Author: Mokhtar

General information

Post-stroke patients with motor dysfunction who were hospitalized in the Department of Rehabilitation Medicine of our hospital from January 1, 2020 to January 1, 2022, aged 50 to 70 years old, were selected.

Inclusion criteria: [12] ① The patient met the diagnostic criteria for stroke established at the Fourth National Academic Conference on Cerebrovascular Diseases in 1995, [13, 14] and stroke was diagnosed as the primary disease on CT or MRI. ② The time between disease onset and enrollment ranged from two weeks to three months. ③ The patient’s vital signs were stable and the patient was conscious, able to understand the instructions and cooperate with the rehabilitation training. ④ The patient’s score on the Kinesthetic and Visual Imagery Questionnaire (KVIQ) was ≥ 25 points. ⑤ The patient signed the required informed consent form. ⑥ Age between 50 and 70 years.

Exclusion criteria: [14] ① The patient suffered from severe cardiac, hepatic or renal insufficiency, a malignant tumor, etc. ② The patient suffered from impaired consciousness, aphasia, mental disorder or severe cognitive impairment. ③ The patient has had other craniocerebral diseases or traumatic sequelae in the past. ④ The patient has previous severe osteoarticular disorders causing abnormal trunk function.

Finally, a total of 100 patients with stroke and motor dysfunction were included, and they were divided into a control group and a trial group according to the random number table, with 50 cases in each group. There was no significant difference (P > 0.05) in general data such as gender, age, disease course and KVIQ between the two groups, and they were comparable. See Table 1 for details. This study was approved by the local ethics committee (approval number: 2018-ethical review-189) and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent.

Treatment methods

The patients in the control group underwent routine rehabilitation therapy and remained in the supine position in the same environment for the same amount of time as the combined trunk motor imagery therapy. Meanwhile, the trial group received both routine rehabilitation therapy and combined trunk motor imagery therapy.

Routine rehabilitation therapy

The training included proper limb positioning, neuromuscular promotion techniques, such as the proprioceptive neuromuscular facilitation technique (PNF), Rood’s approach, motor relearning, occupational therapy, daily living training and traditional therapy. The participants received routine rehabilitation therapy for five hours a day, five times a week, for a period of four weeks.

Motor image therapy

The motor imagery therapy training consisted of six steps: [4, 14] ① Illustration of the task: The therapist first demonstrated and explained the content of the imagery training, asking the patients to carefully observe and identify which part of the limb was ‘active’, what kind of movement was to be performed, and the normal movement to master. feeling. ② Preview: Patients were asked to re-imagine the relevant movements. ③ Motor imagery: Patients listened to the motor imagery instruction tape and practiced the imagery. ④ Rehabilitation training: the patients repeatedly practiced the movements of imagery training. ⑤ Problem solving: The patients learned relevant skills through repeated practice. ⑥ Practical application: the patients convert relevant skills into practical skills. Before the motor images, a video of a normal person’s trunk movements was shown, including stable trunk movements with a Bobath ball, and balance movements while sitting, standing, and reaching to move a water cup. The 10-minute video and audio were shown to patients via a computer in a quiet treatment room. During each training session, patients were instructed to close their eyes and sit on a comfortable chair with their bodies relaxed. The patients then imagined the movement of their body based on the specific motor imagery instructions in the video. During the treatment, the therapist occasionally interrupted the patients to ask questions, to see if they could concentrate on the images of the physical movement. At the end of the session, the patients were asked to refocus their attention on their surroundings, after which they were sent back to their room and asked to feel their physical being. The patients were then asked to pay attention to the environmental sounds. Finally, the narrator counted down from 10 to 1, and the patients were asked to open their eyes when the countdown reached 1. A motor imagery video was shown only during the first treatment, after which the patients underwent motor imagery training according to the motor imagery. guidelines for imagery. The motor imagery therapy sessions were conducted for 30 minutes each, with a frequency of five times per week, for a total of four weeks.

Observation indicators and evaluation methods

The evaluation of the patient’s trunk control was performed before treatment and four weeks after treatment using Sheikh trunk control evaluation. The simple Fugl-Meyer assessment (FMA), the Berg rating scale (BBS), and the balance feedback trainer were used to evaluate the motor and balance functions of the patients. In addition, before and after treatment, the sEMG signals of the bilateral erector spinae and rectus abdominis in the maximum flexion and extension range at a uniform speed under the sitting position were measured by sEMG signals. All evaluations were performed in a blinded manner by the same evaluator.

Sheik Hull Check Evaluation

Sheikh is a scale for evaluating the ability to control the trunk. It involves four movements: turning from the supine position to the hemiplegic side, turning to the healthy side, sitting upright from the supine position and maintaining balance in a sitting position on the bed. The scoring method is: 0 points for non-completion, 12 points for completion but needing some assistance (grasping or leaning on an object), and 25 points for normal completion. A higher total score indicates better trunk control.

BBS rating

The balance function is divided into 14 items, from easy to difficult, and each item is scored based on a five-point scale: 0, 1, 2, 3, and 4. The highest score is 4 points and the lowest score is 0 points. . The highest integral score is 56 points, the lowest is 0 points. The higher the score, the better the balance function.

Evaluation of motor functions

FMA is used to evaluate motor function in patients. The highest score is 100. The higher the score, the better the patients’ motor functioning will be.

Evaluation of balance feedback training equipment

The ProKin 254P (PK-254P) balance feedback training device, manufactured by TecnoBody Ltd., Italy, was used to test the postural stability of the patients. Stability tests were performed in standing position with eyes open using the static mode of the PK-254P balancer. The standard standing posture includes: ① Bilaterally symmetrical standing with A1A5 as central axis. ② The patients raise their heads and look straight ahead. ③ Both upper limbs are naturally placed on either side of the body. ④ The medial edges of both feet are 10 cm apart and the highest point of the bilateral arches is on axis A3A5. Observation parameters are as follows: movement length, movement area, mean front-back movement speed, and mean left-right movement speed.

sEMG signal acquisition

While the patients are seated on a square stool, their trunk is subjected to anterior flexion and posterior extension in the maximum range at uniform velocity. The Shanghai NCC 8-channel sEMG signal acquisition system was used to acquire the bilateral erector spinae and rectus abdominis myoelectric signals. The electrodes were taped to the 3 cm lateral opening on the left and right sides of the L3 spinous process (erector spinae) and the 3 cm lateral opening on the left and right sides 3 cm above the navel (rectus abdominis). The conductive diameter of the electrodes was 1 cm and the distance between the electrodes was 2 cm. Dandruff and oil were removed with a fine gauze and alcohol before testing. The root mean square (RMS) of myoelectric signals was then analyzed. The test was repeated three times with an interval of 30 seconds to obtain the average value. The RMS of the bilateral rectus abdominis and erector spinae of the two groups was evaluated before treatment and four weeks after treatment.

static analysis

SPSS software version 16.0 was used to analyze the data. The measurement data is expressed as (\(\bar x \pm s\)). Parametric statistics were applied when the data collected met the assumptions of homogeneity of variance and normal distribution. When these assumptions were not met, non-parametric statistics were used. The paired sample T-test was used for pre- and post-treatment comparison within the same group, while the independent sample T-test was used for between-group comparison, and P< 0.05 indicated that the difference was statistically significant.

According to the study, skilled free throw shooters – who could make more than 70% of their shots – performed the shooting motion in a more controlled manner. They had lower knee and center of mass peaks and average angular velocities compared to non-experienced shooters. Also, skilled shooters achieved a greater release height and had less forward torso lean at the point of ball release.

“These findings imply that the movement of basketball shooting is not as simple as some may think. Shooting efficiency cannot simply be attributed to one biomechanical variable. It is based on a mix of multiple segmental body movements performed in a controlled manner,” says Dimitrije. Cabarkapa, lead author of the study and deputy director of the Jayhawk Athletic Performance Laboratory.

The study examined 34 men with at least four years of basketball experience, ranging from recreational to collegiate competitive levels. Each participant attempted 10 free throws with a 10-15 second rest interval between each attempt. A three-dimensional markerless motion capture system developed by the Southwest Research Institute (SwRI Enable, San Antonio, Texas), consisting of nine high-definition cameras (120 fps), was used to capture the biomechanical characteristics of free throw shooting movements and to analyse. .

“We are very interested in analyzing basketball shooting mechanics and what performance parameters distinguish skilled and non-skilled shooters,” Cabarkapa said. “High-speed video analysis is one way we can do that, but innovative technological tools like markerless motion capture systems can allow us to dig even deeper into that. In my opinion, the future of sports science is based on the use of non-invasive and time-efficient testing methods.”

The study, conducted at the Jayhawk Athletic Performance Laboratory, also found that when differentiating between made and missed shots by skilled free throw shooters, an overemphasis on release height could be counterproductive.

“These findings can be metaphorically represented by some healthy habits of daily life. Exercise, drinking water and consuming enough vitamins and minerals are all very beneficial to our health. However, overdoing these things can be harmful in certain cases and can even production of the disease. the opposite effect than expected,” Cabarkapa said.

The study, published in the journal Limits in sports and active life, was co-authored with Damjana Cabarkapa and Andrew Fry of the Jayhawk Performance Athletic Laboratory at KU; Jonathan Miller of KU’s Higuchi Biosciences Center; and Tylan Templin, Lance Frazer and Daniel Nicolella of the Southwest Research Institute.

Using motion capture technology without markers is useful for several reasons, the authors said, because other motion capture systems that use markers to be placed on the skin or clothing have several problems, such as not staying in place and the participant’s awareness of the markers. which can change normal movement patterns. This is crucial when testing in a sport-specific environment, where efficiency is key. The use of markerless motion capture technology enables non-invasive assessment.

Dimitrije Cabarkapa said that, to the authors’ knowledge, this is the first study to use this motion capture system to investigate the biomechanical characteristics of skilled free throw shooters. Previous research has shown that teams with better free-throw skills, especially late in the game, are more likely to win. Although the current study did not include the effects of fatigue on shooting mechanics and accuracy, researchers hope to investigate that factor in upcoming studies, as well as the effect of the presence of a defender on shooting mechanics and accuracy.

The laboratory is part of the Wu Tsai Human Performance Alliance, a consortium of researchers investigating optimal human performance. This alliance includes Stanford University, University of Oregon, Boston Children’s Hospital, Salk Institute, University of California San Diego and KU.

“These findings add to the work we have done in the past and to the body of scientific literature related to basketball shooting performance that we are continually expanding in our laboratory,” said Dimitrije Cabarkapa. “We have found that both the preparation and release phases of the shooting motion are critical to achieving solid levels of shooting efficiency. The implementation of innovative technology can allow us to understand the transition phase of the shooting motion and the kinematic chain in more detail Ultimately, our goal is to have an answer to the question every basketball fan wants to know: ‘Why did Steph Curry miss that shot?’”

Alcohol use after injury is associated with prolonged recovery from concussion in NCAA athletes

Chang RC, Singleton M, Chrisman SPD, et al. Alcohol use after injury is associated with prolonged recovery from concussion in NCAA athletes. Clin J Sport Med. Published online 2023:1-8. doi:10.1097/JSM.0000000000001165

https://journals.lww.com/cjsportsmed/Abstract/9900/Postinjury_Alcohol_Use_Is_Associated_With.142.aspx

Take home message

Collegiate athletes can experience long-lasting concussion symptoms if they consume alcohol during recovery. The severity of symptoms may not differ among those who consume alcohol during recovery.

Background

Concussions lead to immediate and variable symptoms that affect quality of life. Many collegiate athletes consume alcohol regularly, but there is no consensus regarding the effects of alcohol consumption after a concussion on symptoms.

Study aim

The authors used a prospective cohort to assess whether alcohol consumption after concussion is associated with resolution of concussion symptoms. The authors also evaluated the impact of alcohol consumption on symptom severity.

Methods

The authors used data from the ongoing Concussion Assessment Research and Education (CARE) Consortium. The authors analyzed data from 29 different clinical sites and 484 of 3,518 athletes with concussion. An athlete who reported consuming at least one alcoholic beverage per week during concussion recovery was considered an alcohol user. The authors used the Sport Concussion Assessment Tool 3 (SCAT3) symptom score sheet to track outcomes after concussion.

Results

Athletes who drank alcohol after a concussion took an average of 22 days to return to full participation in sports. This represents a 33% delay in return to play compared to those who did not consume alcohol after injury. On average, those who drank alcohol after a concussion needed about five additional days to return to full-time sports. Additionally, the more alcohol consumed after the concussion, the longer it took for symptoms to resolve. Alcohol consumption had no influence on the severity of symptoms.

Viewpoints

This study clarifies previous research on the relationship between post-concussion alcohol use and delayed symptom resolution. The delay in symptom resolution may contribute to deconditioning among those who have consumed alcohol after a concussion, which could hinder their willingness to contribute to team success. Interestingly, alcohol consumption after an injury does not play a role in the severity of symptoms, according to this study. This suggests that alcohol may slow the healing process rather than causing additional tissue damage. While these results are important, this study did not standardize a “drink.” Therefore, there is a possibility that different types and volumes of alcohol consumed per drink could influence symptom resolution. Furthermore, the authors focused on less than 15% of athletes with a concussion. Therefore, it will be important to replicate these findings to see if they apply to the broader athletic concussion population.

Clinical implications

In practice, physicians should encourage athletes diagnosed with a concussion to reduce alcohol intake or, ideally, to abstain from alcohol consumption until symptoms resolve. Clinicians should also educate athletes about the role alcohol consumption after injury plays in prolonging concussion symptoms.

Questions for discussion

What strategies, if any, do you use to educate athletes about alcohol consumption after a concussion? What changes do you plan to make to patient education based on this research?

related posts

1. Gender-specific predictors of long-term recovery from concussion
2. Suggested answer to the most common question about concussions: How many days until I can play?
3. Concussion: Is Submaximal Exercise Medicine?

Written by Cade Watts
Reviewed by Jeffrey Driban

Through jeff bloom AT, CSCS Ahwatukee FAST

I often get asked by athletes, “What should I eat?” That’s a pretty vague question, and there really isn’t just one answer. However, there are some simple nutritional guidelines that can help an athlete achieve better performance. In general, athletes should eat a diet that is high in carbohydrates, low in saturated fats, and contains enough protein to rebuild the muscle breakdown that occurs during their training.

Carbohydrates for energy

Carbohydrates are our main source of energy and the fuel we need to compete at a high level. a diet that contains 60% of total calories from carbohydrates is recommended for most athletes. These carbohydrates should come from whole wheat pasta/bread, rice, potatoes, fruit and starchy vegetables.

Protein for better performance

All athletes know that egg white is an important nutrient for better performance, but many protein sources also contain saturated fats that should be avoided. Quality protein choices include lmeat, fish, low-fat dairy products, poultry and beans. Protein intake depends on the size of the athlete, the activity the athlete is doing and the athlete’s overall goals. A good rule of thumb is 0.5 – 0.75 g protein/kg body weight. Athletes looking to increase their muscle mass or those who experience extreme muscle wasting during their sport may require higher levels.

Good fats or bad fats?

Fats have a bad reputation, but are also an important part of any diet. Athletes have to make ends meet 20% of their calories from fat. The key is being able to distinguish the ‘good’ fats from the ‘bad’ fats. “Good” or unsaturated fat can be found in nuts, oils and fish.

Finding a good diet plan is a very individual process and depends on a number of variables. Following the steps above will help you build a solid nutritional foundation and get most athletes moving in the right direction. From there, with just a little adjustment, you can compete at a higher level than ever before!