Kinesiology Commons^™

The Optimal Relationship Between Actuator Stiffness And Actuation Timing For A Passive Ankle Exoskeleton: An Opensim Simulation, Cody Anderson, Hafizur Rahman, Sara Myers

UNO Student Research and Creative Activity Fair

Introduction

The passive ankle exoskeleton developed by Collins et al. (2015) reduced the metabolic cost of walking with an actuation-timing of ~16% of stance [1]; however, other actuation timings have not been extensively investigated. Therefore, the purpose of this study was to determine the optimal relationship between actuator-stiffness and actuation-timing for a passive ankle exoskeleton by using musculoskeletal modeling.

Methods

Kinematics and ground reaction forces were recorded while a healthy-young male walked on overground force-plates, and these data were exported to a musculoskeletal modeling software (OpenSim) for simulation. A passive ankle exoskeleton model was designed and integrated with a default …

Ankle Foot Orthoses Improves Ground Reaction Forces In Patients With Peripheral Artery Disease, Zahra Salamifar, Farah Fallahtafti, Iraklis Pipinos, Jason Johanning, Hafizur Rahman, Mahdi Hassan, Sara Myers

UNO Student Research and Creative Activity Fair

Peripheral artery disease (PAD) is caused by atherosclerotic blockage of the arteries in the legs. Globally, over 236 million people suffer from PAD. Intermittent claudication is the most common PAD symptom that includes muscle pain, cramping, and/or aching induced by physical activities and relieved with rest. PAD impacts gait patterns: specifically, rapid ankle plantar flexion after heel contact, which decreases optimal energy transfer. An ankle-foot orthosis (AFO) is an assistive device that improves gait in patients with neurological conditions. AFOs could help patients with PAD to improve walking kinetics. The purpose of this study was to determine the impact of …

Design And Development Of Software With A Graphical User Interface To Display And Convert Multiple Microscopic Histology Images, Sayed Ahmadreza Razian, Majid Jadidi, Alexey Kamenskiy

UNO Student Research and Creative Activity Fair

Histological images are widely used to assess the microscopic anatomy of biological tissues. Recent advancements in image analysis allow the identification of structural features on histological sections that can help advance medical device development, brain and cancer research, drug discovery, vascular mechanobiology, and many other fields. Histological slide scanners create images in SVS and TIFF formats that were designed to archive image blocks and high-resolution textual information. Because these formats were primarily intended for storage, they are often not compatible with conventional image analysis software and require conversion before they can be used in research. We have developed a user-friendly …

Muscle Forces And Power Are Significantly Reduced During Walking In Patients With Peripheral Artery Disease, Hafizur Rahman, Cody Anderson, Iraklis Pipinos, Jason Johanning, George P. Casale, Jianghu Dong, Holly Despiegelaere, Mahdi Hassan, Sara A. Myers

Journal Articles

Patients with peripheral artery disease (PAD) have significantly reduced lower extremity muscle strength compared with healthy individuals as measured during isolated, single plane joint motion by isometric and isokinetic strength dynamometers. Alterations to the force contribution of muscles during walking caused by PAD are not well understood. Therefore, this study used simulations with PAD biomechanics data to understand lower extremity muscle functions in patients with PAD during walking and to compare that with healthy older individuals. A total of 12 patients with PAD and 10 age-matched healthy older controls walked across a 10-meter pathway with reflective markers on their …

Disentangling The Role Of Religiosity In Human Papillomavirus Vaccination Amidst Covid-19 Pandemic, Ayokunle Olagoke, Brenikki Floyd, Rachel Caskey, Jennifer Hebert-Beirne, Andrew D. Boyd, Yamilé Molina

Health and Kinesiology Faculty Publications

Religion is a complex and sociocultural driver of human papillomavirus (HPV) vaccination decisions, but its exact role has been mixed/unclear. We used a cross-sectional study of 342 Christian parents to examine the associations between the three domains of religiosity (organizational, non-organizational, and intrinsic) and the intention to (i) seek HPV information and (ii) receive the HPV vaccine. Organizational religiosity was the only domain that was positively associated with information-seeking intention regardless of the type of covariates included. Mixed findings in the association between religiosity and HPV vaccination decisions may depend on the religiosity domain being assessed.

How Capuchin Monkeys Use Their Semi-Prehensile Tails, Madhur Mangalam, Callum F. Ross, Patricia Izar, Elisabetta Visalberghi, Dorothy M. Fragaszy

Journal Articles

Among primates, prehensile/semi-prehensile tails have evolved independently in the families Atelidae and Cebidae of the infraorder Platyrrhini (Neotropical monkeys). They facilitate maintaining stability during locomotion on thin, flexible branches and while reaching for food on challenging substrates. How a prehensile/semi-prehensile tail is coordinated with the hind limbs to facilitate controlled, flexible adoption of postures remains unknown. In an experimental set-up in the wild, we induced capuchin monkeys to adopt a tail-assisted, head-down tripodal posture to reach for food, documenting from slow-motion video recordings (120 fps) both qualitative changes in the monkeys’ positional behaviour – the relative orientation of their limbs …

A Kinematic And Emg Dataset Of Online Adjustment Of Reach-To-Grasp Movements To Visual Perturbations, Mariusz P. Furmanek, Madhur Mangalam, Matthew Yarossi, Kyle Lockwood, Eugene Tunik

Journal Articles

Control of reach-to-grasp movements for deft and robust interactions with objects requires rapid sensorimotor updating that enables online adjustments to changing external goals (e.g., perturbations or instability of objects we interact with). Rarely do we appreciate the remarkable coordination in reach-to-grasp, until control becomes impaired by neurological injuries such as stroke, neurodegenerative diseases, or even aging. Modeling online control of human reach-to-grasp movements is a challenging problem but fundamental to several domains, including behavioral and computational neuroscience, neurorehabilitation, neural prostheses, and robotics. Currently, there are no publicly available datasets that include online adjustment of reach-to-grasp movements to object perturbations. This …

Classifying Idiopathic Rapid Eye Movement Sleep Behavior Disorder, Controls, And Mild Parkinson's Disease Using Gait Parameters, Valérie Cochen De Cock, Dobromir Dotov, Sandy Lacombe, Marie Christine Picot, Florence Galtier, Valérie Driss, Castelnovo Giovanni, Christian Geny, Beatriz Abril, Loic Damm, Stefan Janaqi

Journal Articles

Background

Subtle gait changes associated with idiopathic rapid eye movement sleep behavior disorder (iRBD) could allow early detection of subjects with future synucleinopathies.

Objective

The aim of this study was to create a multiclass model, using statistical learning from probability distribution of gait parameters, to distinguish between patients with iRBD, healthy control subjects (HCs), and patients with Parkinson's disease (PD).

Methods

Gait parameters were collected in 21 participants with iRBD, 21 with PD, and 21 HCs, matched for age, sex, and education level. Lasso sparse linear regression explored gait features able to classify the three groups.

Results

The final model …

A Robust Technique For Optimal Fitting Of Roll-Over Shapes Of Human Locomotor Systems, Ganesh M. Bapat, Sara A. Myers

Journal Articles

The roll-over shape (ROS) effectively characterizes the lower limb's ability to roll forward during the single-limb support phase of human walking. ROS is modelled as an optimally fitted circular arc to the center of pressure (CoP) data transformed in the shank/leg-based local coordinate system. The commonly used method for optimal fitting of ROS is complex to implement and eliminates inherent individual variability in the ROS parameters during walking. We propose and validate a novel computerized method for optimal fitting of roll-over shapes of the lower limb during walking. Gait data of a healthy individual from Winter's book was used …

The Interdependent Roles Of The Psychosocial Predictors Of Human Papillomavirus Vaccination Among Christian Parents Of Unvaccinated Adolescents, Ayokunle Olagoke, Rachel Caskey, Brenikki Floyd, Jennifer Herbert-Beirne, Andrew D. Boyd, Yamilé Molina

Health and Kinesiology Faculty Publications

Despite the availability of the human papillomavirus (HPV) vaccine, uptake has been sub-optimal among certain religious groups. Psychosocial factors (threat appraisal, coping appraisal, and attitudes) have been identified as independent determinants of HPV vaccination. However, their interdependent effects have not been tested. We examined the interdependency of these psychosocial factors in predicting HPV vaccination intention among Christian parents of unvaccinated adolescents (using a theory-driven conceptual model). A cross-sectional study of 342 participants showed that perceived self-efficacy (β = 0.2, 0.11–0.29, p = <0.0001) and perceived response efficacy of HPV vaccine (β = 0.65, 0.53–0.77. p < .0001) were positively associated with vaccination intention. Our mediation analysis (using the Preachers and Hayes’ approach) shows that attitudes toward HPV vaccination mediated 59% of the relationship between perceived self-efficacy to vaccinate child and HPV …

Cigarette Smoking After Aerobic Exercise: The Unfavorable Impacts On Vascular Function, Elizabeth J. Pekas, Song-Young Park

Health and Kinesiology Faculty Publications

It is well-accepted that vascular dysfunction plays a key role in the pathophysiology of cardiovascular diseases. Although vascular dysfunction is multi-faceted, exercise is a commonly recommended prophylactic strategy to preserve vascular function. We and others have shown that exercise training can elicit beneficial effects on vascular function (e.g., blood pressure and conduit artery function) in healthy and clinical populations^1-4. In fact, indices of vascular function are enhanced shortly after acute exercise^5,6, suggesting that the postexercise recovery period may be a crucial component for facilitating long-term vascular adaptations⁷. Poor habits may be …

Early Impact Of The Covid-19 Pandemic On Promotion Of Infant Activity, Strength And Communication: A Qualitative Exploration, Kailey Snyder, Priyanka Chaudhary, Angela Pereira, Kimberly Masuda, Jessica Niski, Danae Dinkel

Journal Articles

Introduction

Fostering physical activity, muscle strengthening and communication skills in diverse environments are vital to ensuring healthy infant development; however, promotion of these skills may be impacted by the COVID-19 pandemic. Therefore, the purpose of this study was to explore healthcare workers, parents and childcare providers' perceptions of the pandemic's influence on how they engage with infants to promote physical activity, muscle strength and communication.

Methods

37 subjects (12 = parents; 12 = childcare providers, 13 = healthcare workers) participated in a semi-structured interview. Data were analyzed via an inductive content analysis.

Results

The majority of caregivers identified concerns related …

Claudicating Patients With Peripheral Artery Disease Have Meaningful Improvement In Walking Speed After Supervised Exercise Therapy, Hafizur Rahman, Iraklis Pipinos, Jason M. Johanning, George P. Casale, Mark A. Williams, Jonathan R. Thompson, Yohanis O'Neill-Casto, Sara A. Myers

Journal Articles

Objective

Supervised exercise therapy (SET) is a first-line treatment for patients with peripheral artery disease (PAD). The efficacy of SET is most commonly expressed by significant statistical improvement of parameters that do not clarify how each individual patient will benefit from SET. This study examined the minimal clinically important difference (MCID) in walking speed in claudicating patients with PAD after SET.

Methods

A total of 63 patients with PAD-related claudication (Fontaine stage II PAD) participated in a 6-month SET program. Self-selected walking speed was measured before and after SET. Distribution and anchor-based approaches were used to estimate the MCID for …

Virtual Reality As A Context For Adaptation, Matthew Yarossi, Madhur Mangalam, Stephanie Naufel, Eugene Tunik

Journal Articles

The COVID-19 pandemic has accelerated interest in virtual reality (VR) for education, entertainment, telerehabilitation, and skills training. As the frequency and duration of VR engagement increases—the number of people in the United States using VR at least once per month is forecasted to exceed 95 million—it is critical to understand how VR engagement influences brain and behavior. Here, we evaluate neurophysiological effects of sensory conflicts induced by VR engagement and posit an intriguing hypothesis: the brain processes VR as a unique “context” leading to the formation and maintenance of independent sensorimotor representations. We discuss known VR-induced sensorimotor adaptations to illustrate …

Shared Determinants For Human Papillomavirus And Covid-19 Vaccination Intention: An Opportunity For Resource Consolidation, Ayokunle A. Olagoke, Leslie R. Carnahan, Olakanmi Olagoke, Yamile Molina

Health and Kinesiology Faculty Publications

Purpose

Design

Setting

Subject

Measures

Analysis

Acute High-Intensity Exercise And Skeletal Muscle Mitochondrial Respiratory Function: Role Of Metabolic Perturbation, Matthew T. Lewis, Gregory M. Blain, Corey R. Hart, Gwenael Layec, Matthew J. Rossman, Song-Young Park, Joel D. Trinity, Jayson R. Gifford, Simranjit K. Sidhu, Joshua C. Weavil, Russell S. Richardson

Health and Kinesiology Faculty Publications

Recently it was documented that fatiguing, high-intensity exercise resulted in a significant attenuation in maximal skeletal muscle mitochondrial respiratory capacity, potentially due to the intramuscular metabolic perturbation elicited by such intense exercise. With the utilization of intrathecal fentanyl to attenuate afferent feedback from group III/IV muscle afferents, permitting increased muscle activation and greater intramuscular metabolic disturbance, this study aimed to better elucidate the role of metabolic perturbation on mitochondrial respiratory function. Eight young, healthy males performed high-intensity cycle exercise in control (CTRL) and fentanyl-treated (FENT) conditions. Liquid chromatography-mass spectrometry and high-resolution respirometry were used to assess metabolites and mitochondrial respiratory …

Phi-010 - Beating The Bugs: The Role Of Microbiology Tests In Antimicrobial Stewardship In Spinal Cord Injury Units, Harveen Kaur, Ayokunle Olagoke, Ashley M. Hughes

Health and Kinesiology Faculty Publications

Background: Antimicrobial Stewardship Programs (ASPs) aim to optimize the prescription of antibiotics to combat antimicrobial resistance (AMR), reduce Clostridioides difficile infections, and lower antibiotic expenditures. Although ASPs are implemented in Veterans Health Administrations (VHAs) in the US, they are not targeted at the Spinal Cord Injury (SCI) population, which, relative to other patient populations, is more vulnerable to AMR. The goals of the study were to (1) assess the effectiveness of microbiology testing as a strategy to combat AMR and (2) assess the potential for collaboration among ASP leaders and SCI prescribers for implementation of ASPs in SCI units in …

Sympathoinhibition And Vasodilation Contribute To The Acute Hypotensive Response Of The Superoxide Dismutase Mimic, Mntnbuoe-2-Pyp5+, In Hypertensive Animals, Sarah L. Schlichte, Elizabeth J. Pekas, Taylor J. Bruett, Elizabeth A. Kosmacek, Bryan T. Hackfort, Jordan M. Rasmussen, Kaushik P. Patel, Song-Young Park, Rebecca E. Oberley-Deegan, Matthew C. Zimmerman

Health and Kinesiology Faculty Publications

The pathogenesis of hypertension has been linked to excessive levels of reactive oxygen species (ROS), particularly superoxide (O2•−), in multiple tissues and organ systems. Overexpression of superoxide dismutase (SOD) to scavenge O2•− has been shown to decrease blood pressure in hypertensive animals. We have previously shown that MnTnBuOE-2-PyP5+ (BuOE), a manganese porphyrin SOD mimic currently in clinical trials as a normal tissue protector for cancer patients undergoing radiation therapy, can scavenge O2•− and acutely decrease normotensive blood pressures. Herein, we hypothesized that BuOE decreases hypertensive blood pressures. Using angiotensin II (AngII)-hypertensive mice, we demonstrate that BuOE administered both intraperitoneally and …

Physical Activity, Physical Well-Being, And Psychological Well-Being: Associations With Life Satisfaction During The Covid-19 Pandemic Among Early Childhood Educators, Ken Randall, Timothy G. Ford, Kyong-Ah Kwon, Susan Sisson, Matthew Bice, Danae Dinkel, Jessica Tsotsoros

Journal Articles

Seeking personal well-being and life satisfaction during a global pandemic can be daunting, such is the case for early care and education teachers who were considered non-health care essential workers during the COVID-19 pandemic. The potential changes in their physical activity, along with their overall physical and psychological well-being, may have ultimately influenced their life satisfaction. These changes included the potential for increased sedentary behaviors. Despite the high health risks associated with these factors during the pandemic, the role of physical activity in early care and education teachers’ well-being and life satisfaction remains largely unknown. The purpose of this study …

Cross-Frequency Coupling Explains The Preference For Simple Ratios In Rhythmic Behaviour And The Relative Stability Across Non-Synchronous Patterns, Dobromir Dotov, Laurel Trainor

Journal Articles

Rhythms are important for understanding coordinated behaviours in ecological systems. The repetitive nature of rhythms affords prediction, planning of movements and coordination of processes within and between individuals. A major challenge is to understand complex forms of coordination when they differ from complete synchronization. By expressing phase as ratio of a cycle, we adapted levels of the Farey tree as a metric of complexity mapped to the range between in-phase and anti-phase synchronization. In a bimanual tapping task, this revealed an increase of variability with ratio complexity, a range of hidden and unstable yet measurable modes, and a rank-frequency scaling …

Effects Of Sensory Feedback And Collider Size On Reach-To-Grasp Coordination In Haptic-Free Virtual Reality, Mariusz P. Furmanek, Madhur Mangalam, Kyle Lockwood

Journal Articles

Technological advancements and increased access have prompted the adoption of head- mounted display based virtual reality (VR) for neuroscientific research, manual skill training, and neurological rehabilitation. Applications that focus on manual interaction within the virtual environment (VE), especially haptic-free VR, critically depend on virtual hand-object collision detection. Knowledge about how multisensory integration related to hand-object collisions affects perception-action dynamics and reach-to-grasp coordination is needed to enhance the immersiveness of interactive VR. Here, we explored whether and to what extent sensory substitution for haptic feedback of hand-object collision (visual, audio, or audiovisual) and collider size (size of spherical pointers representing the …

A Qualitative Comparison Of Parent And Childcare Provider Perceptions Of Communication And Family Engagement In Children's Healthy Eating And Physical Activity, Danae Dinkel, Maggie Rasmussen, John Rech, Kailey Snyder, Dipti A. Dev

Journal Articles

Background

Parents and childcare providers play a substantial role in the development of health behaviours among the children they care for. In order to ensure the optimal growth and development of children, communication and family engagement in childcare is critical. Previous studies examining parent or provider perceptions about healthy eating or physical activity have explored these concepts individually and/or have only included only parents or providers. Therefore, the purpose of this study was to compare childcare provider and parent perceptions of communication regarding healthy eating and physical activity as well as use of best practice strategies on family engagement for …

How Tufted Capuchin Monkeys (Sapajus Spp.) And Humans (Homo Sapiens) Handle A Jointed Tool., Dorothy M. Fragaszy, Joshua D. Lukemire, Jose Eduardo Reynoso-Cruz, Stephanie Villarreal Jordan, Spencer Sheheane, Amanda Heaton, Monica Quinones, Madhur Mangalam

Journal Articles

The embodied theory of tooling predicts that when using a grasped object as a tool, individuals accommodate their actions to manage the altered degrees of freedom in the body-plus-object system. We tested predictions from this theory by studying how 3 tufted capuchin monkeys (Sapajus spp.) and 6 humans (Homo sapiens) used a hoe to retrieve a token. The hoe’s handle was rigid, had 2 segments with 1 planar joint, or had 3 segments with 2 (orthogonal) planar joints. When jointed, rotating the handle could render it rigid. The monkeys used more actions to retrieve the token when the handle had …

Body Mass-Normalized Moderate Dose Of Dietary Nitrate Intake Improves Endothelial Function And Walking Capacity In Patients With Peripheral Artery Disease, Elizabeth J. Pekas, Tesean Wooden, Santosh K. Yadav, Song-Young Park

Health and Kinesiology Faculty Publications

Peripheral artery disease (PAD) is characterized by the accumulation of atherosclerotic plaques in the lower extremity conduit arteries, which impairs blood flow and walking capacity. Dietary nitrate has been used to reduce blood pressure (BP) and improve walking capacity in PAD. However, a standardized dose for PAD has not been determined. Therefore, we sought to determine the effects of a body mass-normalized moderate dose of nitrate (0.11 mmol nitrate/kg) as beetroot juice on serum nitrate/nitrite, vascular function, walking capacity, and tissue oxygen utilization capacity in patients with PAD. A total of 11 patients with PAD received either nitrate supplement or …

Examining Supports And Barriers To Breastfeeding Through A Socio-Ecological Lens: A Qualitative Study, Kailey Snyder, Emily Hulse, Holly Dingman, Angie Cantrell, Corrine Hanson, Danae Dinkel

Journal Articles

Background

Early breastfeeding cessation is a societal concern given its importance to the health of mother and child. More effective interventions are needed to increase breastfeeding duration. Prior to developing such interventions more research is needed to examine breastfeeding supports and barriers from the perspective of breastfeeding stakeholders. One such framework that can be utilized is the Socio-Ecological Model which stems from Urie Broffenbrenner’s early theoretical frameworks (1973–1979). The purpose of this study was to examine supports and barriers to breastfeeding across environmental systems.

Methods

A total of 49 representatives participated in a telephone interview in Nebraska, USA in 2019. …

The Use Of Family Engagement Principles By Childcare Providers From Various Childcare Settings: A Qualitative Study, John Rech, Kailey Snyder, Maggie Rasmussen, Dipti A. Dev, Danae Dinkel

Journal Articles

Family engagement in childcare is important to ensure the optimal growth, development, and safety of children. Previous research has explored family engagement practices, but limited research is available on the application of theory to explain the uptake of family engagement principles. The purpose of this study was to explore the use and perceptions of the National Association of the Education for Young Children’s six principles of effective family engagement among childcare providers from various childcare settings following the Innovation-Decision Process of the Diffusion of Innovation Theory. A semi-structured interview with a card-sorting task was used to explore providers’ knowledge, adoption, …

A Qualitative Exploration Of The Feasibility Of Incorporating Depression Apps Into Integrated Primary Care Clinics, Danae Dinkel, Jennifer Harsh Caspari, Louis Fok, Maxine Notice, David J. Johnson, Shinobu Watanabe-Galloway, Margaret R. Emerson

Journal Articles

Background: The use of mobile applications or “apps” is beginning to be identified as a potential cost-effective tool for treating depression. While the use of mobile apps for health management appears promising, little is known on how to incorporate these tools into integrated primary care settings – especially from the viewpoints of patients and the clinic personnel. Purpose: The purpose of this study was to explore patient- and clinic-level perceptions of the use of depression self-management apps within an integrated primary care setting. Methods: Patients (n=17), healthcare providers, and staff (n=15) completed focus groups or semi-structured interviews in-person or via …

The Study Of High Intensity Interval Training's Effect On Enjoyment, Keali Mari

Theses/Capstones/Creative Projects

This study assessed participant’s level of enjoyment in high-intensity training over moderate intensity-training. High intensity interval training is defined as short bouts of exercise performed at a near-maximal effort with rest periods or light activity in between. High intensity interval training involves repeatedly exercising at a high intensity for 30 seconds to several minutes, separated by 1-5 minutes of recovery. This type of exercise has sparked the interest of many active people due to its decreased time commitment and the benefits it elicits. The results of this study show that high intensity interval training induces a higher enjoyment rate pre- …

Beatwalk: Personalized Music-Based Gait Rehabilitation In Parkinson’S Disease, Valérie Cochen De Cock, Dobromir Dotov, Loic Damm, Sandy Lacombe, Petra Ihalainen, Marie Christine Picot, Florence Galtier, Cindy Lebrun, Aurélie Giordano, Valérie Driss, Christian Geny, Ainara Garzo, Erik Hernandez, Edith Van Dyck, Marc Leman, Rudi Villing, Benoit G. Bardy, Simone Dalla Bella

Journal Articles

Taking regular walks when living with Parkinson’s disease (PD) has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors (BeatWalk) and delivered individualized …

Gait Variability Is Affected More By Peripheral Artery Disease Than By Vascular Occlusion, Hafizur Rahman, Iraklis Pipinos, Jason M. Johanning, Sara A. Myers

Journal Articles

Background

Patients with peripheral artery disease with intermittent claudication (PAD-IC) have altered gait variability from the first step they take, well before the onset of claudication pain. The mechanisms underlying these gait alterations are poorly understood.

Aims

To determine the effect of reduced blood flow on gait variability by comparing healthy older controls and patients with PAD-IC. We also determined the diagnostic value of gait variability parameters to identify the presence of PAD.

Methods

A cross-sectional cohort design was used. Thirty healthy older controls and thirty patients with PAD-IC walked on a treadmill at their self-selected speed in pain free …