of subsequent ACL injury than in adults. In adults, delaying RTS until objective physical performance test (PPT) criteria are met reduces re-injury rates. However, normative data on PPTs in children is missing, limiting their utility in this high-risk population. Designing age-specific pediatric guidelines for RTS is therefore a critical area of investigation. Number of Subjects: 63 Materials/Methods: We designed a prospective observational study of 130 healthy pediatric athletes (ages 6 - 18 years, 5 males and 5 females of each age). Each athlete underwent a series of 10 functional tests assessing balance (Y-Balance Test, stork test, stork test on Bosu ball), strength (single leg squat, single leg hop) and composite neuromuscular control (single leg squat on Bosu ball, clockwise and counterclockwise quadrant hop, 6 m timed hop and triple crossover hop). Demographic data including sex, chronologic age, Pubertal Maturity Observational Score (PMOS), height, weight, and body mass index (BMI). Testing order was randomized to reduce confounding from fatigue. Our primary hypothesis was that PPT results would vary predictably with chronologic age. For each PPT, multivariable linear regression was performed including age, sex, PMOS, BMI and testing order as independent variables. Standard “growth curves” for each test were then built based on age and sex. Results: Sixty-three athletes (29 male, 34 female) have completed testing so far (48% enrollment). Mean age was 10.7 +/- 3.2 years (range 6 - 18). Mean PMOS was 3.2 +/- 3.1 (range 0 - 9). PMOS was strongly correlated with chronologic age (Pearson’s? = 0.83), therefore PMOS was excluded as a predictor variable in regression models to avoid multicollinearity. Chronologic age was an independent predictor of all PPT results (p < 0.05 in all cases). There was a learning effect for the Bosu Stork test, with athletes doing this test later in the sequence performing better (ß = 2.47, 95% CI 0.74 - 4.19, p = 0.006). Female sex was an independent predictor of a shorter triple crossover hop distance (ß = -74.1, 95% CI -106.9 to -41.2, p < 0.0001). Balance tests showed the least linear relationships with age. The stork test had a clear ceiling effect by age 10 in females and 13 in males. The Bosu Stork test showed wide variability at all ages. Conclusion: Chronologic age is a strong, typically linear predictor of commonly used PPTs in children. The PMOS did not add additional predictive value. Clinical Relevance: The normative data generated in this study help understand normal neuromuscular development, and provide a foundation for creating age-specific RTS scores.


2018 ◽  
Vol 53 (3) ◽  
pp. 209-229 ◽  
Author(s):  
Lori A. Michener ◽  
Jeffrey S. Abrams ◽  
Kellie C. Huxel Bliven ◽  
Sue Falsone ◽  
Kevin G. Laudner ◽  
...  

Objective:  To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. Background:  In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries. Recommendations:  Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play.


2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0017
Author(s):  
Peter Annear ◽  
Ebert Jay

Objectives: A major reason for undergoing anterior cruciate ligament reconstruction (ACLR) for patients is to return to high demand activity and sport. Published literature supports a return to sport (RTS) at 6-12 months, though the recovery of lower limb strength and functional symmetry is critical and is linked with a patient’s ability to RTS, as well as reducing the incidence of secondary re-tear. This study aimed to compare clinical outcomes and RTS between patients undergoing ACLR utilizing a hamstring graft and those undergoing a hybrid technique which augments the hamstring graft with a synthetic LARS ligament. Methods: A non-randomized study design was used to compare clinical outcomes at 10-12 months post-surgery, in 82 patients undergoing conventional ACLR via a hamstring graft (HG) and 35 patients undergoing a hybrid hamstring/LARS graft (HLG). All patients were assessed using a range of patient-reported outcome (PRO) scores (IKDC, KOOS, Cinncinati, Lysholm, SF-36, Tegner, Noyes, Global Rating of Change – GRC). Limb symmetry indices (LSIs) presenting the operated limb as a percentage of the unaffected limb were calculated for several strength/functional assessments (peak isokinetic quadriceps and hamstring strength, the single, triple and triple crossover hop for distance, and the 6 m timed hop). Results: There were no group differences (p>0.05) in patient demographics and the majority of PROs. The HLG group perceived themselves to be significantly ‘more recovered’ (p=0.046) on the GRC scale (HLG = 3.2, HG = 2.2), and also reported a significantly greater (p=0.004) Tegner score (HLG = 7.2, HG = 5.9). For the HG group, 62% of patients had returned to Noyes Level 1 or 2 activities, versus 80% of the HLG group. For the Tegner score, 57% of patients reported a score >6, versus 77% of the HLG group. There were no significant differences (p>0.05) in LSIs between groups for the strength and functional hop tests. However, the HLG group demonstrated a mean LSI above 90% for all four hop tests, while all four were below 90% in the HG group. Both groups demonstrated mean hamstring strength LSIs above 90%, while the quadriceps strength LSI was 81.9% and 85.8% for the HG and HLG groups, respectively. Conclusion: Patients in the HLG group perceived themselves to be more recovered, and had returned to a higher level of activity/sport, compared with the HG group. While not significant, the HLG group did demonstrate more favorable functional hop and quadriceps strength LSIs, which has been linked with the ability to RTS and the incidence of ACL re-tear. A larger patient cohort and follow-up is required to observe long-term outcomes.


2021 ◽  
Author(s):  
Rebecca Kazinka ◽  
Iris Vilares ◽  
Angus MacDonald

This study modeled spite sensitivity (the worry that others are willing to incur a loss to hurt you), which is thought to undergird suspiciousness and persecutory ideation. Two samples performed a parametric, non-iterative trust game known as the Minnesota Trust Game (MTG). The MTG is designed to distinguish suspicious decision-making from otherwise rational mistrust by incentivizing the player to trust in certain situations. Individuals who do not trust even under these circumstances are particularly suspicious of their potential partner’s intentions. In Sample 1, 243 undergraduates who completed the MTG showed less trust as the amount of money they could lose increased. However, for choices where partners had a financial disincentive to betray the player, variation in the willingness to trust the partner was associated with suspicious beliefs. To further examine spite sensitivity, we modified the Fehr-Schmidt (1999) inequity aversion model, which compares unequal outcomes in social decision-making tasks, to include the possibility for spite sensitivity. In this case, an anticipated partner’s dislike of advantageous inequity (i.e., guilt) parameter could take on negative values, with negative guilt indicating spite. We hypothesized that the anticipated guilt parameter would be strongly related to suspicious beliefs. Our modification of the Fehr-Schmidt model improved estimation of MTG behavior. We isolated the estimation of partner’s spite-guilt, which was highly correlated with choices most associated with persecutory ideation. We replicated our findings in a second sample, where the estimated spite-guilt parameter correlated with self-reported suspiciousness. The “Suspiciousness” condition, unique to the MTG, can be modeled to isolate spite sensitivity, suggesting that spite sensitivity is separate from inequity aversion or risk aversion, and may provide a means to quantify persecution. The MTG offers promise for future studies to quantify persecutory beliefs in clinical populations.


2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0004
Author(s):  
F García-Bol ◽  
V Posada-Franco ◽  
A Roldán-Valero ◽  
R Del Caño-Espinel

Hop Tests (unipodal horizontal jumps) have been recommended as one of the reliable assessment tests when allowing a return to competition for a sportsperson after an anterior cruciate ligament injury1,2,3,4. Currently, comparison is made of the results with the contralateral limb through the symmetry index, a method which might not provide sufficient security upon the return to competitive sport5. Hop tests can be used in preseason to gain reference values prior to a possible injury. The objective of this review is to analise the scientific literature such as the F-Marc6 (reference manual of FIFA) to confirm whether include said tests in preseason for football teams. A search was conducted in the Pubmed y Cochrane databases (17/04/17) with the search terms “Hop Test”, “Football”, “Soccer”, and “Preseason”. Articles in English and Spanish were both accepted. Articles excluded were those that did not make reference to the knee, to football, and those that did not conduct tests during preseason. From a total of 33 articles, 4 with these search criteria were included, 5 articles were added trough the bibliography of other studies, and the F-Marc manual was analised. 4 of the articles used the hop tests in preseason for some type of study, of which 3 were used as part of a prospective assessment for the season. On the other hand, the F-Marc does not consider Hop Tests as an assessment test. Hop tests were not found to be used in preseason as reference values prior to possible future injuries, data which could be beneficial for a safe return to sport. Harris J, Abrams G, Bach B, Williams D, Heidloff D, Bush-Joseph C, Verma N, Forsythe B, Cole B. Return to Sport After ACL Reconstruction. ORTHOPEDICS. 2014; 37: e103-e108. Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011 Dec;27(12):1697-705. Thomeé R, Kaplan Y, Kvist J, Myklebust G, Risberg MA, Theisen D, Tsepis E, Werner S, Wondrasch B, Witvrouw E. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2011 Nov;19(11):1798-805. Bolgla LA, Keskula DR. Reliability of lower extremity functional performance tests. J Orthop Sports Phys Ther. 1997 Sep;26(3):138-42. Wellsandt E, Failla MJ, Snyder-Mackler L. Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury. J Orthop Sports Phys Ther. 2017 Mar 29:1-18. F-MARC. Football Medicine Manual. 2nd Edition. Available from: http://f-marc.com . 2017.


Author(s):  
Xun Zhang ◽  
Pierre Leray ◽  
Jacques Palicot

Heat emission and temperature control in an electronic device are highly correlated with power consumption as well as to equipment’s reliability. Within this context, this chapter discusses a possible solution to restrict the processing component’s heat emission in FPGA-based systems (e.g., Cognitive Radio [CR] equipment). It also describes the implementation, on reconfigurable FPGA based circuit, of a digital thermal sensor, analyzes the applicability of local heat estimations, and empirically describes the temperature-power consumption relationship in a dynamically reconfigurable FPGA platform. Finally, discussions are conducted on the decision making issues related to the use of such sensors to enable “hot-spot” migration in CR equipment.


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