Other Analytical, Diagnostic and Therapeutic Techniques and Equipment Commons^™

Elbow Injury Prevention In Youth Dominican Baseball Players: A Training Intervention Pilot Study, Chelsey Erbaugh Franz, Dawn Hall-Bibb, Myra Stockdale, Aliya Thompson, Bailey Biggs

Internet Journal of Allied Health Sciences and Practice

Background: Research suggests deficits in shoulder and elbow strength and flexibility may explain the role of elbow injuries in overhead athletes, specifically ulnar collateral ligament (UCL) injury in baseball players. Significant damage to this ligament typically requires operative care for continued activity in the sport. Several studies have demonstrated the success of rehabilitation programs post-surgery; however, few studies have examined the role of UCL injury prevention programs. A recognized upper extremity (UE) injury prevention method is the Thrower’s Ten Program. This program may create elbow stability when pitching and throwing, theoretically reducing the risk of UCL injury. Purpose: The purpose …

Assistive Utensil: A Spork For Hand Tremors And Spatial Awareness, Ana Font Hernandez, Jacob Kabariti, Troy Taylor

Publications and Research

In this poster, we present a 3D printed solution for hand tremors and special awareness. Our spork is an assistive device designed and 3D printed for patients suffering from scleroderma, systemic sclerosis, Parkinson's, multiple sclerosis, drug withdrawal, etc. The scale-based handle will act as a counterweight to offset the contents on the other end and reduce shakiness. The larger grip allows an easy and comfortable hold. The product will be 3D printed for a customizable fit and at an affordable price. Lastly, the product will include a haptic feedback sensor to assist the visually impaired in locating food contents on …

Transcranial Direct Current Stimulation (Tdcs) Improves Performance On Spelling And Word Detection Tasks, J. Kevin Wilson

Psychology ETDs

Deficits in written language involving spelling can have negative effects on a person’s education and occupation. Conventional spelling therapy is a time consuming and cost-prohibitive option, if even available, highlighting the need for improved methods for remediation. One possible way to address this need may be through the use of transcranial direct current stimulation (tDCS). This study sought to examine the effects of tDCS on performance during spelling, word detection, and facial recognition tasks. Active or sham tDCS was randomly assigned to typically functioning adults. The anode electrode was placed over Broca’s area (F7 in the 10/20 EEG system) and …

Concussion Competencies: A Framework For School-Based Concussion Management (Flyer), Arthur C. Maerlender, Jonathan Lichtenstein, Jennifer Parent-Nichols

Center for Brain, Biology, and Behavior: Faculty Publications

This volume grew out of many years of clinical practice, research, and program projects. It is the culmination of more than 50 years of work with kids, brains, and schools. While there is research behind the Competencies and the underlying content, the intent was to create a user-friendly manual that cut across levels of responsibility and care. Concussion Competencies was not intended to be a textbook in the traditional manner; however, the Competencies have been shown to be a useful approach to teaching this material.

This volume is organized around a set of Competencies that have been shown to be …

Factor Structure And Gender Invariance Testing For The Sport Anxiety Scale-2 (Sas-2), Leilani Madrigal, Vincenzo Roma, Todd Caze, Arthur C. Maerlender, Debra Hope

Center for Brain, Biology, and Behavior: Faculty Publications

This study aimed to provide further psychometric validation of the Sport Anxiety Scale-2 (SAS-2) by assessing the factor structure, invariance across gender, and convergent and divergent validity of the SAS-2 by correlating both related (i.e., anxiety sensitivity, brief fear of negative evaluation, intolerance of uncertainty, and negative affect) and unrelated constructs (i.e., positive affect, self-confidence). A total of 542 current and former competitive athletes completed a questionnaire through Amazon’s Mechanical Turk system. All data were collected via online survey. Participants were randomly assigned to an exploratory factor analysis (n = 271) and confirmatory factor analysis group (n = 271). Results …

Accumulating Data To Optimally Predict Obesity Treatment (Adopt): Recommendations From The Biological Domain, Michael Rosenbaum, Tanya Agurs-Collins, Molly S. Bray, Kevin D. Hall, Mark Hopkins, Maren Laughlin, Paul S. Maclean, Padma Maruvada, Cary R. Savage, Dana M. Small, Luke Stoeckel

Center for Brain, Biology, and Behavior: Faculty Publications

Background: The responses to behavioral, pharmacological, or surgical obesity treatments are highly individualized. The Accumulating Data to Optimally Predict obesity Treatment (ADOPT) project provides a framework for how obesity researchers, working collectively, can generate the evidence base needed to guide the development of tailored, and potentially more effective, strategies for obesity treatment. Objectives: The objective of the ADOPT biological domain subgroup is to create a list of high-priority biological measures for weight-loss studies that will advance the understanding of individual variability in response to adult obesity treatments. This list includes measures of body composition, energy homeostasis (energy intake and output), …

Left Lateralized Cerebral Glucose Metabolism Declines In Amyloid-Β Positive Persons With Mild Cognitive Impairment, Christopher M. Weise, Kewei Chen, Yinghua Chen, Xiaoying Kuang, Cary R. Savage, Eric M. Reiman

Center for Brain, Biology, and Behavior: Faculty Publications

Background: Previous publications indicate that Alzheimer's Disease (AD) related cortical atrophy may develop in asymmetric patterns, with accentuation of the left hemisphere. Since fluorodeoxyglucose positron emission tomography (FDG PET) measurements of the regional cerebral metabolic rate of glucose (rCMRgl) provide a sensitive and specific marker of neurodegenerative disease progression, we sought to investigate the longitudinal pattern of rCMRgl in amyloid-positive persons with mild cognitive impairment (MCI) and dementia, hypothesizing asymmetric declines of cerebral glucose metabolism. Methods: Using florbetapir PET and cerebrospinal fluid (CSF) measures to define amyloid-β (Aβ) positivity, 40 Aβ negative (Aβ-) cognitively unimpaired controls (CU; 76 ± 5y), …

Novel Biomarkers Of Physical Activity Maintenance In Midlife Women: Preliminary Investigation, Kelly A. Bosak, Vlad B. Papa, Morgan G. Brucks, Cary R. Savage, Joseph E. Donnelly, Laura E. Martin

Center for Brain, Biology, and Behavior: Faculty Publications

The precision health initiative is leading the discovery of novel biomarkers as important indicators of biological processes or responses to behavior, such as physical activity. Neural biomarkers identified by magnetic resonance imaging (MRI) hold promise to inform future research, and ultimately, for transfer to the clinical setting to optimize health outcomes. This study investigated resting-state and functional brain biomarkers between midlife women who were maintaining physical activity in accordance with the current national guidelines and previously acquired age-matched sedentary controls. Approval was obtained from the Human Subjects Committee. Participants included nondiabetic, healthy weight to overweight (body mass index 19–29.9 kg/m …

Mesotocin Influences Pinyon Jay Prosociality, J. F. Duque, W. Leichner, H. Ahmann, Jeffrey R. Stevens

Center for Brain, Biology, and Behavior: Faculty Publications

Many species exhibit prosocial behavior , in which one individual’s actions benefit another individual, often without an immediate benefit to itself. The neuropeptide oxytocin is an important hormonal mechanism influencing prosociality in mammals, but it is unclear whether the avian homologue mesotocin plays a similar functional role in birds. Here, we experimentally tested prosociality in pinyon jays (Gymnorhinus cyanocephalus), a highly social corvid species that spontaneously shares food with others. First, we measured prosocial preferences in a prosocial choice task with two different pay-off distributions: Prosocial trials delivered food to both the subject and either an empty cage …

Power Mobility Sensor Data Collection Verified Through Standardized Pediatric Assessments, Ayshka Elise Rodriguez-Velez

UNF Graduate Theses and Dissertations

The collaboration between the School of Engineering and the Department of Physical Therapy at the University of North Florida has introduced the possibility of creating a new environment for pediatric physical therapy assessments. There are currently no methods for remotely monitoring children with impairments. However, with embedded sensor technology in the form of power mobility and accepted therapy assessment tools, remote monitoring can become a possibility. As a part of this work, a ride-on toy car was developed as a remote monitoring device and a case study with a child with a mobility impairment was used as a proof of …

The Pathway To The Use Of A Structured And Supported Approach To Debriefing, Anne H. Zachry, S. B. Lancaster

Faculty Presentations

Debriefing plays a critical role in the transfer of knowledge in simulation education. Various methods are used in the debriefing process based on a variety of factors; this presentation sheds light on the pathway to the use of a structured and supported approach as traversed in the Department of Occupational Therapy at the University of Tennessee Healthcare Center as well as reflections and lessons learned along the way. Engagement in this session will allow learners to further develop their debriefing skills through exposure to information about strategies to use in the debriefing process that can be used as part of …

Reliability And Concurrent Validity Of Select C3 Logix Test Components, Madeline Simon, Arthur C. Maerlender, Katelyn Metzger, Laura Decoster, Amy Hollingworth, Tamara Valovich Mcleod

Center for Brain, Biology, and Behavior: Faculty Publications

We sought to investigate the one-week and within-session reliability of the instrumented balance error scoring system test and the concurrent validity/one-week reliability of two neurocognitive assessments available through C3 Logix. (n = 37) Participants completed two balance error scoring system tests separated by the Trails A, Trails B, and Symbol Digit Modality test available through C3 Logix, and with paper and pencil. We found that the instrumented balance error scoring system test demonstrated strong one-week reliability and that neuropsychological tests available through C3 Logix show acceptable concurrent validity with standard (comparable) paper and pencil measures.

Examining The Relationship Between Home Literacy Environment And Neural Correlates Of Phonological Processing In Beginning Readers With And Without A Familial Risk For Dyslexia: An Fmri Study, Sara J. Powers, Yingying Wang, Sara D. Beach, Georgios D. Sideridis, Nadine Gaab

Center for Brain, Biology, and Behavior: Faculty Publications

Developmental dyslexia is a language-based learning disability characterized by persistent difficulty in learning to read. While an understanding of genetic contributions is emerging, the ways the environment affects brain functioning in children with developmental dyslexia are poorly understood. A relationship between the home literacy environment (HLE) and neural correlates of reading has been identified in typically developing children, yet it remains unclear whether similar effects are observable in children with a genetic predisposition for dyslexia. Understanding environmental contributions is important given that we do not understand why some genetically at-risk children do not develop dyslexia. Here we investigate for the …

Brain Encoding Of Saltatory Velocity Through A Pulsed Pneumotactile Array In The Lower Face, Rebecca Custead, Hyuntaek Oh, Yingying Wang, Steven M. Barlow

Center for Brain, Biology, and Behavior: Faculty Publications

Processing dynamic tactile inputs is a primary function of the somatosensory system. Spatial velocity encoding mechanisms by the nervous system are important for skilled movement production and may play a role in recovery of sensorimotor function following neurological insult. Little is known about tactile velocity encoding in mechanosensory trigeminal networks required for speech, suck, mastication, and facial gesture.

High resolution functional magnetic resonance imaging (fMRI) was used to investigate the neural substrates of velocity encoding in the human orofacial somatosensory system during unilateral saltatory pneumotactile stimulation of perioral and buccal hairy skin in 20 neurotypical adults. A custom multichannel, scalable …

Rehabilitation Of An Injured Golden Eagle (Aquila Chrysaetos): A Case Study, Fida Muhammad Khan, Fakhar-I- Abbas, Abu Ul Hassan Faiz

Journal of Bioresource Management

Habitat destruction and anthropogenic activities cause wild birds to migrate towards urban areas in search of food and sometimes nesting in high-roof buildings, where they are caught by local people using different techniques and are further used for hunting or recreational purposes. An injured Golden Eagle (Aquila chrysaetos) was found entangled in bushes near the vicinity of Balkasar Research Complex, Chakwal, Pakistan. After complete physical examination, a wound on the right wing and closed leg fracture was diagnosed. The successful treatment was done by anti-parasitic and anti-bacterial drugs with careful monitoring. Splint was adjusted after aligning the fractured …

Lessons To Be Learned: How A Comprehensive Neurobiological Framework Of Atypical Reading Development Can Inform Educational Practice, Ola Ozernov-Palchik, Xi Yu, Yingying Wang, Nadine Gaab

Center for Brain, Biology, and Behavior: Faculty Publications

Dyslexia is a heritable reading disorder with an estimated prevalence of 5–17%. A multiple deficit model has been proposed that illustrates dyslexia as an outcome of multiple risks and protective factors interacting at the genetic, neural, cognitive, and environmental levels. Here we review the evidence on each of these levels and discuss possible underlying mechanisms and their reciprocal interactions along a developmental timeline. Current and potential implications of neuroscientific findings for contemporary challenges in the field of dyslexia, as well as for reading development and education in general, are then discussed.

Alternative Interventions For Children Coping With Chronic Conditions: A Critical Review Of The Literature, Nina M. Pelsi, Kim S. Amer

DePaul Discoveries

Reduction of stressors and anxiety levels in adolescents with chronic illnesses is a critical concept in pediatric health care in America today. The many stressors associated with chronic illness include displaying physical and mental differences, social stigma, financial difficulty, and family stress. These stressors may affect the adolescent’s ability to learn and cope in everyday life. The current research was a critical review of the literature examining studies done with adolescents coping with chronic diseases and illnesses. The aim was to analyze the most efficacious non-pharmacological methods for reducing stressors in adolescents with chronic illness. A critical review of the …

The Neuropsychology Of Sport And Performance, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty Publications

Neuropsychological theory has been a mainstay for understanding pathology within the brain-behavior context. However, our theories for predicting superior behavior are not as well developed. Sport neuropsychology was developed on the presumption that athletes represent a population in a relatively well-controlled environment for studying brain pathology due to injury. This study of pathology within a high-performance environment has been responsible for identifying the effects of mild traumatic brain injury (mTBI) on individual functioning. Far less attention has been paid to the other end of the performance continuum, and yet, viable brain-behavior hypotheses should hold true across the spectrum of function …

Validity And Reliability Of Baseline Testing In A Standardized Environment, Kathryn L. Higgins, Todd Caze, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty Publications

Objective — The Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to determine cognitive recovery from concussion based on comparing post-injury scores to baseline scores. This model is based on the premise that ImPACT baseline test scores are a valid and reliable measure of optimal cognitive function at baseline. Growing evidence suggests that this premise may not be accurate and a large contributor to invalid and unreliable baseline test scores may be the protocol and environment in which baseline tests are administered. This study examined the effects of a standardized environment and administration …

Measurement Of Cortisol In Saliva: A Comparison Of Measurement Error Within And Between International Academic‑Research Laboratories, Jessica L. Calvi, Frances R. Chen, Victoria Brann Benson, Eleanor Brindle, Matt Bristow, Alpana De, Sonja Entringer, Helen Findlay, Christine Heim, Eric A. Hodges, Heiko Klawitter, Sonia Lupien, Holly M. Rus, Jitske Tiemensma, Silvanna Verlezza, Claire-Dominique Walker, Douglas A. Granger

Center for Brain, Biology, and Behavior: Faculty Publications

Objective: Hundreds of scientific publications are produced annually that involve the measurement of cortisol in saliva. Intra- and inter-laboratory variation in salivary cortisol results has the potential to contribute to crossstudy inconsistencies in findings, and the perception that salivary cortisol results are unreliable. This study rigorously estimates sources of measurement variability in the assay of salivary cortisol within and between established international academic-based laboratories that specialize in saliva analyses. One hundred young adults (Mean age: 23.10 years; 62 females) donated 2 mL of whole saliva by passive drool. Each sample was split into multiple- 100 μL aliquots and …

Patterns Of Referral In High School Concussion Management Programs: A Pilot Study Of Consultants From Different Disciplines, Jonathan Lichtenstein, Kate S. Linnea, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty Publications

School-based concussion management programs cover thousands of young athletes, yet there is little in the way of research to assess program processes or outcomes. This study examined the referral patterns of consultants working with ten high school concussion management programs. In addition to the number of referrals made to specialists, other potential outcome variables were explored. The sample included over 5,000 athlete-seasons and 298 concussions managed directly by certified athletic trainers. All programs used computerized neuropsychological testing (both baseline and post injury). Two groups were compared: five programs used a clinical neuropsychologist (NP) as the testing consultant and five used …

Attention Is Associated With Postural Control In Those With Chronic Ankle Instability, Adam B. Rosen, Nicholas T. Than, William Z. Smith, Jennifer M. Yentes, Melanie L. Mcgrath, Mukul Mukherjee, Sarah A. Myers, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty Publications

Chronic ankle instability (CAI) is often debilitating and may be affected by a number of intrinsic and environmental factors. Alterations in neurocognitive function and attention may contribute to repetitive injury in those with CAI and influence postural control strategies. Thus, the purpose of this study was to determine if there was a difference in attentional functioning and static postural control among groups of Comparison, Coper and CAI participants and assess the relationship between them within each of the groups. Recruited participants performed single-limb balance trials and completed the CNS Vital Signs (CNSVS) computer-based assessment to assess their attentional function. Center …

Sandbagging On The Immediate Post-Concussion Assessment And Cognitive Testing (Impact) In A High School Athlete Population, Kathryn L. Higgins, Robert L. Denny, Arthur C. Maerlender

Center for Brain, Biology, and Behavior: Faculty Publications

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to assess cognitive functioning after a concussion. It is recommended that application of ImPACT utilizes a baseline administration so athletes have an individualized baseline with which to compare post-injury results should they sustain a concussion. It has been suggested that athletes may provide suboptimal effort, called “sandbagging,” in order to return to their baseline cognitive scores, and thus to play, more quickly. This research examines ImPACT baseline scores when high school athletes were asked to attempt to “sandbag,” and compares those scores with scores …

Psychological And Neural Contributions To Appetite Self-Regulation, Luke E. Stoeckel, Leann L. Birch, Todd Heatherton, Traci Mann, Christine Hunter, Susan Czajkowski, Lisa Onken, Paige K. Berger, Cary R. Savage

Center for Brain, Biology, and Behavior: Faculty Publications

Objective: This paper reviews the state of the science on psychological and neural contributions to appetite self-regulation in the context of obesity. Methods: Three content areas (neural systems and cognitive functions; parenting and early childhood development; and goal setting and goal striving) served to illustrate different perspectives on the psychological and neural factors that contribute to appetite dysregulation in the context of obesity. Talks were initially delivered at an NIH workshop consisting of experts in these three content areas, and then content areas were further developed through a review of the literature. Results: Self-regulation of appetite involves a complex interaction …

Pilot Study Of Endurance Runners And Brain Responses Associated With Delay Discounting, Laura E. Martin, Jason-Flor V. Sisante, David R. Wilson, Angela A. Moody, Cary R. Savage, Sandra A. Billinger

Center for Brain, Biology, and Behavior: Faculty Publications

High levels of endurance training have been associated with potentially negative health outcomes and addictive-like symptoms such as exercise in the presence of injury and higher levels of impulsivity. This pilot study examined the relationships among self-report measures of addictive symptoms related to exercise and behavioral and neural measures of impulsivity in endurance runners. We hypothesized endurance runners would have increased preference for immediate rewards and greater activation of cognitive control regions when making decisions involving delayed rewards. Twenty endurance runners (at least 20 miles/week) were recruited to undergo measures of self-report exercise addiction symptoms, impulsive decision-making (delay discounting) and …

Lateral Hypothalamic Activity Indicates Hunger And Satiety States In Humans, Omid Talakoub, Raquel R. Paiva, Matija Milosevic, Marcelo Q. Hoexter, Ruth Franco, Eduardo Alho, Jessie Navarro, Jose F. Pereira Jr., Milos R. Popovic, Cary Savage, Antonio C. Lopes, Pedro Alvarenga, Durval Damiani, Manoel J. Teixeira, Euripides C. Miguel, Erich T. Fonoff, Marcelo C. Batistuzzo, Clement Hamani

Center for Brain, Biology, and Behavior: Faculty Publications

Lateral hypothalamic area (LHA) local field potentials (LFPs) were recorded in a Prader–Willi patient undergoing deep brain stimulation (DBS) for obesity. During hunger, exposure to food-related cues induced an increase in beta/ low-gamma activity. In contrast, recordings during satiety were marked by prominent alpha rhythms. Based on these findings, we have delivered alphafrequency DBS prior to and during food intake. Despite reporting an early sensation of fullness, the patient continued to crave food. This suggests that the pattern of activity in LHA may indicate hunger/satiety states in humans but attest to the complexity of conducting neuromodulation studies in obesity.

Methylphenidate And Memory And Attention Adaptation Training For Persistent Cognitive Symptoms After Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial, Brenna C. Mcdonald, Laura A. Flashman, David B. Arciniegas, Robert J. Ferguson, Li Xing, Jaroslaw Harezlak, Gwen C. Sprehn, Flora M. Hammond, Arthur C. Maerlender, Carrie L. Kruck, Karen L. Gillock, Kim Frey, Rachel N. Wall, Andrew J. Saykin, Thomas W. Mcallister

Center for Brain, Biology, and Behavior: Faculty Publications

The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluate and compare the efficacy of two cognitive rehabilitation interventions (Memory and Attention Adaptation Training (MAAT) and Attention Builders Training (ABT)), with and without pharmacologic enhancement (i.e., with methylphenidate (MPH) or placebo), for treating persistent cognitive problems after traumatic brain injury (TBI). Adults with a history of TBI at least four months prior to study enrollment with either objective cognitive deficits or subjective cognitive complaints were randomized to receive MPH or placebo and MAAT or ABT, yielding four treatment combinations: MAAT/MPH (N=17), ABT/MPH (N=19), MAAT/placebo (N=17), and ABT/placebo (N=18). …

Developing A Data Repository Of Standard Concussion Assessment Clinical Data For Research Involving College Athletes, Arthur C. Maerlender, Jennifer Mize Nelson, Julie A. Honaker

Center for Brain, Biology, and Behavior: Faculty Publications

In sports concussion research, obtaining quality data from a sufficient number of participants to reach statistical power has been a particular problem. In addition, the necessary requirements of accessibility, informed consent, and confidentiality must be met. There is need to develop more efficient and controlled methods for collecting data to answer research questions in this realm, but the ability to collect and store these data in an efficient manner at the local level is limited. By virtue of their training, neuropsychologists can play a key role in improving data collection quality. The purpose of this paper is to describe a …

1st Place Research Paper: The Effectiveness Of Yoga Therapy On An Adult, Post-Stroke Population: A Systematic Review, Baylor E. Hogan

Kevin and Tam Ross Undergraduate Research Prize

Objectives: The objectives of this paper are to (1) give a brief overview of stroke pathophysiology (2) outline yoga as a therapeutic strategy (3) present the current research on yoga rehabilitation for stroke (4) discuss the efficacy of yoga for chronic stroke.

Methods: Relevant terms were searched in PubMed, Web of Science, Academic OneFile, ScienceDirect, and Google Scholar electronic databases. Studies were excluded if they contained pediatric stroke, non-stroke neurological diseases, or subjects with comorbidities. Statistically significant data was extracted for the primary measures of nine trials.

Results: Four studies measured statistically significant outcomes (p<0.05). These included improvements in balance, independence, endurance, trait anxiety, fear of falling, self-efficacy, pain, strength, range of motion (ROM), activity, participation, and quality of life (QoL). Discussion: Lack of statistical significance in post-stroke depression (PSD) measures may be due to inadequate intervention length or a psychosocial cause of depression. Improvements in balance, flexibility, and strength from yoga participation permitted progress in disability and functionality. Finally, overall health-related quality of life (HRQL) is affected by the severity of mental disorders and physical disability. Yoga can have a positive effect in both domains and therefore, may improve HRQL.

Conclusion: …

Reliability Of Clinical Evaluators Of Spasticity In Patients With Stroke, Tiffany Alvino, Shiney David, Chelsea Gendvil

Dissertations, Theses, and Capstone Projects

Spasticity is characterized by hyperexcitable stretch reflexes with amplitude increases in response to velocity dependent passive movement and resistance. Spasticity is the result of abnormal function of segmental and suprasegmental neuronal circuits. The objective of this study was to determine any positive correlation between three clinical evaluators of spasticity (i.e., the pendulum test, the patellar tendon tap test (PTT), and the Modified Ashworth scale) in their reliability to assess spasticity in people post-stroke. It was hypothesized that the use of force movement sensors along with surface electromyography increases the reliability of the standardized clinical tests. The results show that all …