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Salva-Coll G, Lluch A, Esplugas M, Carreño A, Scott-Tennent A, Larrea-Zabalo M, Garcia-Elias M. Scapholunate and lunotriquetral joint dynamic stabilizers and their role in wrist neuromuscular control and proprioception. J Hand Ther 2024; 37:273-281. [PMID: 37852909 DOI: 10.1016/j.jht.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Recent research interest has grown in exploring the role of muscles, isometric contraction, proprioception, and neuromuscular control in addressing dynamic scapholunate and lunotriquetral joint instability, marking a shift in the understanding of wrist stability. PURPOSE To present a comprehensive review of the carpal ligaments anatomy and wrist biomechanics, with a particular focus on the role of proprioception in dynamic carpal stability and their role in managing scapholunate (SL) and lunotriquetral (LTq) dynamic instabilities. STUDY DESIGN We conducted a systematic search of the literature and review of the most relevant papers published and indexed in pubmed, related to wrist biomechanics, proprioception and its contribution to carpal dynamic stability. METHODS The study involved a comprehensive review of neuromuscular mechanisms in dynamic stabilization of the carpus, based on cadaver studies. The 3D position of the scaphoid, triquetrum, and capitate was monitored before and after tendon loading. RESULTS The extensor carpi ulnaris (ECU) and the flexor carpi radialis (FCR) are identified as the primary pronators of the midcarpal joint. The ECU's pronation effect can potentially strain the scapholunate ligament, while the supinator muscles, the abductor pollicis longus (APL), the extensor carpi radialis longus (ECRL), and the flexor carpi ulnaris (FCU), have a protective role, particularly in cases of scapholunate ligament dysfunctions. The FCR, despite being a pronator of the distal row, has a beneficial effect as it provokes supination of the scaphoid. CONCLUSIONS Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. Proprioception, encompassing joint position sensation and neuromuscular control, is pivotal for stability. Biomechanical research informs tailored muscle strengthening for specific carpal issues. Supinator muscles should be strengthened for SL injuries, and ECU-focused strengthening and proprioceptive training are key for dynamic LTq instabilities. Ongoing research should delve into the intricate relationship between carpal ligaments, muscles, and proprioception to enhance wrist stability.
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Affiliation(s)
- Guillem Salva-Coll
- Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Ibacma Institute, Balearic Institute for Hand and Wrist Surgery, Palma de Mallorca, Spain.
| | - Alex Lluch
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Department of Hand and Upper Extremity Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - Mireia Esplugas
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
| | - Ana Carreño
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Hand and Elbow Surgery, Hospital Clinic, Barcelona, Spain
| | - Ana Scott-Tennent
- Hospital Universitari Arnau de Vilanova, Lleida, Spain; Hospital Universitari Santa Maria, Lleida, Spain
| | - Maria Larrea-Zabalo
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain; Mutua Universal Delfos, Barcelona, Spain
| | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
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Ghorbani M, Yaali R, Sadeghi H, Luczak T. The effect of foot posture on static balance, ankle and knee proprioception in 18-to-25-year-old female student: a cross-sectional study. BMC Musculoskelet Disord 2023; 24:547. [PMID: 37403076 DOI: 10.1186/s12891-023-06678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND & PURPOSE Afferent input from the sole affects postural stability. Cutaneous reflexes from the foot are important to posture and gait. Lower-limb afferents alone provide enough information to maintain upright stance and are critical in perceiving postural sway. Altered feedback from propreoceptive receptors alters gait and patterns of muscle activation. The position and posture of the foot and ankle may also play an important role in proprioceptive input.Therefore, the current research aims to compare static balance and ankle and knee proprioception in people with and without flexible flatfeet. METHODOLOGY 91 female students between the ages of 18 and 25 voluntarily participated in this study, of which 24 were in the flexible flatfoot group and 67 were in the regular foot group after evaluating the longitudinal arch of the foot. The position sense of ankle and knee joints were measured using the active reconstruction test of the ankle and knee angle; Static balance was measured using the Sharpened Romberg test. Data were non-normally distributed. Accordingly, non-parametric tests were applied. The Kruskal-Wallis test was applied to compare differences between groups in variables. RESULT Kruskal-Wallis test showed a significant difference between two groups of flat feet and normal feet in the variables of static balance and position sense of ankle plantarflexion, ankle dorsiflexion, and knee flexion (p ≤ 0.05). A significant correlation was found between static balance and sense of ankle and knee position in the group with normal feet. The analysis of the regression line also showed that ankle and knee position sense could predict the static balance score in the regular foot group (ankle dorsiflexion position sense 17% (R2 = 0.17), ankle plantarflexion position sense 17% (R2 = 0.17) and knee flexion position sense 46% (R2 = 0.46) explain of changes in static balance). DISCUSSION & CONCLUSION Flexible flatfoot soles can cause loss of balance and sense of joint position; therefore, according to this preliminary study, clinicians must be aware and should take into account this possible deficit in the management of these patients.
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Affiliation(s)
- Maryam Ghorbani
- Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, Kharazmi University of Tehran, Tehran, Iran
| | - Rasoul Yaali
- Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, Kharazmi University of Tehran, Tehran, Iran.
| | - Hassan Sadeghi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University of Tehran, Tehran, Iran
| | - Tony Luczak
- NSPARC, Mississippi State University, Mississippi, USA
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Symbiotic electroneural and musculoskeletal framework to encode proprioception via neurostimulation: ProprioStim. iScience 2023; 26:106248. [PMID: 36923003 PMCID: PMC10009292 DOI: 10.1016/j.isci.2023.106248] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/23/2022] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Peripheral nerve stimulation in amputees achieved the restoration of touch, but not proprioception, which is critical in locomotion. A plausible reason is the lack of means to artificially replicate the complex activity of proprioceptors. To uncover this, we coupled neuromuscular models from ten subjects and nerve histologies from two implanted amputees to develop ProprioStim: a framework to encode proprioception by electrical evoking neural activity in close agreement with natural proprioceptive activity. We demonstrated its feasibility through non-invasive stimulation on seven healthy subjects comparing it with standard linear charge encoding. Results showed that ProprioStim multichannel stimulation was felt more natural, and hold promises for increasing accuracy in knee angle tracking, especially in future implantable solutions. Additionally, we quantified the importance of realistic 3D-nerve models against extruded models previously adopted for further design and validation of novel neurostimulation encoding strategies. ProprioStim provides clear guidelines for the development of neurostimulation policies restoring natural proprioception.
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Elshennawy S, Zahreldin AA, Mortada H, Hozien M, Youssef ASA, Galal A, Shahien M, Elfeky A, Elaraby A, Hamed M. The Efficacy of Physical Therapy Modalities in Patients With Hemophilia: A Systematic Review of Randomized Controlled Trials With Meta-analysis. Arch Phys Med Rehabil 2023; 104:475-489. [PMID: 35868453 DOI: 10.1016/j.apmr.2022.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of rehabilitation of patients with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation. DATA SOURCES Seven databases-PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence Database, Google Scholar, and Clinicaltrials.gov-were systematically searched for randomized controlled trials evaluating any physical therapy modality to manage hemophilia. STUDY SELECTION After abstract and full-text filtration, a methodological quality assessment was performed using the Physiotherapy Evidence Database scale for the studies that met the eligibility criteria. DATA EXTRACTION Relevant data were extracted from eligible studies and outcomes were categorized according to the ICF. DATA SYNTHESIS Using Review Manager and Microsoft Excel, a quantitative analysis using standardized mean differences with the 95% confidence interval was completed. Statistical heterogeneity between studies was explored using the I2 test. A fixed effect model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random effects models were used instead. RESULTS 35 randomized controlled trials with 1216 participants were included in this systematic review; 13 of them dealt with pediatric patients. Most of the studies were of good quality; 12 studies were of low quality. Meta-analysis showed a significant difference in favor of manual therapy, laser, and therapeutic exercises on selected outcomes of body function and structure, activity, and participation categories of the ICF model. CONCLUSION This systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status in combination with educational sessions to improve the quality of life of patients with hemophilic arthropathy. For pediatric patients with hemophilic arthropathy, using laser therapy is promising for improving functional capacity.
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Affiliation(s)
- Shorouk Elshennawy
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | | | - Hossam Mortada
- Biomechanics Department, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | - Menna Hozien
- Department of Neurological Disorders and Surgery Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | - Ahmed S A Youssef
- Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt; Huazhong University of Science and Technology, Wuhan, China
| | - Amira Galal
- Faculty of Physical Therapy, Egyptian Chinese University, Cairo, Egypt
| | | | - Amr Elfeky
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Maged Hamed
- Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt.
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Bertrand-Charette M, Roy JS, Bouyer LJ. Effect of acute ankle experimental pain on lower limb motor control assessed by the modified star excursion balance test. Front Sports Act Living 2023; 5:1082240. [PMID: 36741244 PMCID: PMC9890167 DOI: 10.3389/fspor.2023.1082240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction Following most musculoskeletal injuries, motor control is often altered. Acute pain has been identified as a potential contributing factor. However, there is little evidence of this interaction for acute pain following ankle sprains. As pain is generally present following this type of injury, it would be important to study the impact of acute pain on ankle motor control. To do so, a valid and reliable motor control test frequently used in clinical settings should be used. Therefore, the objective of this study was therefore to assess the effect of acute ankle pain on the modified Star Excursion Balance Test reach distance. Methods Using a cross-sectional design, 48 healthy participants completed the modified Star Excursion Balance Test twice (mSEBT1 and mSEBT2). Following the first assessment, they were randomly assigned to one of three experimental groups: Control (no stimulation), Painless (non-nociceptive stimulation) and Painful (nociceptive stimulation). Electrodes were placed on the right lateral malleolus to deliver an electrical stimulation during the second assessment for the Painful and Painless groups. A generalized estimating equations model was used to compare the reach distance between the groups/conditions and assessments. Results Post-hoc test results: anterior (7.06 ± 1.54%; p < 0.0001) and posteromedial (6.53 ± 1.66%; p < 0.001) directions showed a significant reach distance reduction when compared to baseline values only for the Painful group. Regarding the anterior direction, this reduction was larger than the minimal detectable change (5.87%). Conclusion The presence of acute pain during the modified Star Excursion Balance Test can affect performance and thus might interfere with the participant's lower limb motor control. As none of the participants had actual musculoskeletal injury, this suggests that pain and not only musculoskeletal impairments could contribute to the acute alteration in motor control.
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Affiliation(s)
- Michaël Bertrand-Charette
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Laurent J. Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada,Correspondence: Laurent J. Bouyer
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Bertrand-Charette M, Jeffrey-Gauthier R, Roy JS, Bouyer LJ. Gait Adaptation to a Phase-Specific Nociceptive Electrical Stimulation Applied at the Ankle: A Model to Study Musculoskeletal-Like Pain. Front Hum Neurosci 2022; 15:762450. [PMID: 34975433 PMCID: PMC8718644 DOI: 10.3389/fnhum.2021.762450] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Lower limb pain, whether induced experimentally or as a result of a musculoskeletal injury, can impair motor control, leading to gait adaptations such as increased muscle stiffness or modified load distribution around joints. These adaptations may initially reduce pain but can also lead to longer-term maladaptive plasticity and to the development of chronic pain. In humans, many current experimental musculoskeletal-like pain models are invasive, and most don’t accurately reproduce the movement-related characteristics of musculoskeletal pain. The main objective of this study was to measure pain adaptation strategies during gait of a musculoskeletal-like experimental pain protocol induced by phase-specific, non-invasive electrical stimulation. Methods: Sixteen healthy participants walked on a treadmill at 4 km/h for three consecutive periods (BASELINE, PAIN, and POST-PAIN). Painful electrical stimulations were delivered at heel strike for the duration of heel contact (HC) using electrodes placed around the right lateral malleolus to mimic ankle sprains. Gait adaptations were quantified bilaterally using instrumented pressure-sensitive insoles. One-way ANOVAs and group time course analyses were performed to characterize the impact of electrical stimulation on heel and forefoot contact pressure and contact duration. Results: During the first few painful strides, peak HC pressure decreased on the painful side (8.6 ± 1.0%, p < 0.0001) and increased on the non-stimulated side (11.9 ± 0.9%, p < 0.0001) while HC duration was significantly reduced bilaterally (painful: 12.1 ± 0.9%, p < 0.0001; non-stimulated: 4.8 ± 0.8%, p < 0.0001). No clinically meaningful modifications were observed for the forefoot. One minute after the onset of painful stimulation, perceived pain levels stabilized and peak HC pressure remained significantly decreased on the painful side, while the other gait adaptations returned to pre-stimulation values. Discussion: These results demonstrate that a non-invasive, phase-specific pain can produce a stable painful gait pattern. Therefore, this protocol will be useful to study musculoskeletal pain locomotor adaptation strategies under controlled conditions.
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Affiliation(s)
- Michaël Bertrand-Charette
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Renaud Jeffrey-Gauthier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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Furmanek MP, Słomka KJ, Sobiesiak A, Rzepko M, Juras G. The Effects of Cryotherapy on Knee Joint Position Sense and Force Production Sense in Healthy Individuals. J Hum Kinet 2018; 61:39-51. [PMID: 29599858 PMCID: PMC5873335 DOI: 10.1515/hukin-2017-0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The proprioceptive information received from mechanoreceptors is potentially responsible for controlling the joint position and force differentiation. However, it is unknown whether cryotherapy influences this complex mechanism. Previously reported results are not universally conclusive and sometimes even contradictory. The main objective of this study was to investigate the impact of local cryotherapy on knee joint position sense (JPS) and force production sense (FPS). The study group consisted of 55 healthy participants (age: 21 ± 2 years, body height: 171.2 ± 9 cm, body mass: 63.3 ± 12 kg, BMI: 21.5 ± 2.6). Local cooling was achieved with the use of gel-packs cooled to -2 ± 2.5°C and applied simultaneously over the knee joint and the quadriceps femoris muscle for 20 minutes. JPS and FPS were evaluated using the Biodex System 4 Pro apparatus. Repeated measures analysis of variance (ANOVA) did not show any statistically significant changes of the JPS and FPS under application of cryotherapy for all analyzed variables: the JPS’s absolute error (p = 0.976), its relative error (p = 0.295), and its variable error (p = 0.489); the FPS’s absolute error (p = 0.688), its relative error (p = 0.193), and its variable error (p = 0.123). The results indicate that local cooling does not affect proprioceptive acuity of the healthy knee joint. They also suggest that local limited cooling before physical activity at low velocity did not present health or injury risk in this particular study group.
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Affiliation(s)
- Mariusz P Furmanek
- Jerzy Kukuczka Academy of Physical Education in Katowice, Department of Human Motor Behavior, Katowice, Poland
| | - Kajetan J Słomka
- Jerzy Kukuczka Academy of Physical Education in Katowice, Department of Human Motor Behavior, Katowice, Poland
| | - Andrzej Sobiesiak
- University of Windsor, Department of Mechanical, Automotive & Materials Engineering Windsor, Ontario, Canada
| | - Marian Rzepko
- University of Rzeszow, Faculty of Physical Education, Rzeszow, Poland
| | - Grzegorz Juras
- Jerzy Kukuczka Academy of Physical Education in Katowice, Department of Human Motor Behavior, Katowice, Poland
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Ghai S, Schmitz G, Hwang TH, Effenberg AO. Auditory Proprioceptive Integration: Effects of Real-Time Kinematic Auditory Feedback on Knee Proprioception. Front Neurosci 2018; 12:142. [PMID: 29568259 PMCID: PMC5852112 DOI: 10.3389/fnins.2018.00142] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/22/2018] [Indexed: 01/23/2023] Open
Abstract
The purpose of the study was to assess the influence of real-time auditory feedback on knee proprioception. Thirty healthy participants were randomly allocated to control (n = 15), and experimental group I (15). The participants performed an active knee-repositioning task using their dominant leg, with/without additional real-time auditory feedback where the frequency was mapped in a convergent manner to two different target angles (40 and 75°). Statistical analysis revealed significant enhancement in knee re-positioning accuracy for the constant and absolute error with real-time auditory feedback, within and across the groups. Besides this convergent condition, we established a second divergent condition. Here, a step-wise transposition of frequency was performed to explore whether a systematic tuning between auditory-proprioceptive repositioning exists. No significant effects were identified in this divergent auditory feedback condition. An additional experimental group II (n = 20) was further included. Here, we investigated the influence of a larger magnitude and directional change of step-wise transposition of the frequency. In a first step, results confirm the findings of experiment I. Moreover, significant effects on knee auditory-proprioception repositioning were evident when divergent auditory feedback was applied. During the step-wise transposition participants showed systematic modulation of knee movements in the opposite direction of transposition. We confirm that knee re-positioning accuracy can be enhanced with concurrent application of real-time auditory feedback and that knee re-positioning can modulated in a goal-directed manner with step-wise transposition of frequency. Clinical implications are discussed with respect to joint position sense in rehabilitation settings.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
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El papel de la propiocepción y el control neuromuscular en las inestabilidades del carpo. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2017. [DOI: 10.1016/j.ricma.2015.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
La congruencia articular, la integridad ligamentaria y la compresión de las superficies articulares ocasionada por la contracción muscular se han considerado históricamente los tres pilares básicos para la estabilidad del carpo. En los últimos años se ha propuesto un nuevo factor para explicar los mecanismos de estabilización carpiana, la propiocepción y el control neuromuscular. La propiocepción en la muñeca se origina en órganos sensoriales localizados en los ligamentos y cápsulas articulares (los mecanorreceptores). La estimulación de los mismos inicia un reflejo involuntario que provoca una respuesta muscular selectiva dirigida a proteger la zona de la muñeca donde se ha originado la señal aferente. En este trabajo de revisión se pretende dar a conocer el concepto de propiocepción y control neuromuscular, el papel que tienen en la estabilidad del carpo y las posibles aplicaciones en la práctica clínica.
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Lin YH, Sun MH. The effect of lifting and lowering an external load on repositioning error of trunk flexion-extension in subjects with and without low back pain. Clin Rehabil 2016; 20:603-8. [PMID: 16894803 DOI: 10.1191/0269215506cr971oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To determine whether the repositioning error of trunk flexion-extension in individuals with low back pain is different from that in those not experiencing low back pain when lifting and lowering external loads. Design: A case-control study. Setting: Physical therapy department of a medical centre. Subjects: Twenty subjects with subacute low back pain and 20 control subjects without low back pain. Interventions: Tasks with and without lifting and lowering an external load. Main outcome measures: The trunk repositioning errors were measured with Measurand Shape Tape. Results: In subjects with low back pain, trunk repositioning errors were significantly reduced when lifting and lowering an external load in the direction of flexion (3.779 ±1.26 degrees in a loaded condition versus 4.82±2.97 degrees in an unloaded condition; P B< 0.05) and extension (3.17±2.15 degrees in a loaded condition versus 5.039±3.74 degrees in an unloaded condition; p < 0.05). In control subjects, trunk repositioning errors were not significantly changed when lifting and lowering an external load in the direction of flexion (2.80±1.39 degrees in a loaded condition versus 2.63±1.24 degrees in an unloaded condition; p < 0.05) and extension (2.87±1.40 degrees in a loaded condition versus 3.15±1.50 degrees in an unloaded condition; P>0.05). The direction of motion (trunk flexion or extension) was not shown to be significant in this study. Conclusion: Performing the task whilst lifting or lowering a submaximal load showed a reduced trunk repositioning error in subjects with subacute low back pain. Lifting and lowering a submaximal load might be considered as one of the rehabilitative strategies to hasten a return to work.
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Affiliation(s)
- Yang Hua Lin
- Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Rd., Kweishan, Taoyuan, Taiwan 333.
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11
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Abstract
Evolution has endowed all humans with a continuum of innate, hard-wired, automatically activated defense behaviors, termed the defense cascade. Arousal is the first step in activating the defense cascade; flight or fight is an active defense response for dealing with threat; freezing is a flight-or-fight response put on hold; tonic immobility and collapsed immobility are responses of last resort to inescapable threat, when active defense responses have failed; and quiescent immobility is a state of quiescence that promotes rest and healing. Each of these defense reactions has a distinctive neural pattern mediated by a common neural pathway: activation and inhibition of particular functional components in the amygdala, hypothalamus, periaqueductal gray, and sympathetic and vagal nuclei. Unlike animals, which generally are able to restore their standard mode of functioning once the danger is past, humans often are not, and they may find themselves locked into the same, recurring pattern of response tied in with the original danger or trauma. Understanding the signature patterns of these innate responses--the particular components that combine to yield the given pattern of defense-is important for developing treatment interventions. Effective interventions aim to activate or deactivate one or more components of the signature neural pattern, thereby producing a shift in the neural pattern and, with it, in mind-body state. The process of shifting the neural pattern is the necessary first step in unlocking the patient's trauma response, in breaking the cycle of suffering, and in helping the patient to adapt to, and overcome, past trauma.
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Şahin N, Bianco A, Patti A, Paoli A, Palma A, Ersöz G. Evaluation of knee joint proprioception and balance of young female volleyball players: a pilot study. J Phys Ther Sci 2015; 27:437-40. [PMID: 25729185 PMCID: PMC4339155 DOI: 10.1589/jpts.27.437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023] Open
Abstract
[Purpose] The main purpose of our study was the evaluation of the effects of long-term
volleyball practice on knee joint proprioception and balance of young female athletes.
[Subjects and Methods] An observational case-control study was performed. The study
enrolled 19 female volleyball players in the experimental group and 19 sedentary
counterparts as controls. A Biodex balance system and dynamometer were used for the
evaluations. The paired t-test was used to determine the significance of differences
between the performance of athletes and controls. [Results] The knee proprioception
analysis showed a significant difference at 60° joint position in active and passive
tests. A similar trend, but without significance, was found for the 20° joint position. In
the postural stability tests both groups showed similar results with no significant
differences between them. [Conclusion] In conclusion, the results indicate a significant
influence on joint proprioception is elicited by long-term exposure to a team sport like
volleyball. However, the postural stability indexes showed similar trends in both groups,
highlighting the analogous ontogenesis of the subjects investigated and the low influence
of volleyball practice on postural stability.
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Affiliation(s)
- Neşe Şahin
- Faculty of Sport Science, Ankara University, Turkey
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, Italy
| | - Antonino Patti
- Sport and Exercise Sciences Research Unit, University of Palermo, Italy
| | - Antonio Paoli
- Department of Biomedical Science, University of Padova, Italy
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, University of Palermo, Italy
| | - Gülfem Ersöz
- Faculty of Sport Science, Ankara University, Turkey
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Hwang JA, Bae SH, Do Kim G, Kim KY. The effects of sensorimotor training on anticipatory postural adjustment of the trunk in chronic low back pain patients. J Phys Ther Sci 2013; 25:1189-92. [PMID: 24259943 PMCID: PMC3818747 DOI: 10.1589/jpts.25.1189] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/10/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to examine the effects of sensorimotor training on the anticipatory postural adjustment (APA) of chronic low back pain (CLBP) patients. [Subjects and Methods] Fourteen CLBP patients were randomly assigned to Group II (ordinary physical therapy, n=7) and Group III (sensorimotor training, n=7). In addition, a normal group (Group I) consisting of seven subjects was chosen as the control group. The two CLBP groups received their own treatment five times per week, for four weeks, for 40 minutes each time. Changes in pain and functional performance evaluation were examined by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). In order to look at the change in APA, muscle onset time was examined using electromyography (EMG). [Results] Group III showed significant changes in both VAS and ODI. According to comparison of the results for muscle onset time, there were significant decreases in Group III's transversus abdominis muscle (TrA) and external oblique muscle (EO) in the standing and sitting positions. There were significant differences between Group II and III in terms of the TrA in the sitting position. [Conclusion] Sensorimotor training makes patients capable of learning how to adjust muscles, thereby alleviating pain and improving muscle performance.
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Affiliation(s)
- Jin Ah Hwang
- Department of Physical Therapy, College of Health and Welfare, Dongshin University
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14
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Sohn MK, Lee SS, Song HT. Effects of acute low back pain on postural control. Ann Rehabil Med 2013; 37:17-25. [PMID: 23526750 PMCID: PMC3604230 DOI: 10.5535/arm.2013.37.1.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/28/2012] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the changes in static and dynamic postural control after the development of acute low back pain. Methods Thirty healthy right-handed volunteers were divided into three groups; the right back pain group, the left back pain group, and the control group. 0.5 mL of 5% hypertonic saline was injected into L4-5 paraspinal muscle for 5 seconds to cause muscle pain. The movement of the center of gravity (COG) during their static and dynamic postural control was measured with their eyes open and with their eyes closed before and 2 minutes after the injection. Results The COGs for the healthy adults shifted to the right quadrant and the posterior quadrant during their static and dynamic postural control test (p<0.05). The static and dynamic instability index while they had their eyes closed was significantly increased than when they had their eyes open with and without acute back pain. After pain induction, their overall and anterior/posterior instability was increased in both the right back pain group and the left back pain group during the static postural control test (p<0.05). A right deviation and a posterior deviation of the COG still remained, and the posterior deviation was greater in the right back pain group (p<0.05). Conclusion The static instability, particularly the anterior/posterior instability was increased in the presence of acute low back pain, regardless of the visual information and the location of pain.
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Affiliation(s)
- Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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15
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Matthews M, Bridges S. Does the use of dynamic elastomeric fabric scoliosis suits provide an improved and more user friendly option for early intervention in childhood scoliosis? SCOLIOSIS 2012. [PMCID: PMC3304956 DOI: 10.1186/1748-7161-7-s1-p3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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16
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Cho YR, Hong BY, Lim SH, Kim HW, Ko YJ, Im SA, Lee JI. Effects of joint effusion on proprioception in patients with knee osteoarthritis: a single-blind, randomized controlled clinical trial. Osteoarthritis Cartilage 2011; 19:22-8. [PMID: 21034839 DOI: 10.1016/j.joca.2010.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 10/08/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effects of joint effusion on proprioceptive status in patients with knee osteoarthritis (OA). DESIGN A single-blind, randomized, controlled clinical trial in 40 female subjects aged 50 years and over with painful knee OA. All subjects were randomly assigned to either the control or experimental group. A volume of 20 mL of normal saline was injected into the knee joint cavity of subjects in the experimental group under ultrasonographic guidance. Proprioceptive acuity was assessed by active repositioning of the lower limb using an electrogoniometer to measure knee joint position sense (JPS) under both non-weight-bearing (NWB) and weight-bearing (WB) conditions twice, with a 20-min rest interval. The experimental group performed the task twice (Test 1 and Test 2) before and within 5 min after joint infusion. The control group also performed Test 1 and Test 2 without joint infusion. The outcome of interest was the absolute angular error (AAE), ignoring the direction of the error, between the randomized target angle and the patient's reproduced angle of JPS values. RESULTS Compared with the control group, JPS was significantly compromised in the experimental group in the NWB test after joint infusion (P=0.025). However, no significant differences in the angular error were observed between Test 1 and Test 2 in the control group for the NWB or WB test or in the experimental group for the WB test after infusion (P>0.05). CONCLUSIONS This study showed that joint effusion impairs proprioceptive function in osteoarthritic knee joints.
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Affiliation(s)
- Y R Cho
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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17
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A comparison of physical characteristics and swing mechanics between golfers with and without a history of low back pain. J Orthop Sports Phys Ther 2010; 40:430-8. [PMID: 20592479 DOI: 10.2519/jospt.2010.3152] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [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 using a cross-sectional design. OBJECTIVES To examine the kinematics and kinetics of the trunk and the physical characteristics of trunk and hip in golfers with and without a history of low back pain (LBP). BACKGROUND Modified swing patterns and general exercises have been suggested for golfers with back pain. Yet we do not know what contributes to LBP in golfers. To create and validate a low back-specific exercise program to help prevent and improve back injuries in golfers, it may be valuable to understand the differences in biomechanical and physical characteristics of golfers with and without a history of LBP. METHODS Sixteen male golfers with a history of LBP were matched by age and handicap with 16 male golfers without a history of LBP. All golfers underwent a biomechanical swing analysis, trunk and hip strength and flexibility assessment, spinal proprioception testing, and postural stability testing. RESULTS The group with a history of LBP demonstrated significantly less trunk extension strength at 60 degrees/s and left hip adduction strength, as well as limited trunk rotation angle toward the nonlead side. No significant differences were found in postural stability, trunk kinematics, and maximum spinal moments during the golf swing. CONCLUSION Deficits observed in this study may affect a golfer's ability to overcome the spinal loads generated during the golf swing over time. Exercises for improving these physical deficits can be considered, although the cause-effect of LBP in golfers still cannot be determined.
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LLINáS A, SILVA M, PASTA G, LUCK JV, ASENCIO J, FERNANDEZ PALAZZI F, CAVIGLIA H, MANCO-JOHNSON M, SEUSER A. Controversial subjects in musculoskeletal care of haemophilia: cross fire. Haemophilia 2010; 16 Suppl 5:132-5. [DOI: 10.1111/j.1365-2516.2010.02311.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wong YM, Ng G. Resistance training alters the sensorimotor control of vasti muscles. J Electromyogr Kinesiol 2009; 20:180-4. [PMID: 19303323 DOI: 10.1016/j.jelekin.2009.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 02/11/2009] [Accepted: 02/16/2009] [Indexed: 10/21/2022] Open
Abstract
The present study examined and compared two modes of weight training (bodybuilding and power-lifting) on the surface EMG of vasti muscles, knee joint position sense and isometric knee extension force in 48 able-bodied subjects. Subjects were randomly allocated into either a moderate loading and repetitions (bodybuilding) training or a high loading and low repetitions (power-lifting) training, or a no training control group. Training was conducted on alternate days with individual supervision. After 8 weeks of training, subjects from both training groups showed significantly earlier EMG onset timing and higher amplitude of vastus medialis obliquus relative to vastus lateralis (p=0.005 or <0.001), and improved knee joint position sense (p<0.001), but no such changes were found in the control group. However, the changes were not significantly different (p>0.05) between the two training groups. The findings suggested that the neuromotor control of the vasti muscles could be altered by regular weight training.
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Affiliation(s)
- Y M Wong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
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20
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GOMIS M, QUEROL F, GALLACH JE, GONZÁLEZ LM, AZNAR JA. Exercise and sport in the treatment of haemophilic patients: a systematic review. Haemophilia 2009; 15:43-54. [DOI: 10.1111/j.1365-2516.2008.01867.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Efficacy of a target-matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis. J Orthop Sports Phys Ther 2008; 38:19-25. [PMID: 18357655 DOI: 10.2519/jospt.2008.2512] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A randomized clinical trial design. OBJECTIVE To investigate the efficacy of high, repetitive, target-matching foot-stepping exercise (TMFSE) performed in a sitting position on proprioception, functional score, and walking velocity for patients with knee osteoarthritis (OA). BACKGROUND Researchers have suggested that exercises to address knee OA should include proprioceptive training. However, most patients cannot tolerate conventional proprioceptive training performed in a standing position. METHODS AND MEASURES Forty-nine subjects (mean age +/- SD, 63.3 +/- 8.1) with knee OA were randomly assigned to the exercise or no intervention groups. The exercise group practiced TMFSE in sitting, 3 sessions weekly for 6 weeks. All subjects underwent assessments of knee reposition error, functional incapacity score, and walking velocity prior to and after intervention. RESULTS The TMFSE significantly improved reposition error from a mean +/- SD of 3.0 degrees +/- 1.6 degrees to 1.5 degrees +/- 0.6 degree, walking velocity on ground level from 44.1 +/- 2.9 to 38.6 +/- 2.5 sec for 60 meters, time to complete a stairs task from 34.2 +/- 2.1 to 26.5 +/- 2.3 seconds, time to complete a figure-of-eight from 51.3 +/- 6.7 to 29.1 +/- 3.6 seconds, and score on a functional incapacity scale from 12.0 +/- 3.1 to 4.9 +/- 1.7, in subjects with knee OA after 6-week intervention (P <.0125). In contrast, the control group showed no change in any of the measured tests. CONCLUSION TMFSE in sitting appears to be an option for exercise in patients with mild to moderate knee OA. This may be an especially attractive option for patients who may have pain with weight-bearing exercises. A longitudinal study with a larger sample size is needed to confirm the potential use of TMFSE for patients with knee OA.
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Silfies SP, Cholewicki J, Reeves NP, Greene HS. Lumbar position sense and the risk of low back injuries in college athletes: a prospective cohort study. BMC Musculoskelet Disord 2007; 8:129. [PMID: 18166132 PMCID: PMC2259335 DOI: 10.1186/1471-2474-8-129] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Accepted: 12/31/2007] [Indexed: 11/14/2022] Open
Abstract
Background Impaired proprioception in the lumbar spine has often been reported in people with low back pain. However, no prospective studies exist to assert the cause and effect of this association. We hypothesized that athletes with a history of low back injury (LBI) would demonstrate poorer lumbar position sense (PS) than athletes without a history of LBI, and that this deficit would be a risk factor for future LBI. Methods This was a prospective cohort study with 2–3 year follow-up. Lumbar spine PS in the transverse plane was evaluated in 292 athletes using three tests: 1) passive and 2) active trunk repositioning, and 3) motion perception threshold. Mean absolute (accuracy) and variable (precision) errors were computed. Results There were no significant differences in the repositioning errors or motion perception threshold between athletes with and without a history of LBI or between those who did and did not get injured during the follow-up. Active trunk repositioning resulted in smaller errors than passive repositioning (1.6°± 0.8°) versus 2.1°± 1.0°) and 1.7°± 0.8°) versus 2.3°± 1.1°) for the absolute and relative errors, respectively). Conclusion Poor trunk PS in transverse plane is not associated with LBI in athletes, nor does it appear that poor trunk PS predisposes athletes to LBI.
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Affiliation(s)
- Sheri P Silfies
- Rehabilitation Sciences Research Laboratory, Drexel University, Philadelphia, PA, USA.
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23
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24
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Abstract
Treatment of scoliosis has been under discussion in relation to surgical intervention since the Boston brace was presented by Hall in 1976 (Hall et al. 1976; Watts et al. 1977). The effects of rigid bracing on thoracic skeletal integrity and the possible deformation of ribs due to the high localized pressure due to prolonged wear (Biorthex 1999; Coillard et al. 1999) have been highlighted. The lack of compliance (Houghton et al. 1987) has encouraged clinicians to investigate other options for non-surgical treatment. The Spinecor and Triac bracing systems have been developed as a result of this research; however, both of these orthoses had been designed with idiopathic scoliosis in mind. Little research has been done into the effects of bracing on the neuropathic curve. The use of dynamic Lycra garments in the treatment of neurological scoliosis offers the advantage of deformity correction without the bulk and discomfort of rigid braces. Recent clinical experience has shown that the Lycra suits have a positive effect in the treatment of scoliosis. This study discusses the treatment of a child presenting with a spinal tumour and although not truly of neurological presentation indicates that the garment can be used for the different scoliotic presentations.
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Affiliation(s)
- M Matthews
- Directorate of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK.
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25
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Assessment of Upper Limb Neuromuscular Control via a Target-Pointing Task: A Reliability Study. J Sport Rehabil 2003. [DOI: 10.1123/jsr.12.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective:To examine the accuracy and reliability of upper limb target pointing among normal subjects.Design:Prospective observational.Setting:Community sports-medicine practice.Participants:28 male and female normal right-handed volunteers age 22–35 years.Intervention:8-point target-pointing task completed with both upper limbs.Main Outcome Measures:Accuracy of point reproduction (cm error) and reliability over time (ICC2,1).Results:Target-pointing errors were 4.8–9.9 cm. Subject error and reach height explained 88% of performance variability. Error was greater when pointing to the lower half of the target (P< .05) and to ipsilateral points (P< .05). Gender, test day, reach length, and arm dominance did not affect accuracy. Test–retest reliability ranged from .30 to .71.Conclusion:Target-pointing tasks might be useful to assess upper limb neuromuscular control. Points with lower errors and greater reliabilities might be useful to differentiate normal vs abnormal performances, whereas a battery of reliable points over a spectrum of errors might be useful to document changes over time.
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Hilberg T, Herbsleb M, Puta C, Gabriel HHW, Schramm W. Physical training increases isometric muscular strength and proprioceptive performance in haemophilic subjects. Haemophilia 2003; 9:86-93. [PMID: 12558784 DOI: 10.1046/j.1365-2516.2003.00679.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sufficient muscular strength and proprioception lessen the risk of joint damage, however, both are impaired in haemophilic subjects. The aim of the study was to investigate proprioceptive performance and isometric muscular strength before and after a specialized training in haemophilic subjects (H) compared with two groups of control subjects (C). Nine subjects with severe haemophilia A, and eight 'active' C (AC) without haemophilia took part in a physical training programme over a 6-month period. Eleven 'passive' C (PC) were requested to avoid any additional training during this period. Proprioceptive performance and isometric strength were determined before and after the training programme. The maximal isometric muscular strength in the legs, bilaterally measured by knee extensor (and leg press) was increased (P < 0.05) by 34% (29%) after training in the H and by 20% (28%) in the AC groups while remaining unchanged in the PC group. The performance in one-leg-stand tests after training was increased (P < 0.05) in the H and AC groups. An improvement of angle reproduction of 20 degrees and 40 degrees (P < 0.05) in the H compared with the PC groups was seen in the tests. Quantitative sensory testing by the tuning fork showed an increase (P < 0.05) in performance of both H and AC groups. The results of the present study confirm that specific sports therapy focused on proprioceptive function and accompanied by gentle strength training with low resistance and 20-25 repetitions is able to increase proprioceptive performance and muscular strength with a minimal stress to the joints. It is strongly recommended that specialized sports therapy be included as an integral component of the complete treatment regimen of haemophilic subjects.
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Affiliation(s)
- T Hilberg
- Department of Sports Medicine, Friedrich-Schiller-University Jena, Germany.
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27
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Hilberg T, Herbsleb M, Gabriel HH, Jeschke D, Schramm W. Proprioception and isometric muscular strength in haemophilic subjects. Haemophilia 2001; 7:582-8. [PMID: 11851757 DOI: 10.1046/j.1365-2516.2001.00563.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Haemophilia is characterized by intra-articular bleeding, often requiring immobilization, which may result in muscle atrophy and impaired proprioception. The aim of the study was to investigate differences in proprioceptive performance and isometric muscular strength of the lower limbs in haemophilic subjects compared with control subjects. Twelve subjects with severe haemophilia (11 haemophilia A; one haemophilia B) vs. 12 control subjects were matched for anthropometric data and tested for differences of proprioception (one-leg-stand, posturomed, angle-reproduction, and tuning fork tests) and isometric strength (leg press, knee extensor). The static proprioceptive performance of the haemophilic group, as measured by the one-leg-stand test (on hard or soft ground, with open or closed eyes; P < 0.05) was demonstrably impaired (by 41-363%). In contrast, the dynamic proprioceptive performance measured by the posturomed test did not show any difference between the groups. The local proprioceptive performance (angle-reproduction test) of the knee, (the most commonly affected joint in haemophiliacs) showed a trend to impaired function but was not distinctly different from that of controls. The quantitative sensory function (tuning fork) showed significant (P < 0.05) impairment of 9-10% in the haemophilic subjects. Additionally, the isometric muscular strength of the leg extensor was weaker (32-38%) in the haemophilic group when the limbs were tested individually as well as bilaterally (P < 0.05). In conclusion, the results suggest that global proprioceptive performance is impaired and that the isometric strength of the leg extensors is weaker in the haemophilic subjects. Therefore, specialized training for global proprioception would be helpful in order to compensate for proprioceptive deficits. This exercise regimen should also include safe strength-training for an optimal stabilization of the joints, but must be adapted to the individual needs and situations of the haemophilic subjects.p
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Affiliation(s)
- T Hilberg
- Department of Sports Medicine, Friedrich-Schiller-University Jena, Germany.
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Greene HS, Cholewicki J, Galloway MT, Nguyen CV, Radebold A. A history of low back injury is a risk factor for recurrent back injuries in varsity athletes. Am J Sports Med 2001; 29:795-800. [PMID: 11734495 DOI: 10.1177/03635465010290062001] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this prospective study, we investigated whether a history of previous low back injury and dissatisfaction with a coach and teammates could predict future low back injury in varsity athletes during a 1-year follow-up period. Of 679 Yale varsity athletes surveyed in 1999, 18.3% (124) reported that they had sustained a low back injury within the past 5 years, and 6.8% (46) sustained a low back injury in the follow-up season. There were no differences in incidence rates between men and women or between athletes involved in contact or noncontact sports. A history of low back injury was the significant predictor for sustaining low back injury in the following year, and athletes who reported previous low back injury were at three times greater risk. Athletes who still had pain at the time of the survey were six times more likely to sustain a low back injury than were athletes without a history of low back injury. These results suggest that some risk factors associated with a history of low back injury predispose athletes to sustain recurrent injury. They may be congenital or a result of insufficient recovery time after the first low back injury episode.
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Affiliation(s)
- H S Greene
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06520-8071, USA
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