Functional range of motion in the upper extremity and trunk joints: Nine functional everyday tasks with inertial sensors

New clinical decision tool to assist physical therapists with joint mobilization application to the pediatric population

Joint mobilizations are well-established and extensively researched treatment modality for adults. However, it remains largely unexplored in the pediatric population. Physical therapists hesitate to perform joint mobilization on children because of lack of knowledge, concern for the developing skeletal system, and the paucity of research on the topic. The aim of this article is to present a decision tool created for a continuing education course with the purpose to instruct pediatric therapists in the safe and effective use of joint mobilizations in children. It is based on the pediatric paradigm of developmental and functional assessment to best address the concerns and preferences of physical therapists (PTs). To advance research in pediatric joint mobilization, PTs should listen to the concerns of pediatric therapists and respond to those concerns with effective, evidence-supported training. This decision tree will serve as a resource for the education of pediatric therapists in the safe and effective use of joint mobilizations.

Evaluation of a cadaveric wrist motion simulator using marker-based X-ray reconstruction of moving morphology

Surgical intervention is a common option for the treatment of wrist joint arthritis and traumatic wrist injury. Whether this surgery is arthrodesis or a motion preserving procedure such as arthroplasty, wrist joint biomechanics are inevitably altered. To evaluate effects of surgery on parameters such as range of motion, efficiency and carpal kinematics, repeatable and controlled motion of cadaveric specimens is required. This study describes the development of a device that enables cadaveric wrist motion to be simulated before and after motion preserving surgery in a highly controlled manner. The simulator achieves joint motion through the application of predetermined displacements to the five major tendons of the wrist, and records tendon forces. A pilot experiment using six wrists aimed to evaluate its accuracy and reproducibility. Biplanar X-ray videoradiography (BPVR) and X-Ray Reconstruction of Moving Morphology (XROMM) were used to measure overall wrist angles before and after total wrist arthroplasty. The simulator was able to produce flexion, extension, radioulnar deviation, dart thrower's motion and circumduction within previously reported functional ranges of motion. Pre- and post-surgical wrist angles did not significantly differ. Intra-specimen motion trials were repeatable; root mean square errors between individual trials and average wrist angle and tendon force profiles were below 1° and 2 N respectively. Inter-specimen variation was higher, likely due to anatomical variation and lack of wrist position feedback. In conclusion, combining repeatable intra-specimen cadaveric motion simulation with BPVR and XROMM can be used to determine potential effects of motion preserving surgeries on wrist range of motion and biomechanics.

Deep squat test - Functional movement Screen: Convergent validity and ability to discriminate subjects with different levels of joint mobility

BACKGROUND

Functional Movement Screen (FMS) is an important tool in the assessment of exercise practice. Assuming FMS lacks precise validity for assessing postural deficits, further research is needed to assess whether it is a sufficiently precise tool for analysing joint mobility. Research aims were to evaluate: convergent validity of Deep Squat (DS) - one of FMS tests - regarding joint mobility, using data from a three-dimensional motion analysis as a comparable method; DS's ability to discriminate between subjects with different joint mobility levels.

METHODS

Sixty subjects were selected (23.6 ± 3.8 years). DS was performed according to FMS guidelines. Subjects' performance in frontal and sagittal planes was recorded by two video cameras and subsequently scored by two FMS-certified evaluators. Three-dimensional motion analyses of DS were acquired by a Vicon Motion Capture System (200 Hz). Ten trials were acquired for each subject. Ankle, knee, hip, and shoulder angular positions in sagittal plane were determined from the FullBody PlugInGait model. Spearman's coefficient examined the correlation between angular positions and DS score. Kruskal-Wallis test was used to assess the DS ability to discriminate between subjects with different joint mobility levels by comparing different scores.

RESULTS

Negligible to moderate correlations were found between DS score and angular positions (-0.5 < r < 0.5). Only shoulder angular positions showed differences between score "1" and "2" (p < 0.05). Shoulder and hip angular positions showed no differences between score "2" and "3" (p < 0.05).

CONCLUSIONS

DS yielded low convergent validity regarding joint mobility and did not show the ability to discriminate between subjects with different joint mobility levels.

Range of Motion Limitations in Middle-aged Adults With Cerebral Palsy

Objective

To describe limitations in range of motion (ROM) in middle-aged adults with cerebral palsy (CP), and identify associations with CP subtype, gross motor function, sex and age.

Design

Population-based cohort study.

Setting

Local and regional referral centers.

Participants

Inclusion criteria: diagnosis of CP, born 1959 to 1978 and living in the county of Västra Götaland, Sweden. In the population-based register of CP in Western Sweden, 417 subjects were identified and 139 volunteered to participate. Adults with CP, born elsewhere, who had moved into the area were invited through patient organizations and habilitation units, and eleven chose to participate. In total 150 participants, age 37-58 years (mean 48) 65 women (43%) (N=150). All CP subtypes and Gross Motor Function Classification (GMFCS) levels were represented.

Interventions

Not applicable.

Main Outcome Measures

Passive ROM was measured in the upper and lower extremity and was classified into 4 levels (inspired by The Spinal Alignment and Range of Motion Measure and adapted from the values of the American Academy of Orthopedic Surgeons); good=1, vs mild=2, moderate=3 or severe=4 limitation. The results were summarized to obtain a total score of the participants' ROM limitations.

Results

Moderate to severe limitations were present in 98 % of the participants. There was a correlation to GMFCS level in both the upper and lower extremity (P<.001), but no correlation with age. Upper extremity limitations were most common in dyskinetic CP, lower extremity limitations were most common in dyskinetic CP and bilateral spastic CP. Men had more limitations in the lower extremity (P=.001). The most common limitation in the lower extremity was hamstrings tightness (82%) and hip abduction (80%), and in the upper extremity, limited shoulder abduction (57%).

Conclusions

Limited ROM is common in adults with CP, most pronounced in shoulders, hip joints and hamstrings muscles, with no differences related to age in this age-span.

Movement preferences of the wrist and forearm during activities of daily living

BACKGROUND

During activities of daily living, the main degrees of freedom of the forearm and wrist-forearm pronation-supination (PS), wrist flexion-extension (FE), and wrist radial-ulnar deviation (RUD)-combine seamlessly to allow the hand to engage with and manipulate objects in our environment. Yet the combined behavior of these three degrees of freedom is relatively unknown.

PURPOSE

To provide a characterization of natural forearm and wrist kinematics (joint configuration, movement direction, and speed) during activities of daily living.

STUDY DESIGN

This is a descriptive cross-sectional study.

METHODS

Ten healthy subjects performed 24 activities of daily living chosen to represent a wide variety of activities, while we measured their PS, FE, and RUD angles using electromagnetic motion capture. The orientation of the forearm and wrist was represented in the three-dimensional "configuration space" spanned by PS, FE, and RUD. From the time course of forearm and wrist orientation in configuration space, we extracted three-dimensional distributions of joint configuration, movement direction, and speed.

RESULTS

Most joint configurations were focused in a relatively small area: subjects spent roughly 50% of the time in the central 20% of their functional range of motion. Some movement directions were significantly more common than others (p < 0.001); in particular, the direction of the dart-thrower's motion (DTM) was about three times more common than motion perpendicular to it. Most movements were slow: the likelihood of moving at increasing speeds dropped off exponentially. Interestingly, the most common high-speed motion combined the DTM with a twist from pronation to supination. As this motion allows one to pick up an object in front of one's body and bring it to the head, it is essential for self-care. Thus, although many activities of daily living follow the DTM without significant forearm rotation, the greatest importance of the DTM may lie in its combination with forearm rotation.

CONCLUSIONS

Despite the wide variety of activities, we found evidence of preferred movement behavior, and this behavior showed significant coupling between the wrist and forearm.

Upper Limb Position Tracking with a Single Inertial Sensor Using Dead Reckoning Method with Drift Correction Techniques

Inertial sensors are widely used in human motion monitoring. Orientation and position are the two most widely used measurements for motion monitoring. Tracking with the use of multiple inertial sensors is based on kinematic modelling which achieves a good level of accuracy when biomechanical constraints are applied. More recently, there is growing interest in tracking motion with a single inertial sensor to simplify the measurement system. The dead reckoning method is commonly used for estimating position from inertial sensors. However, significant errors are generated after applying the dead reckoning method because of the presence of sensor offsets and drift. These errors limit the feasibility of monitoring upper limb motion via a single inertial sensing system. In this paper, error correction methods are evaluated to investigate the feasibility of using a single sensor to track the movement of one upper limb segment. These include zero velocity update, wavelet analysis and high-pass filtering. The experiments were carried out using the nine-hole peg test. The results show that zero velocity update is the most effective method to correct the drift from the dead reckoning-based position tracking. If this method is used, then the use of a single inertial sensor to track the movement of a single limb segment is feasible.

Schober Test and Its Modifications Revisited-What Are We Actually Measuring? Computerized Tomography-Based Analysis

OBJECTIVE

Examine Schober test's (ST), Modified ST (MST), and Modified-Modified ST (MMST) surface markers' accuracy in spanning lumbar L1-S1 motion segments and repeatability related to actual patient anatomy as measured on sagittal CT scans.

METHODS

The study included 25 patients of varying heights, weights, and gender without prior spinal surgery or deformity. Researchers assessed patients' CT scans for ST, MST, and MMST skin levels of the measured cephalic and caudal endpoints.

RESULTS

The original ST failed to include at least one lumbar motion segment in all patients, omitting the L1-L2 motion segment in 17 patients and the L2-L3 in another eight. The additional cephalic length of the MST did not improve the inclusion of the actual L1-S1 components. The MMST measured 19 'patients' entire L1-S1 motion segments, reaching a 76% accuracy rate. WMST, measuring 16 cm (instead of MMST's 15 cm), improved the measurement significantly, measuring the L1-S1 motion segments in all cases (with 100% accuracy).

CONCLUSION

ST and its modifications fail to span the L1-S1 motion segments and are thus prone to underestimating lumbar spine motion. This study shows that the WMST is much more accurate than previous modifications and is a better tool for evaluating lumbar spine motion.

Shoulder-specific rehabilitation combined with aerobic exercises versus solely shoulder-specific rehabilitation in patients with type 2 diabetes mellitus: study protocol for a randomized controlled superiority trial

Background

Musculoskeletal disorders are very common in patients with diabetes mellitus (DM). The upper limb is one of the regions that is most frequently affected generally presenting limited joint mobility, pain, and a decreased muscle strength. Most clinical trials with a focus on shoulder musculoskeletal rehabilitation are carried out in patients who do not present DM. Thus, the purpose of the present study is to compare the effects of two distinct treatment protocols (conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises versus solely conventional shoulder musculoskeletal rehabilitation) on shoulder pain, function, strength, kinematics, and supraspinatus tendon thickness in patients with type 2 DM after 12 weeks of intervention and a subsequent follow-up at week 20.

Methods

A randomized controlled superiority trial will be conducted. Participants with a clinical diagnosis of type 2 DM of both sexes, age between 40 and 70 years, presenting shoulder pain will be randomly assigned to one of the following groups: (1) conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises; (2) solely conventional shoulder musculoskeletal rehabilitation. All individuals will be evaluated before starting the treatment protocol (baseline) and at the end of treatment (post 12 weeks) and as a follow-up at 20 weeks. The shoulder function assessed by the SPADI (Shoulder Pain and Disability Index) questionnaire will be considered as primary outcome; the secondary outcome will be shoulder pain, measured with NPRS scales. Other outcomes will include range of motion, measured using a digital inclinometer; isometric shoulder muscle strength, measured using a manual muscle dynamometer; shoulder kinematics, measured using three-dimensional inertial units measurement; supraspinatus tendon thickness, measured using an ultrasound; AGE accumulation, using a skin autofluorescence measurement; and HbA1c (hemoglobin a1c), fasting glucose and lipid profile measured by a simple blood test.

Discussion

DM is a highly prevalent disease and a public health problem worldwide, and the upper extremity musculoskeletal disorders in DM are barely recognized and largely underestimated. In this way, it would be interesting to analyze if the combination of aerobic exercises with conventional musculoskeletal rehabilitation protocols could generate better results in the functionality, pain, mobility and an improvement in the biochemical aspects related to the hyperglycemia of these patients compared to solely the conventional musculoskeletal rehabilitation.

Trial registration

ClinicalTrials.gov NCT04817514. Registered on March 26, 2021.

Autonomous Exercise Generator for Upper Extremity Rehabilitation: A Fuzzy-Logic-Based Approach

In this paper, an autonomous exercise generation system based of fuzzy logic approach is presented. This work attempts to close a gap in the design of a completely autonomous robotic rehabilitation system that can recommend exercises to patients based on their data, such as shoulder range of motion (ROM) and muscle strength, from a pre-set library of exercises. The input parameters are fed into a system that uses Mamdani-style fuzzy logic rules to process them. In medical applications, the rationale behind decision making is a sophisticated process that involves a certain amount of uncertainty and ambiguity. In this instance, a fuzzy-logic-based system emerges as a viable option for dealing with the uncertainty. The system’s rules have been reviewed by a therapist to ensure that it adheres to the relevant healthcare standards. Moreover, the system has been tested with a series of test data and the results obtained ensures the proposed idea’s feasibility.

Comparison of Motion Analysis Systems in Tracking Upper Body Movement of Myoelectric Bypass Prosthesis Users

Current literature lacks a comparative analysis of different motion capture systems for tracking upper limb (UL) movement as individuals perform standard tasks. To better understand the performance of various motion capture systems in quantifying UL movement in the prosthesis user population, this study compares joint angles derived from three systems that vary in cost and motion capture mechanisms: a marker-based system (Vicon), an inertial measurement unit system (Xsens), and a markerless system (Kinect). Ten healthy participants (5F/5M; 29.6 ± 7.1 years) were trained with a TouchBionic i-Limb Ultra myoelectric terminal device mounted on a bypass prosthetic device. Participants were simultaneously recorded with all systems as they performed standardized tasks. Root mean square error and bias values for degrees of freedom in the right elbow, shoulder, neck, and torso were calculated. The IMU system yielded more accurate kinematics for shoulder, neck, and torso angles while the markerless system performed better for the elbow angles. By evaluating the ability of each system to capture kinematic changes of simulated upper limb prosthesis users during a variety of standardized tasks, this study provides insight into the advantages and limitations of using different motion capture technologies for upper limb functional assessment.

Acute Effects of Static Self-Stretching Exercises and Foam Roller Self-Massaging on the Trunk Range of Motions and Strength of the Trunk Extensors

Although the effectiveness of static self-stretching exercises (SSSEs) and foam roller self-massaging (FRSM) in joint range of motion and muscle strength of the lower limbs has been extensively investigated, little is known about their effectiveness on the posterior trunk muscles. The present study aimed to investigate the acute effects of two 7-min SSSEs and FRSM intervention protocols on the range of trunk movements and the strength of the trunk extensors. Twenty-five healthy active males (n = 14) and females (n = 11) performed each intervention separately, one week apart. The range of motion (ROM) of the trunk-hip flexion (T-HF), the ROM of the trunk side-flexion (TSF) and rotation (TR) bilaterally, as well as the isometric maximum strength (TESmax) and endurance (TESend) of the trunk extensors were measured before and after each intervention. The ROMs of T-HF, TSF, and TR were significantly increased following both SSSEs and FRSM. The TESmax and TESend were also significantly increased after FRSM, but decreased following SSSEs. While both interventions were effective in increasing the range of motion of the trunk, a single 7-min session of FRSM presented more advantages over a similar duration SSSEs protocol due to the increase in the strength of the trunk extensors it induced.

Monitoring daily shoulder activity before and after reverse total shoulder arthroplasty using inertial measurement units

BACKGROUND

The purpose of this study was to use at-home, portable, continuous monitoring technologies to record arm motion and activity preoperatively and postoperatively after reverse total shoulder arthroplasty (RTSA).

METHODS

Thirty-three patients indicated for RTSA were monitored preoperatively and 3 and 12 months postoperatively. Inertial measurement units were placed on the sternum and upper arm of the operative limb, recording humeral motion relative to the torso for the duration of a waking day. Elevation events per hour (EE/h) > 90°, time spent at >90°, and activity intensity were calculated and compared between time points. Patient-reported outcome measures were also collected at all time points.

RESULTS

At 3 (P = .040) and 12 (P = .010) months after RTSA, patients demonstrated a significantly greater number of EE/h > 90° compared with preoperatively. There were no significant differences (P ≥ .242) in the amount of time spent at different elevation angles at any time point or in arm activity intensity. Overall, 95% of the day was spent at elevation angles < 60°, and 90% of the day was spent in a low- or moderate-intensity state. Pearson correlations demonstrated relationships between forward elevation and the number of EE/h (r = 0.395, P = .001) and the number of EE/h > 90° (r = 0.493, P < .001).

CONCLUSION

After RTSA, patients significantly increase the frequency of arm elevation to higher angles. However, we found no differences in the amount of time spent at different elevation angles. Overall, after RTSA, >95% of the day was spent at elevation angles < 60° and <1% of the day was spent at >90° of elevation.

Intra- and inter-rater reliability of joint range of motion tests using tape measure, digital inclinometer and inertial motion capturing

Background

In clinical practice range of motion (RoM) is usually assessed with low-cost devices such as a tape measure (TM) or a digital inclinometer (DI). However, the intra- and inter-rater reliability of typical RoM tests differ, which impairs the evaluation of therapy progress. More objective and reliable kinematic data can be obtained with the inertial motion capture system (IMC) by Xsens. The aim of this study was to obtain the intra- and inter-rater reliability of the TM, DI and IMC methods in five RoM tests: modified Thomas test (DI), shoulder test modified after Janda (DI), retroflexion of the trunk modified after Janda (DI), lateral inclination (TM) and fingertip-to-floor test (TM).

Methods

Two raters executed the RoM tests (TM or DI) in a randomized order on 22 healthy individuals while, simultaneously, the IMC data (Xsens MVN) was collected. After 15 warm-up repetitions, each rater recorded five measurements.

Findings

Intra-rater reliabilities were (almost) perfect for tests in all three devices (ICCs 0.886–0.996). Inter-rater reliability was substantial to (almost) perfect in the DI (ICCs 0.71–0.87) and the IMC methods (ICCs 0.61–0.993) and (almost) perfect in the TM methods (ICCs 0.923–0.961). The measurement error (ME) for the tests measured in degree (°) was 0.9–3.3° for the DI methods and 0.5–1.2° for the IMC approaches. In the tests measured in centimeters the ME was 0.5–1.3cm for the TM methods and 0.6–2.7cm for the IMC methods. Pearson correlations between the results of the DI or the TM respectively with the IMC results were significant in all tests except for the shoulder test on the right body side (r = 0.41–0.81).

Interpretation

Measurement repetitions of either one or multiple trained raters can be considered reliable in all three devices.