Publications by authors named "Zdenek Svoboda"

64 Publications

Gait Variability and Complexity during Single and Dual-Task Walking on Different Surfaces in Outdoor Environment.

Sensors (Basel) 2021 Jul 14;21(14). Epub 2021 Jul 14.

Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, 771 11 Olomouc, Czech Republic.

Nowadays, gait assessment in the real life environment is gaining more attention. Therefore, it is desirable to know how some factors, such as surfaces (natural, artificial) or dual-tasking, influence real life gait pattern. The aim of this study was to assess gait variability and gait complexity during single and dual-task walking on different surfaces in an outdoor environment. Twenty-nine healthy young adults aged 23.31 ± 2.26 years (18 females, 11 males) walked at their preferred walking speed on three different surfaces (asphalt, cobbles, grass) in single-task and in two dual-task conditions (manual task-carrying a cup filled with water, cognitive task-subtracting the number 7). A triaxial inertial sensor attached to the lower trunk was used to record trunk acceleration during gait. From 15 strides, sample entropy (SampEn) as an indicator of gait complexity and root mean square (RMS) as an indicator of gait variability were computed. The findings demonstrate that in an outdoor environment, the surfaces significantly impacted only gait variability, not complexity, and that the tasks affected both gait variability and complexity in young healthy adults.
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http://dx.doi.org/10.3390/s21144792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8309897PMC
July 2021

Analysis of Whole-Body Coordination Patterning in Successful and Faulty Spikes Using Self-Organising Map-Based Cluster Analysis: A Secondary Analysis.

Sensors (Basel) 2021 Feb 14;21(4). Epub 2021 Feb 14.

School of Sport and Exercise Science, University of Lincoln, Lincolnshire LN6 7TS, UK.

This study investigated the whole-body coordination patterning in successful and faulty spikes using self-organising map-based cluster analysis. Ten young, elite volleyball players (aged 15.5 ± 0.7 years) performed 60 volleyball spikes in a real-game environment. Adopting the cluster analysis, based on a self-organising map, whole-body coordination patterning was explored between successful and faulty spikes of individual players. The self-organising maps (SOMs) portrayed whole body, lower and upper limb coordination dissimilarities during the jump phase and the ball impact phases between the successful and faulty spikes. The cluster analysis illustrated that the whole body, upper limb and lower limb coordination patterning of each individual's successful spikes were similar to their faulty spikes. Range of motion patterning also demonstrated no differences in kinematics between spike outcomes. Further, the upper limb angular velocity patterning of the players' successful/faulty spikes were similar. The SPM analysis portrayed significant differences between the normalized upper limb angular velocities from 35% to 45% and from 76% to 100% of the spike movement. Although the lower limb angular velocities are vital for achieving higher jumps in volleyball spikes, the results of this study portrayed that the upper limb angular velocities distinguish the differences between successful and faulty spikes among the attackers. This confirms the fact that volleyball coaches should shift their focus toward the upper limb velocity and coordination training for higher success rates in spiking for volleyball attackers.
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http://dx.doi.org/10.3390/s21041345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917820PMC
February 2021

Acute Effect of Ankle Kinesio™ Taping on Lower-Limb Biomechanics During Single-Legged Drop Landing.

J Sport Rehabil 2020 Dec 26;30(5):689-696. Epub 2020 Dec 26.

Context: Chronic ankle instability is documented to be followed by a recurrence of giving away episodes due to impairments in mechanical support. The application of ankle Kinesiotaping (KT) as a therapeutic intervention has been increasingly raised among athletes and physiotherapists.

Objectives: This study aimed to investigate the impacts of ankle KT on the lower-limb kinematics, kinetics, dynamic balance, and muscle activity of college athletes with chronic ankle instability.

Design: A crossover study design.

Participants: Twenty-eight college athletes with chronic ankle sprain (11 females and 17 males, 23.46 [2.65] y, 175.36 [11.49] cm, 70.12 [14.11] kg) participated in this study.

Setting: The participants executed 3 single-leg drop landings under nontaped and ankle Kinesio-taped conditions. Ankle, knee, and hip kinematics, kinetics, and dynamic balance status and the lateral gastrocnemius, medial gastrocnemius, tibialis anterior, and peroneus longus muscle activity were recorded and analyzed.

Results: The application of ankle KT decreased ankle joint range of motion (P = .039) and angular velocities (P = .044) in the sagittal plane, ground reaction force rate of loading (P = .019), and mediolateral time to stability (P = .035). The lateral gastrocnemius (0.002) and peroneus longus (0.046) activity amplitudes also experienced a significant decrease after initial ground contact when the participants' ankles were taped, while the application of ankle KT resulted in an increase in the peroneus longus (0.014) activity amplitudes before initial ground contact.

Conclusions: Ankle lateral supports provided by KT potentially decreases mechanical stresses applied to the lower limbs, aids in dynamic balance, and lowers calf muscle energy consumption; therefore, it could be offered as a suitable supportive means for acute usage in athletes with chronic ankle instability.
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http://dx.doi.org/10.1123/jsr.2020-0212DOI Listing
December 2020

Gender and Age Related Differences in Leg Stiffness and Reactive Strength in Adolescent Team Sports Players.

J Hum Kinet 2020 Aug 31;74:119-129. Epub 2020 Aug 31.

Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.

The aim of the present study was to identify potential gender differences in leg stiffness and reactive strength during hopping tasks in 13 to16-year old team sports players. Reactive strength index (RSI) and leg stiffness were obtained in two consecutive seasons from 51 girls (U14: n = 31, U16: n = 20) and 65 boys (U14: n = 32, U16: n = 33). A significant main effect on absolute (U14: p = 0.022, η= 0.084; U16: p < 0.001, η= 0.224) and relative leg stiffness (U14 p<0.001; η= 0.195; U16; p = 0.008, η= 0.128) for gender was found in both groups with values higher in boys than in girls. For absolute and relative stiffness gender differences in the U14 group were significant in the 1 year only (p=0.027 and p=0.001), and for the U16s in the 2 year only (p < 0.001 and p = 0.022). For RSI, a significant main effect for gender was observed in the U16 group only (p < 0.001 η= 0.429) with values significantly higher in boys than in girls in both years of measurement (p = 0.001; p < 0.001). Results of this study support previous limited findings, mostly related to non-athletes, suggesting lower stretch-shortening cycle capability in adolescence female compared to male, however our data only partly supports the theory that quality of neuromuscular functions increases with age until post puberty.
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http://dx.doi.org/10.2478/hukin-2020-0020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706640PMC
August 2020

The immediate effects of sensorimotor foot orthoses on foot kinematics in healthy adults.

Gait Posture 2021 02 19;84:93-101. Epub 2020 Nov 19.

Allied Health Research Unit, University of Central Lancashire, UK. Electronic address:

Background: Sensorimotor foot orthoses is an alternative concept, which in addition to mechanical effects, are designed to change muscle activation by altering sensory input to the plantar surface of the foot. However, there is little evidence of how these affect the kinematics of the foot during gait.

Research Question: The aim of the study was to explore the immediate effect of calcaneal medial heel bars and retrocapital bars on foot kinematics during the stance phase of gait.

Methods: Kinematic data were collected from 32 healthy individuals using an eight camera motion capture system and a six-degrees-of-freedom multi-segment foot model in three different orthotic conditions; calcaneal medial heel bar, retrocapital bar, and no orthosis. Vector field statistical analysis was performed to explore the effect of the orthotic conditions over the kinematic time series curves during stance phase. Peak median and interquartile ranges were also reported during the different phases of stance.

Results: The calcaneal medial bar significantly decreased rearfoot eversion for the majority of the stance phase and compensatory increased midfoot eversion during the entire stance phase compared to the no orthosis condition. The retrocapital bar rotated the foot externally significantly abducting the rearfoot for the entire stance phase and the midfoot for the majority of stance phase.

Significance: The calcaneal medial heel bar and retrocapital bar significantly altered the foot kinematics in a way that may benefit patients with abnormal pronation and intoeing gait.
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http://dx.doi.org/10.1016/j.gaitpost.2020.11.022DOI Listing
February 2021

Ankle-knee coupling responses to ankle Kinesio™ taping during single-leg drop landings in collegiate athletes with chronic ankle instability.

J Sports Med Phys Fitness 2021 Apr 22;61(4):582-591. Epub 2020 Oct 22.

Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA.

Background: Ankle Kinesio-taping (KT) is being globally used an intervention to provide the ankle joint complex with sufficient support against sudden excessive mechanical stress during various activities. However, its effects on proximal joints are unclear. This study investigated the impact of ankle KT on ankle-knee joint coupling in sagittal, frontal and transverse planes.

Methods: Adopting a pretest post-test study design, 30 collegiate athletes with chronic ankle instability performed 3 single-leg drop landings in each non-taped and Kinesio-taped conditions and their movement kinematics were recorded using 6 optoelectronic cameras.

Results: The ankle angular velocities in sagittal (P=0.038, d=0.64) and transverse planes (P=0.001, d=0.95) decreased after KT application, while the knee internal rotation velocities increased (P=0.020, d=0.51). The coupling angles revealed that the ankle movement ratios significantly decreased in 3 planes in comparison with knee movement ratios.

Conclusions: Outcomes of this study illustrated that application of ankle KT leaves the individuals with a stiffer ankle joint, which increases the mechanical stresses to this joint and decreases its stiffness in absorbing the applied shocks. Further, ankle KT application resulted in more knee internal rotation moments and may increase the risk of knee injuries during landing after a long-term usage in patients with instability ankle sprain.
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http://dx.doi.org/10.23736/S0022-4707.20.11264-7DOI Listing
April 2021

Evaluation of Postural Stability Differences in the Elderly Through Recurrent Analysis.

Stud Health Technol Inform 2020 Sep;273:197-202

Faculty of Physical Culture, Palacky University Olomouc, trida Miru 117, Olomouc, Czech Republic.

Measuring the center of pressure (CoP) for a subject positioned on a force plate is one of the most commonly used tools to investigate balance. Several studies have proven a significant degradation of the body's stability after the age of 60. The conclusions, however, are based on a limited number of indicators and without systematic nonlinear analysis methods being used to evaluate the progression of CoP parameter values. Neither the change in CoP movement in subjects over 60 years of age nor the considerations of their body mass index (BMI) has been systematically evaluated by nonlinear methods so far. This study is based on one of the frequent methods for nonlinear evaluation - the Recurrent Quantification analysis. This article discusses the applicability of this method with regards to the evaluation of changes in postural stability of subjects over 60 years of age. Postural stability changes were evaluated using CoP motion and tested by the nonlinear method. For this research purpose, a group of 103 elderly women were selected and divided into age-respective groups of 60-69 years and 70-79 years old. Each age group was further divided into a subgroup of normal and overweight subjects according to their BMI. The following recurrent analysis parameters were employed in the evaluation of CoP motion in medial-lateral and anterior-posterior directions: determinism (DET), laminarity (LAM) and trapping time (TT). The results of the Wilcoxon test revealed a statistically significant difference between the values in parameters for the different age groups of overweight subjects almost in all the cases. Conversely, statistically significant differences between age groups rarely occurred in a subgroup of subjects with a normal BMI.
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http://dx.doi.org/10.3233/SHTI200639DOI Listing
September 2020

Kinematic differences between successful and faulty spikes in young volleyball players.

J Sports Sci 2020 Oct 17;38(20):2314-2320. Epub 2020 Jun 17.

Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc , Olomouc, Czech Republic.

This study was designated to investigate the kinematical differences between successful and faulty spikes, in order to identify the best strategies leading to better spike performance. Simulating a real-game condition, 13 elite youth attackers performed 6 spikes in the presence of 2 blocks. The kinematic variables of the spike performances were recorded using 6 optoelectronic cameras (Vicon Motion systems, Oxford, UK). The paired sample t-test was used to compare the kinematic variables recorded during the delivery of successful and faulty spikes. Among the successful trials, both the angular velocities of the knees (≈12.4%) and hips (≈13.3%), and the vertical velocity of the centre of mass at take-off (≈6.5%) and arm swing (≈8.2%) were considerably higher during the plant phase. Consequently, the jump (≈4.3%) and spike (≈1.5%) heights, as well as the wrist velocity (≈5.5%), were significantly higher during the jump phase of successful spikes. In successful spike performances, the attackers adopted higher hip and knee angular velocities, combined with efficient arm swings, to produce higher take-off velocities and reach higher jump heights. This approach provides them with the better position regarding the ball and the blockers to find the best path and hit the ball with higher arm velocities.
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http://dx.doi.org/10.1080/02640414.2020.1782008DOI Listing
October 2020

The effect of ankle Kinesio™ taping on ankle joint biomechanics during unilateral balance status among collegiate athletes with chronic ankle sprain.

Phys Ther Sport 2020 Sep 25;45:161-167. Epub 2020 Jul 25.

Department of Health and Exercise Science, Appalachian State University, ASU Box 32071, Boone, NC, 28608, USA.

Objectives: To determine the effects of ankle Kinesio-taping (KT) on postural sway, lower limb ROM, and muscle activity during a unilateral balance tasks.

Design: Case control study design.

Setting: Data were collected at the human movement analysis laboratory.

Participants: 30 collegiate athletes with chronic ankle sprain (11 females and 19 males, 23.91 ± 2.58 years).

Main Outcome Measure: Hip, knee and ankle joints ranges of motion (ROMs); postural sway area and velocities in both anteroposterior and mediolateral directions; and muscular activity amplitudes (% peak) of lateral and medial gastrocnemius, tibialis anterior and peroneus longus in a 20s single leg balance test in two non-taped (control) and KT (intervention) conditions.

Results: Significant decrease observed in ankle lateral ROM (p = 0.048, d = 0.52), mediolateral postural sway velocity (p = 0.029, d = 1.25), and peroneus longus activity amplitudes (p = 0.042, d = 0.55) after KT application.

Conclusion: Acute application of KT among athletes with chronic ankle instability could provide lateral mechanical support to the ankle, potentially decreasing the velocity of frontal plane sway, and decreasing the magnitude of muscle activation. These data suggest that KT may be beneficial for improving static joint stability among individuals with chronic ankle sprain, and thus could be considered an option to allow safe return-to-activity.
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http://dx.doi.org/10.1016/j.ptsp.2020.06.007DOI Listing
September 2020

Basketball players possess a higher bone mineral density than matched non-athletes, swimming, soccer, and volleyball athletes: a systematic review and meta-analysis.

Arch Osteoporos 2020 08 5;15(1):123. Epub 2020 Aug 5.

Human Exercise and Training Laboratory, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia.

Basketball athletes possess a higher bone mineral density (BMD) than matched non-athletes and swimming, soccer, and volleyball athletes. Differences appear to be exacerbated with continued training and competition beyond adolescence. The greater BMD in basketball athletes compared to non-athletes, swimming, and soccer athletes is more pronounced in males than females.

Purpose: The aim of this study was to examine differences in total and regional bone mineral density (BMD) between basketball athletes, non-athletes, and athletes competing in swimming, soccer, and volleyball, considering age and sex.

Methods: PubMed, MEDLINE, ERIC, Google Scholar, and Science Direct were searched. Included studies consisted of basketball players and at least one group of non-athletes, swimming, soccer, or volleyball athletes. BMD data were meta-analyzed. Cohen's d effect sizes [95% confidence intervals (CI)] were interpreted as: trivial ≤ 0.20, small = 0.20-0.59, moderate = 0.60-1.19, large = 1.20-1.99, and very large ≥ 2.00.

Results: Basketball athletes exhibited significantly (p < 0.05) higher BMD compared to non-athletes (small-moderate effect in total-body: d = 1.06, CI 0.55, 1.56; spine: d = 0.67, CI 0.40, 0.93; lumbar spine: d = 0.96, CI 0.57, 1.35; upper limbs: d = 0.70, CI 0.29, 1.10; lower limbs: d = 1.14, CI 0.60, 1.68; pelvis: d = 1.16, CI 0.05, 2.26; trunk: d = 1.00, CI 0.65, 1.35; and femoral neck: d = 0.57, CI 0.16, 0.99), swimming athletes (moderate-very large effect in total-body: d = 1.33, CI 0.59, 2.08; spine: d = 1.04, CI 0.60, 1.48; upper limbs: d = 1.19, CI 0.16, 2.22; lower limbs: d = 2.76, CI 1.45, 4.06; pelvis d = 1.72, CI 0.63, 2.81; and trunk: d = 1.61, CI 1.19, 2.04), soccer athletes (small effect in total-body: d = 0.58, CI 0.18, 0.97), and volleyball athletes (small effect in total-body: d = 0.32, CI 0.00, 0.65; and pelvis: d = 0.48, CI 0.07, 0.88). Differences in total and regional BMD between groups increased with age and appeared greater in males than in females.

Conclusion: Basketball athletes exhibit a greater BMD compared to non-athletes, as well as athletes involved in swimming, soccer, and volleyball.
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http://dx.doi.org/10.1007/s11657-020-00803-7DOI Listing
August 2020

Whole body coordination patterning in volleyball spikes under various task constraints: exploratory cluster analysis based on self-organising maps.

Sports Biomech 2020 Aug 3:1-15. Epub 2020 Aug 3.

Experimental Anatomy Research Group, Faculty of Physical Education and Physiotherapy, Free University of Brussels, Brussel, Belgium.

Task and environment-related constraints can influence spike performance in volleyball players. This study was designated to investigate the impact of awareness of the presence or absence of a defensive block by the opponents on the performance and coordination pattern of spikes in elite volleyball attackers. Simulating a real-game scenario, 10 elite youth attackers (aged 15.5 ± 0.7 years) executed six spikes each with prior notification about the presence/absence of defences and six spikes without any notification. In each condition, they were blocked by two opponents in three trials. The coordination patterning of the attackers was explored using cluster analysis based on a Self-Organising Map (SOM). The SOMs and the cluster analysis showed that the coordination pattern of the spike execution was very individual-specific; however, in the third layer of the cluster analysis, it was revealed that the movement pattern of spike execution had similarities in the scenario wherein the players had prior awareness of the defences. Providing the attackers with information on the opponents' condition or performance could shift the attackers' focus from a game-oriented condition to the rivals' behaviour, which consequently resulted in deterioration of their spike performance.
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http://dx.doi.org/10.1080/14763141.2020.1788132DOI Listing
August 2020

Balance abilities of junior ice hockey players.

J Sports Med Phys Fitness 2021 Feb 28;61(2):183-187. Epub 2020 Jul 28.

Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic.

Background: Postural control is required during various fast-paced and offensive ice hockey actions, and therefore seems to be an important component in ice hockey performance.

Methods: Data were collected from two ice hockey teams with differing performance levels. The higher-performance team consisted of 26 players (with ages of 16.3±0.9 y, heights of 178.26±6.71 cm, and weights of 74.3±9.6 kg). The lower-performance team consisted of 19 players (with ages of 16.2±1.8 y, heights of 176.11±9.81 cm, and weights of 68.7±13.9 kg). Each participant performed six unilateral stances under static conditions on a balance pad placed on a force platform and five bilateral stances under dynamic conditions using a wobble board placed on the force platform.

Results: The higher-level players performed better in the unilateral static stance task in both the anterior-posterior direction and the medial-lateral direction (with a P value of P<0.001), and total velocity (P=0.001). The higher-level players also performed better in both the anterior-posterior and medial-lateral directions, and total velocity (with P value of P<0.001), in the bilateral dynamic stance task and therefore performed significantly better than the lower-level players.

Conclusions: Hockey players who possess a highly developed postural control strategy have a superior ability to compensate for unexpected postural disturbances and collisions, and thus possess a strong competitive advantage. Therefore, testing the balance abilities of hockey players under static and dynamic conditions may be useful for evaluating their competitive performance levels.
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http://dx.doi.org/10.23736/S0022-4707.20.11057-0DOI Listing
February 2021

A comparison of coordination and its variability in lower extremity segments during treadmill and overground running at different speeds.

Gait Posture 2020 06 1;79:139-144. Epub 2020 May 1.

Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Av. Esperança s/n, Campus Samambaia, Goiânia, 74690-900, Brazil.

Background: Recently, the use of treadmills for walking and running has increased due to lifestyle changes. However, biomechanical differences in coordination between running on a treadmill or overground have not been adequately addressed.

Research Question: The purpose of this study was to compare coordination and its variability in lower limb segments during treadmill and overground running at different speeds.

Methods: Twenty physically active university undergraduate students participated in this study. Each participant ran trials for both overground and treadmill running at slow and fast speeds. Three-dimensional kinematic data of the lower limb segments were captured. The continuous relative phase (CRP) was used to compute coordination and its variability (VCRP) for foot, shank, and thigh segments of the dominant side of the participants.

Results: A vector analysis using statistical parametric mapping (SPM) revealed that there were statistically significant differences in the calculated CRPs for treadmill and overground running in the stance phase of running and for different running speeds in the late stance and swing phases. However, the VCRPs calculated for the two locations and speeds did not exhibit any statistically significant differences.

Conclusion: The findings of this study suggest differences in segment coupling between treadmill and overground running may affect lower extremity biomechanics. In addition, changes in the coupling patterns for different running speeds suggest that segment coordination is not stable in the range of training speeds used by runners. Finally, the lack of differences in the variability of segment couplings during treadmill and overground conditions at different speeds potentially demonstrates similar dynamic neuromuscular control and degrees of freedom at these different running locations and speeds.
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http://dx.doi.org/10.1016/j.gaitpost.2020.04.022DOI Listing
June 2020

Comparison of Step Count Assessed Using Wrist- and Hip-Worn Actigraph GT3X in Free-Living Conditions in Young and Older Adults.

Front Med (Lausanne) 2019 5;6:252. Epub 2019 Nov 5.

Univ. Grenoble Alpes, AGEIS, Grenoble, France.

Walking represents a major component of physical activity (PA), and its restriction could degrade autonomy and quality of life. An important objective for preventive and/or rehabilitative strategies to improve balance and gait in normal and pathological aging conditions is to focus on physical activity. Activity monitors have recently been getting increasingly popular and represent a modern solution to measure-and communicate-PA notably in terms of steps/day. These activity monitors are well-suited for various populations as they can be worn on a variety of locations on the body, including the wrist and the hip (i.e., the two most common locations), in an undifferentiated way according to the manufacturer's instruction. The aim of this study was hence to verify potential differences in step count (SC) by comparing this parameter assessed using wrist- and hip-worn activity trackers over a 24-h period in free-living conditions in young and older adults. Young adults ( = 22) and older adults ( = 22) voluntarily participated in this study. They were required to wear two commercially-available Actigraph GT3X+ activity monitors simultaneously at two locations recommended by the manufacturer, i.e., one positioned around the wrist and one above the hip, over a 24-h period in free-living conditions. The manufacturer's software was used to obtain estimates of the SC. For both groups, the wrist-worn activity tracker provided significantly higher SC than the hip-worn activity tracker did. For both placements on the body, older adults exhibited significantly lower SC than young adults. Interestingly, for both young and older participants, the difference between both measurements tended to decrease for longer distances. The different estimations of the step count provided by the comparison between two identical Actigraph GT3x on the wrist or the hip during the 24-h observation period in free-living conditions in young and older adults strongly suggests that caution is needed when using total step per day values as an outcome to quantify walking behavior. Probably we can suggest the same caution across implementation of different activity Tracker.
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http://dx.doi.org/10.3389/fmed.2019.00252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849483PMC
November 2019

Standing balance of professional ballet dancers and non-dancers under different conditions.

PLoS One 2019 22;14(10):e0224145. Epub 2019 Oct 22.

Department of Physiotherapy, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic.

Ballet training has been reported to positively influence balance ability. It is not entirely clear how improved balance ability manifests under standing conditions with different demands on postural control. The aim of the study was to compare balance of ballet dancers and non-dancers in a unipedal stance under different conditions. Twenty-five professional ballet dancers and twenty-five controls completed four unipedal standing balance tests: firm surface with eyes open and closed; foam mat surface with eyes open; and firm surface with eyes open immediately after performing ten 360° whole-body turns. The centre of pressure (COP) data were obtained with a force platform and the direction-specific standard deviations, velocities, and sample entropy of the COP displacement were computed. A three-way analysis of variance was used to compare groups, genders, and conditions. For standing immediately after performing ten turns, the postural sway parameters were significantly larger in the control group compared to the ballet dancers in both men and women. In this stance condition the values of postural sway and COP velocities in the control group were larger in the men compared to the women. For both genders in the control group all postural sway and COP velocity parameters were larger in standing with eyes closed and standing after performing 10 turns compared to standing with eyes open on both firm and foam surface. In the ballet dancers all COP velocity parameters were larger in standing with eyes closed compared to all other conditions. The results from the present study indicate that professional ballet dancers do not have a better general balance ability than untrained subjects.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224145PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6804995PMC
March 2020

Effect of aging on the association between ankle muscle strength and the control of bipedal stance.

PLoS One 2019 3;14(10):e0223434. Epub 2019 Oct 3.

Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic.

Previous studies reported a significant association between postural control and lower-limb strength of several muscle groups, however, they were focused especially on knee muscles and ankle plantar and dorsal flexors. The aim of the present study is to examine the correlation between the muscle strength of ankle invertors, evertors, plantar flexors, and dorsal flexors and the control of bipedal stance in young and older adults. Thirty one young (aged 22.8 ± 2.6 years) and thirty one older adults (aged 70.5 ± 7.2 years) voluntarily participated in this study. Ankle muscle strength was evaluated by an isokinetic dynamometer. Normalized peak torque and work were averaged for four repetitions and for both lower limbs. The control of bipedal stance was evaluated by the sample entropy derived from an accelerometer placed on the lumbar spine while the subject stood on a foam pad with eyes open. Results showed significant age-related differences in ankle muscle strength and sample entropy in medial-lateral direction. More interestingly, the correlation between ankle muscle strength and the sample entropy was significantly different between young and older adults. Indeed, no significant correlation was observed in the younger adults. Conversely, in the older adults, the work of the ankle evertors positively correlated with sample entropy in the medial-lateral direction during bipedal stance (r = 0.36), whereas the peak torque and work of the dorsal flexors were significantly correlated with sample entropy in the anterior-posterior direction during bipedal stance (r = 0.44 for both variables). In the young adults, results suggest that, standing on foam with eyes open is a relatively easy postural task that does not require the full ankle muscle strength capacity. Taken together, the present findings suggest that older adults have a different association between ankle muscle strength and the sample entropy during bipedal stance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223434PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776385PMC
March 2020

Nonlinear approach to study the acute effects of static and dynamic stretching on local dynamic stability in lower extremity joint kinematics and muscular activity during pedalling.

Hum Mov Sci 2019 Jun 5;66:440-448. Epub 2019 Jun 5.

Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic.

Researchers have reported contradictory results on the effect of static and dynamic stretching on subsequent performance. Due to the importance of performance through static and dynamic stretching, the aim of this study is to investigate the acute effects of static and dynamic stretching protocols on local dynamic stability in lower extremity joint kinematics and muscular activities during pedalling using a nonlinear dynamics approach. Using a randomised crossover trial design, fifteen active males participated voluntarily in this research (mass: 69.02 ± 10.52 kg, height: 174.00 ± 6.74 cm, and age: 21.20 ± 1.47 years) and completed a pedalling trial in situations of without stretching (WS), after static (SS), and dynamic stretching (DS) of lower extremity. The lower extremity joint angles in the sagittal plane and the electrical activity of soleus, gastrocnemius medialis, tibialis anterior, vastus medialis, biceps femoris, and rectus femoris muscles were collected during 30 pedalling cycles at 70 rates per minute. The results of the repeated measure ANOVA indicated that the knee and ankle angle largest LyE was significantly lower in DS compared to WS and SS. The largest LyE in muscle activity is also significantly lower for all the muscles after DS compared to WS and SS (P ≤ 0.05). Regarding the positive effects of DS on the joints and the muscle activity local dynamic stability, it is suggested to use DS than SS in the warm-up program before repetitive activities like pedalling.
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http://dx.doi.org/10.1016/j.humov.2019.05.025DOI Listing
June 2019

Acute Effect of Ankle Kinesio and Athletic Taping on Ankle Range of Motion During Various Agility Tests in Athletes With Chronic Ankle Sprain.

J Sport Rehabil 2020 Jul 18;29(5):527-532. Epub 2019 Oct 18.

Background: Taping is a preventive measure commonly used for protecting and strengthening the ankle joint to prevent further musculoskeletal damage. Ankle taping prevents excessive range of motion (ROM) of the ankle joint and allows the improvement of proprioception to adjust balance. Appropriate ankle stability is essential for various activities, such as sprinting, turning, cutting, and jumping, which are associated with agility.

Aim: To assess the acute effect of Kinesio taping and athletic taping on the ankle ROM of athletes with chronic ankle sprain during various agility tests that include sprinting, turning, and cutting actions.

Methods: Twenty-five physically active volunteers with chronic ankle sprain performed the Illinois, 5-0-5, 10-m shuttle, hexagon, compass drill, and T agility tests in 3 ankle conditions (nontaped, Kinesio taped, and athletic taped), in random order. Ankle ROM was recorded using the Vicon motion capture system.

Results: In comparison with the nontaped ankle condition, in the ankle Kinesio-taping condition, the results showed a significant increase of ankle ROM in the sprinting part of the Illinois, 5-0-5, 10-m shuttle, and T agility tests (P ≤ .01), whereas in the ankle athletic-taping condition, no significant difference was found in ankle ROM during all agility tests.

Conclusion: In sports that need linear sprinting, Kinesio taping seems to be a suitable intervention for the improvement of sports performance as it provides increased ankle ROM.
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http://dx.doi.org/10.1123/jsr.2018-0398DOI Listing
July 2020

Effect of COL5A1, GDF5, and PPARA Genes on a Movement Screen and Neuromuscular Performance in Adolescent Team Sport Athletes.

J Strength Cond Res 2019 Aug;33(8):2057-2065

Department of Physical Education, Gdansk University of Physical Education and Sport, Gdansk, Poland.

Stastny, P, Lehnert, M, De Ste Croix, M, Petr, M, Svoboda, Z, Maixnerova, E, Varekova, R, Botek, M, Petrek, M, Lenka, K, and Cięszczyk, P. Effect of COL5A1, GDF5, and PPARA genes on a movement screen and neuromuscular performance in adolescent team sport athletes. J Strength Cond Res 33(8): 2057-2065, 2019-The risk of injury increases with adolescents' chronological age and may be related to limited muscle function neuromuscular, genetic, and biomechanical factors. The purpose of this study was to determine whether COL5A1, PPARA, and GDF5 genes are associated with muscle functions and stretch-shortening cycle performance in adolescent athletes. One hundred forty-six youth players (14.4 ± 0.2 years) from various team sports (basketball n = 54, soccer n = 50, handball n = 32) underwent a manual test for muscle function, maturity estimation, functional bend test (FBT), passive straight leg raise (SLR) test, leg stiffness test, test of reactive strength index (RSI), and gene sampling for COL5A1, PPARA, and GDF5. The χ test did not show any differences in allele or genotype frequency between participants before and after peak height velocity. Multivariate analysis of variance showed that COL5A1 rs12722 CT heterozygotes had worse score in FBT (p < 0.001), worse score in SLR (p = 0.003), and lower maturity offset (p = 0.029, only in females) than TT homozygotes. Male GDF5 rs143383 GG homozygotes showed better score in SLR than AA and AG genotypes (p = 0.003), and AA and AG genotypes in both sex had greater RSI than GG homozygotes (p = 0.016). The PPARA rs4253778 CC homozygotes had greater RSI than GG and GC genotypes (p = 0.004). The CT genotype in COL5A1 rs12722 is possible predictor of functional movement disruption in the posterior hip muscle chain, causing shortening in FBT and SLR, which includes hamstrings function. CT genotype in COL5A1 rs12722 should be involved in programs targeting hamstring and posterior hip muscle chain.
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http://dx.doi.org/10.1519/JSC.0000000000003142DOI Listing
August 2019

Does maturation influence neuromuscular performance and muscle damage after competitive match-play in youth male soccer players?

Eur J Sport Sci 2019 Sep 18;19(8):1130-1139. Epub 2019 Feb 18.

b Faculty of Physical Culture , Palacký University in Olomouc , Olomouc , Czech Republic.

Poor neuromuscular control and fatigue have been proposed as a risk factor for non-contact injuries especially around peak height velocity (PHV). This study explored the effects of competitive soccer match-play on neuromuscular performance and muscle damage in male youth soccer players. 24 youth players aged 13-16y were split into a PHV group (-0.5 to 0.5y) and post PHV group (1.0-2.5y) based on maturity off-set. Leg stiffness, reactive strength index (RSI), muscle activation, creatine kinase (CK), and muscle soreness were determined pre and post a competitive soccer match. Paired t-tests were used to explore differences pre and post competitive match play and independent sample t-tests for between groups differences for all outcome measures. There was no significant fatigue-related change in absolute and relative leg stiffness or muscle activation in both groups, except for the gastrocnemius in the post PHV group. RSI, CK and perceived muscle soreness were significantly different after soccer match-play in both groups with small to large effects observed (ES:0.41-2.82). There were no significant differences between the groups pre match-play except for absolute and relative leg stiffness ( < 0.001; ES = 1.16 and 0.63 respectively). No significant differences were observed in the fatigue related responses to competitive match play between groups except for perceived muscle soreness. The influence of competitive match-play on neuromuscular function and muscle damage is similar in male youth around the time of PHV and those post-PHV indicating that other factors must contribute to the heightened injury risk around PHV.
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http://dx.doi.org/10.1080/17461391.2019.1575913DOI Listing
September 2019

Comparison of gait kinematics between professional ballet dancers and non-dancers.

Neuro Endocrinol Lett 2018 Dec;39(5):385-390

Faculty of Medicine, University of Ostrava, Ostrava,, Czech Republic.

Objectives: The aims of the study were to assess the kinematics of the lower limbs and pelvis during normal walking in professional ballet dancers and to investigate relationships between movements of segments of the lower limbs and pelvis.

Methods: Thirty one professional ballet dancers and twenty eight controls completed five walking trials at their preferred speed. Kinematic data in the basic anatomical planes for ankle, knee, and hip joints as well as for the pelvis were collected with an optoelectronic motion system.

Results: The female ballet dancers had in comparison with the controls significantly larger (p < 0.01) knee flexion in the swing phase and hip abduction in the preswing phase. Compared to the control group, the male ballet dancers had significantly larger dorsiflexion in the final stance and the total pelvic tilt range of motion. The number of significant correlations between kinematic parameters was higher in the female ballet dancers.

Conclusions: It can be concluded that specific movement techniques and compensatory strategies used in ballet dance can alter relationships between movements of segments of the lower limbs during normal walking. The relationships between movements in the joints of the lower limbs and pelvis are stronger in women.
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December 2018

Reliability of Ankle⁻Foot Complex Isokinetic Strength Assessment Using the Isomed 2000 Dynamometer.

Medicina (Kaunas) 2018 Jun 4;54(3). Epub 2018 Jun 4.

Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University, 771 11 Olomouc, Czech Republic.

For quantifying muscle strength in clinical and research practice, establishing the reliability of measurements, specifically to the procedures used, is essential for credible findings. The objective was to establish the reliability of isokinetic measurement of ankle plantar and dorsal flexors (PF/DF) and invertors and evertors (INV/EV) on an IsoMed 2000 dynamometer. Twenty healthy subjects (10 males, 10 females, mean age: 23.1 ± 3.1 years) completed an isokinetic measurement session. The intraclass correlation coefficient (ICC) and standard error of measurement were assessed for peak torque and work of ankle PF/DF (concentric and eccentric) and INV/EV (concentric) for the preferred and nonpreferred limb. Standardized isokinetic measurements of reciprocal PF/DF and INV/EV muscle actions were associated with ICC ranging from 0.77 to 0.98 for the majority of observed parameters. The exception was work in the eccentric mode in the ankle DF and peak torque in the concentric mode in the ankle INV on the preferred limb, where ICC ranged from 0.64 to 0.71. The IsoMed 2000 isokinetic dynamometer can be reliably employed in future studies for reciprocal ankle PF/DF and INV/EV assessment in healthy adult subjects after implementation of a familiarization session.
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http://dx.doi.org/10.3390/medicina54030043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122110PMC
June 2018

Postural Stability Evaluation of Patients Undergoing Vestibular Schwannoma Microsurgery Employing the Inertial Measurement Unit.

J Healthc Eng 2018 18;2018:2818063. Epub 2018 Apr 18.

Third Faculty of Medicine, Charles University in Prague, Ruská 2411/87, Prague, Czech Republic.

The article focuses on a noninvasive method and system of quantifying postural stability of patients undergoing vestibular schwannoma microsurgery. Recent alternatives quantifying human postural stability are rather limited. The major drawback is that the posturography system can evaluate only two physical quantities of body movement and can be measured only on a transverse plane. A complex movement pattern can be, however, described more precisely while using three physical quantities of 3-D movement. This is the reason why an inertial measurement unit (Xsens MTx unit), through which we obtained 3-D data (three Euler angles or three orthogonal accelerations), was placed on the patient's trunk. Having employed this novel method based on the volume of irregular polyhedron of 3-D body movement during quiet standing, it was possible to evaluate postural stability. To identify and evaluate pathological balance control of patients undergoing vestibular schwannoma microsurgery, it was necessary to calculate the volume polyhedron using the 3-D Leibniz method and to plot three variables against each other. For the needs of this study, measurements and statistical analysis were made on nine patients. The results obtained by the inertial measurement unit showed no evidence of improvement in postural stability shortly after surgery (4 days). The results were consistent with the results obtained by the posturography system. The evaluated translation variables (acceleration) and rotary variables (angles) measured by the inertial measurement unit correlate strongly with the results of the posturography system. The proposed method and application of the inertial measurement unit for the purpose of measuring patients with vestibular schwannoma appear to be suitable for medical practice. Moreover, the inertial measurement unit is portable and, when compared to other traditional posturography systems, economically affordable. Inertial measurement units can alternatively be implemented in mobile phones or watches.
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http://dx.doi.org/10.1155/2018/2818063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932418PMC
November 2019

Local dynamic stability during gait for predicting falls in elderly people: A one-year prospective study.

PLoS One 2018 10;13(5):e0197091. Epub 2018 May 10.

EA AGEIS, Universite Grenoble-Alpes, La Tronche, France.

Computing the local dynamic stability using accelerometer data from inertial sensors has recently been proposed as a gait measure which may be able to identify elderly people at fall risk. However, the assumptions supporting this potential were concluded as most studies implement a retrospective fall history observation. The aim of this study was to evaluate the potential of local dynamic stability for fall risk prediction in a cohort of subjects over the age of 60 years using a prospective fall occurrence observation. A total of 131 elderly subjects voluntarily participated in this study. The baseline measurement included gait stability assessment using inertial sensors and clinical examination by Tinetti Balance Assessment Tool. After the baseline measurement, subjects were observed for a period of one year for fall occurrence. Our results demonstrated poor multiple falls predictive ability of trunk local dynamic stability (AUC = 0.673). The predictive ability improved when the local dynamic stability was combined with clinical measures, a combination of trunk medial-lateral local dynamic stability and Tinetti total score being the best predictor (AUC = 0.755). Together, the present findings suggest that the medial-lateral local dynamic stability during gait combined with a clinical score is a potential fall risk assessment measure in the elderly population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197091PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944953PMC
July 2018

The differences between overground and treadmill walking in nonlinear, entropy-based and frequency variables derived from accelerometers in young and older women - preliminary report.

Acta Bioeng Biomech 2018 ;20(1):93-100

Palacky University Olomouc, Faculty of Physical Culture, Department of Natural Sciences in Kinanthropology, Olomouc, Czech Republic.

Purpose: The aim of this study was to compare gait stability and variability between walking conditions and age groups.

Methods: Twenty-six healthy younger and older females participated. Trunk acceleration in the vertical (V), medial-lateral (ML) and anteriorposterior (AP) directions during 5 minutes walking overground and 3 minutes walking on the treadmill at self-selected speed were recorded. Root mean square and standard deviations of acceleration, stride time and its variability, Lyapunov exponents (LE), multiscale entropy (MSE) and harmonic ratios (HR) were computed.

Results: Both age groups showed significantly higher stride time variability and short-term LE in all directions during overground walking. For the older group, overground walking showed higher V and AP standard deviation. Significantly lower values for overground walking were observed for long-term LE (V and ML for the younger group, ML for the older group), HR (ML for the older group) and MSE (V for the older group). Significant age-related differences were found for V long-term LE for overground walking.

Conclusions: The present findings suggest that both linear and advanced computational techniques for gait stability and variability assessment in older adults are sensitive to walking conditions.
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September 2018

Advanced conservative treatment of complete acute rupture of the lateral ankle ligaments: Verifying by stabilometry.

Foot Ankle Surg 2018 Feb 17;24(1):65-70. Epub 2017 Jan 17.

Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: The aim of this study was to investigate the result of the specific conservative treatment of acute lateral ankle ligaments rupture and verify the effect of this therapy by stabilometry.

Methods: 17 young athletes were examined after acute lateral ankle sprain (grade III). Diagnosis was based on musculoskeletal ultrasound examinations. Pressure plate evaluated postural stability after conservative treatment at regular intervals during 1year.

Results: There were no significant differences in postural stability in double-leg stance between limbs. In single-leg stance, COP confidence ellipse (p=0,011) and COP excursion in sagittal plane (p=0,000) were significantly higher for the injured leg when compared with the uninjured leg only one week after removing the cast.

Conclusions: After conservative treatment of grade III injuries with STABHA, immobilization with full weight bearing on the injured leg for 6 weeks and rehabilitation, stabilometry results showed that none of the patients had impaired postural stability or were at risk of functional ankle instability in the monitored period.
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http://dx.doi.org/10.1016/j.fas.2016.12.001DOI Listing
February 2018

The Effects of Nordic Walking and Slope of the Ground on Lower Limb Muscle Activity.

J Strength Cond Res 2018 Jan;32(1):217-222

1Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic;2Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain; and3MovLab, CICANT, Lusofona University of Humanities and Technology, Lisbon, Portugal.

Psurny, M, Svoboda, Z, Janura, M, Kubonova, E, Bizovska, L, Martinez Lemos, RI, and Abrantes, J. The effects of Nordic walking and slope of the ground on lower limb muscle activity. J Strength Cond Res 32(1): 217-222, 2018-Nordic walking (NW) has proven to be a simple and safe mode of exercise that can be used in various types of sport, recreation, and rehabilitation activities. The aim of this study was to assess the effect of Nordic walking and slope of the ground on lower limb muscle activity. The experimental group consisted of 22 healthy men (aged 22.8 ± 1.4 years). The subjects walked on a treadmill at a self-selected speed. Two walking conditions (NW and walking) and 2 ground slopes (level ground and uphill walking at an 8% incline) were used. The surface electromyographic signals of the gastrocnemius lateralis, tibialis anterior, vastus medialis, rectus femoris, biceps femoris and gluteus medius were recorded. Nordic walking resulted in increased activity of some lower limb muscles, particularly during the first half of the stance phase, and decreased muscle activity during the first half of the swing phase. Uphill walking elicited increased muscle activity compared with level walking, particularly during the stance phase and the second half of the swing phase during both walking and NW, and the change was more pronounced during walking. We concluded that NW increased muscle activity in the lower extremities compared with walking, particularly on level ground. Increasing the ground slope enhanced the muscle activity to a much greater extent than NW.
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http://dx.doi.org/10.1519/JSC.0000000000002195DOI Listing
January 2018

Evaluation of the effect of heel lift on postural stability and symmetry of muscle activity.

J Back Musculoskelet Rehabil 2017 Sep;30(5):1037-1044

The Rehabilitation Center Kladruby, Kladruby, Czech Republic.

Background: Although a leg length inequality (LLI) has the effect on the performed movement, more complex indices for the evaluation of kinematic variables of postural stability and a symmetry of a muscle activity during standing in subjects with the LLI were never used before.

Objective: The objective is to present appropriate parameters for an evaluation of kinematic variables of postural stability and muscle activity during standing, i.e. to consider EMG signals, in patients with LLI.

Methods: New indices are offered, such as a sway velocity (i.e. the mCTSIB method) and a modified symmetry index (SI), for a quantitative evaluation of EMG signals. The set of data for evaluating the effect of a heel lift was measured on patients with the LLI and healthy volunteers.

Results: Prior to the heel lift application, significant statistic differences were found between the mCTSIB of patients and the CG. These differences were no longer statistically significant after the heel lift was applied. As for the SI, the lowest values were found in the CG, while the greatest values were collected among patients before applying the heel lift.

Conclusions: The results point out the benefits of using the newly applied indices in patients with the LLI. Both methods may become useful tools for the evaluation of the physical state of patients with the LLI in a medical practice.
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http://dx.doi.org/10.3233/BMR-169616DOI Listing
September 2017

Intra- and inter-session reliability of traditional and entropy-based variables describing stance on a wobble board.

Med Eng Phys 2017 12 12;50:29-34. Epub 2017 Sep 12.

Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava 70833, Czech Republic.

A wobble board (WB) is a balance rehabilitation tool that is used in physiotherapy to improve strength and stability. The WB tested in this study includes a sensory module for measuring patients' tilt and rotation during stance. The aim of this study was to assess the reliability and validity of a balance measurement using a WB. Thirty healthy young adults participated in this study. The participants stood on the WB to simultaneously record the tilt of the WB and the center of pressure data using a force plate. The data were recorded during five measurement sessions on various days, with four trials each. Sways, velocities and indexes of complexity (CI) were computed. For reliability assessment, we used intra-class correlation coefficients within and between sessions; for validity, we computed Spearman correlation coefficients. The velocities and CI showed good intra-session reliability, and the sways showed mostly poor intra-session reliability. The results of inter-session reliability showed good to excellent reliability for CI, poor reliability for sways and poor to good reliability for velocities. The Spearman correlation coefficient showed excellent agreement between the mean velocities computed from the force plate and the WB. Our results confirm that the WB tested is suitable for stability assessment in young adults.
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http://dx.doi.org/10.1016/j.medengphy.2017.08.017DOI Listing
December 2017

Evaluation of Plantar Pressure Distribution in Relationship to Body Mass Index in Czech Women During Walking.

J Am Podiatr Med Assoc 2017 May;107(3):208-214

Background: Excessive body weight seems to be a risk factor for foot loading. We sought to investigate the effect of different body mass index (BMI) levels on plantar pressure distribution during walking.

Methods: In total, 163 women aged 45 to 65 years (mean ± SD: age, 57.4 ± 5.3 years; BMI, 27.0 ± 5.3) participated in the study. The women were divided, on the basis of BMI, into a normal-weight, overweight, or obese group. The study used the four following plantar pressure parameters (PPPs): contact percentage, absolute pressure impulse, relative pressure impulse, and absolute peak pressure, which were recorded in ten foot regions using a pressure measurement system.

Results: The normal-weight group, compared with the overweight and obese groups, had significantly lower absolute PPP values. In the hallux, second through fifth metatarsals, midfoot, and heel regions, we observed significant between-group differences in the two absolute PPPs (peak pressure and pressure impulse) (P < .001). Between-group differences in the relative PPPs were found in the fourth metatarsal, midfoot, and medial heel (relative impulse) and in the second metatarsal (contact percentage) (P < .001).

Conclusions: Higher BMI values correspond to a higher load on the foot during walking in women. The relative foot load in obese women is characterized by a pressure increase in the lateral forefoot and midfoot and by a pressure decrease in the medial heel.
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http://dx.doi.org/10.7547/15-143DOI Listing
May 2017
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