We examined the reliability of in-shoe foot pressure measurement using the Pedar in-shoe pressure measurement system for 25 participants walking at treadmill speeds of 0.89, 1.12, and 1.34 meters/sec. The measurement system uses EMED insoles, which consist of 99 capacitive sensors, sampled at 50 Hz. Data were collected for 20 seconds at two separate times while participants walked at each gait speed. Differences in some of the loading variables across speed relative to the total foot and across the different anatomical regions were detected. Different anatomical regions of the foot were loaded differently with variations in walking speed. The results indicated the need to control speed when evaluating loading parameters using in-shoe pressure measurement techniques. Coefficients of reliability were calculated. Variables such as peak force for the total foot required two steps to achieve a coefficient of reliability of 0.98. To achieve excellent reliability (> 0.90) in the peak force, force time integral, peak pressure, and pressure time integral across the total foot and the seven regions, a maximum of eight steps was needed. In general, timing variables, such as the instant of peak force and the instant of peak pressure, tended to be the least reliable measures.

Therapists are recommended to use Schneck and Henderson's 10-grip scale only for documenting the persons' grips and changes in their grips, but if comparisons between individual persons are desired, then Schneck's five-level scale, which affords greater generalizability, should be used. Further, children with graphomotor performance deficits are not likely to benefit from grip manipulations because such strategies were shown to make better only performance that is already good.

).Muscular fatigue and fatigue-induced physiologic tremor can encumber both novice surgeons as well as experienced surgeons during long or demanding surgeries. Muscle cooling has been shown to reduce muscular fatigue levels and physiologic tremor amplitude.1,2 Cooling vests and garments have been available to operating room (OR) staff for some time now, but the investigation of their efficacy has been limited. As the current surgical workforce ages, 3 a larger portion of the medical community is calling for a more objective evaluation of surgeons nearing retirement. 4Increases in limb tremor amplitude were reported after fatigue-induced exercise and after localized muscle heating. 2,5In contrast, limb cooling and intermittent ischemia has been shown to reduce limb tremor amplitude. With age, skeletal muscle mass, muscle strength, and quality of muscle all decline $5% per decade in both static and dynamic muscle strength measures.6 Reduction in muscle mass is a prominent contributor to chronic muscle fatigue. A recent study found that a group of active, well-trained older men (average age of 70 years) who exercised regularly as compared with sedentary cohorts have Keywords ► muscle fatigue ► surgeon fatigue ► muscle cooling ► tremor reduction ► fatigue ► physiologic tremor ► surgical tremor AbstractA localized, intermittent muscle-cooling protocol was implemented to determine cooling garment efficacy in reducing upper extremity muscular fatigue and tremor in novice (n ¼ 10) and experienced surgeons (n ¼ 9). Subjects wore a muscle-cooling garment while performing multiple trials of a forearm exercise and paired suturing task to induce muscular fatigue and exercise-induced tremor. A reduction in tremor amplitude and an extension in time to fatigue were expected with muscle cooling as compared with control trials. Each subject completed an intervention session (5°C cooling condition) and a control session (32°C or thermal neutral condition). A paired samples t test indicated that tremor amplitude was significantly reduced (t [8] ¼ 1.89458; p < 0.05) in experienced surgeons in two dimensions (up and down, and back and forth). Tremor amplitude was reduced in novice surgeons but the effect was not significant. Time to fatigue and suture time improved in both cohorts with muscle cooling, but the effect did not reach significance. Results from the pilot work suggest muscle cooling as an intervention for reduction of fatigue and tremor is very promising, warranting further investigation. Surgical specialties that require prolonged procedures might benefit more from this intervention.

Background: This study is the first to correlate sonographic findings of subcutaneous tissue to structural and biomechanical properties. Methods: Precisely sized tissue specimens (59 samples) were collected from five abdominoplasty procedures. A Philips Lumify L12-4 linear array probe, connected to an Android tablet, was used to obtain ultrasound images of the superficial fascial system. A no. 1 Vicryl suture on a CTX needle placed though a needle guide within a three-dimensionally printed template ensured equal bites of subcutaneous tissue across specimens. Suture pull-out strength was measured until failure at a displacement rate of 2.12 mm/second using an Admet MTEST Quattro. Mean gray value for the superficial fascial system in associated ultrasonographic images was quantified by CellProfiler. Results: Superficial fascial system visualization can be accomplished using high-resolution portable ultrasound. Comparing multiple specimens’ imaging, interpatient and intrapatient variability of superficial fascial system quantity and structural characteristics are apparent. The superficial fascial system is highly abundant in some patients, but has limited presence in others. Individual-specimen mean gray value and whole-patient mean gray value positively correlated with tissue tensile strength (p = 0.006) and patient-average tissue tensile strength (p = 0.036), respectively. Whole-patient mean gray value accounted for 98.5 percent of the variance seen in patient-average tensile strength, making it a strong predictor for tensile strength. Conclusions: Portable ultrasound and image-processing technology can visualize, quantify, and predict subcutaneous tissue strength of the superficial fascial system. The superficial fascial system quantity correlates with suture tensile strength. Clinically, preoperative superficial fascial system quantification may aid in outcome predictions, manage patient expectations, and potentially lower complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, V.