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Russell BS, Owens EF, Hosek RS, Dever LL, Weiner MT. Assessment of forces during side-posture adjustment with the use of a table-embedded force plate: Reference values for education. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:73-81. [PMID: 37721390 PMCID: PMC11095653 DOI: 10.7899/jce-22-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/26/2023] [Accepted: 03/18/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Force-sensing treatment tables are becoming more commonly used by chiropractic educational institutions. However, when a table-embedded force platform is the sole measurement method, there is little information available about what force-time values instructors and students should expect for side-posture spinal manipulative thrusts. The purpose of this report is to provide force-time values recorded with such a system during side-posture manipulation with human recipients. METHODS Student volunteers were examined by and received lumbar or pelvic side-posture manipulation from experienced chiropractors who were diplomates of the Gonstead Clinical Studies Society. Forces were recorded using proprietary software of a Bertec force platform; force and time data were analyzed with a custom-programmed software tool in Excel. RESULTS Seven doctors of chiropractic performed 24 thrusts on 23 student recipients. Preload forces, averaging 69.7 N, and thrust loading duration, averaging 167 milliseconds, were similar to previous studies of side-posture manipulation. Peak loads were higher than previous studies, averaging 1010.9 N. Other variables included prethrust liftoff force, times from thrust onset to peak force and peak load to resolution of thrust, and average rates of force loading and unloading. CONCLUSION The values we found will be used for reference at our institution and may be useful to instructors at other chiropractic educational institutions, in the teaching of lumbar side-posture manipulation. A caveat is that the values of this study reflect multiple sources of applied force, not solely the force applied directly to the spine.
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Russell BS, Keller M, Wynd SE, Hosek RS, Owens EF, Hoiriis KT. Angular Kinematics of Chiropractic Supine Cervical Spine Manipulation: Rotational Measures and Comparisons to Doctor and Recipient Perceptions. J Manipulative Physiol Ther 2022; 45:497-507. [PMID: 36922054 DOI: 10.1016/j.jmpt.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 03/17/2023]
Abstract
OBJECTIVES The primary purposes of this study were to measure axial rotation during supine cervical spinal manipulative therapy (cSMT) and to record recipients' and doctors' perceptions of rotational magnitudes. METHODS Experienced doctors of chiropractic (DCs) provided supine cSMT and acted as recipients of cSMT. Participants who received SMT wore inertial measurement units attached to the forehead and sternum for motion capture. Afterward, recipients and DCs completed questionnaires asking about their perceptions of motion. Data were analyzed for magnitudes of axial rotation at peak thrust and correlations with patient and doctor perceptions. Secondary analyses included angular velocity, angular acceleration, and other kinematic variables. RESULTS We recorded 23 SMT events with 14 DCs. Rotation at thrust peaks averaged 32.4° (17.4°). Doctors' and recipients' perceptions of rotation were higher than measured values 45% and 50% of the time, respectively. Maximum angular velocity and acceleration averaged 221.9°/s (124.9) and 4786.5°/s2 (2456.6), respectively. We found no correlation between perceptions and velocity or acceleration; doctors' perceptions had an inverse correlation with measurements. CONCLUSION On average, we found rotation during supine cSMT to be 32°. Both DCs and SMT recipients overestimated rotation compared with actual measurements. These factors should be considered in discussions of rotation and SMT.
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Affiliation(s)
- Brent S Russell
- Life University Center for Chiropractic Research, Atlanta, Georgia.
| | - Mackenzie Keller
- Life University Center for Chiropractic Research, Atlanta, Georgia
| | - Shari E Wynd
- Department of Foundational Sciences, Texas Chiropractic College, Pasadena, Texas
| | - Ronald S Hosek
- Life University Center for Chiropractic Research, Atlanta, Georgia
| | - Edward F Owens
- Life University Center for Chiropractic Research, Atlanta, Georgia
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Petersen EJ, Thurmond SM, Shaw CA, Miller KN, Lee TW, Koborsi JA. Reliability and accuracy of an expert physical therapist as a reference standard for a manual therapy joint mobilization trial. J Man Manip Ther 2020; 29:189-195. [PMID: 33234048 DOI: 10.1080/10669817.2020.1844853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective: Previous studies on learning joint mobilization techniques have used expert practitioners as the reference standard as there is no current evidence on what ideal forces would be for effective mobilizations. However, none of these trials have documented the reliability or accuracy of the reference standard. Therefore, the purpose of this study was to report both the reliability and accuracy of an expert physical therapist (PT) acting as a reference standard for a manual therapy joint mobilization trial.Methods: A secondary analysis was performed using data from a published randomized, controlled, crossover study. The mobilization technique studied was the central posterior to anterior (PA) joint mobilization of the L3 vertebra. Reliability and accuracy data for the reference standard were collected over four time periods spanning 16 weeks.Results: Intrarater reliability of the expert PT for R1 and R2 joint forces was excellent (R1 Force ICC3,3 0.95, 95%CI 0.76-0.99 and R2 Force ICC3,3 0.90, 95%CI 0.49-0.99). Additionally, the expert PT was 92.3% accurate (mean % error±SD, 7.7 ± 5.5) when finding Grade III mean peak mobilization force and 85.1% accurate (mean % error±SD, 14.9 ± 8.3) when finding Grade IV mean peak mobilization force. Finally, correlations between actual applied forces and computed ideal forces were excellent (Pearson r 0.79-0.92, n = 24, P < 0.01 for all correlations).Discussion: The expert PT in this manual therapy joint mobilization trial showed excellent reliability and accuracy as the reference standard. The study supports the use of implementing quantitative feedback devices into the teaching of joint mobilization when a reliable and accurate reference standard has been identified.Level of Evidence: 2b.
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Affiliation(s)
- Evan J Petersen
- School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
| | - Stephanie M Thurmond
- College of Health and Human Services, Bowling Green State University, Bowling Green, OH, USA
| | - Catherine A Shaw
- School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
| | - Kelly N Miller
- School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
| | - Tommy W Lee
- School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
| | - Jonathan A Koborsi
- School of Physical Therapy, University of the Incarnate Word, San Antonio, TX, USA
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Petersen EJ, Thurmond SM, Buchanan SI, Chun DH, Richey AM, Nealon LP. The effect of real-time feedback on learning lumbar spine joint mobilization by entry-level doctor of physical therapy students: a randomized, controlled, crossover trial. J Man Manip Ther 2019; 28:201-211. [PMID: 31593528 DOI: 10.1080/10669817.2019.1673953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To examine the effects of real-time, objective feedback on learning lumbar spine joint mobilization techniques by entry-level Doctor of Physical Therapy (DPT) students. METHODS A randomized, controlled, crossover design was used. Twenty-four 1st Year DPT students were randomized into two groups. Group 1 (n = 12) practiced with the real-time feedback device first and then without it, while Group 2 (n = 12) practiced without the device first and then with it. Both practice periods with and without the device were 4 weeks long. Data were collected at Baseline, 5 weeks, 11 weeks, and 16 weeks. The crossover period was 5 weeks long, during which neither group practiced with or without the device. Eight force parameters were measured: R1 force; R2 force; Grade III and Grade IV mean peak force, frequency, and amplitude. RESULTS When students practiced with the real-time feedback device, they more closely matched the reference standard for two outcomes: 1) the mean difference in R2 force between student and reference standard was better with device (38.0 ± 26.7 N) than without it (51.0 ± 38.5 N); P = .013; and 2) the mean difference in Grade III peak to peak amplitude force was also better with device (8.9 ± 9.3 N) than without it (11.8 ± 11.0); P = .026. All other force parameters improved when students practiced with the real-time feedback device, however, the differences between when they practiced without the device were not statistically significant. DISCUSSION Real-time, objective feedback using a direct force measurement device improved learning for some aspects of lumbar spine joint mobilization by entry-level physical therapy students. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Evan J Petersen
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Stephanie M Thurmond
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Sydney I Buchanan
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Diana H Chun
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Ashley M Richey
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
| | - Lauren P Nealon
- School of Physical Therapy, University of the Incarnate Word , San Antonio, TX, USA
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Rowell RM, Gudavalli MR, Silverman S. A pilot study of the effect of force feedback training on students learning flexion-distraction chiropractic technique. THE JOURNAL OF CHIROPRACTIC EDUCATION 2019; 33:100-105. [PMID: 30590012 PMCID: PMC6759014 DOI: 10.7899/jce-18-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We compared traditional training alone and with the addition of force feedback training for learning flexion-distraction chiropractic technique. METHODS Participants were randomly allocated to two groups (traditional or traditional plus force feedback training). Students' forces were measured before training and after force feedback training. Students rated the helpfulness of the training and the comfort of the force transducer. RESULTS Thirty-one students were enrolled. Both groups delivered similar forces at baseline. Group 1 students' subsequent force measurements were higher after force feedback training. Group 2 students' forces were unchanged. Group 2 students were trained with force feedback for week 2 of the class, and forces were higher after feedback and similar to those in group 1. Students rated the training as very or somewhat helpful. Students also experienced discomfort as a patient and a student-doctor due to the force transducer that was used. Students who received force feedback training learned to deliver higher forces, which were closer to the forces delivered by experienced doctors of chiropractic. Students who did not receive force feedback continued to deliver lower forces. CONCLUSION Force feedback helped students deliver forces closer to the desired force level and to learn this delivery faster than students who were not trained with force feedback.
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Effects of Reduced Effort on Mechanical Output Obtained From Maximum Vertical Jumps. Motor Control 2018; 23:205-215. [PMID: 30352527 DOI: 10.1123/mc.2017-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the effect of reduced effort on maximum countermovement jumps. Groups of unskilled and skilled jumpers performed countermovement jumps without an arm swing at 100% and 50% effort. The results revealed markedly reduced jump height and work performed at 50% effort, although the maximum force and power output remained virtually unchanged. The observed differences were consistent across individuals with different jumping skills. A possible cause of differences in changes across the tested variables was a reduced countermovement depth associated with the 50% effort jumps. It is known to cause an increase in maximum force and power outputs, but not in jump height. Therefore, the jump height and work performed may be more closely related to our sense of effort when jumping, rather than our maximum force and power output. From a practical perspective, the present findings reiterate the importance of maximizing effort for making valid assessments of muscle mechanical capacities, as tested by maximal vertical jumps and, possibly, other maximum performance tasks.
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González-Sánchez M, Ruiz-Muñoz M, Ávila-Bolívar AB, Cuesta-Vargas AI. Kinematic real-time feedback is more effective than traditional teaching method in learning ankle joint mobilisation: a randomised controlled trial. BMC MEDICAL EDUCATION 2016; 16:261. [PMID: 27716215 PMCID: PMC5054622 DOI: 10.1186/s12909-016-0789-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND To analyse the effect of real-time kinematic feedback (KRTF) when learning two ankle joint mobilisation techniques comparing the results with the traditional teaching method. METHODS Double-blind randomized trial. SETTINGS Faculty of Health Sciences. PARTICIPANTS undergraduate students with no experience in manual therapy. Each student practised intensely for 90 min (45 min for each mobilisation) according to the random methodology assigned (G1: traditional method group and G2: KRTF group). G1: an expert professor supervising the student's practice, the professorstudent ratio was 1:8. G2: placed in front of a station where, while they performed the manoeuvre, they received a KRTF on a laptop. OUTCOME MEASURES total time of mobilisation, time to reach maximum amplitude, maximum angular displacement in the three axes, maximum and average velocity to reach the maximum angular displacement, average velocity during the mobilisation. RESULTS Among the pre-post intervention measurements, there were significant differences within the two groups for all outcome variables, however, G2 (KRTF) achieved significantly greater improvements in kinematic parameters for the two mobilisations (significant increase in displacement, velocity and significant reduction in the mobilisations runtime) than G1. Ankle plantar flexion: G1's measurement stability (post-intervention) ranged between 0.491 and 0.687, while G2's measurement stability ranged between 0.899 and 0.984. Ankle dorsal flexion mobilisation: G1 the measurement stability (post-intervention) ranged from 0.543 and 0.684 while G2 ranged between 0.899 and 0.974. CONCLUSION KRTF was proven to be more effective tool than traditional teaching method in the teaching - learning process of two joint mobilisation techniques. TRIAL REGISTRATION NCT02504710.
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Affiliation(s)
- Manuel González-Sánchez
- Departamento de Fisioterapia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Arquitecto Francisco Peñalosa s/n. (ampliación Campus Teatinos), 29071 Málaga, Spain
| | - Maria Ruiz-Muñoz
- Departamento de Enfermería y Podología, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | | | - Antonio I. Cuesta-Vargas
- Departamento de Fisioterapia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Arquitecto Francisco Peñalosa s/n. (ampliación Campus Teatinos), 29071 Málaga, Spain
- School of Clinical Sciences at Queensland University, Brisbane, Australia
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Stainsby BE, Clarke MCS, Egonia JR. Learning spinal manipulation: A best-evidence synthesis of teaching methods. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:138-151. [PMID: 26998630 PMCID: PMC5067123 DOI: 10.7899/jce-15-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. METHODS For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. RESULTS Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. CONCLUSIONS Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.
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Boysen JC, Salsbury SA, Derby D, Lawrence DJ. A focus group study of chiropractic students following international service learning experiences. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:124-130. [PMID: 27258817 PMCID: PMC5067121 DOI: 10.7899/jce-15-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students. METHODS Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes. RESULTS The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor-patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning. CONCLUSION Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices.
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Lardon A, Cheron C, Pagé I, Dugas C, Descarreaux M. Systematic Augmented Feedback and Dependency in Spinal Manipulation Learning: a Randomized Comparative Study. J Manipulative Physiol Ther 2016; 39:185-91. [DOI: 10.1016/j.jmpt.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/19/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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Loranger M, Treboz J, Boucher JA, Nougarou F, Dugas C, Descarreaux M. Correlation of expertise with error detection skills of force application during spinal manipulation learning. THE JOURNAL OF CHIROPRACTIC EDUCATION 2016; 30:1-6. [PMID: 26270897 PMCID: PMC4770989 DOI: 10.7899/jce-15-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Most studies on spinal manipulation learning demonstrate the relevance of including motor learning strategies in chiropractic curricula. Two outcomes of practice are the production of movement in an efficient manner and the improved capability of learners to evaluate their own motor performance. The goals of this study were to evaluate if expertise is associated with increased spinal manipulation proficiency and if error detection skills of force application during a high-velocity low-amplitude spinal manipulation are related to expertise. METHODS Three groups of students and 1 group of expert chiropractors completed 10 thoracic spine manipulations on an instrumented device with the specific goal of reaching a maximum peak force of 300 N after a brief period of practice. After each trial, participants were asked to give an estimate of their maximal peak force. Force-time profiles were analyzed to determine the biomechanical parameters of each participant and the participant's capacity to estimate his or her own performance. RESULTS Significant between-group differences were found for each biomechanical parameter. No significant difference was found between groups for the error detection variables (p > .05). The lack of significant effects related to the error detection capabilities with expertise could be related to the specificity of the task and how the training process was structured. CONCLUSION This study confirms that improvements in biomechanical parameters of spinal manipulation are related to expertise. Feedback based on error detection could be implemented in chiropractic curricula to improve trainee abilities in detecting motor execution errors.
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Chapman PD, Stomski NJ, Losco B, Walker BF. The simulated early learning of cervical spine manipulation technique utilising mannequins. Chiropr Man Therap 2015; 23:23. [PMID: 26240752 PMCID: PMC4522963 DOI: 10.1186/s12998-015-0067-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy. METHODS We developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks. RESULTS This study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either "usual learning" (n = 19) or "mannequin learning" (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ(2) = 0.10, p = 0.75), four weeks (χ(2) = 0.40, p = 0.53), and eight weeks (χ(2) = 0.07, p = 0.79). CONCLUSIONS This study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially gain competence in neck manipulation by using mannequins before proceeding to perform neck manipulation on each other.
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Affiliation(s)
| | - Norman J Stomski
- />School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia
| | - Barrett Losco
- />Discipline of Chiropractic, School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia
| | - Bruce F Walker
- />Discipline of Chiropractic, School of Health Professions, Murdoch University, 90 South St, Murdoch, 6150 WA Australia
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Cuesta-Vargas AI, González-Sánchez M, Lenfant Y. Inertial Sensors as Real-Time Feedback Improve Learning Posterior-Anterior Thoracic Manipulation: A Randomized Controlled Trial. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Consistency and Malleability of Manipulation Performance in Experienced Clinicians: A Pre-Post Experimental Design. J Manipulative Physiol Ther 2015. [DOI: 10.1016/j.jmpt.2015.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gudavalli MR, Vining RD, Salsbury SA, Corber L, Long CR, Patwardhan AG, Goertz CM. Clinician proficiency in delivering manual treatment for neck pain within specified force ranges. Spine J 2015; 15:570-6. [PMID: 25452013 PMCID: PMC4375060 DOI: 10.1016/j.spinee.2014.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/23/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose. PURPOSE To assess clinicians' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients. STUDY DESIGN An observational study nested within a randomized clinical trial. SAMPLE Two research clinicians provided study interventions to 48 participants with neck pain. OUTCOME MEASURES Clinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21-50 N; and high force 51-100 N). METHODS Participants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over 2 weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces according to treatment groups. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback. Peak traction force data were extracted and descriptively analyzed. RESULTS Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback. CONCLUSIONS This study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force-based dose response clinical studies.
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Affiliation(s)
- Maruti Ram Gudavalli
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
| | | | | | - Lance Corber
- Palmer Center for Chiropractic Research, Davenport, IA, USA
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Schuck SO, Whetstone A, Hill V, Levine P, Page SJ. Game-Based, Portable, Upper Extremity Rehabilitation in Chronic Stroke. Top Stroke Rehabil 2015; 18:720-7. [DOI: 10.1310/tsr1806-720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Exploring the role of quantitative feedback in inhaler technique education: a cluster-randomised, two-arm, parallel-group, repeated-measures study. NPJ Prim Care Respir Med 2014; 24:14071. [PMID: 25393603 PMCID: PMC4373466 DOI: 10.1038/npjpcrm.2014.71] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 06/11/2014] [Accepted: 07/20/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Feedback is a critical component of any educational intervention. When it comes to feedback associated with inhaler technique education, there is a lack of knowledge on its role or its potential to solve the major issue of poor inhaler technique. AIMS This study aims to explore the role of feedback in inhaler technique education and its impact on the inhaler technique of patients over time. METHODS A parallel-group, repeated-measures study was conducted in the community pharmacy in which the effectiveness of current best practice inhaler technique education utilising qualitative visual feedback (Group 1) was compared with a combination of qualitative and quantitative visual feedback (Group 2). The impact of these two interventions on inhaler technique maintenance was evaluated. Community pharmacists were randomly allocated to recruit people with asthma who were using a dry powder inhaler. At Visit 1 their inhaler technique was evaluated and education delivered and they were followed up at Visit 2 (1 month later). RESULTS Both educational interventions resulted in an increase in the proportion of patients with correct inhaler technique: from 4% to 51% in Group 1 and from 6% to 83% in Group 2 (Pearson's Chi-Squared, P=0.03, n=49, and Pearson's Chi-Squared, P=0.01, n=48, respectively). The magnitude of improvement was statistically significantly higher for Group 2 compared with Group 1 (n=97, P=0.02, Pearson's Chi-Square test). CONCLUSIONS The nature of feedback has an impact on the effectiveness of inhaler technique education with regard to correct inhaler technique maintenance over time.
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Gudavalli MR, Rowell RM. Three-dimensional chiropractor-patient contact loads during side posture lumbar spinal manipulation: a pilot study. Chiropr Man Therap 2014. [DOI: 10.1186/s12998-014-0029-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
Patients with low back pain often seek chiropractic care and more than ninety percent of Chiropractors use lumbar side posture manipulation for the treatment of low back pain. During this procedure chiropractors deliver forces by means of hand contact on the patient in a side lying position. The objective of this pilot study was to report on the three-dimensional forces at the hand contact between the chiropractor and the simulated patient (asymptomatic volunteers) during side posture lumbar high velocity low amplitude adjustments.
Methods
In 2005, two licensed chiropractors delivered spinal manipulations to the lumbar spines of the participants. A three-dimensional force transducer (Model # Mini-45, ATI-Industrial Automation, Apex, North Carolina) was used to measure the three-dimensional loads. The force-time histories were analyzed for preloads, peak loads, duration of thrusts to peak load, duration of thrust for completion, rate of loading, and magnitudes of the three forces and the resultant total force delivered by the chiropractor.
Results
The two chiropractors delivered a total of 14 thrusts to the five asymptomatic volunteers. Normal force (Fz) is the dominating force, followed by inferior-superior force (Fx). The lateral force (Fy) occurred in both directions.
Conclusions
This study reports on the three dimensional load (three forces and the total resultant force) characteristics of chiropractor-patient hand contact while delivering a chiropractic high velocity low amplitude (HVLA) manipulation in a side lying position.
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Cuesta-Vargas AI, Williams J. Inertial sensor real-time feedback enhances the learning of cervical spine manipulation: a prospective study. BMC MEDICAL EDUCATION 2014; 14:120. [PMID: 24942483 PMCID: PMC4075507 DOI: 10.1186/1472-6920-14-120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 06/12/2014] [Indexed: 06/01/2023]
Abstract
BACKGROUND Cervical Spinal Manipulation (CSM) is considered a high-level skill of the central nervous system because it requires bimanual coordinated rhythmical movements therefore necessitating training to achieve proficiency. The objective of the present study was to investigate the effect of real-time feedback on the performance of CSM. METHODS Six postgraduate physiotherapy students attending a training workshop on Cervical Spine Manipulation Technique (CSMT) using inertial sensor derived real-time feedback participated in this study. The key variables were pre-manipulative position, angular displacement of the thrust and angular velocity of the thrust. Differences between variables before and after training were investigated using t-tests. RESULTS There were no significant differences after training for the pre-manipulative position (rotation p = 0.549; side bending p = 0.312) or for thrust displacement (rotation p = 0.247; side bending p = 0.314). Thrust angular velocity demonstrated a significant difference following training for rotation (pre-training mean (sd) 48.9°/s (35.1); post-training mean (sd) 96.9°/s (53.9); p = 0.027) but not for side bending (p = 0.521). CONCLUSION Real-time feedback using an inertial sensor may be valuable in the development of specific manipulative skill. Future studies investigating manipulation could consider a randomized controlled trial using inertial sensor real time feedback compared to traditional training.
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Affiliation(s)
- Antonio I Cuesta-Vargas
- Departamento de Psiquiatría y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Málaga, Andalucia Tech, Cátedra de Fisioterapia y Discapacidad, Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetria (AE-14), Malaga, Spain
- School of Clinical Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jonathan Williams
- School of Health and Social Care, Bournemouth University, Bournemouth, UK
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Williams JM, Cuesta-Vargas A. Quantification of Prone Thoracic Manipulation Using Inertial Sensor–Derived Accelerations. J Manipulative Physiol Ther 2014; 37:230-5. [DOI: 10.1016/j.jmpt.2014.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/04/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
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Triano JJ, McGregor M, Dinulos M, Tran S. Staging the use of teaching aids in the development of manipulation skill. ACTA ACUST UNITED AC 2014; 19:184-9. [PMID: 24503216 DOI: 10.1016/j.math.2014.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
Skill development in manual therapies is influenced by a number of factors. The effects of the training program organization, mentor coaching, feedback in various forms, and electromechanical training aids are factors that have been studied. A significant gap exists in understanding when teaching aids might be most effective within a defined curriculum structure. This project used the ratio of instructional theory and laboratory practice to define the learning context. An electromechanical training aid (Dynadjust™) was introduced at different stages (year 2 and year 4) of training for high-velocity, low-amplitude (HVLA) manipulation. Learners were assigned to either the Aid group or the NoAid group. Independent assessment of skill was evaluated before and after 6 weeks by means of recording force-time profiles of HVLA performance. Repeated measures analysis of variance (ANOVA) evaluated change scores in the force amplitude and rate of rise in force. Program features were dominated by a low ratio of laboratory practice to didactic foundational education components. Use of the aid was not associated with any measurable gains for participants when used in year 2. Later participation in year 4 suggested enhanced development in rate of rise for force (p < 0.0597) and for peak force (p < 0.0303). Careful attention should be given to the sequencing of content and laboratory work in designing curricula for training programs. For programs using lower ratios of laboratory contact hours, teaching aids to augment practice may result in better performance gains when introduced later than if added early in the curriculum.
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Affiliation(s)
- John J Triano
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1.
| | - Marion McGregor
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1
| | - Maricelle Dinulos
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1
| | - Steven Tran
- Biomechanics and Elastography Laboratory, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario, Canada M2H J1
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Effect of sampling rates on the quantification of forces, durations, and rates of loading of simulated side posture high-velocity, low-amplitude lumbar spine manipulation. J Manipulative Physiol Ther 2013; 36:261-6. [PMID: 23790603 DOI: 10.1016/j.jmpt.2013.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 12/21/2012] [Accepted: 01/18/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Quantification of chiropractic high-velocity, low-amplitude spinal manipulation (HVLA-SM) may require biomechanical equipment capable of sampling data at high rates. However, there are few studies reported in the literature regarding the minimal sampling rate required to record the HVLA-SM force-time profile data accurately and precisely. The purpose of this study was to investigate the effect of different sampling rates on the quantification of forces, durations, and rates of loading of simulated side posture lumbar spine HVLA-SM delivered by doctors of chiropractic. METHODS Five doctors of chiropractic (DCs) and 5 asymptomatic participants were recruited for this study. Force-time profiles were recorded during (i) 52 simulated HVLA-SM thrusts to a force transducer placed on a force plate by 2 DCs and (ii) 12 lumbar side posture HVLA-SM on 5 participants by 3 DCs. Data sampling rate of the force plate remained the same at 1000 Hz, whereas the sampling rate of the force transducer varied at 50, 100, 200, and 500 Hz. The data were reduced using custom-written MATLAB (Mathworks, Inc, Natick, MA) and MathCad (version 15; Parametric Technologies, Natick, MA) programs and analyzed descriptively. RESULTS The average differences in the computed durations and rates of loading are smaller than 5% between 50 and 1000 Hz sampling rates. The differences in the computed preloads and peak loads are smaller than 3%. CONCLUSIONS The small differences observed in the characteristics of force-time profiles of simulated manual HVLA-SM thrusts measured using various sampling rates suggest that a sampling rate as low as 50 to 100 Hz may be sufficient. The results are applicable to the manipulation performed in this study: manual side posture lumbar spine HVLA-SM.
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Entwicklung und Relevanz biomechanischer Parameter einer Manipulationstechnik. MANUELLE MEDIZIN 2013. [DOI: 10.1007/s00337-013-1033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Myers CA, Enebo BA, Davidson BS. Optimized prediction of contact force application during side-lying lumbar manipulation. J Manipulative Physiol Ther 2013. [PMID: 23206961 DOI: 10.1016/j.jmpt.2012.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purposes of this study included the following: (1) to predict L3 contact force during side-lying lumbar manipulation by combining direct and indirect measurements into a single mathematical framework and (2) to assess the accuracy and confidence of predicting L3 contact force using common least squares (CLS) and weighted least squares (WLS) methods. METHODS Five participants with no history of lumbar pain underwent 10 high-velocity, low-amplitude lumbar spinal manipulations at L3 in a side-lying position. Data from 5 low-force criterion standard trials where the L3 contact force was directly measured were used to generate participant-specific force prediction algorithms. These algorithms were used to predict L3 contact force in 5 experimental trials performed at therapeutic levels. The accuracy and effectiveness of CLS and WLS methods were compared. RESULTS Differences between the CLS-predicted forces and the criterion standard-measured forces were 621.0 ± 193.5 N. Differences between the WLS-predicted forces and the criterion standard-measured forces were -3.6 ± 9.1 N. The 95% limits of agreement ranged from 234.0 to 1008.0 N for the CLS and -21.9 to 14.7 N for the WLS. During both the criterion standard and experimental trials, the CLS overestimated contact forces with larger variance than the WLS. CONCLUSION This novel method to predict spinal contact force combines direct and indirect measurements into a single framework and preserves clinically relevant practitioner-participant contacts. As advanced instrumentation becomes available, this framework will enable advancements in training and high-quality research on mechanisms of spinal manipulative therapy.
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Affiliation(s)
- Casey A Myers
- Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
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Biomechanics – Review of approaches for performance training in spinal manipulation. J Electromyogr Kinesiol 2012; 22:732-9. [DOI: 10.1016/j.jelekin.2012.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 03/15/2012] [Accepted: 03/27/2012] [Indexed: 11/23/2022] Open
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Hirthe L, Möller C. Evidenz für die Effekte von Feedbackmethoden beim Erlernen von manuellen Behandlungstechniken. MANUELLE MEDIZIN 2012. [DOI: 10.1007/s00337-012-0915-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Learning lumbar spine mobilization: the effects of frequency and self-control of feedback. J Orthop Sports Phys Ther 2012; 42:114-24. [PMID: 22030595 DOI: 10.2519/jospt.2012.3691] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study, longitudinal. OBJECTIVES To investigate the effects of frequency and self-control of feedback on physiotherapy students learning lumbar spinal mobilization. BACKGROUND Posterior-to-anterior mobilization is included in most physiotherapy curricula. However, force application varies between therapists and the optimal feedback for learning is unknown. METHODS Sixty-two physiotherapy students were randomized to 3 feedback groups: constant (100% of practice trials), intermittent (33%), and self-controlled (varied according to student choice) feedback. Students performed 12 practice trials of grade II posterior-to-anterior mobilization to the third lumbar vertebra while receiving real-time feedback. The differences between students' force parameters (mean peak force [N], force amplitude [N], and oscillation frequency [Hz]) and those of a physiotherapist expert were compared between groups posttest and at a follow-up of 5 to 7 days using analysis of covariance. Students completed a survey regarding their perceptions of feedback. RESULTS Students in the self-controlled group applied mean peak force (mean difference between student and expert, 6.7 N; 95% confidence interval [CI]: 4.4, 9.0) and force amplitude (6.3 N; 95% CI: 4.2, 8.4) that more closely matched the expert's than those applied by the constant group (13.7 N; 95% CI: 8.7, 18.6; P = .021, and 13.1 N; 95% CI: 8.9, 17.4; P = .028) at posttest, with similar results at follow-up for force amplitude only (self-controlled, 9.5 N; 95% CI: 5.8, 18.1; constant, 21.0 N; 95% CI: 13.3, 28.7; P = .018). There were no other significant differences. All students reported a better understanding of manual force application, but feedback preferences varied. CONCLUSION Self-controlled feedback appears to be more beneficial than constant feedback for students learning to apply forces during lumbar mobilization.
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Knobe M, Holschen M, Mooij SC, Sellei RM, Münker R, Antony P, Pfeifer R, Drescher W, Pape HC. Knowledge transfer of spinal manipulation skills by student-teachers: a randomised controlled trial. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:992-8. [PMID: 22223196 DOI: 10.1007/s00586-011-2140-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 08/02/2011] [Accepted: 12/25/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess the use of peer-assisted learning (PAL) of complex manipulative motor skills with respect to gender in medical students. METHODS In 2007-2010, 292 students in their 3rd and 4th years of medical school were randomly assigned to two groups [Staff group (SG), PAL group (PG)] led by either staff tutors or student-teachers (ST). The students were taught bimanual practical and diagnostic skills (course education module of eight separate lessons) as well as a general introduction to the theory of spinal manipulative therapy. In addition to qualitative data collection (Likert scale), evaluation was performed using a multiple-choice questionnaire in addition to an objective structured clinical examination (OSCE). RESULTS Complex motor skills as well as palpatory diagnostic competencies could in fact be better taught through professionals than through ST (manipulative OSCE grades/diagnostic OSCE score; SG vs. PG; male: P = 0.017/P < 0.001, female: P < 0.001/P < 0.001). The registration of theoretical knowledge showed equal results in students taught by staff or ST. In both teaching groups (SG: n = 147, PG: n = 145), no significant differences were observed between male and female students in matters of manipulative skills or theoretical knowledge. Diagnostic competencies were better in females than in males in the staff group (P = 0.041) Overall, students were more satisfied with the environment provided by professional teachers than by ST, though male students regarded the PAL system more suspiciously than their female counterparts. CONCLUSIONS The peer-assisted learning system does not seem to be generally qualified to transfer such complex spatiotemporal demands as spinal manipulative procedures.
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Affiliation(s)
- Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
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Triano JJ, Gissler T, Forgie M, Milwid D. Maturation in Rate of High-Velocity, Low-Amplitude Force Development. J Manipulative Physiol Ther 2011; 34:173-80. [DOI: 10.1016/j.jmpt.2011.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/04/2011] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
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Quantifying the High-Velocity, Low-Amplitude Spinal Manipulative Thrust: A Systematic Review. J Manipulative Physiol Ther 2010; 33:542-53. [DOI: 10.1016/j.jmpt.2010.08.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 05/25/2010] [Accepted: 06/08/2010] [Indexed: 11/19/2022]
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Bertolucci LF. Muscle repositioning: combining subjective and objective feedbacks in the teaching and practice of a reflex-based myofascial release technique. Int J Ther Massage Bodywork 2010; 3:26-35. [PMID: 21589699 PMCID: PMC3091424 DOI: 10.3822/ijtmb.v3i1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Muscle Repositioning (MR) is a new style of myofascial release that elicits involuntary motor reactions detectable by electromyography. This article* describes the principal theoretical and practical concepts of MR, and summarizes a workshop presented October 31, 2009, after the Second International Fascia Research Congress, held at Vrije Universitiet, Amsterdam. The manual mechanical input of MR integrates the client’s body segments into a block, which is evident as a result of the diagnostic manual oscillations the practitioner imparts to the client’s body. Segmental integration is achieved when the client’s body responds as a unit to the oscillatory assessment. It appears that manually sustaining the condition of segmental integration evokes involuntary muscle reactions, which reactions might correspond to mechanisms that maintain homeostasis, such as pandiculation. It might be that these reactions are part of the MR mechanism of action and underlie its clinically observed efficacy in the treatment of musculoskeletal disorders. For the practitioner and the client alike, segmental integration provides unique sensations. In teaching MR, these paired sensations can be used as kinesthetic feedback resources, because quality of touch can be guided by the client’s reported sensations, which should match the practitioner’s sensations. Another form of feedback with respect to quality of touch is the visually discernable degree of segmental integration. Finally, because the involuntary motor activity elicited by the MR touch can be objectively monitored through electromyography and possibly other instrumented measurements, the MR approach might yield objectivity, precision, and reproducibility—features seldom found in manual therapies.
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Descarreaux M, Dugas C. Learning Spinal Manipulation Skills: Assessment of Biomechanical Parameters in a 5-Year Longitudinal Study. J Manipulative Physiol Ther 2010; 33:226-30. [DOI: 10.1016/j.jmpt.2010.01.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 11/27/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
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Real-time feedback improves accuracy of manually applied forces during cervical spine mobilisation. ACTA ACUST UNITED AC 2009; 15:19-25. [PMID: 19632877 DOI: 10.1016/j.math.2009.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 05/05/2009] [Accepted: 05/17/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine if real-time feedback enables students to apply mobilisation forces to the cervical spine that are similar to an expert physiotherapist. METHODS An instrumented treatment table collected mobilisation force data with feedback about forces displayed on a computer screen. An expert physiotherapist performed posteroanterior mobilisation of C7 on 21 asymptomatic subjects while forces were recorded. These data were used as force targets for 51 students who mobilised one of the asymptomatic subjects on two occasions. Students' forces were recorded before and after practice either with (experimental group) or without real-time feedback (control group). Improved performance was defined as a smaller difference between expert and student forces, comparing groups with non-parametric statistics. RESULTS Students receiving feedback applied more accurate forces than controls (median difference between student and expert forces in the experimental group, 4.0N, inter-quartile range (IQR) 1.9-7.7; in controls, 14.3N, IQR 6.2-26.2, difference between groups p<0.001). One week later, these students still applied forces that more closely matched the expert's compared to controls (p<0.01), but the differences between the students' and expert's forces were greater (6.4N, IQR 3.1-14.7). CONCLUSION Practice with real-time objective feedback enables students to apply forces similar to an expert, supporting its use in manual therapy training.
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Bertolucci LF. Muscle Repositioning: a new verifiable approach to neuro-myofascial release? J Bodyw Mov Ther 2008; 12:213-24. [PMID: 19083677 DOI: 10.1016/j.jbmt.2008.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/25/2008] [Accepted: 05/01/2008] [Indexed: 11/19/2022]
Abstract
The clinical observation of involuntary motor activity during application of a particular style of myofascial release (Muscle Repositioning-MR) has led to the hypothesis that this technique might evoke neurological reactions. Preliminary EMG recordings presented here show involuntary tonic cervical erector action during MR. Involuntary eye movements were also observed. This article presents these experimental data, along with clinical observations during the application of MR in the treatment of musculoskeletal conditions. The author hypothesizes that MR might constitute a novel manual technique: it produces unique palpatory sensations for the practitioner (e.g., a sense of firmness to the touch and the integration of bodily segments into a single block) that correspond to unique sensory experiences for the client. The article raises the possibility that MR's specific sensory input might activate the central nervous system, thus eliciting neural reactions. These reactions, in turn, might be related to the technique's efficacy. As the EMG objectively measures reactions contemporaneous with subjective palpatory phenomena, MR potentially brings the objective and subjective into congruence. EMG monitoring of touch could serve as an objective criterion in the development of treatment protocols, as well as a feedback tool for teaching. Greater objectivity, precision and reproducibility are all possible outcomes of such an approach. The author believes that MR can be used in various therapeutic settings--either as the principal approach, or as an adjunct to a variety of other approaches.
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van Zoest GG, Staes FF, Stappaerts KH. Three-Dimensional Manual Contact Force Evaluation of Graded Perpendicular Push Force Delivery by Second-Year Physiotherapy Students During Simple Feedback Training. J Manipulative Physiol Ther 2007; 30:438-49. [DOI: 10.1016/j.jmpt.2007.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 03/13/2007] [Accepted: 03/25/2007] [Indexed: 11/17/2022]
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