Evaluation of a soft exosuit designed to reduce metabolic requirements during walking.

Previous ankle exoskeleton assistance techniques that were able to demonstrate metabolic reductions can be categorized into those that delivered moment profiles similar to the biological ankle moment throughout the stance phase, and others that delivered positive power only during push off. Both assistance techniques and a powered-off condition were compared in treadmill walking (1.5 m s^-1) with a soft exosuit. We hypothesized that both techniques can result in a similar metabolic reduction when providing a similar level of average positive exosuit power at each ankle (0.12 W kg^-1) and hip (0.02 W kg^-1) while the underlying global center-of-mass and local joint biomechanics would be different. We found a similar net metabolic rate reduction of 15% relative to walking with the suit powered-off for both techniques. The ankle moment inspired technique showed larger magnitudes of reductions for biological moment and power at the hip and the ankle. The ankle power inspired technique might benefit from higher biological efficiency, when reducing positive instead of negative power at the knee and when almost keeping the isometric function of the plantarflexors before push-off. Changes at the ankle caused energetic reductions at the knee, hip and the center-of-mass. A major contribution to metabolic reduction might be based on them. As the lower limb biomechanics that led to these reductions were different, we believe that humans alter their gait to maximize their energetic benefit based on the exosuit assistance. For further insights on mechanisms that lead to metabolic reduction, joint mechanics and muscle-tendon dynamics must be analyzed in combination.

Clinical evaluation of scapular dyskinesis (SD) aims to identify abnormal scapulothoracic movement, underlying causal factors, and the potential relationship with shoulder symptoms. The literature proposes different methods of dynamic clinical evaluation of SD, but improved reliability and agreement values are needed. The present study aimed to evaluate the intrarater and interrater agreement and reliability of three SD classifications: 1) 4-type classification, 2) Yes/No classification, and 3) scapular dyskinesis test (SDT). Seventy-five young athletes, including 45 men and 30 women, were evaluated. Raters evaluated the SD based on the three methods during one series of 8–10 cycles (at least eight and maximum of ten) of forward flexion and abduction with an external load under the observation of two raters trained to diagnose SD. The evaluation protocol was repeated after 3 h for intrarater analysis. The agreement percentage was calculated by dividing the observed agreement by the total number of observations. Reliability was calculated using Cohen Kappa coefficient, with a 95% confidence interval (CI), defined by Kappa coefficient ±1.96 multiplied by the measurement standard error. The interrater analyses showed an agreement percentage between 80% and 95.9% and an almost perfect reliability (k>0.81) for the three classification methods in all the test conditions, except the 4-type and SDT classification methods, which had substantial reliability (k<0.80) in shoulder abduction. Intrarater analyses showed agreement percentages between 80.7% and 89.3% and substantial reliability (0.67 to 0.81) for both raters in the three classifications. CIs ranged from moderate to almost perfect categories. This indicates that the three SD classification methods investigated in this study showed high reliability values for both intrarater and interrater evaluation throughout a protocol that provided SD evaluation training of raters and included several repetitions of arm movements with external load during a live assessment.

Impaired muscle function at the hip has been implicated to be a major factor related to falls in older adults. Therefore, the aim of this study was to analyze the rate of torque development (RTD), reaction time (RT), and peak torque (PT) of hip abductors and hip adductors in young women (YW), older women nonfallers (ONF), and older women fallers (OF). Eighteen YW and 44 older women divided among OF (n = 20) and ONF (n = 24) performed maximum isometric hip abductor and adduction contractions on a dynamometer. YW had 40% greater PT and 61.5% greater RTD for hip abductors than the ONF. Compared with OF, YW had 47.5% greater PT and 68% greater RTD. OF showed less RTD at 150 ms (31%) and 200 ms (34.5%) than ONF for hip abductors. PT of hip adductors was 52% greater in YW than in the two older groups, whereas RTD was 71% greater. OF showed less RTD than ONF for hip abductors according to standardized effect sizes. No RT differences were observed between the three groups. We conclude that older women (OF and ONF) have less strength and ability to develop force rapidly than YW for hip abductors and adductors. Low hip strength and slowed force development in ONF during hip abduction may increase fall risk in older women.

To investigate the effect on shoulder pain and disability of teaching patients with shoulder pain how to undertake a home-based exercise program. A randomized controlled trial conducted from September 2015 to January 2016. Participants’ home. Sixty participants with shoulder pain who were waiting for physiotherapeutic treatment. The control group (n = 30) received minimal education about their shoulder condition and instructions to continue their activities as normal. The intervention group (n = 30) received a two-month home exercise program with one-hour sessions delivered by a physiotherapist to begin and one month after the program for exercise instructions. The primary outcome was change in the Shoulder Pain and Disability Index (SPADI). The secondary outcomes included change in the numeric pain rating scale and medication intake for pain relief. The patients’ average age was 54.3 (13.8) years. SPADI scores at baseline were 60.9 (16.5) in the intervention and 64.7 (15.3) in the control group. After two months, the SPADI scores decreased to 18.8 (28.6) and to 61.4 (24.0), respectively, in the intervention and control groups with an estimated mean difference of 40.0, effect size: 1.61. The intervention group showed a reduced pain intensity (estimated mean difference: 3.7, effect size: 2.43) and medication intake (chi-square: 0.001). The number needed to treat was 1.2 for one patient to have a SPADI score <20. Teaching patients with shoulder pain how to undertake a home-based exercise program improved shoulder function and reduced pain intensity and medication intake over two months.

We investigated the effects of chronic (eight weeks) low-to moderate-intensity swimming training on thermal pain sensitivity in streptozotocin-induced diabetic female rats. Female Wistar rats (n = 51) were divided into the following groups: trained streptozotocin-induced diabetic rats [hyperglycemic trained (HT)], sedentary streptozotocin-induced diabetic rats [hyperglycemic sedentary (HS)], normoglycemic trained rats (NT) and normoglycemic sedentary rats (NS). Diabetes was induced by a single injection of streptozotocin (50 mg/kg, i.p.). One day after the last exercise protocol (60 min/day, five days/week for eight weeks) in the trained groups or after water stress exposure (ten min/twice a week) in the sedentary groups, the rats were subjected to a hot plate test. After eight weeks of swimming training, streptozotocin-induced diabetic rats presented a significantly lower body mass (trained: 219.5 ± 29 g, sedentary: 217.8 ± 23 g) compared with the normoglycemic groups (trained: 271 ± 24 g, sedentary: 275.7 ± 32 g). Interestingly, we did not find differences in blood glucose levels (mg/dl) between the trained and sedentary groups of the hyperglycemic or normoglycemic rats (HT: 360.2 ± 66.6, HS: 391.7 ± 66.7, NT: 83.8 ± 14.0, NS: 77.5 ± 10.1). In the hot plate test, the rats from the HT group presented a significantly lower latency than the other rats (HT: 11.7 ± 7.38 s, HS: 7.02 ± 7.38 s, NT: 21.21 ± 7.64 s, NS: 22.82 ± 7.82 s). Low-to-moderate swimming training for a long duration reduces thermal hyperalgesia during a hot plate test in streptozotocin-induced diabetic female rats.