Health is a multidimensional, holistic, concept integrating physical and mental health. In childhood, the most common cause of physical disability is Cerebral Palsy (CP). For individuals with CP, health and well-being is impacted by the complex interactions among their physical impairments, activity, participation and environmental barriers. Although CP is considered non-progressive, secondary conditions (pain and fatigue) and their functional consequences have been found to worsen as the individual with CP ages. While preliminary evidence shows that many of the physical impairments (pain, fatigue, depression) reported in adults with CP begin during late adolescence, there is little information about the role personal and environmental factors, impairments, activity limitations, and participation restrictions have on health and well-being of young adults with CP. To understand the health and well-being of young adults with CP, the International Classification of Functioning, Disability and Health (ICF), a World Health Organization framework, guided the selection of survey instruments for this study. Surveys were sent to 610 young adults (18-30 years) with CP. 95 surveys were returned, 55 were self-reported and 40 were completed by proxies. Increasing severity of impairment was associated with decreased participation in daily activities and social roles, while loss of ambulatory ability, pain, fatigue, depression, and activity level did not differ by severity of impairment. Environmental barriers restricted the level of participation only for the self-report participants. Health status was decreased in those who self-reported increased pain, fatigue, and depression; offset by emotional support. Life satisfaction was decreased by depression and poor health; offset by emotional support. Addressing the physical impairments, activity limitations, participation restrictions, personal factors and environmental barriers impacting young adults with CP requires coordinated efforts among the medical, educational and vocational systems. These efforts need to begin early with appropriate assessment and treatment of impairments, provision of assistive technologies and augmentative communication, and adaptation of the environment to facilitate participation in activities and social roles. The health and well-being in young adults with CP can also be improved with enhanced emotional support beyond the family unit through peer support groups, mentors, and other adult role models.

This investigation examined the heart rate responses and movement characteristics of experienced footbag net players during singles play. Footbag net is a net/court sport similar to volleyball, but it is played with a footbag (e.g., Hacky-SackTM) using only the feet. In singles footbag net, players are allowed either one or two kicks to propel the footbag over the net. Subjects were 15 males and 1 female, ranging in age from 18- 60 years, with a mean age of 33.6 years. Subjects played two games of singles footbag net using two different scoring systems: "sideout" scoring and "rally" scoring. Mean heart rates were 149.4 bpm for games played under the sideout scoring system and 148.7 bpm for games played under the rally scoring system. Sideout games were 1.2 minutes (~11%) longer than rally games. The mean heart rate responses to competitive play using sideout scoring and rally scoring were not significantly different (p>0.05). For play under both scoring systems, the average exercise intensity--expressed as a percentage of age-predicted maximum heart rate (MHRest)--was 80-81% MHRest. Accelerometer counts accumulated during play were similar for both scoring systems. It is recommended that additional research be conducted to evaluate the extent to which accelerometry may contribute to physiological and metabolic measurements of footbag net competition.

Previous studies show that pure tone thresholds are strongly correlated with distortion product otoacoustic emission amplitudes when evaluating the frequency range from 1 to 8 kHz (Avan & Bonfils, 1993). Little is known about correlations between these two measures at higher frequencies from 9-16 kHz. This study compared pure tone thresholds and distortion product otoacoustic emissions (DPOAEs) in this high frequency range for 29 normal hearing subjects ages 18-30. Pure tone thresholds were obtained at 250-16 kHz and distortion product otoacoustic emissions (DPOAE) 2,211-17,675 were measured in the same ears. DPOAE amplitudes were measured using a constant F1/F2 ratio of 1.2, with F2 values ranging from 2,211-17,675 Hz. Data obtained from 50 ears showed a decline in DPOAE amplitude with increasing frequency of the F1 and F2 primary stimulus tones. Behavioral thresholds demonstrated an increase with increasing frequency of the pure tone stimulus. Pearson r-correlation analysis demonstrated a weak relationship between measures. Further investigation revealed that equipment variables prevented accurate readings.

The problem of this study was to determine the relative contribution of the strength of shoulder internal rotators among various muscle groups to ball speed in the fastball pitch as exhibited by college pitchers. An objective of the study was to explain at least 40% of the contribution of ball speed. The literature appears to be somewhat inconclusive as to the quantification of component contributors of muscle groups m the upper extremity to ball speed. It appears in the literature that variables other than upper extremity strength account for approximately 50% of ball speed. Some research has indicated that strength of the shoulder internal rotators is a major contributor while most research of this type has either been inconclusive or qualitative m nature. Eighteen college pitchers were tested for upper extremity peak torque production on the Cybex II Isokinetic Dynamometer at speeds of 90 and 240 degrees/second. Fastball speed was measured with a hand held radar gun. Results of regression analyses performed on the data indicate a strong correlation between the internal rotators of the upper extremity and fastball speed. A regression equation using a hierarchical strategy to maximize R2 accounted for 40% of contribution to ball speed using independent variables of shoulder internal rotation at 90° /sec. (X1) and elbow flexion at 240°/sec. (X2); ie, Speed=62.861+245X1 +.39X2. The standardized beta weights for this equation indicate that the greater contributor to ball speed was Sho/Int/Rot-90 when the effects of Elb/Fl-240 are controlled. When elbow extension at 90° /sec. was added to the equation as X3 approximately 59% of ball speed is explained; ie, Speed=68.605 + 268X1 + 807 X2 - .430X3.

The purpose of this dissertation series was to examine oxygen uptake kinetics in skeletal muscle by evaluating responses of local muscle deoxygenation during incremental exercise in healthy individuals using near-infrared spectroscopy (NIRS). Metabolic activity in skeletal muscle, as part of the integrative responses of the cardiovascular, respiratory and neuromuscular systems, are major determinants of an individual’s physical capacity and function. The workings of these systems, called whole-body metabolism, affect the capability of an individual to engage in activities of daily living, to exercise, and participate in athletic performance. Thus, they have a strong impact on health as engagement in physical activity is well known to be effective in improving cardiorespiratory fitness and reducing the risks of chronic disease. At this time, the in vivo relationships between whole-body metabolism and local muscle metabolic activity are not well understood, but with the availability of NIRS technology this is possible. NIRS is a noninvasive optical technique used to continuously measure changes in muscle tissue oxygen saturation locally, allowing interrogation of the functional integration between muscle metabolism and the cardiovascular system in intact human beings, which is what the series of studies in this dissertation evaluate. Healthy adults and adolescents were enrolled as healthy control participants into an observational study evaluating changes in local muscle oxygen uptake in neuromuscular disease during exercise. Participants performed a maximal cardiopulmonary exercise test (CPET) on a recumbent cycle ergometer. Changes in muscle deoxygenation (HHb), reflecting local oxygen uptake, were measured using NIRS and whole-body metabolism was assessed synchronously via expired gas analysis. After an initial increase in HHb at exercise onset, a consistent pattern of plateau in HHb was observed in the healthy participants near the end of peak exercise. Despite increasing workload and oxygen uptake (VO2) in the final minutes of the test, it was unclear what mechanisms were contributing to this HHb response. It was hypothesized that the HHb-Workload relationship evaluated at the time of VO2peak would be non-linear, such that a greater maximum workload achieved at VO2peak would not be linearly matched by greater ΔHHb (i.e., greater total change from rest to VO2peak). First, a critical evaluation of the literature was conducted to explore this hypothesis. Chapter 2 provides the results of a scoping review that was performed in order to better understand the scientific evidence using NIRS that describes the relationships between indices of muscle oxygen saturation and workload during incremental exercise. This formed the basis to pursue the hypothesis-driven research presented in the subsequent chapters, interrogating the overarching question of this dissertation related to the HHb-Workload relationship. The review revealed there are three methodological approaches to examining changes in muscle oxygen saturation and workload, the least common of which was examination of HHb and workload at the VO2peak time point. Changes in muscle oxygen saturation and work have also been studied as the change in muscle oxygenation over the duration of exercise and at a certain time point or intensity during incremental exercise. Based on the literature, it was clear that there was a dearth of research examining the HHb plateau response in relation to work at VO2peak. Accordingly, chapter 3 provides the results of a pilot study that evaluated the relationship between change in HHb (ΔHHb) and the maximum workload (MW) achieved at VO2peak, where it was hypothesized that the relationship at this time point would be non-linear. A polynomial regression model was used to describe the relationship. The results of this study showed that at lower maximum workloads there were initial increases in ΔHHb with increasing maximum workload but at the highest maximum workloads, ΔHHb attenuated. A polynomial model including ΔHHb and MW, with VO2peak (an indicator of cardiorespiratory fitness) as a covariate, best characterized the relationship. Age was not significantly related to ΔHHb or MW, and VO2peak appeared to play a partial role as its inclusion as a covariate helped explain approximately a quarter of the variance, suggesting other factors may be contributing to the attenuated HHb response. From this pilot work it was hypothesized that the attenuation in ΔHHb at higher maximum workloads, and the HHb plateau observed during CPET, could be explained by muscle efficiency. If so, a longer duration and lesser slope of the HHb plateau in the minutes leading up to VO2peak occurs in muscles with higher metabolic efficiency. As muscle efficiency is defined as a ratio of external work accomplished to internal energy expended, the hypothesis, if true, would support a better matching of the internal work (VO2) to the external work (workload on the ergometer). Chapter 4 provides the results of a secondary analysis that sought to determine whether the observed plateau in HHb reflected muscular efficiency by comparing the slope of the HHb plateau (HHb[s]) to a commonly used method of assessing muscle efficiency, delta efficiency (DE). It was hypothesized that HHb[s] and DE would be inversely and significantly correlated, providing a potential mechanism for the attenuated HHb response and a noninvasive method for assessing muscle efficiency. In contrast to the hypothesis, HHb[s] and DE were not associated, suggesting that a mechanism other than muscle efficiency is contributing to the HHb plateau. Collectively, this series of studies demonstrate that there is a need to better understand the relationship between HHb and workload in healthy individuals, because of a paucity of evidence exploring the HHb-MW relationship at VO2peak, the finding that ΔHHb attenuates at higher maximum workloads, and that results suggest the HHb plateau phenomenon cannot be explained by muscle efficiency. Future work should seek to elucidate the mechanism that allows healthy individuals to achieve higher workloads (i.e., continue exercising at high intensity) without further increasing muscle oxygen uptake, in a larger more heterogeneous sample.

The human brain relies on the complex interactions of distinct brain regions to support cognitive processes. The interplay between the hippocampus and neocortical regions plays a key role in the formation, storage, and retrieval of long-term episodic memories. Oscillatory activities during sleep are a fundamental mechanism that binds distributed neuronal networks into functionally coherent ensembles. However, the large-scale hippocampal-neocortical oscillatory mechanisms that support flexible modulation of long-term memory remain poorly understood. Furthermore, alterations to physiologic spatiotemporal patterns that are essential for intact memory function can result in pathophysiology in brain disorders such as focal epilepsy. Investigating how epileptic network activity disrupts connectivity in distributed networks and the organization of oscillatory activity are additional crucial areas that require further research. Our experiments on rodents and human patients with epilepsy have provided valuable insights into these mechanisms. In rodents, we used high-density microelectrode arrays in tandem with hippocampal probes to analyze intracranial electroencephalography (iEEG) from multiple cortical regions and the hippocampus. We identified key hippocampal-cortical oscillatory biomarkers that were differentially coordinated based on the age, strength, and type of memory. We also analyzed iEEG from patients with focal epilepsy and demonstrated how individualized pattern of pathologic-physiologic coupling can disrupt large-scale memory circuits. Our findings may offer new opportunities for therapies aimed at addressing distributed network dysfunction in various neuropsychiatric disorders.

The purpose of the present study was to investigate the psychophysiological effects of exercise on measures of cardiovascular fitness, depression, self-esteem, and anxiety. The 1.5 mile run (Cooper, 1972) was used to determine changes in cardiovascular fitness. The Zung Self-Rating Depression Scale was used to measure varying levels of depression. The Rosenberg Self-Esteem Scale was used to measure self-esteem. The Spielberger State-Trait Anxiety Inventory was used to measure state anxiety. An Electromyographic Assay and Digital Skin Temperature were performed on the Experimental and Corrective Therapy Groups in order to measure physiological concomitants of anxiety. A Body Composition Assay was performed in order to measure changes in body composition.

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Human faces provide a rich source of behavioral data. Following acute, potentially traumatic events, manual and automated coding systems of facial behavior may help identify individuals at risk for developing psychopathology. In the present study, OpenFace, an automated system, and FACS, a manual method, were compared as predictors of long-term functioning using facial behavioral data from clinical interviews collected one-month after a potentially traumatic event that brought participants into the emergency department of a Level-1 Trauma Center in New York City. We evaluated similarities and differences in facial emotions identified by FACS and OpenFace to determine their predictive accuracy in capturing Depression and PTSD 6-months and 12-months later. The findings suggest OpenFace is a more sensitive and precise measure of facial behavior than FACS.