Single-subject methodology: an alternative approach

Fatigue-induced alterations in force production, trajectory and performance in alpine skiing

In giant slalom, the ability to apply a high amount of force in the radial direction is essential for performance. A race is characterized by repeated turns performed at high velocity, potentially inducing fatigue. Therefore, this study aimed to assess the effect of fatigue on performance, trajectory characteristics, and force production capacities onto the snow. Twelve skiers ran a 4-turn section with (FATIGUE) and without pre-induced fatigue (CONTROL). Knee extensor maximal voluntary contraction (MVC) was performed before the experiment and after both conditions. Section time, energy dissipation, path length, total force output, force application effectiveness, and EMG activity of the main lower-limb muscles were compared between conditions. Multiple linear regressions were used to understand whether interindividual variability in the kinematic, kinetic and EMG between conditions explains variability in performance changes with fatigue. MVC was lower after FATIGUE (-19.1 ± 6.4%, p < 0.001) but did not change after CONTROL. FATIGUE was associated with longer section times (+0.21 ± 0.11 s, p < 0.001), energy dissipation (-0.78 ± 1.05 J.s.kg.m-1, p = 0.026), path length (+1.1 ± 1.6 m, p = 0.033) and lower force application effectiveness (-0.1 ± 0.1, p = 0.017). This study experimentally demonstrates that fatigue in giant slalom results in lower force application effectiveness, inducing over-dissipation of mechanical energy and longer path length, leading to lower performance.

Use of subject-specific models to detect fatigue-related changes in running biomechanics: a random forest approach

Running biomechanics are affected by fatiguing or prolonged runs. However, no evidence to date has conclusively linked this effect to running-related injury (RRI) development or performance implications. Previous investigations using subject-specific models in running have demonstrated higher accuracy than group-based models, however, this has been infrequently applied to fatigue. In this study, two experiments were conducted to determine whether subject-specific models outperformed group-based models to classify running biomechanics during non-fatigued and fatigued conditions. In the first experiment, 16 participants performed four treadmill runs at or around the maximal lactate steady state. In the second experiment, nine participants performed five prolonged runs using commercial wearable devices. For each experiment, two segments were extracted from each trial from early and late in the run. For each participant, a random forest model was applied with a leave-one-run-out cross-validation to classify between the early (non-fatigued) and late (fatigued) segments. Additionally, group-based classifiers with a leave-one-subject-out cross validation were constructed. For experiment 1, mean classification accuracies for the single-subject and group-based classifiers were 68.2 ± 8.2% and 57.0 ± 8.9%, respectively. For experiment 2, mean classification accuracies for the single-subject and group-based classifiers were 68.9 ± 17.1% and 61.5 ± 11.7%, respectively. Variable importance rankings were consistent within participants, but these rankings differed from each participant to those of the group. Although the classification accuracies were relatively low, these findings highlight the advantage of subject-specific classifiers to detect changes in running biomechanics with fatigue and indicate the potential of using big data and wearable technology approaches in future research to determine possible connections between biomechanics and RRI.

Identifying underlying individuality across running, walking, and handwriting patterns with conditional cycle-consistent generative adversarial networks

In recent years, the analysis of movement patterns has increasingly focused on the individuality of movements. After long speculations about weak individuality, strong individuality is now accepted, and the first situation-dependent fine structures within it are already identified. Methodologically, however, only signals of the same movements have been compared so far. The goal of this work is to detect cross-movement commonalities of individual walking, running, and handwriting patterns using data augmentation. A total of 17 healthy adults (35.8 ± 11.1 years, eight women and nine men) each performed 627.9 ± 129.0 walking strides, 962.9 ± 182.0 running strides, and 59.25 ± 1.8 handwritings. Using the conditional cycle-consistent generative adversarial network (CycleGAN), conditioned on the participant's class, a pairwise transformation between the vertical ground reaction force during walking and running and the vertical pen pressure during handwriting was learned in the first step. In the second step, the original data of the respective movements were used to artificially generate the other movement data. In the third step, whether the artificially generated data could be correctly assigned to a person via classification using a support vector machine trained with original data of the movement was tested. The classification F1-score ranged from 46.8% for handwriting data generated from walking data to 98.9% for walking data generated from running data. Thus, cross-movement individual patterns could be identified. Therefore, the methodology presented in this study may help to enable cross-movement analysis and the artificial generation of larger amounts of data.

Identification of subject-specific responses to footwear during running

Placing a stronger focus on subject-specific responses to footwear may lead to a better functional understanding of footwear's effect on running and its influence on comfort perception, performance, and pathogenesis of injuries. We investigated subject-specific responses to different footwear conditions within ground reaction force (GRF) data during running using a machine learning-based approach. We conducted our investigation in three steps, guided by the following hypotheses: (I) For each subject x footwear combination, unique GRF patterns can be identified. (II) For each subject, unique GRF characteristics can be identified across footwear conditions. (III) For each footwear condition, unique GRF characteristics can be identified across subjects. Thirty male subjects ran ten times at their preferred (self-selected) speed on a level and approximately 15 m long runway in four footwear conditions (barefoot and three standardised running shoes). We recorded three-dimensional GRFs for one right-foot stance phase per running trial and classified the GRFs using support vector machines. The highest median prediction accuracy of 96.2% was found for the subject x footwear classification (hypothesis I). Across footwear conditions, subjects could be discriminated with a median prediction accuracy of 80.0%. Across subjects, footwear conditions could be discriminated with a median prediction accuracy of 87.8%. Our results suggest that, during running, responses to footwear are unique to each subject and footwear design. As a result, considering subject-specific responses can contribute to a more differentiated functional understanding of footwear effects. Incorporating holistic analyses of biomechanical data is auspicious for the evaluation of (subject-specific) footwear effects, as unique interactions between subjects and footwear manifest in versatile ways. The applied machine learning methods have demonstrated their great potential to fathom subject-specific responses when evaluating and recommending footwear.

Centre of pressure golf swing movement strategies are better defined using a continuous approach than by segregated styles

The relationships between movement style and golf performance have been well researched, but the premise of segregated movement styles has not been fully examined. The purpose of this investigation was to examine the postulation that centre of pressure data are not best described by segregated styles but instead by a continuum and to determine relationships between centre of pressure, handicap and clubhead speed using a continuous approach. Centre of pressure paths of driver and 5-iron shots from 104 amateur golfers were analysed using discrete and continuous methods. Discrete methods used different cluster evaluation criteria which result in two-cluster and twenty-cluster solutions being considered "optimum". The two-cluster solution showed the characteristics of "front-foot" and "reverse" centre of pressure styles. However, a continuous principal component analysis method revealed that the clusters were not well separated and provided support for a multidimensional continuum. The principal components had a high correlation with handicap and clubhead speed. Lower handicap and higher swing speed golfers tended to display a centre of pressure with a "front-foot" style and a fast transition towards the front foot at the start of the downswing. A continuous characterisation of centre of pressure styles has more utility than the segregated styles previously described.

A continuous times-series and discrete measure analysis of two individual divers performing the 3½ pike somersault dive

Springboard diving training is often focused upon skill repetition to establish movement accuracy, stability and consistency. Within-participant study designs provide the ability to understand how individuals create these skills under different movement strategies. IMUs measured angular velocity time-series data of two athletes performing multiple repetitions of forward 3½ somersault pike dives. Functional Principal Component Analyses (fPCA) were performed to examine individual movement structure and variability. The first five fPC's represented approximately 98% of the variability in angular velocity for both divers. To determine the relative importance of angular velocity variability, Pearson's correlations for pairwise comparisons were used to assess the relationship between fPC scores and discrete performance variables during takeoff, flight and entry. Divers exhibited a different number and types of significant correlations (International = 4; National = 11). Only one correlation was common for both divers; higher angular velocity during Initial Flight and/or Somersault phases resulted in more vertically aligned entry posture (International: fPC1 r = -0.761, p < 0.05; National: fPC3 r = -0.796, p < 0.01). Findings identify individualised angular velocity time-series structure and kinematic performance variables (International = angular; National = linear) that can be used by coaching/sport science teams to optimisation performance success.

Effects of footwear on the gait kinematics of women with unilateral transtibial amputation: an observational case series

PURPOSE

Prosthesis geometry and behaviour limit the footwear options available to women. Using a commercially available prosthetic foot that permits user-alignment to accommodate shoes with different heel heights, we investigated the effect of footwear on gait kinematics, with and without adjustment for differences in heel-forefoot differential.

MATERIALS AND METHODS

Three women with transtibial amputation walked at a self-selected pace, first in an athletic shoe (prosthetist-aligned; baseline condition), then (i) in a flatter shoe without realigning the prosthesis, and (ii) in flat and heeled shoes following user re-alignment. Kinematics in each condition were compared to baseline.

RESULTS

Baseline gait patterns were highly variable across participants. Gait was slower in comparison to baseline in all conditions, but movement compensations varied across participants. An increased lower limb extension tendency was evident with the misaligned prosthesis. With user re-alignment to accommodate the shoe there were fewer deviations from baseline, however kinematic differences remained in both the flat and heeled shoes.

CONCLUSIONS

The user-alignment feature of the prosthetic foot reduced the effect of a change in footwear on kinematics, and permitted walking in heeled shoes when it might otherwise not be possible. Persistence of some deviations suggests differences in walking task demand remained despite adjustment.Implications for rehabilitationPermitting prosthesis users to don footwear of choice may improve body image, well-being and quality of life following amputation.Prosthetic feet that permit user ankle adjustment can reduce gait deviations associated with a change in footwear heel height, although kinematic adaptations are individual.

Distinct Kinematic and Neuromuscular Activation Strategies During Quiet Stance and in Response to Postural Perturbations in Healthy Individuals Fitted With and Without a Lower-Limb Exoskeleton

Many individuals with disabling conditions have difficulty with gait and balance control that may result in a fall. Exoskeletons are becoming an increasingly popular technology to aid in walking. Despite being a significant aid in increasing mobility, little attention has been paid to exoskeleton features to mitigate falls. To develop improved exoskeleton stability, quantitative information regarding how a user reacts to postural challenges while wearing the exoskeleton is needed. Assessing the unique responses of individuals to postural perturbations while wearing an exoskeleton provides critical information necessary to effectively accommodate a variety of individual response patterns. This report provides kinematic and neuromuscular data obtained from seven healthy, college-aged individuals during posterior support surface translations with and without wearing a lower limb exoskeleton. A 2-min, static baseline standing trial was also obtained. Outcome measures included a variety of 0 dimensional (OD) measures such as center of pressure (COP) RMS, peak amplitude, velocities, pathlength, and electromyographic (EMG) RMS, and peak amplitudes. These measures were obtained during epochs associated with the response to the perturbations: baseline, response, and recovery. T-tests were used to explore potential statistical differences between the exoskeleton and no exoskeleton conditions. Time series waveforms (1D) of the COP and EMG data were also analyzed. Statistical parametric mapping (SPM) was used to evaluate the 1D COP and EMG waveforms obtained during the epochs with and without wearing the exoskeleton. The results indicated that during quiet stance, COP velocity was increased while wearing the exoskeleton, but the magnitude of sway was unchanged. The OD COP measures revealed that wearing the exoskeleton significantly reduced the sway magnitude and velocity in response to the perturbations. There were no systematic effects of wearing the exoskeleton on EMG. SPM analysis revealed that there was a range of individual responses; both behaviorally (COP) and among neuromuscular activation patterns (EMG). Using both the OD and 1D measures provided a more comprehensive representation of how wearing the exoskeleton impacts the responses to posterior perturbations. This study supports a growing body of evidence that exoskeletons must be personalized to meet the specific capabilities and needs of each individual end-user.

A Descriptive Case Study of Skilled Football Goalkeepers During 1 v 1 Dyads: A Case for Adaptive Variability in the Quiet Eye

Evidence investigating skilled performers in sport suggests that a prominent component of skilled behavior is, in part, due to the development of more effective and efficient perception-action couplings. Further, the Quiet Eye has emerged as a useful tool in which to investigate how skilled performers regulate action through fixating on visual information within the immediate environment before the onset of a goal directed movement. However, only a few contributions to the literature have attempted to examine the individual variations within these Quiet Eye fixations in skilled participants. In this case study, we first asked how goalkeepers control their actions, via the Quiet Eye in a representative task. Second, we sought to examine whether inter- and intra- individual differences in the Quiet Eye are present in skilled goalkeepers as a functional component of skilled performance. Results were consistent with previous work on football goalkeepers, with QE fixations located at the ball and visual pivot. However, individual analysis reveals different Quiet Eye gaze patterning between (inter) and within (intra) the goalkeepers during saving actions. To conclude, we have provided a descriptive case study in attempt to understand the Quiet Eye behaviors of a skilled sample of professional goalkeepers. In doing so we have suggested how adaptive variability, founded upon an Ecological Dynamics framework, may provide further insight into the function of the Quiet Eye.

A Proposed Framework to Describe Movement Variability within Sporting Tasks: A Scoping Review

Movement variability is defined as the normal variations in motor performance across multiple repetitions of a task. However, the term "movement variability" can mean different things depending on context, and when used by itself does not capture the specifics of what has been investigated. Within sport, complex movements are performed repeatedly under a variety of different constraints (e.g. different situations, presence of defenders, time pressure). Movement variability has implications for sport performance and injury risk management. Given the importance of movement variability, it is important to understand the terms used to measure and describe it. This broad term of "movement variability" does not specify the different types of movement variability that are currently being assessed in the sporting literature. We conducted a scoping review (1) to assess the current terms and definitions used to describe movement variability within sporting tasks and (2) to utilise the results of the review for a proposed framework that distinguishes and defines the different types of movement variability within sporting tasks. To be considered eligible, sources must have assessed a sporting movement or skill and had at least one quantifiable measure of movement variability. A total of 43 peer-reviewed journal article sources were included in the scoping review. A total of 280 terms relating to movement variability terminology were extracted using a data-charting form jointly developed by two reviewers. One source out of 43 (2%) supplied definitions for all types of movement variability discussed. Moreover, 169 of 280 terms (60%) were undefined in the source material. Our proposed theoretical framework explains three types of movement variability: strategic, execution, and outcome. Strategic variability describes the different approaches or methods of movement used to complete a task. Execution variability describes the intentional and unintentional adjustments of the body between repetitions within the same strategy. Outcome variability describes the differences in the result or product of a movement. These types emerged from broader frameworks in motor control and were adapted to fit the movement variability needs in sports literature. By providing specific terms with explicit definitions, our proposed framework can ensure like-to-like comparisons of previous terms used in the literature. The practical goal of this framework is to aid athletes, coaches, and support staff to gain a better understanding of how the different types of movement variability within sporting tasks contribute to performance. The framework may allow training methods to be tailored to optimise the specific aspects of movement variability that contribute to success. This review was retrospectively registered using the Open Science Framework (OSF) Registries ( https://osf.io/q73fd ).

Always Pay Attention to Which Model of Motor Learning You Are Using

This critical review considers the epistemological and historical background of the theoretical construct of motor learning for a more differentiated understanding. More than simply reflecting critically on the models that are used to solve problems-whether they are applied in therapy, physical education, or training practice-this review seeks to respond constructively to the recent discussion caused by the replication crisis in life sciences. To this end, an in-depth review of contemporary motor learning approaches is provided, with a pragmatism-oriented clarification of the researcher's intentions on fundamentals (what?), subjects (for whom?), time intervals (when?), and purpose (for what?). The complexity in which the processes of movement acquisition, learning, and refinement take place removes their predictable and linear character and therefore, from an applied point of view, invites a great deal of caution when trying to make generalization claims. Particularly when we attempt to understand and study these phenomena in unpredictable and dynamic contexts, it is recommended that scientists and practitioners seek to better understand the central role that the individual and their situatedness plays in the system. In this way, we will be closer to making a meaningful and authentic contribution to the advancement of knowledge, and not merely for the sake of renaming inventions.

Biomechanical responses to landing strategies of female artistic gymnasts

HIGHLIGHTS

An increase in the range of motion at the knee and hip may support the recommendation of the men's landing style.Gymnasts appear to utilise individual landing strategies to complete the landing objective, supporting the use of a single-subject design.

Differences in Baseball Batting Movement Patterns Between Facing a Pitcher and a Pitching Machine

Purpose: Pitching machines are widely used for baseball batting practice. However, these machines cannot precisely simulate a live pitcher's pitching motion. To understand if a batter's movement strategy would be altered due to disparate visual information provided by a pitching machine as opposed to a live pitcher, the present study aimed to compare differences in baseball batting movement patterns under the two delivery conditions. Methods: To examine movement variations and different strategies of each high-level athlete rather than obtaining averaged group performance, single-subject analysis was adopted. Four professional baseball players were recruited to bat around 50 pitches under each delivery condition. Vertical ground reaction forces of the participants' batting movements were recorded. Relative timings of key events and values of several kinetic parameters during batting were examined. Results: When batting against the pitching machine, batters initiated forward stepping earlier (relative to ball release), had smaller loading rate at landing the step, and altered the duration from forward bat swing to ball impact. These results might be attributed to lacking visual cues of a live pitcher's whole body kinematics prior to ball release. Without sufficient visual information, greater uncertainty and incomplete weight transfer affected the batter's decision making and movement execution. Conclusion: The batters in this study did adjust their movement strategy in batting against a pitching machine. With dissimilar batting movement patterns under the two delivery conditions, extensive reliance on training with pitching machines is not recommended.

Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

Background: Soft robotic exosuits can facilitate immediate increases in short- and long-distance walking speeds in people with post-stroke hemiparesis. We sought to assess the feasibility and rehabilitative potential of applying propulsion-augmenting exosuits as part of an individualized and progressive training program to retrain faster walking and the underlying propulsive strategy. Methods: A 54-yr old male with chronic hemiparesis completed five daily sessions of Robotic Exosuit Augmented Locomotion (REAL) gait training. REAL training consists of high-intensity, task-specific, and progressively challenging walking practice augmented by a soft robotic exosuit and is designed to facilitate faster walking by way of increased paretic propulsion. Repeated baseline assessments of comfortable walking speed over a 2-year period provided a stable baseline from which the effects of REAL training could be elucidated. Additional outcomes included paretic propulsion, maximum walking speed, and 6-minute walk test distance. Results: Comfortable walking speed was stable at 0.96 m/s prior to training and increased by 0.30 m/s after training. Clinically meaningful increases in maximum walking speed (Δ: 0.30 m/s) and 6-minute walk test distance (Δ: 59 m) were similarly observed. Improvements in paretic peak propulsion (Δ: 2.80 %BW), propulsive power (Δ: 0.41 W/kg), and trailing limb angle (Δ: 6.2 degrees) were observed at comfortable walking speed (p's < 0.05). Likewise, improvements in paretic peak propulsion (Δ: 4.63 %BW) and trailing limb angle (Δ: 4.30 degrees) were observed at maximum walking speed (p's < 0.05). Conclusions: The REAL training program is feasible to implement after stroke and capable of facilitating rapid and meaningful improvements in paretic propulsion, walking speed, and walking distance.

Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis

BACKGROUND

Gait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors.

METHODS

Five healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability.

RESULTS

For subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO.

CONCLUSIONS

This exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

Patients' experiences and effects of non-pharmacological treatment for myalgic encephalomyelitis/chronic fatigue syndrome - a scoping mixed methods review

PURPOSE

The EU COST Action 15111 collaboration on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) aims to assess current research and identify knowledge gaps in Europe. Presently, our purpose is to map the effects of non-pharmacological therapies (NPTs) for ME/CFS, and what patients find important in the treatment process.

METHODS

A scoping mixed methods literature review of European studies identified 16 papers fulfiling our inclusion criteria. The quantitative and qualitative studies were synthesized separately in tables. Additionally, extracts from the qualitative studies were subjected to translational analysis.

RESULTS

Effect studies addressed cognitive behavioural therapy (CBT, n = 4), multimodal rehabilitation (n = 2) and activity-pacing (n = 2). CBT reduced fatigue scores more than usual care or waiting list controls. The effects of rehabilitation and activity-pacing were inconsistent. The contents, assessment methods and effects of rehabilitation and activity pacing studies varied. For patients, health professionals' recognition of ME/CFS and support were crucial, but they expressed ambiguous experiences of what the NPTs entail.

CONCLUSIONS

Methodological differences make comparisons across NPTs impossible, and from a patient perspective the relevance of the specific contents of NPTs are unclear. Future well-designed studies should focus on developing NPTs tailored to patients' concerns and evaluation tools reflecting what is essential for patients.

Rehabilitation interventions need more than methodological standardisation: an individualised approach

OBJECTIVES

The main aim in the current study was to use a single-subject analysis to profile the physical performance characteristics of individuals within an injured group and a between-group approach to profile the group as a whole. These profiles were then used to inform single-subject and between-group rehabilitation interventions.

METHODS

Fifty-three (28 with athletic groin pain and 25 non-injured) Gaelic football players (24.8 years±7.1 years; 179 cm±5.5 cm; 79.7 kg±9.2 kg) underwent 3D biomechanical analysis, which was used to measure a series of physical performance characteristics. The non-injured group was used to create a 'performance database' to compare the injured individuals, and a between-group analysis was also conducted. The scores from each analysis were used to inform the targets of interventions.

RESULTS

The analysis highlighted the variety of profiles that existed across the tested individuals and that these profiles differed from that of the between-group analysis. By analysing individuals in a single-subject approach, detail can be seen that is lost with between-group analysis.

Recovery of Lower Extremity Function in the Initial Year Following Periacetabular Osteotomy: A Single Subject Analysis

BACKGROUND

Little is known regarding how lower extremity joint function recovers in the 6 months following periacetabular osteotomy (PAO) for activities other than walking.

PURPOSE

Assess patient-reported outcomes, hip strength, lower extremity joint moments, and moment distributions during sit-to-stand in a female athlete during the one-year period following PAO.

METHODS

Patient-reported outcomes (i.e. hip and groin outcome score; HAGOS), hip strength, and lower extremity joint moments and contributions to peak support moment during the sit-to-stand were assessed pre-operatively and at 6 weeks, 12 weeks, 6 months, and 13 months following PAO.

RESULTS

HAGOS scores returned to normative ranges, however overall quality of life scores remained low. By 13-month muscle strength recovered to baseline values. Following surgery, peak support and hip extensor moments were higher on the non-surgical limb, but the contributions of hip, knee, and ankle to peak support moment did not change. On the surgical limb, while peak support moments were lower, the hip contributed less, and the knee contributed more. These asymmetric loading patterns gradually normalized over 1 yea-.

CONCLUSIONS

Asymmetric loading following PAO should be considered when developing rehabilitation plans following this surgery.

Effects of the Barbell Load on the Acceleration Phase during the Snatch in Elite Olympic Weightlifting

The load-depended loss of vertical barbell velocity at the end of the acceleration phase limits the maximum weight that can be lifted. Thus, the purpose of this study was to analyze how increased barbell loads affect the vertical barbell velocity in the sub-phases of the acceleration phase during the snatch. It was hypothesized that the load-dependent velocity loss at the end of the acceleration phase is primarily associated with a velocity loss during the 1st pull. For this purpose, 14 male elite weightlifters lifted seven load-stages from 70–100% of their personal best in the snatch. The load–velocity relationship was calculated using linear regression analysis to determine the velocity loss at 1st pull, transition, and 2nd pull. A group mean data contrast analysis revealed the highest load-dependent velocity loss for the 1st pull (t = 1.85, p = 0.044, g = 0.49 [−0.05, 1.04]) which confirmed our study hypothesis. In contrast to the group mean data, the individual athlete showed a unique response to increased loads during the acceleration sub-phases of the snatch. With the proposed method, individualized training recommendations on exercise selection and loading schemes can be derived to specifically improve the sub-phases of the snatch acceleration phase. Furthermore, the results highlight the importance of single-subject assessment when working with elite athletes in Olympic weightlifting.

The correlation between jump height and mechanical power in a countermovement jump is artificially inflated

The countermovement jump is commonly used to assess an athlete's neuromuscular capacity. The aim of this study was to identify the mechanism behind the strong correlation between jump height and mechanical power in a countermovement jump. Three athletes each performed between 47 and 60 maximal-effort countermovement jumps on a force platform. For all three athletes, peak mechanical power and average mechanical power were strongly correlated with jump height (r = 0.54-0.90). The correlation between jump height and peak power was largely determined by the correlation between jump height and the velocity at peak power (r = 0.83-0.94) and was not related to the correlation between jump height and the ground reaction force at peak power (r = -0.20-0.18). These results confirm that the strong correlation between jump height and power is an artefact arising from how power is calculated. Power is a compound variable calculated from the product of instantaneous ground reaction force and instantaneous velocity, and application of statistical theory shows that the correlation between jump height and power is artificially inflated by the near-perfect correlation between jump height and the velocity at peak power. Despite this finding, mechanical power might still be useful in assessing the neuromuscular capacity of an athlete.

Analysis of the Effectiveness of Sub-sensory Electrical Noise Stimulation During Visuomotor Adaptations in Different Visual Feedback Conditions

Sub-sensory electrical noise stimulation has been shown to improve motor performance in tasks that mainly rely on proprioceptive feedback. During the execution of movements such as reaching, proprioceptive feedback combines dynamically with visual feedback. It is still unclear whether boosting proprioceptive information in tasks where proprioception mixes with vision can influence motor performance. To better understand this point, we tested the effect of electrical noise stimulation applied superficially to the muscle spindles during four different experiments consisting of isometric reaching tasks under different visual feedback conditions. The first experiment (n = 40) consisted of a reach-and-hold task where subjects had to hold a cursor on a target for 30 s and had visual feedback removed 10 s into the task. Subjects performed 30 repetitions of this task with different stimulation levels, including no stimulation. We observed that trials in which the stimulation was present displayed smaller movement variability. Moreover, we observed a positive correlation between the level of stimulation and task performance. The other three experiments consisted of three versions of an isometric visuomotor adaptation task where subjects were asked to reach to random targets in <1.5 s (otherwise incurring in negative feedback) while overcoming a 45° clockwise rotation in the mapping between the force exerted and the movement of the cursor. The three experiments differed in the visual feedback presented to the subjects, with one group (n = 20) performing the experiment with full visual feedback, one (n = 10) with visual feedback restricted only to the beginning of the trajectory, and one (n = 10) without visual feedback of the trajectory. All subjects performed their experiment twice, with and without stimulation. We did not observe substantial effects of the stimulation when visual feedback was present (either completely or partially). We observed a limited effect of the stimulation in the absence of visual feedback consisting in a significant smaller number of negative-feedback trials and a significant smaller movement time in the first block of the adaptation phase. Our results suggest that sub-sensory stimulation can be beneficial when proprioception is the main feedback modality but mostly ineffective in tasks where visual feedback is actively employed.

Changes in human walking dynamics induced by uneven terrain are reduced with ongoing exposure, but a higher variability persists

During walking, uneven terrain alters the action of the ground reaction force from stride to stride. The extent to which such environmental inconsistencies are withstood may be revealed by the regulation of whole-body angular momentum (L) during walking. L quantifies the balance of momenta of the body segments (thigh, trunk, etc.) about their combined center of mass, and remains close to zero during level walking. A failure to constrain L has been linked to falls. The aim of this study was to explore the ability of young adults to orchestrate their movement on uneven terrain, illustrated by the range of L (L_R) and its variability (vL_R). In eleven male adults, we observed significant increases in sagittal plane L_R, and vL_R in all three planes of motion during walking on an uneven in comparison to a flat surface. No reductions in these measures were observed within a 12-minute familiarisation period, suggesting that unimpaired adults either are unable to, or do not need to eliminate the effects of uneven terrain. Transverse plane L_R, in contrast, was lower on immediate exposure, and then increased, pointing to the development of a less restrictive movement pattern, and would support the latter hypothesis.

Association Between Temporal Spatial Parameters and Overuse Injury History in Runners: A Systematic Review and Meta-analysis

BACKGROUND

Temporal spatial parameters during running are measurable outside of clinical and laboratory environments using wearable technology. Data from wearable technology may be useful for injury prevention, however the association of temporal spatial parameters with overuse injury in runners remains unclear.

OBJECTIVE

To identify the association between overuse injury and temporal spatial parameters during running.

DATA SOURCES

Electronic databases were searched using keywords related to temporal spatial parameters, running, and overuse injury, and authors' personal article collections through hand search.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles included in this systematic review contained original data, and analytically compared at least one temporal spatial parameter (e.g. cadence) between uninjured and retrospectively or prospectively injured groups of runners. Articles were excluded from this review if they did not meet these criteria or measured temporal spatial parameters via survey.

STUDY APPRAISAL AND SYNTHESIS METHOD

The internal validity of each article was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analyses were conducted for temporal spatial parameters if data existed from at least three separate cohorts of the same prospective or retrospective design. Data were pooled and analyzed using an inverse variance fixed-effect model.

RESULTS

Thirteen articles which tested a total of 24 temporal spatial parameters during running were included in the review. Meta-analyses were conducted on four temporal spatial parameters using data from eleven retrospective studies. Healthy runners and those with a history of overuse injury had a similar average stride time (mean difference: 0.00 s, 95% CI - 0.01 to 0.01 s), contact time (mean difference: 0.00 s, 95% CI 0.00 to 0.01 s), cadence (mean difference: 0.3 steps per minute (spm), 95% CI - 1.8 to 2.5 spm), and stride length (mean difference 0.00 m, 95% CI - 0.05 to 0.05 m) during running.

LIMITATIONS

Data pooled for meta-analyses were limited to retrospective design studies. Studies included in the systematic review had low methodological consistency.

CONCLUSION

Based on pooled results from multiple studies, stride time, contact time, cadence, and stride length averages are not distinguishable between runners either with or without a history of overuse injury. More prospective studies are required to determine the association of temporal spatial parameters with overuse injury development in runners.

SYSTEMATIC REVIEW REGISTRATION REGISTRY AND NUMBER

CRD42018112290.

Principal Component Analysis Reveals the Proximal to Distal Pattern in Vertical Jumping Is Governed by Two Functional Degrees of Freedom

The successful completion of motor tasks requires effective control of multiple degrees of freedom (DOF), with adaptations occurring as a function of varying performance constraints. In this study we sought to compare the emergent coordination strategies employed in vertical jumping under different task constraints [countermovement jump (CMJ) with arm swing-CMJas and no arm swing-CMJnas]. In order to achieve this, principal component analysis (PCA) was conducted on joint moment waveform data from the hip, knee and ankle. This statistical approach has the advantage of analyzing the whole movement within a time series and reduces multidimensional datasets to lower dimensions for analysis. Both individual and group analyses were conducted. For individual analysis, PCA was conducted on combined hip, knee, and ankle joint moment data for each individual across both CMJnas (thirty-eight participants), and CMJas (twenty-two participants) conditions. PCA was also performed comparing all data from each individual across CMJnas and CMJas conditions. The results revealed a maximum of three principal components (PC) explained over 90% of the variance in the data sets for both conditions and within individual and group analyses. For individual analysis, no more than 2PCs were required for both conditions. For group analysis, CMJas required 3PCs to explain over 90% of the variance within the dataset and CMJnas only required 2PCs. Reconstruction of the original NJM waveforms from the PCA output demonstrates a greater loading of hip and knee joint moments to PC1, with PC2 showing a greater loading to ankle joint moment. The reduction in dimensions of the original data shows the proximal to distal extension pattern in the sagittal plane, typical of vertical jumping tasks, is governed by only 2 functional DOF, at both a group, and individual level, rather than the typically reported 3 mechanical DOF in some forms of jumping.

Reviewing the Variability-Overuse Injury Hypothesis: Does Movement Variability Relate to Landing Injuries?

PURPOSE

Overuse injuries are common in sport, but complete understanding of injury risk factors remains incomplete. Although biomechanical studies frequently examine musculoskeletal injury mechanisms, human movement variability studies aim to better understand neuromotor functioning, with proposed connections between overuse injury mechanisms and changes in motor variability.

METHOD

In a narrative review, we discuss the variability-overuse injury hypothesis, which suggests repeated load application leads to mechanical tissue breakdown and subsequent injury when exceeding the rate of physiological adaptation. Due to the multidisciplinary nature of this hypothesis, we incorporate concepts from motor control, neurophysiology, biomechanics, as well as research design and data analysis. We therefore summarize multiple perspectives while proposing theoretical relationships between movement variability and lower extremity overuse injuries.

RESULTS

Experimental data are presented and summarized from published experiments examining interactions between experimental task demands and movement variability in the context of drop landing movements, along with comparisons to previous movement variability studies.

CONCLUSION

We provide a conceptual framework for sports medicine researchers interested in predicting and preventing sports injuries. Under performance conditions with greater task demands, we predict reduced trial-to-trial movement variability that could increase the likelihood of overuse injuries.

Recommendations for Measurement and Management of an Elite Athlete

Athletes who merit the title 'elite' are rare and differ both quantitatively and qualitatively from athletes of lower qualifications. Serving and studying elite athletes may demand non-traditional approaches. Research involving elite athletes suffers because of the typical nomothetic requirements for large sample sizes and other statistical assumptions that do not apply to this population. Ideographic research uses single-athlete study designs, trend analyses, and statistical process control. Single-athlete designs seek to measure differences in repeated measurements under prescribed conditions, and trend analyses may permit systematic monitoring and prediction of future outcomes. Statistical process control uses control charting and other methods from management systems to assess and modify training processes in near real-time. These methods bring assessment and process control into the real world of elite athletics.

Dynamic balance changes within three weeks of fitting a new prosthetic foot component

Balance during walking is of high importance to prosthesis users and may affect walking during baseline observation and evaluation. The aim of this study was to determine whether changes in walking balance occurred during an adaptation period following the fitting of a new prosthetic component. Margin of stability in the medial-lateral direction (MOS_ML) and an anterior instability margin (AIM) were used to quantify the dynamic balance of 21 unilateral transtibial amputees during overground walking. Participants trialled two prosthetic feet presenting contrasting movement/balance constraints; a Higher Activity foot similar to that of their own prosthesis, and a Lower Activity foot. Participants were assessed before (Visit 1) and after (Visit 2) a 3-week adaptation period on each foot. With the Higher Activity component, MOS_ML decreased on the prosthetic side, and increased on the sound side from Visit 1 to Visit 2, eliminating a significant inter-limb difference apparent at Visit 1 (Visit 1-sound=0.062m, prosthetic=0.075m, p=0.018; Visit 2-sound=0.066m, prosthetic=0.074m, p=0.084). No such change was seen with the Lower Activity foot (Visit 1-sound=0.064m, prosthetic=0.077m, p=0.007; Visit 2-sound=0.063m, prosthetic=0.080m, p<0.001). Significant changes in AIM were observed at Visit 2 (Visit 1: -0.16 (0.08) m, Visit 2: -0.17 (0.08) m; F=23.396, p<0.01). These findings suggest that changes in balance during walking can occur following the initial receipt of a device regardless of whether the component is of the same functional category as the one an individual is accustomed to using.

Intra-individual gait patterns across different time-scales as revealed by means of a supervised learning model using kernel-based discriminant regression

OBJECTIVE

Traditionally, gait analysis has been centered on the idea of average behavior and normality. On one hand, clinical diagnoses and therapeutic interventions typically assume that average gait patterns remain constant over time. On the other hand, it is well known that all our movements are accompanied by a certain amount of variability, which does not allow us to make two identical steps. The purpose of this study was to examine changes in the intra-individual gait patterns across different time-scales (i.e., tens-of-mins, tens-of-hours).

METHODS

Nine healthy subjects performed 15 gait trials at a self-selected speed on 6 sessions within one day (duration between two subsequent sessions from 10 to 90 mins). For each trial, time-continuous ground reaction forces and lower body joint angles were measured. A supervised learning model using a kernel-based discriminant regression was applied for classifying sessions within individual gait patterns.

RESULTS AND DISCUSSION

Discernable characteristics of intra-individual gait patterns could be distinguished between repeated sessions by classification rates of 67.8 ± 8.8% and 86.3 ± 7.9% for the six-session-classification of ground reaction forces and lower body joint angles, respectively. Furthermore, the one-on-one-classification showed that increasing classification rates go along with increasing time durations between two sessions and indicate that changes of gait patterns appear at different time-scales.

CONCLUSION

Discernable characteristics between repeated sessions indicate continuous intrinsic changes in intra-individual gait patterns and suggest a predominant role of deterministic processes in human motor control and learning. Natural changes of gait patterns without any externally induced injury or intervention may reflect continuous adaptations of the motor system over several time-scales. Accordingly, the modelling of walking by means of average gait patterns that are assumed to be near constant over time needs to be reconsidered in the context of these findings, especially towards more individualized and situational diagnoses and therapy.

A Comparative Evaluation of Gait between Children with Autism and Typically Developing Matched Controls

Anecdotal reports suggest children with autism spectrum disorder (ASD) ambulate differently than peers with typical development (TD). Little empirical evidence supports these reports. Children with ASD exhibit delayed motor skills, and it is important to determine whether or not motor movement deficits exist during walking. The purpose of the study was to perform a comprehensive lower-extremity gait analysis between children (aged 5-12 years) with ASD and age- and gender-matched-samples with TD. Gait parameters were normalized to 101 data points and the gait cycle was divided into seven sub-phases. The Model Statistic procedure was used to test for statistical significance between matched-pairs throughout the entire gait cycle for each parameter. When collapsed across all participants, children with ASD exhibited large numbers of significant differences (p < 0.05) throughout the gait cycle in hip, knee, and ankle joint positions as well as vertical and anterior/posterior ground reaction forces. Children with ASD exhibited unique differences throughout the gait cycle, which supports current literature on the heterogeneity of the disorder. The present work supports recent findings that motor movement differences may be a core symptom of ASD. Thus, individuals may benefit from therapeutic movement interventions that follow precision medicine guidelines by accounting for individual characteristics, given the unique movement differences observed.

Acute and chronic effects of aquatic treadmill training on land treadmill running kinematics: A cross-over and single-subject design approach

The aim of this study was to determine if selected kinematic measures (foot strike index [SI], knee contact angle and overstride angle) were different between aquatic treadmill (ATM) and land treadmill (LTM) running, and to determine if these measures were altered during LTM running as a result of 6 weeks of ATM training. Acute effects were tested using 15 competitive distance runners who completed 1 session of running on each treadmill type at 5 different running speeds. Subsequently, three recreational runners completed 6 weeks of ATM training following a single-subject baseline, intervention and withdrawal experiment. Kinematic measures were quantified from digitisation of video. Regardless of speed, SI values during ATM running (61.3 ± 17%) were significantly greater (P = 0.002) than LTM running (42.7 ± 23%). Training on the ATM did not change (pre/post) the SI (26 ± 3.2/27 ± 3.1), knee contact angle (165 ± 0.3/164 ± 0.8) or overstride angle (89 ± 0.4/89 ± 0.1) during LTM running. Although SI values were different between acute ATM and LTM running, 6 weeks of ATM training did not appear to alter LTM running kinematics as evidenced by no change in kinematic values from baseline to post intervention assessments.

Does skill specialisation influence individual differences in drag flicking speed and accuracy?

Research has revealed that individual soccer goalkeepers respond differently to penalty shots, depending on their specific perceptual and motor capabilities. However, it remains unclear whether analogous differences exist between individual penalty takers, and if specialising in penalty taking affects the occurrence of differences between individuals. The present study examined individual differences in penalty shot speed and accuracy for specialists in penalty taking versus non-specialists. Expert specialist field hockey drag flickers and equivalently skilled non-specialists performed drag flicks towards predetermined targets placed in the face of a standard field hockey goal. Comparisons in shot speed and accuracy were made at a group level (specialists vs. non-specialists) as well as between individuals. Results revealed differences in both speed and accuracy between specialists, but only differences in speed between non-specialists. Specialists generated significantly greater shot speed than non-specialists (P < .001) and were more accurate to some, but not all, targets (top left, P < .006, bottom left P < .001). In addition, it was found that in specialists increasing practice correlated with decreasing accuracy. This may indicate that excessive practice could potentially reduce a specialist's accuracy in shooting towards specific targets.

Exploratory Investigation of Impact Loads During the Forward Handspring Vault

The purpose of this study was to examine kinematic and kinetic differences in low and high intensity hand support impact loads during a forward handspring vault. A high-speed video camera (500 Hz) and two portable force platforms (500 Hz) were installed on the surface of the vault table. Two-dimensional analyses were conducted on 24 forward handspring vaults performed by 12 senior level, junior Olympic program female gymnasts (16.9 ±1.4 yr; body height 1.60 ±0.1 m; body mass 56.7 ±7.8 kg). Load intensities at impact with the vault table were classified as low (peak force < 0.8 × body weight) and high (peak force > 0.8 × body weight). These vaults were compared via crucial kinetic and kinematic variables using independent t-tests and Pearson correlations. Statistically significant (p < 0.001) differences were observed in peak force (t(24) = 4.75, ES = 3.37) and time to peak force (t(24) = 2.07, ES = 1.56). Statistically significant relationships between the loading rate and time to peak force were observed for high intensity loads. Peak force, time to peak force, and a shoulder angle at impact were identified as primary variables potentially involved in the determination of large repetitive loading rates on the forward handspring vault.

Meniscal translation during knee flexion: what do we really know?

PURPOSE

Translation during knee flexion is a key function of the menisci. The amount of translation displayed by the medial and lateral meniscus during knee flexion, particularly while loadbearing, remains relatively unknown. To address this lack of knowledge, a systematic review of the relevant literature was performed.

METHODS

We performed a literature search for studies in which a primary aim was to report the anterior-posterior translation of the menisci during knee flexion. Data were collected on the characteristics of the sample, the imaging approach, measurement and analysis techniques, and outcome variables. We scored the quality of studies and their reporting using a modified Coleman methodology score with ten criteria, with a maximum possible score of 100.

RESULTS

Twelve full-text studies were retrieved that met the inclusion criteria. Of these, the in vitro studies (N = 4) scored the lowest for methodology (median 44.5), with in vivo studies of healthy knees (N = 4) (median 60) and in vivo comparative studies (N = 4) scoring highest (median 74.5). The evidence from studies with the highest methodology scores (>65) (N = 4) indicate that the lateral meniscus translates more posteriorly than the medial meniscus during flexion. In addition, meniscal translation is influenced by loading, particularly in knee rotation, but not by ACL deficiency, despite greater posterior translation of the medial femoral condyle during flexion.

CONCLUSIONS

The generally low methodological quality of studies suggests that caution is required when interpreting meniscal translation during knee flexion reported in the literature. While the methods for assessing meniscal translation in vivo continue to improve and provide opportunity for clinical implementation, there remains a lack of robust evidence regarding meniscal translation in the healthy knee for comparative purposes. A number of recommendations are made for future studies to address key limitations identified in previous investigations. Additional studies of high methodological quality are required to quantify the relationships between joint loading, joint pathology and meniscal translation during knee flexion.

LEVEL OF EVIDENCE

III.

Manipulating the stride length/stride velocity relationship of walking using a treadmill and rhythmic auditory cueing in non-disabled older individuals. A short-term feasibility study

One target for rehabilitating locomotor disorders in older adults is to increase mobility by improving walking velocity. Combining rhythmic auditory cueing (RAC) and treadmill training permits the study of the stride length/stride velocity ratio (SL/SV), often reduced in those with mobility deficits. We investigated the use of RAC to increase velocity by manipulating the SL/SV ratio in older adults. Nine participants (6 female; age: 61.1 ± 8.8 years) walked overground on a gait mat at preferred and fast speeds. After acclimatization to comfortable speed on a treadmill, participants adjusted their cadence to match the cue for 3 min at 115% of preferred speed by either (a) increasing stride length only or (b) increasing stride frequency only. Following training, participants walked across the gait mat at preferred velocity without, and then with, RAC. Group analysis determined no immediate overground velocity increase, but reintroducing RAC did produce an increase in velocity after both conditions. Group and single subject analysis determined that the SL/SV ratio changed in the intended direction only in the stride length condition. We conclude that RAC is a powerful organizer of gait parameters, evidenced by its induced after-effects following short duration training.

Physical fitness improvements and occupational low-back loading - an exercise intervention study with firefighters

The impact of exercise on firefighter job performance and cardiorespiratory fitness has been studied extensively, but its effect on musculoskeletal loading remains unknown. The aim of this study was to contrast the physical fitness and low-back loading outcomes of two groups of firefighters who completed different exercise programmes. Before and after 12 weeks of exercise, subjects performed a physical fitness test battery, the Functional Movement Screen™ (FMS) and simulated job tasks during which peak L4/L5 joint compression and reaction shear forces were quantified using a dynamic biomechanical model. Subjects who exercised exhibited statistically significant improvements (p < 0.05) in body composition, cardiorespiratory fitness, muscular strength, power, endurance and flexibility, but FMS scores and occupational low-back loading measures were not consistently affected. Firefighters who are physically fit are better able to perform essential job duties and avoid cardiac events, but short-term improvements in physical fitness may not necessarily translate into reduced low-back injury risk.

Criterion and construct validity of prosthesis-integrated measurement of joint moment data in persons with transtibial amputation

Prosthesis-integrated sensors are appealing for use in clinical settings where gait analysis equipment is unavailable, but accurate knowledge of patients' performance is desired. Data obtained from load cells (inferring joint moments) may aid clinicians in the prescription, alignment, and gait rehabilitation of persons with limb loss. The purpose of this study was to assess the accuracy of prosthesis-integrated load cells for routine use in clinical practice. Level ground walking of persons with transtibial amputation was concurrently measured with a commercially available prosthesis-integrated load cell, a 10-camera motion analysis system, and piezoelectric force plates. Ankle and knee flexion/extension moments were derived and measurement methods were compared via correlation analysis. Pearson correlation coefficients ranged from 0.661 for ankle pronation/supination moments to 0.915 for ankle flexion/extension moments (P < .001). Root mean squared errors between measurement methods were in the magnitude of 10% of the measured range and were explainable. Differences in results depicted differences between systems in definition and computation of measurement variables. They may not limit clinical use of the load cell, but should be considered when data are compared directly to conventional gait analysis data. Construct validity of the load cell (ie, ability to measure joint moments in-situ) is supported by the study results.

The head tracks and gaze predicts: how the world's best batters hit a ball

Hitters in fast ball-sports do not align their gaze with the ball throughout ball-flight; rather, they use predictive eye movement strategies that contribute towards their level of interceptive skill. Existing studies claim that (i) baseball and cricket batters cannot track the ball because it moves too quickly to be tracked by the eyes, and that consequently (ii) batters do not – and possibly cannot – watch the ball at the moment they hit it. However, to date no studies have examined the gaze of truly elite batters. We examined the eye and head movements of two of the world’s best cricket batters and found both claims do not apply to these batters. Remarkably, the batters coupled the rotation of their head to the movement of the ball, ensuring the ball remained in a consistent direction relative to their head. To this end, the ball could be followed if the batters simply moved their head and kept their eyes still. Instead of doing so, we show the elite batters used distinctive eye movement strategies, usually relying on two predictive saccades to anticipate (i) the location of ball-bounce, and (ii) the location of bat-ball contact, ensuring they could direct their gaze towards the ball as they hit it. These specific head and eye movement strategies play important functional roles in contributing towards interceptive expertise.

Course setting and selected biomechanical variables related to injury risk in alpine ski racing: an explorative case study

Background

Course setting has often been discussed as a potential preventative measure in the World Cup ski-racing community. However, there is limited understanding of how it is related to injury risk.

Objective

This study was undertaken to investigate the effect of increased horizontal gate distance on energy-related and injury mechanism-related variables.

Methods

During a video-based three-dimensional (3D)-kinematic field measurement, a top world-class racer performed giant slalom runs at two course settings with different horizontal gate distances. A full-body segment model was reconstructed in 3D and selected biomechanical parameters were calculated.

Results

For the analysed turn, no significant differences were found in turn speed for increased horizontal gate distance. However, a large effect size was observed for speed reduction towards the end of the turn. Turn forces were by tendency higher at the beginning and significantly higher towards the end of the turn. Additionally, significant differences were found in higher inward leaning, and large effect sizes were observed for a decreased fore/aft position after gate passage.

Conclusions

On the basis of the data of this study, no final conclusion can be made about whether, for a section of consecutive turns, increasing horizontal gate distance is an effective tool for speed reduction. However, this study pointed out two major drawbacks of this course setting modification: (1) it may increase fatigue as a consequence of loading forces acting over a longer duration; (2) it may increase the risk of out-of-balance situations by forcing the athlete to exhaust his backward and inward leaning spectrum.

Human movement variability, nonlinear dynamics, and pathology: is there a connection?

Fields studying movement generation, including robotics, psychology, cognitive science, and neuroscience utilize concepts and tools related to the pervasiveness of variability in biological systems. The concept of variability and the measures for nonlinear dynamics used to evaluate this concept open new vistas for research in movement dysfunction of many types. This review describes innovations in the exploration of variability and their potential importance in understanding human movement. Far from being a source of error, evidence supports the presence of an optimal state of variability for healthy and functional movement. This variability has a particular organization and is characterized by a chaotic structure. Deviations from this state can lead to biological systems that are either overly rigid and robotic or noisy and unstable. Both situations result in systems that are less adaptable to perturbations, such as those associated with unhealthy pathological states or absence of skillfulness.

A new classification of diabetic gait pattern based on cluster analysis of biomechanical data

BACKGROUND

The diabetic foot, one of the most serious complications of diabetes mellitus and a major risk factor for plantar ulceration, is determined mainly by peripheral neuropathy. Neuropathic patients exhibit decreased stability while standing as well as during dynamic conditions. A new methodology for diabetic gait pattern classification based on cluster analysis has been proposed that aims to identify groups of subjects with similar patterns of gait and verify if three-dimensional gait data are able to distinguish diabetic gait patterns from one of the control subjects.

METHOD

The gait of 20 nondiabetic individuals and 46 diabetes patients with and without peripheral neuropathy was analyzed [mean age 59.0 (2.9) and 61.1(4.4) years, mean body mass index (BMI) 24.0 (2.8), and 26.3 (2.0)]. K-means cluster analysis was applied to classify the subjects' gait patterns through the analysis of their ground reaction forces, joints and segments (trunk, hip, knee, ankle) angles, and moments.

RESULTS

Cluster analysis classification led to definition of four well-separated clusters: one aggregating just neuropathic subjects, one aggregating both neuropathics and non-neuropathics, one including only diabetes patients, and one including either controls or diabetic and neuropathic subjects.

CONCLUSIONS

Cluster analysis was useful in grouping subjects with similar gait patterns and provided evidence that there were subgroups that might otherwise not be observed if a group ensemble was presented for any specific variable. In particular, we observed the presence of neuropathic subjects with a gait similar to the controls and diabetes patients with a long disease duration with a gait as altered as the neuropathic one.

Objective evaluation of expert performance during human robotic surgical procedures

Robotic laparoscopic surgery has revolutionized minimally invasive surgery and has increased in popularity due to its important benefits. However, evaluation of surgical performance during human robotic laparoscopic procedures in the operating room is very limited. We previously developed quantitative measures to assess robotic surgical proficiency. In the current study, we want to determine if training task performance is equivalent to performance during human surgical procedures performed with robotic surgery. An expert with more than 5 years of robotic laparoscopic surgical experience performed two training tasks (needle passing and suture tying) and one human laparoscopic procedure (Nissan fundoplication) using the da Vinci™ Surgical System (dVSS). Segments of the human procedure that required needle passing and suture tying were extracted. Time to task completion, distance traveled, speed, curvature, and grip force were measured at the surgical instrument tips. Single-subject analysis was used to compare training task performance and human surgical performance. Nearly all objective measures (8 out of 13) were significantly different between training task performance and human surgical performance for both the needle passing and the suture tying tasks. The surgeon moved slower, made more curved movements, and used more grip force during human surgery. Even though it appears that the surgeon performed better in the training tasks, it is likely that during human surgical procedures, the surgeon is more cautious and meticulous in the movements performed in order to prevent tissue damage or other complications. The needle passing and the suture tying training tasks may be suitable to establish a foundation of surgical skill; however, further training may be necessary to improve transfer of learning to the operating room. We recommend that more realistic training tasks be developed to better predict performance during robotic surgical procedures and testing the transferability of basic skill acquisition to surgical performance.

The associations between fast bowling technique and ball release speed: A pilot study of the within-bowler and between-bowler approaches

The inability of the between-bowlers methodology to control parameters external to technique could lead to erroneous significant and non-significant associations being reported between fast-bowling technique and ball release speed. Using Pearson's product - moment correlation, we first examined the effectiveness of a within-bowler methodology to identify associations between technique and ball release speed of an elite semi-open fast bowler over 20 deliveries. These results were compared with associations identified from a between-bowlers methodology in which 20 single-performance trials bowled by elite fast bowlers adopting a semi-open shoulder alignment were collated. Sufficient variation was observed in within-bowler ball release speed to allow f relationships to be identified between technique and ball release speed. Although greater variation in bowling technique parameters was observed in the between-bowlers methodology, no associations were identified between technique and ball release speed. Multiple stepwise regression analysis showed that 87.5% of the within-bowler variation in ball release speed can be attributed to run-up velocity, angular velocity of the bowling arm, vertical velocity of the non-bowling arm, and stride length. The within-bowler methodology provided significant detailed information about the individual bowler that the between-bowlers methodology overlooked, forming the basis of a performance enhancement programme. It is recommended that within-bowler methodology be used in future investigation of technique relationships.

Different centre of pressure patterns within the golf stroke II: group-based analysis

Although the golf coaching literature stresses the importance of weight transfer during the swing, research has been conflicting or lacking statistical support. A potential problem with previous studies is that no attempt was made to account for different movement strategies in the golf swing. This study evaluated the relationship between centre of pressure measures and club head velocity within two previously identified swing styles, the "Front Foot" and "Reverse" styles. Thirty-nine Front Foot golfers and 19 Reverse golfers performed swings with a driver while standing on two force plates. From the force plate data, centre of pressure displacement, velocity, range, and timing parameters were calculated. Correlation and regression analysis indicated that a larger range of centre of pressure and a more rapid centre of pressure movement in the downswing was associated with a larger club head velocity at ball contact for the Front Foot group. For the Reverse golfers, positioning the centre of pressure further from the back foot at late backswing and a more rapid centre of pressure transfer towards the back foot at ball contact was associated with a larger club head velocity at ball contact. This study has highlighted the importance of identifying different movement strategies before evaluating performance measures, as different parameters were found to be important for the Front Foot and Reverse styles.

Different centre of pressure patterns within the golf stroke I: Cluster analysis

Weight transfer research in the golf swing has produced conflicting and inconclusive results. A limitation of previous studies is the assumption that only one swing "style" exists within the golf swing. If different styles, or movement strategies, exist and if the different styles are analysed together in a single group, statistical errors will result. The aim of this study was to determine if different weight transfer styles exist in the golf swing by applying cluster analysis to centre of pressure (CP) patterns in the direction of hit (CPy) and to evaluate cluster analysis issues. Sixty-two professional to high handicap golfers performed simulated drives, hitting a golf ball into a net, while standing on two force plates. Centre of pressure position relative to the feet (CPy%) was quantified at eight swing events identified from 200-Hz video. Cluster analysis identified two major CPy% styles: a "Front Foot" style and a "Reverse" style. Both styles began with CPy% positioned evenly between the feet, moved to the back foot during backswing, and then forward during early downswing. Beyond early downswing, the Front Foot group continued to move CPy% to the Front Foot through to ball contact, while the Reverse group moved CPy% towards the back foot through ball contact and follow-through. Both weight transfer styles were evident across skill levels from professional to high handicap golfers, indicating that neither style was a technical error. Cluster analysis should include hierarchical and non-hierarchical clustering and use objective measures combined with theoretical assessment to determine the optimal number of clusters. Furthermore, a number of validation procedures should always be used to validate the solution.

Lower back and elbow injuries in golf

Golf injuries to the lower back and elbow are common problems in both the professional and amateur player, and any information regarding the successful treatment of these injuries has important implications for the medical practitioner. This paper presents the successful management and outcome of two case studies associated with low back pain and lateral epicondylitis in golf. Exercise therapy and conditioning has been shown to be an effective treatment modality for these two types of injury. In particular, a dynamic exercise programme which incorporates golf functional rehabilitation, is a modern and accepted method by both the patient and the clinician. Effective programmes need to be golf-specific to maintain the interest of the participant and yet at the same time they need to be able to accommodate other factors such as age, gender and the level of the golfer. Furthermore, it is critical that the clinical practitioner has a fundamental knowledge of normal swing mechanics and a working knowledge of the musculoskeletal requirements needed to swing a golf club. In the case of the lower back injury, evaluation was based on detailed computer tomography and centred on the conditioning of the transversus abdominis muscle. Although this muscle is not considered to be paraspinal, it has particularly important implications in the maintenance of spinal stability so that other more specific golf functioning exercises and rehabilitation can be performed. For the case study of lateral epicondylitis detailed evaluation and consideration of neuropathy was an important factor in the diagnostic process. In part, it was necessary to deviate from conventional treatment to produce an effective outcome. A comprehensive resistance-strength-training programme and golf functional 'hitting' programme was used to treat the problem. The conformity by the patient to complete the exercise regimen has been an issue of concern for clinicians managing and treating golf-related problems. Many golfers are 'fanatical' and unless they can see that by continuing the programme their injury will be overcome, it is difficult trying to restrict their time on the golf course. The two case studies described in this article highlight how an extensive and dynamic golf functional programme could be used as an effective method for managing and preventing golf injuries.