Research Roundup: July 2020


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Footwear Alters Lower Extremity Coordination Variability

Romer, Braden H., Wendi Weimar, and John Fox. "Footwear Alters Lower Extremity Coordination Variability." Perceptual and Motor Skills 126, no. 5 (2019), 764-778. doi:10.1177/0031512519863183.

This was a small study gauging the influence of footwear on motor coordination, and thus results are not transferable across populations. However, the findings are interesting from a clinical perspective, as this adds to information re: training for functional tasks with appropriate footwear.


Key Points
  • Footwear, footwear components, and tactile feedback are capable of producing significant changes in gait mechanics and lower extremity muscle activity.
  • The amplitude and time to peak amplitude for the tibialis anterior, peroneus longus, and medial gastrocnemius are significantly different between barefoot and shod gait.

  • Footwear has a mechanical effect on gait, due to the increased mass of the distal segment of the shoe when the walker is shod.
  • Footwear causes significant alterations in spatiotemporal variables, and also causes significant changes in lower extremity coordination variability.
  • Footwear exerts significant mass effect on mechanical and physiological gait parameters when running.
  • Footwear that provides augmented plantar facilitation causes a significant decrease in the incidence of extra limb movements as well as center-of-pressure trajectory in response to postural perturbations.

  • Barefoot gait is associated with a reduced stride length and higher cadence compared to shod gait.
  • Significant differences in joint kinematics occur during barefoot gait, including 
    • Increased plantarflexion;
    • Decreased hip flexion; and 
    • Increased knee flexion at foot contact.

  • Augmented tactile feedback has the ability to significantly alter spatiotemporal gait parameters and gait symmetry measures in young, healthy adults.
    • The authors suggest that augmented tactile feedback appears to enhance proprioceptive feedback and neuromuscular control in a variety of populations.
  • The use of a textured insole appears to have no effect on lower extremity coordination when placed within a shoe.

  • The primary source of neuromuscular adaptations between shod and barefoot gait is through the more proximal joint rather than the distal lower extremity joint.
  • An increase in variability of joint coordination may indicate a lower synergistic state among the various movement control centers.

  • There is also increased lower extremity variability during slower versus "normal" walking, due to greater challenges to the neuromuscular system from a temporal increase in the single support phase of gait.


Clinically: Pilates in Practice
  • While building foot and lower limb strength while barefoot is essential for foundational movement training, most people we work with spend a significant amount of time in shoes.
    • It is worth assessing movement in shoes and barefoot.
    • It is worth treating/facilitating movement with shoes on, if appropriate. 
  • Especially consider the parameters of returning to a functional task: what footwear will someone be using, and how will this affect their lower extremity coordination?
  • When training reciprocal lower limb movements, practice at different speeds to challenge the neuromuscular system: Scooter on the Reformer; Step Ups on the Wunda Chair; Walking at the Tower.
  • Integrate tactile feedback to support the transition from barefoot to shod training: Footwork in different positions on the feet; straps and handles in different positions on the feet; soft vs hard surfaces.
  • Integrate manual therapy where appropriate.



Do Exercises Prevent Falls Among Older Adults? Where Are We Now? A Systematic Review

Helen Senderovich MD, MCFP, Pascale M. Tsai HBSc (2020). Do Exercises Prevent Falls Among Older Adults? Where Are We Now? A Systematic Review. JAMDA xxx (1-10). 

This systematic review focused on a variety of interventions for fall prevention, and yet the results were inconclusive for many of these interventions.


Key Points
  • Falls have a high incidence among community-dwelling older adults due to deconditioning, a sedentary lifestyle, and comorbidities.
  • The ability of exercise to reduce falls depends on baseline care.
  • Vitamin D deficiencies increase the likelihood of falls, and are also associated with decreased muscle strength.
  • Single interventions only introduce exercise regimens to prevent falls.
  • Multiple interventions combine exercise with other interventions such as:
    • Medication minimization.
    • Social environment modification.
    • Home environment modification.
    • Management of postural hypotension.

  • Exercise is an essential component of care, and may improve the quality of life of residents in long-term care facilities.
  • Exercises are an important component of each intervention, as they may promote mobility, prevent loss of muscle mass, and facilitate neurologic modifications that improve muscle conditioning.
  • The key exercise types that contribute to significant fall reduction include:
    • Strength; 
    • Coordination;
    • Balance maintenance training;
    • Mobility training;
    • Resistance; and
    • Low-frequency gait.
  • Single and multiple component interventions that are designed for fall prevention should consider muscle strengthening and balance training exercises.
  • Interventions should be individually designed while taking into consideration exercise type, frequency, and intensity, and also administrative support.

  • Unassisted exercise increases the risk for adverse events, therefore participants in must be taught proper techniques for unsupervised exercises at home.

  • The willingness of participants to take part in exercise interventions are influenced by:
    • Fear of falling.
    • Mobility.
    • Confidence.
    • Motivation.


Clinically: Pilates in Practice
  • When working with older adults who are at risk for falls, take the time to get to know motivating factors for exercise (and for everyone, really!).
  • Include exercises with higher resistance to train strength. 
  • Include single limb exercises for balance training: Standing Leg Press at the Wunda  Chair; Dipping Bird at the Tower; Scooter on the Reformer. 
  • Ensure to include exercises that incorporate arm swing for reciprocal limb movements: Archer on the Reformer; Punching at the Tower.
  • Core Align gait series for hip/knee/ankle integration.



The Beneficial Effect of Combining Feedback, Observational Learning and Motor Imagery on Football Pass Performance

Nicolas Robin*, Eric Joblet, Emmanuel Roublot, Guillaume R. Coudevylle (2020). The Beneficial Effect of Combining Feedback, Observational Learning and Motor Imagery on Football Pass Performance. Motricidade; 16(1): 55-65.  

This study observed the effect of combining observation of a model, motor imagery, and expert feedback after short physical practices for non-expert learners. The authors conclude, however, that there is a need for more in-depth research to confirm the beneficial effect of combining motor imagery and observation of a model. 


Key Points
  • Motor learning is a change resulting from practice, which can be facilitated by the use of feedback, mental practices (such as action observation), or motor imagery.

  • External feedback provides important information, enhances attention, and facilitates task performance by pointing out vital practice components that may not be available to the performer.
  • Feedback enhances goal attainment, but may lead to dependency and prevent the processing of intrinsic feedback.

  • Motor imagery is a conscious process that requires individuals to mentally simulate an action without performing it.
  • Motor imagery and observation of a model are forms of motor simulation that activate the motor system in the absence of overt motor execution.

  • The observation of a model leads to a reduction in the number of physical practice trials required to achieve a set goal.
  • The combination of motor imagery and observation of a model causes a significant increase in excitability and corticomotor activity.
  • The feedback model plus imagery group increased the performance from the pre- to the post-test, whereas the performance of all the other groups remained stable across the experimental conditions.

  • Observation of a model and motor imagery should be incorporated into training sessions along with cues about motor action corrections, especially when there is a short intervention period. 


Clinically: Pilates in Practice
  • Even short practice sessions can facilitate motor learning; it is not essential to schedule longer sessions to ensure that learning occurs. 
  • Getting a client to observe a task will allow them to get an idea of the movement requirements, which can then facilitate their motor image of that task. 
    • Ask the client to imagine themselves doing the movement task, after observing the instructor perform the task.
  • Feedback is more effective when combined with motor imagery, therefore take the time to rehearse the movement mentally with clients.
  • Find the combination for learning that best fits with the client's understanding and expectations. 

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