Hollman, John H.

ObjectiveThe primary aim of this study was to determine the inter‐ and intrarater reliability of ultrasound (US) measurements of the ischiofemoral space (IFS) following a brief training session. A secondary aim was to determine if reliability correlated with sonographer experience.DesignProspective cohort study.SettingPhysical medicine and rehabilitation department within a tertiary care institution.ParticipantsSeven male and 3 female individuals were recruited to serve as models. Nine physician sonographers (3 postgraduate year [PGY]‐2 residents, 3 PGY‐4 residents, 3 physicians) were recruited to serve as sonographers.Methods or InterventionsSonographers received a 15‐minute educational session on identifying the IFS with US, followed by 20 minutes of practice. Models were then placed in a prone position and secured to prevent hip movement. All operators measured bilateral IFSs in each model twice with a washout period between measurements. Operators were blinded to all measurements.Main Outcome MeasuresPrimary outcomes were inter‐ and intrarater reliability interclass coefficients (ICCs) of IFS measurements among the groups with different levels of US experience. Secondary outcomes included comparisons of inter‐ and intrarater reliability ICCs of IFS measurements between groups, and the difference of mean IFS measurements between groups.ResultsIntrarater reliability ICCs were 0.829, 0.680, and 0.596 for physician, PGY‐4, and PGY‐2 groups, respectively. Interrater reliability ICCs were 0.722, 0.427, and 0.558 for physician, PGY‐4, and PGY‐2 groups, respectively. No statistically significant differences in reliability were identified between groups. Mean IFS measurements were 31.2, 33.4, and 34.0 mm for physician, PGY‐4, and PGY‐2 groups, respectively. Physician measurements were significantly smaller than the PGY‐4 and PGY‐2 measurements (P < .049 and P < .01).ConclusionsFollowing a brief training session, experienced sonographers demonstrated excellent IFS measurement intrarater reliability, whereas PGY‐4 and PGY‐2 sonographers demonstrated fair intrarater reliability. All sonographers demonstrated fair interrater reliability.Level of EvidenceII

Background: External rotation (ER) strengthening of the shoulder is an integral component of rehabilitative and preventative programs for overhead athletes. A variety of shoulder ER strengthening exercises are reported, including those intended to integrate the core musculature. The purpose of this study was to examine ER torque and electromyographic (EMG) activation of shoulder and trunk muscles while performing resisted isometric shoulder ER in 3 positions (standing, side lying, and side plank). Hypothesis: Significantly greater force and shoulder muscle activation would be generated while side lying given the inherent stability of the position, and greater trunk muscle activation would be generated in the less stable plank position. Study Design: Quasi-experimental repeated-measures study. Level of Evidence: Level 5. Methods: A convenience sample of 25 healthy overhead recreational athletes (9 men, 16 women) participated in this study. EMG electrodes were placed on the infraspinatus, posterior deltoid, middle trapezius, multifidi, internal obliques, and external obliques. EMG signals were normalized to a maximal isometric contraction. Participants performed resisted isometric ER in standing, side-lying, and side plank positions. Results were analyzed using a repeated-measures analysis of variance with post hoc Bonferroni corrections (α = 0.05). Results: There was no significant difference in ER torque between positions (α = 0.05). A significant difference in EMG activity of shoulder and trunk musculature between positions was found in 7 of the 8 muscles monitored. Significantly greater EMG activity in the infraspinatus, middle trapezius, and the nondominant external and internal obliques was found in the side plank position as compared with standing and side lying. Conclusion: While there was no difference in ER torque between the 3 exercise positions, EMG activity of the shoulder and trunk muscles was dependent on body position. Clinical Relevance: If a clinician is seeking to integrate trunk muscle activation while performing shoulder ER strengthening, the side plank position is preferred as compared with standing or side lying.

The purpose of this study was to assess the correlations of acceleration measurements between an instrumented hockey helmet and the Hybrid III headform and to determine whether collision with a broad surface affects the correlations between these data. A CCM Vector hockey helmet, instrumented with the Head Impact Telemetry System, was fitted onto an instrumented Hybrid III headform and dropped onto an inclined plate to simulate impacts in hockey. The helmet and headform were dropped from 0.15, 0.30, and 0.60 m at different orientations to create impacts to the vertex, occipital, right, left, and forehead surfaces. Peak linear and rotational acceleration magnitudes and head injury criteria were assessed for each system. Correlations were assessed with the Pearson correlation coefficient, and linear regression models were generated. Relative error was assessed, and results were compared with the Wilcoxon signed rank test. Peak acceleration magnitudes generally had strong mathematical correlations, although a 1:1 linear relationship for rotational acceleration data was not observed. Differences between helmet and head peak acceleration magnitudes were significant. The linear relationship varied according to the impact direction. Instrumented helmet and head data demonstrated a strong mathematical correlation, but measures of linear acceleration generally had better 1:1 agreement than rotational acceleration measures. There is some dependence in the relationship between the helmet and head data on the impact direction, with vertex strikes showing the weakest correlation. Although data generated from the helmet may be useful for interpreting head accelerations experienced by on-ice players, additional analysis of the time-series data should be performed to understand its full utility.

Background: Behavioral Shaping Therapy (BeST) is a program that uses a multidisciplinary approach to treat patients diagnosed with functional movement disorder (FMD). While this diagnosis is classified as a psychological disorder by the Diagnostic and Statistical Manual of Mental Disorders, the BeST program focuses on treating the physical manifestations of FMD. Occupational therapists are an integral part of the multidisciplinary team, employing a variety of cognitive behavioral and motor reprogramming techniques to normalize movement patterns. Method: Patients 18 years of age or older with a confirmed diagnosis of FMD participated in this study. This retrospective chart review used the Canadian Occupation Performance Measure to examine the patients’ satisfaction and perceived change in task performance on discharge from the program. Results: Results from the dependent t-test indicated a positive outcome after participating in the BeST program, with a mean change in performance of 3.4 and a mean change in satisfaction of 4.7. Discussion: This study shows that occupational therapy can have a positive effect on patients diagnosed with FMD.