Physiotherapy
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7190
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Item ASSESSING LOWER LIMB SOMATOSENSORY FUNCTION OF CHILDREN WITH UPPER MOTOR NEURON LESIONS(2024-12-11) Marsico, PetraThrough the somatosensory system, we receive information about the external and internal state of our body as the foundation of our feedback-control system for all motor activities. Therefore, somatosensory function is essential for motor control, and motor learning. Lower limb somatosensory function is particularly important for balance, gait and mobility. Different modalities of the somatosensory system can be impaired in children with Upper Motor Neuron (UMN) lesions. Therefore, we require child-friendly outcome measures to assess somatosensory function of the lower limbs that can be included in a toolbox for clinicians and researchers. Methods: An overview of the current state of knowledge was compiled on the basis of a systematic review. The systematic review analysed the psychometric properties of the available measures for assessing lower limb somatosensory function. Subsequently, an expert panel participated in a Delphi study to identify the most important modalities of lower limb somatosensory function in relation to motor outcomes. We developed standardised protocols to assess various somatosensory modalities and investigated validity, reliability, and feasibility in children with UMN lesions. We investigated the relationships between tactile function, body awareness, and motor outcomes. Finally, we developed a sensor-based tool to assess lower limb proprioception and assessed its validity, reliability, and feasibility. Results and conclusions: The toolbox provides outcome measures to assess six modalities of lower limb exteroception, proprioception, and body awareness in children with UMN lesions. The feasibility and psychometric properties of the investigated outcome measures are confirmed as good. The correlations between the individual somatosensory and motor function assessments vary greatly. Structural body awareness and joint position sense showed the highest relationship to motor activity and are included into the core toolbox. Further studies should investigate the validity, reliability, and feasibility of a tactile localisation tasks of the whole lower limb to assess body awareness.Item PLAYING-RELATED MUSCULOSKELETAL DISORDERS AMONG MUSIC STUDENTS IN EUROPE(2023) Cruder, CinziaBackground and aims: The achievement and improvement of musical competences and technical abilities to reach the highest levels of performance may expose music students to a wide range of playing-related musculoskeletal disorders (PRMDs). The main aim of the present thesis was to longitudinally identify the factors associated with increased risk of PRMD onset among music students enrolled in different pan-European music institutions. Further goals were to determine the prevalence and incidence of PRMDs amongst music students during their training, as well as to describe and characterise the study population. Methods: 850 students from 56 European conservatories and music universities completed a web-based questionnaire on lifestyle and physical activity participation levels, musical practice habits, behaviours toward prevention, health history and PRMDs, as well as psychological distress, perfectionism and fatigue. The onset of PRMDs was assessed prospectively at 6 and 12 months. Results: At baseline, 560 participants (65.0%) self-reported a positive history of MSK complaints in the previous 12 months, 408 (48.0%) of whom self-reported PRMDs. Self-reported PRMDs were significantly associated with coming from West Europe (RRR=4.524; RRR>1), being a first- or a second-year Masters student (RRR=2.747; RRR>1), having more years of experience (RRR=1.040; RRR>1) and higher rates of perceived exertion after 45 minutes of practice without breaks (RRR=1.044; RRR>1). The incidences of PRMD onset at 6 and 12 months were 28.8% and 49.0%, respectively. Longitudinally, changes in physical activity level (both increase and decrease; 6-month AOR=2.343, 12-month-AOR=2.346; AOR>1), increased levels of fatigue (6-month AOR=1.084, 12-month-AOR=1.081; AOR>1) and increased level of socially-prescribed perfectionism (6-month AOR=1.102; AOR>1) were significantly associated with PRMD onset. The presence of MSK complaints at baseline (6-month AOR=0.145, 12-month-AOR=0.441; AOR<1), as well as changes to BMI and to levels of psychological distress (12-month AOR=0.663 and 0.914, respectively; AOR<1) retarded the onset of PRMDs. Conclusions: Cross-sectional and longitudinal findings showing high prevalence and incidence of PRMDs amongst music students, have been critically appraised as potential correlates, determinants and factors in the development of PRMDs. The findings offer contextualisation for revisiting contemporary evidence-based preventive strategies and optimisation of tailor-made interventions aimed at minimising the impact of PRMDs.Item Development Of A Balance Recovery Confidence Scale For Community-Dwelling Older Adults(2022) Soh, Shawn Leng-HsienFalls are concerning issues for older people. There is a lack of instruments that measure balance recovery confidence. Balance recovery confidence refers to the perceived ability to arrest falls. Patient-reported outcome measures (PROMs) are used to obtain information directly from the person being cared for. The overall aim of this thesis is to present the development of a PROM that measures balance recovery confidence in community-dwelling older adults. Methods: A sequential series of steps was taken to develop the PROM. First, a literature review was done to understand the self-efficacy theory, types of falls-related psychological concerns, PROMs used, the role of balance recovery control and the development of a PROM for the construct of interest. Four studies were then implemented. The first study systematically reviewed existing falls efficacy-related PROMs for their development, content validity and structural validity. The second study assessed the feasibility of studying near-falls and balance recovery among community-dwelling older adults. The third study constructed and validated the content of the balance recovery confidence scale with 22 community-dwelling older adults and 28 healthcare professionals. The final study assessed the psychometric properties of the newly developed PROM with 84 community-dwelling older adults in Singapore. Results and conclusions: Existing falls efficacy-related PROMs lack high-quality evidence in their development and content validity. The systematic review affirmed an absence of a suitable PROM of balance recovery confidence for community-dwelling older adults. The feasibility study demonstrated that balance recovery was a relatable concept for older adults. A 19-item balance recovery confidence scale was constructed and validated with experts’ consensus. Field testing showed that the scale has excellent psychometric properties, having moderate correlations with the Activities-specific Balance Confidence Scale, Falls Efficacy Scale-International, Late Life Function and Disability Instrument-Function and strong correlation with reactive postural control performance. Keywords: Patient-reported outcome measures, falls efficacy, balance recovery confidence, psychometric propertiesItem Sensorimotor and neuromuscular performance capabilities in elite young soccer players(2021) Clancy, ColinFollowing a review of the literature and using a prospective observational design delivered in an ecologically valid setting, this thesis enhances knowledge of sensorimotor (SM) and neuromuscular (NM) performance capabilities in elite young soccer players, culminating with a controlled cohort study to further investigate the influence of high intensity exercise stress on performance capabilities. Alterations in player perceived capabilities using the Borg Category-Ratio Scale (CR-10) and Perceived percentage of completed task duration (PTD), were also investigated. Impaired NM performance as a symptom of fatigue has previously been demonstrated in elite soccer players. However, the results from outcome measures offering such detailed and granular biological insights have not been documented previously. In addition, this research project aimed to observe (Chapter 6) and then provoke (Chapter 7) turbulence, physiologically, to examine whether the SM system is similarly affected, thereby verifying this mechanism as operational for soccer players. To objectify the conditioning dosage to which elite young soccer players are typically exposed to, Chapter 3 offered a season-long patterning of training and match-workload. To further contextualise the backdrop of this research project, NM performance capabilities were benchmarked by comparison with senior professional players in Chapter 4. Performance capabilities of sixteen elite male soccer players (age: 19.2 ± 1.1 years; height: 183.3 ± 6.1 cm; body mass: 76.1 ± 7.8 kg) were evaluated at weekly intervals over a 6-week in-season mesocycle (Chapter 5), and daily during a weekly competitive microcycle (Chapter 6). Assessments of peak twitch force (PTFe) and electromechanical delay (EMD) demonstrated significant changes in NM performance capability (p < 0.05; 13.6% and 15.1% impairments, respectively) whereas SM performance capability was preserved (p > 0.05). Congruence amongst fluctuating patterns of intra-mesocycle training workloads and concomitant neuromuscular performance responses was noted over time for Acute Training Load (ATL) with PF (r = -0.59; p < 0.05) (Chapter 5). Corresponding analysis of training workloads and conditioning status as influencers of post-match strength resilience and recovery identified potential for aspects of NM performance to be altered by careful manipulation of antecedent training workloads (r = 0.59-0.62; p < 0.05) (Chapter 6). Within routine aspects of the competitive season, greatest deficits in NM performance were observed immediately following match-play (p < 0.05; Cohen’s d: 0.32 [PF] and 0.89 [EMD]). Subsequently, using a potent, controlled exposure to exercise stress, an intermittent isometric fatigue trial (IIFT) was deployed to examine concurrent SM and NM performance responses while exploring alterations in player perceived capabilities. Declines in PF, rate of force development (RFD) and EMD performance following the IIFT reached statistical significance with effect magnitudes larger than observed within the ecologically relevant settings (p < 0.001; Cohen’s d: 0.58 [PF], 0.52 [RFD] and 2.34 [EMD]). Interestingly, SM performance capabilities remained intact following the IIFT (p > 0.05). Additionally, although both CR-10 and PTD ultimately demonstrated efficacy in predicting exercise cessation, a significant interaction effect (p < 0.01) was observed indicating a divergence between candidate explanatory paradigms of self-perception of capabilities for players within the task. This thesis has increased current knowledge and understanding by providing a novel exploratory evaluation of sensorimotor and neuromuscular performance capabilities in early career professional soccer players. The findings presented in this thesis will better inform future studies on conditioning soccer players and allow more targeted prophylactic strategies to be implemented by performance support staff. Key words: Sensorimotor, neuromuscular, soccer