Background The craniocervical flexion test (CCFT) is recommended when examining patients with neck pain related conditions and as a deep cervical retraining exercise option. During the execution of the CCFT the examiner should visually assess that the amount of craniocervical flexion range of motion (ROM) progressively increases. However, this task is very subjective. The use of inertial wearable sensors may be a user-friendly option to measure and objectively monitor the ROM. The objectives of our study were (1) to measure craniocervical flexion range of motion (ROM) associated with each stage of the CCFT using a wearable inertial sensor and to determine the reliability of the measurements and (2) to determine craniocervical flexion ROM targets associated with each stage of the CCFT to standardize their use for assessment and training of the deep cervical flexor (DCF) muscles. Methods Adults from a university community able to successfully perform the CCFT participated in this study. Two independent examiners evaluated the CCFT in two separate sessions. During the CCFT, a small wireless inertial sensor was adhered to the centre of the forehead to provide real-time monitoring and to record craniocervical flexion ROM. The intra- and inter-rater reliability of the assessment of craniocervical ROM was calculated. This study was approved by the Research Ethics Committee of CEU San Pablo University (236/17/08). Results Fifty-six participants (18 males, 23 females; mean [SD] age, 21.8 [3.45] years) were included in the study and successfully completed the study protocol. All interclass correlation coefficient (ICC) values indicated good or excellent reliability of the assessment of craniocervical ROM using a wearable inertial sensor. There was high variability between subjects on the amount of craniocervical ROM necessary to achieve each stage of the CCFT. Conclusions The use of inertial sensors is a reliable method to measure the craniocervical flexion ROM associated with the CCFT. The great variability in the ROM limits the possibility to standardize a set of targets of craniocervical flexion ROM equivalent to each of the pressure targets of the pressure biofeedback unit.

BACKGROUND The use of wearable inertial sensors has shown to be an easy-to-use and reliable option to objectively measure and monitor the range of motion (ROM) associated with each stage of the craniocervical flexion test (CCFT). However, previous research showed limitations when discriminating between each of the stages of the CCFT to standardize a set of ROM targets, since the instrumentation used only provided data of ROM on each of six pressure stages of the CCFT and the process of associating values of ROM and pressure was not automatically synchronized by a computer. OBJECTIVE The aim of the study is to develop a novel real-time, high-precision (Computer-based) time synchronization system to continuously record pressure and craniocervical flexion ROM during the CCFT in order to assess its feasibility on measuring and discriminating the values of ROM between different pressure levels. METHODS This is a descriptive, observational, cross-sectional study in a sample of asymptomatic participants in order to allow for the description of normative values of ROM and pressure during an ideal execution of the CCFT. All participants performed a testing procedure consisting on the performance of full-range craniocervical flexion and the CCFT. During the CCFT, a low-range pressure sensor and a wireless inertial sensor simultaneously registered data of pressure and ROM. A web application was developed using HTML and NodeJS technologies. It allowed for real-time synchronization of processing, visualization, and storage of data from both sensors at a frequency of 50Hz. A biofeedback computer screen allowed for real-time observation and assessment of the correct performance of the CFFT for both the examiner and the patient by observing pressure and ROM graphics at the same time. RESULTS A total of 45 participants successfully finished the study protocol (20 males, 25 females; mean [SD] age, 32 [11.48] years). One-way analyses of variance (ANOVAs) showed large effect significant interactions between pressure levels and the percentage of full craniocervical flexion ROM when considering the 6 pressure reference levels of the CCFT (P<0.001; η2=0.697), 11 pressure levels separated by 1 mmHg (P<0.001; η2=0.683) and 21 pressure levels separated by 0.5 mmHg (P<0.001; η2=0.671). Curve estimation regression analysis showed a significant curvilinear relationship (quadratic model) between pressure and ROM both measured in percentage (R=.811; P<.001) and in degrees (R=.805; P<.001). CONCLUSIONS The novel time synchronizing system developed in this study seems a feasible option for future research and clinical practice to provide real-time monitoring of both pressure and ROM through a computer screen high-precision feedback during the performance of the CCFT. The values of craniocervical flexion ROM presented in this study could serve as reference targets to further investigate the potential use of inertial sensor technology to assess or train deep cervical flexors. CLINICALTRIAL Not applicable

Interventions: A microbiological sampling was carried out in the physiotherapy centers. The samples were studied using the usual culture and analysis methodology for characterization and isolation of a range of bacteria. Main Outcome Measures: Absolute and relative frequency of microorganism isolation. Results: In the analysis, pathogens normally responsible for nosocomial infections were detected, especially on instruments and equipment used by the physiotherapist such as sponge electrodes, and were significantly more contaminated than the rest of the places studied (P<.01). Conclusion: This situation confirms the absence of measures and protocols for the prevention and control of such infections in the physiotherapist's environment, which is why they must be considered to protect both physiotherapy professionals and patients.

Background Patients with craniocervical pain have shown reduced performance in the craniocervical flexion test (CCFT). However, there is limited evidence of other possible kinematic alterations not assessed in the context of the CCFT. Previous studies on other functional or planar movements have reported alterations in sensorimotor control (e.g., range of motion [ROM], velocity, or smoothness) in subjects with neck pain. The objective of this study was to explore the association between sensorimotor control variables associated with craniocervical flexion movement and different characteristics related to pain, age, disability, and fear of movement in individuals with non-traumatic chronic neck pain and asymptomatic controls. Methods This was an observational, cross-sectional study in patients with non-traumatic neck pain and asymptomatic participants. Regression models were used to assess whether descriptive characteristics of the sample, including: (a) age, (b) intensity of pain, (c) neck disability, (d) chronicity of pain, and (e) fear of movement could explain sensorimotor control variables such as ROM, velocity, jerk, head repositioning accuracy, and conjunct motion. All these variables were recorded by means of light inertial measurement unit sensors during the performance of three maximal repetitions of full range craniocervical flexion in the supine position. Results A total of 211 individuals were screened and 192 participants finished the protocol and were included in the analyses. Participants had an average age of 34.55 ± 13.93 years and included 124 patients with non-traumatic neck pain and 68 asymptomatic subjects. Kinesiophobia partially explained lower craniocervical flexion ROM (p = .01) and lower peak velocity in flexion (P < .001). Age partially explained increased craniocervical extension ROM (P < .001) and lower peak velocity in flexion (P = .03). Chronicity partially explained increased lateral flexion conjunct motion (P = .008). All models showed low values of explained variance (< 32%) and low absolute values of regression coefficients. Conclusions This study did not find a clear relationship between population characteristics and sensorimotor control variables associated with the craniocervical flexion movement. Kinesiophobia might have some association with reduced ROM in craniocervical flexion, but further research in this field is needed in large samples of patients with higher levels of kinesiophobia pain or disability.

The aim of this study was to determine blood pressure (BP) and heart rate (HR) responses triggered during an isokinetic testing protocol in professional soccer players and compare cardiovascular parameters at completion of this isokinetic protocol with those during a treadmill test. Using purposive sampling, 63 professional soccer players were recruited. Cardiovascular responses were measured noninvasively during a bilateral testing protocol of knee flexion and extension. Treadmill ergospirometry following an incremental speed protocol was performed to analyze the same cardiovascular parameters at rest and at completion of this test. There were significant differences in diastolic blood pressure (DBP) and HR according to field position. The parameters presented high homogeneity at both competitive levels. Systolic blood pressure, mean arterial pressure, HR, and rate pressure product at completion of the treadmill test were significantly higher than those at completion of the isokinetic protocol. Intermittent isokinetic testing protocol of the knee triggers normal and safe BP and HR responses in healthy professional soccer players. The HR of the defenders was higher than those of the forwards and midfielders but was independent of the competitive level. The values of cardiovascular parameters at isokinetic protocol completion were lower than those during the treadmill test.