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Oyekan AA, LeVasseur CM, Chen SR, Padmanabhan A, Makowicz N, Donaldson WF, Lee JY, Shaw JD, Anderst WJ. The Effects of Cervical Orthoses on Head and Intervertebral Range of Motion. Spine (Phila Pa 1976) 2023; 48:1561-1567. [PMID: 37339257 DOI: 10.1097/brs.0000000000004755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023]
Abstract
STUDY DESIGN Prospective Cohort. OBJECTIVE Quantify and compare the effectiveness of cervical orthoses in restricting intervertebral kinematics during multiplanar motions. SUMMARY OF BACKGROUND DATA Previous studies evaluating the efficacy of cervical orthoses measured global head motion and did not evaluate individual cervical motion segment mobility. Prior studies focused only on the flexion/extension motion. METHODS Twenty adults without neck pain participated. Vertebral motion from the occiput through T1 was imaged using dynamic biplane radiography. Intervertebral motion was measured using an automated registration process with validated accuracy better than 1 degree. Participants performed independent trials of maximal flexion/extension, axial rotation, and lateral bending in a randomized order of unbraced, soft collar (foam), hard collar (Aspen), and cervical thoracic orthosis (CTO) (Aspen) conditions. Repeated-measures ANOVA was used to identify differences in the range of motion (ROM) among brace conditions for each motion. RESULTS Compared with no collar, the soft collar reduced flexion/extension ROM from occiput/C1 through C4/C5, and reduced axial rotation ROM at C1/C2 and from C3/C4 through C5/C6. The soft collar did not reduce motion at any motion segment during lateral bending. Compared with the soft collar, the hard collar reduced intervertebral motion at every motion segment during all motions, except for occiput/C1 during axial rotation and C1/C2 during lateral bending. The CTO reduced motion compared with the hard collar only at C6/C7 during flexion/extension and lateral bending. CONCLUSIONS The soft collar was ineffective as a restraint to intervertebral motion during lateral bending, but it did reduce intervertebral motion during flexion/extension and axial rotation. The hard collar reduced intervertebral motion compared with the soft collar across all motion directions. The CTO provided a minimal reduction in intervertebral motion compared with the hard collar. The utility in using a CTO rather than a hard collar is questionable, given the cost and little or no additional motion restriction.
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Affiliation(s)
- Anthony A Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
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McMullin P, Emmett D, Gibbons A, Clingo K, Higbee P, Sykes A, Fullwood DT, Mitchell UH, Bowden AE. Dynamic segmental kinematics of the lumbar spine during diagnostic movements. Front Bioeng Biotechnol 2023; 11:1209472. [PMID: 37840657 PMCID: PMC10568473 DOI: 10.3389/fbioe.2023.1209472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background: In vivo measurements of segmental-level kinematics are a promising avenue for better understanding the relationship between pain and its underlying, multi-factorial basis. To date, the bulk of the reported segmental-level motion has been restricted to single plane motions. Methods: The present work implemented a novel marker set used with an optical motion capture system to non-invasively measure dynamic, 3D in vivo segmental kinematics of the lower spine in a laboratory setting. Lumbar spinal kinematics were measured for 28 subjects during 17 diagnostic movements. Results: Overall regional range of motion data and lumbar angular velocity measurement were consistent with previously published studies. Key findings from the work included measurement of differences in ascending versus descending segmental velocities during functional movements and observations of motion coupling paradigms in the lumbar spinal segments. Conclusion: The work contributes to the task of establishing a baseline of segmental lumbar movement patterns in an asymptomatic cohort, which serves as a necessary pre-requisite for identifying pathological and symptomatic deviations from the baseline.
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Affiliation(s)
- Paul McMullin
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Darian Emmett
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Andrew Gibbons
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Kelly Clingo
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Preston Higbee
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Andrew Sykes
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - David T. Fullwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
| | - Ulrike H. Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT, United States
| | - Anton E. Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT, United States
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Roig-Maimó MF, Salinas-Bueno I, Mas-Sansó R, Varona J, Martínez-Bueso P. The Influence of Mobile Device Type on Camera-Based Monitoring of Neck Movements for Cervical Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:2482. [PMID: 36904689 PMCID: PMC10007212 DOI: 10.3390/s23052482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
We developed a mobile application for cervical rehabilitation that uses a non-invasive camera-based head-tracker sensor for monitoring neck movements. The intended user population should be able to use the mobile application in their own mobile device, but mobile devices have different camera sensors and screen dimensions that could affect the user performance and neck movement monitoring. In this work, we studied the influence of mobile devices type on camera-based monitoring of neck movements for rehabilitation purposes. We conducted an experiment to test whether the characteristics of a mobile device affect neck movements when using the mobile application with the head-tracker. The experiment consisted of the use of our application, containing an exergame, in three mobile devices. We used wireless inertial sensors to measure the real-time neck movements performed while using the different devices. The results showed that the effect of device type on neck movements was not statistically significant. We included the sex factor in the analysis, but there was no statistically significant interaction between sex and device variables. Our mobile application proved to be device-agnostic. This will allow intended users to use the mHealth application regardless of the type of device. Thus, future work can continue with the clinical evaluation of the developed application to analyse the hypothesis that the use of the exergame will improve therapeutic adherence in cervical rehabilitation.
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Affiliation(s)
| | - Iosune Salinas-Bueno
- Department of Nursing and Physiotherapy, University of the Balearic Islands and Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
| | - Ramon Mas-Sansó
- Department of Mathematics and Computer Science, University of the Balearic Islands, 07122 Palma, Spain
| | - Javier Varona
- Department of Mathematics and Computer Science, University of the Balearic Islands, 07122 Palma, Spain
| | - Pau Martínez-Bueso
- Department of Nursing and Physiotherapy, University of the Balearic Islands and Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain
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4
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Shanbehzadeh S, ShahAli S, Ebrahimi Takamjani I, Vlaeyen JWS, Salehi R, Jafari H. Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis. 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 2022; 31:1802-1820. [PMID: 35583666 DOI: 10.1007/s00586-022-07261-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/07/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically review the influence of pain-related threat beliefs or disability on trunk kinematic or postural control in LBP. METHOD Eight electronic databases were searched from January 1990 to July 1, 2020. Meta-analysis using random-effect model was performed for 18 studies on the association between pain-related threat beliefs or disability and lumbar range of motion. Pearson r correlations were used as the effect size. RESULT Negative correlations were observed between lumbar range of motion (ROM) and pain-related threat beliefs (r = - 0.31, p < 0.01, 95% CI: - 0.39, - 0.24) and disability (r = - 0.24, p < 0.01, 95% CI: - 0.40, - 0.21). Nonsignificant correlations were reported between pain-related threat beliefs and center of pressure parameters during static standing in 75% of the studies. In 33% of the studies, moderate negative correlations between disability and postural control were observed. CONCLUSION Motor behaviors are influenced by several factors, and therefore, the relatively weak associations observed between reduced lumbar ROM with higher pain-related threat beliefs and perceived disability, and postural control with disability are to be expected. This could aid clinicians in the assessment and planning rehabilitation interventions. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Affiliation(s)
- Sanaz Shanbehzadeh
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Isamael Ebrahimi Takamjani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Johan W S Vlaeyen
- KU Leuven - University of Leuven, Health Psychology Research Group, Leuven, Belgium.,Experimental Health Psychology, Maastricht University, Maastricht, Netherlands
| | - Reza Salehi
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Jafari
- KU Leuven - University of Leuven, Health Psychology Research Group, Leuven, Belgium.,Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King's College London, London, United Kingdom
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5
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Scholz C, Masalha W, Naseri Y, Klingler JH, Hohenhaus M, Hubbe U. Laminectomy and fusion in multilevel degenerative cervical myelopathy - Correlation between objective and subjective postoperative restriction of cervical spine mobility. J Clin Neurosci 2021; 94:135-139. [PMID: 34863428 DOI: 10.1016/j.jocn.2021.10.013] [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: 10/06/2020] [Revised: 07/12/2021] [Accepted: 10/05/2021] [Indexed: 11/20/2022]
Abstract
For patients with multilevel degenerative cervical myelopathy (DCM), laminectomy and fusion is an established technique. A concomitant effect of multilevel fusion is a restriction of cervical spine mobility. This retrospective study on DCM-patients with at least 4 laminectomy and fusion levels, compares data between objective and subjective restriction of the postoperative cervical spine mobility. The patient-reported restriction of cervical spine mobility was acquired by a five-step score. Measurements of cervical range of motion were performed using the CROM device and were correlated with the subjective scores. Fusion was performed over 6 levels in most of the 36 patients. For the subjective cervical spine mobility, 52.8% reported none to medium, 38.9% severe and 8.3% complete restriction. Mean objective cervical range of motion was 45.0° for flexion-extension, 26.3° for total lateral flexion and 51.4° for total rotation and therefore evidently reduced compared to non-operated patient cohorts in literature. There was a significant medium, negative correlation between the objective measurements and the patient-reported general restriction of cervical spine mobility, and with the physical component summary of SF-8. The significant objective reduction of cervical range of motion after laminectomy and multilevel fusion correlates with the patient-reported assessment for general restriction.
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Affiliation(s)
- Christoph Scholz
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Waseem Masalha
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Yashar Naseri
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ulrich Hubbe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Does the postoperative cervical lordosis angle affect the cervical rotational range of motion after cervicothoracic multilevel fusion? Clin Biomech (Bristol, Avon) 2021; 90:105484. [PMID: 34547606 DOI: 10.1016/j.clinbiomech.2021.105484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/13/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laminectomy and multilevel fusion in patients with degenerative cervical myelopathy lead to severe restriction in cervical spine mobility. Since fusions from C2 to the thoracic spine result in a permanently stiff subaxial cervical spine, it seems obvious to restore physiological cervical lordosis, especially with regard to sagittal balance. However, there are reports that a fusion in a more lordotic position leads to a reduction of rotational cervical range of motion in the still mobile segments C0-C2. This study investigates the relationship between postoperative cervical lordosis and the objective rotational range of motion and subjective restriction. METHODS In this single-center, retrospective cohort study, patients with degenerative cervical myelopathy operated via laminectomy and fusion from C2 to the thoracic spine were included. X-ray imaging was evaluated for common lordosis parameters. The patient-reported rotational restriction of cervical spine mobility was acquired by a five-step score. Objective rotational range of motion was measured. The radiological parameters for cervical lordosis (C2-C7 lordotic angle, C2-C7 Cobb angle) were correlated with the measurements and the patient-reported subjective scores. FINDINGS We found a significant, medium negative correlation between the measurements for rotation and the C2-C7 lordotic angle and a significant, large negative correlation to the C2-C7 Cobb angle. For subjective restriction, no or only small correlation was observed. INTERPRETATION We found significant negative correlations between radiological cervical lordosis and objective measurements for rotation. These results indicate that for this particular patient population, a stronger postoperative cervical lordosis does not seem favorable under the aspect of rotational range of motion.
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Xin H, Zhang L, Diao H, Jia J, Jin Z. Numerical wear study of metal‐on‐ultrahigh molecular weight polyethylene‐based cervical total disc arthroplasty by coupling finite element analysis and multi‐body dynamics. BIOSURFACE AND BIOTRIBOLOGY 2021. [DOI: 10.1049/bsb2.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hua Xin
- Advance Machinery Surface Technology Research Center College of Mechanical and Electrical Engineering Shaanxi University of Science & Technology Xi'an Shaanxi China
| | - Lei Zhang
- Advance Machinery Surface Technology Research Center College of Mechanical and Electrical Engineering Shaanxi University of Science & Technology Xi'an Shaanxi China
| | - Hao Diao
- School of Mechanical Engineering State Key Laboratory for Manufacturing Systems Engineering Xi'an Jiaotong University Xi'an Shaanxi China
| | - Junhong Jia
- Advance Machinery Surface Technology Research Center College of Mechanical and Electrical Engineering Shaanxi University of Science & Technology Xi'an Shaanxi China
| | - Zhongmin Jin
- School of Mechanical Engineering State Key Laboratory for Manufacturing Systems Engineering Xi'an Jiaotong University Xi'an Shaanxi China
- School of Mechanical Engineering Institute of Medical and Biological Engineering University of Leeds Leeds UK
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8
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Salinas-Bueno I, Roig-Maimó MF, Martínez-Bueso P, San-Sebastián-Fernández K, Varona J, Mas-Sansó R. Camera-Based Monitoring of Neck Movements for Cervical Rehabilitation Mobile Applications. SENSORS (BASEL, SWITZERLAND) 2021; 21:2237. [PMID: 33806813 PMCID: PMC8004650 DOI: 10.3390/s21062237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
Vision-based interfaces are used for monitoring human motion. In particular, camera-based head-trackers interpret the movement of the user's head for interacting with devices. Neck pain is one of the most important musculoskeletal conditions in prevalence and years lived with disability. A common treatment is therapeutic exercise, which requires high motivation and adherence to treatment. In this work, we conduct an exploratory experiment to validate the use of a non-invasive camera-based head-tracker monitoring neck movements. We do it by means of an exergame for performing the rehabilitation exercises using a mobile device. The experiments performed in order to explore its feasibility were: (1) validate neck's range of motion (ROM) that the camera-based head-tracker was able to detect; (2) ensure safety application in terms of neck ROM solicitation by the mobile application. Results not only confirmed safety, in terms of ROM requirements for different preset patient profiles, according with the safety parameters previously established, but also determined the effectiveness of the camera-based head-tracker to monitor the neck movements for rehabilitation purposes.
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Affiliation(s)
- Iosune Salinas-Bueno
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain; (I.S.-B.); (P.M.-B.)
| | - Maria Francesca Roig-Maimó
- Department of Mathematics and Computer Science, University of the Balearic Islands, 07122 Palma, Spain; (J.V.); (R.M.-S.)
| | - Pau Martínez-Bueso
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma, Spain; (I.S.-B.); (P.M.-B.)
| | | | - Javier Varona
- Department of Mathematics and Computer Science, University of the Balearic Islands, 07122 Palma, Spain; (J.V.); (R.M.-S.)
| | - Ramon Mas-Sansó
- Department of Mathematics and Computer Science, University of the Balearic Islands, 07122 Palma, Spain; (J.V.); (R.M.-S.)
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Bynum R, Garcia O, Herbst E, Kossa M, Liou K, Cowan A, Hilton C. Effects of Dry Needling on Spasticity and Range of Motion: A Systematic Review. Am J Occup Ther 2021; 75:7501205030p1-7501205030p13. [PMID: 33399051 DOI: 10.5014/ajot.2021.041798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE This systematic review summarizes existing studies on dry needling for spasticity and range of motion (ROM) and discusses its potential for use as an occupational therapy intervention. OBJECTIVE To examine existing studies on the effects of dry needling on spasticity and ROM. DATA SOURCES Article citations and abstracts from Scopus, Cochrane Library, PubMed, CINAHL, and a university library search. STUDY SELECTION AND DATA COLLECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in abstracting data. Peer-reviewed journal articles published in English between January 2007 and June 2019 were searched. Of 270 identified studies, 10 met the inclusion criteria. Studies were divided into categories on the basis of outcome measures (Modified Modified Ashworth Scale and ROM). Pain outcome measures were excluded because a systematic review addressing this outcome has recently been completed. FINDINGS Strong evidence was found to support the use of dry needling to decrease spasticity and increase ROM. CONCLUSIONS AND RELEVANCE This systematic review suggests that dry needling is an effective physical agent modality to decrease spasticity and increase ROM, both of which are potentially beneficial to functional outcomes. WHAT THIS ARTICLE ADDS This article provides information that may be helpful in determining the appropriateness of dry needling as an occupational therapy intervention.
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Affiliation(s)
- Rachel Bynum
- Rachel Bynum, MOT, OTR, is Graduate, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Olivia Garcia
- Olivia Garcia, MOT, OTR, is Occupational Therapist, Winter Pediatric Therapy, Houston, TX. At the time of the study, Garcia was Graduate Student, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Emily Herbst
- Emily Herbst, MOT, OTR, is Occupational Therapist, Encompass Health Rehabilitation Hospital, Round Rock, TX. At the time of the study, Herbst was Graduate Student, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Mary Kossa
- Mary Kossa, MOT, OTR, is Graduate, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Katrina Liou
- Katrina Liou, MOT, OTR, is Graduate, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - April Cowan
- April Cowan, OTD, OTR, CHT, is Associate Professor of Instruction, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Claudia Hilton
- Claudia Hilton, PhD, MBA, OTR, FAOTA, is Associate Professor, Occupational Therapy Department, University of Texas Medical Branch, Galveston;
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Laminectomy and fusion in multilevel degenerative cervical myelopathy -How severely do patients feel restricted by a postoperatively reduced mobility of the cervical spine? Clin Neurol Neurosurg 2020; 197:106160. [DOI: 10.1016/j.clineuro.2020.106160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 01/14/2023]
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11
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Christe G, Rochat V, Jolles BM, Favre J. Lumbar and thoracic kinematics during step-up: Comparison of three-dimensional angles between patients with chronic low back pain and asymptomatic individuals. J Orthop Res 2020; 38:1248-1256. [PMID: 31879969 DOI: 10.1002/jor.24575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/21/2019] [Indexed: 02/04/2023]
Abstract
While alterations in spinal kinematics have been repeatedly observed in patients with chronic low back pain (CLBP), their exact nature is still unknown. Specifically, there is a need for comprehensive assessments of multisegment spinal angles during daily-life activities. The purpose of this exploratory study was to characterize three-dimensional angles at the lower lumbar, upper lumbar, lower thoracic, and upper thoracic joints in CLBP patients and asymptomatic controls during stepping up with three different step heights. Spinal angles of 10 patients with nonspecific CLBP (six males; 38.7 ± 7.2 years old, 22.3 ± 1.6 kg/m2 ) and 11 asymptomatic individuals (six males; 36.7 ± 5.4 years old, 22.9 ± 3.8 kg/m2 ) were measured in a laboratory using a camera-based motion capture system. Seven out of the 12 angle curves had characteristic patterns, leading to the identification of 20 characteristic peaks. Comparing peak amplitudes between groups revealed statistically significantly smaller sagittal- and frontal-plane angles in the patient group at the upper lumbar joint with the two higher steps and at the lower lumbar joint with the higher step. Significantly reduced angles were also observed in sagittal plane at the upper thoracic joint with the two smaller steps. Moreover, a higher number of significant differences between groups was detected with the two higher steps than with the smallest step. In conclusion, this study showed the value of a comprehensive description of spinal angles during step-up tasks and provided insights into the alterations with CLBP. These preliminary results support prior research suggesting that CLBP rehabilitation should facilitate larger amplitudes of motion during functional activities.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentin Rochat
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Khademolhosseini Y, Pirouzi S, Ghanbari A, Arabzadeh S, Rezaei I. Head and neck extension more than 30° may disturb standing balance in healthy older adults. Geriatr Nurs 2020; 41:490-495. [PMID: 32145993 DOI: 10.1016/j.gerinurse.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
Although there is clinical evidence of postural instability at extreme angles of head extension, the effects of lower angles on balance have been not investigated. This study aimed to investigate the effects of different head and neck extension angles on standing balance in older adults, and to determine the critical angle of instability. Twenty-eight healthy older adults were tested at 0°, 20°, 30° and 40° head and neck extension. The center of pressure (COP) parameters were recorded with a force plate. Significant differences were observed between 30° and 40° compared to 0° in anteroposterior and mediolateral COP displacement and total COP velocity, and between 40° and 0° in mediolateral COP velocity. Head and neck extension at 30° was the critical angle associated with the appearance of instability, and this value should be considered in the ergonomic design of work and living spaces, exercise programming and daily activities in older adults.
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Affiliation(s)
| | - Soraya Pirouzi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ghanbari
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soudeh Arabzadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Rezaei
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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13
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Marich AV, Hwang CT, Sorensen CJ, van Dillen LR. Examination of the Lumbar Movement Pattern during a Clinical Test and a Functional Activity Test in People with and without Low Back Pain. PM R 2019; 12:140-146. [PMID: 31140705 DOI: 10.1002/pmrj.12197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 05/22/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND It is assumed that the lumbar movement pattern observed during a clinical test is representative of the movement pattern used during a functional activity. Very little is known about how the lumbar movement pattern during a clinical test is associated with the lumbar movement pattern during a functional activity and how the lumbar movement pattern is associated with functional limitation. OBJECTIVE The purpose was to examine the lumbar movement pattern during a clinical test and a functional activity test in people with and people without low back pain (LBP), and the relationship of lumbar motion to LBP-related functional limitation. DESIGN Observational study. PARTICIPANTS 16 back-healthy adults and 32 people with chronic LBP. METHODS Participants performed a standardized clinical test of forward bending and a functional activity test of picking up an object. MAIN OUTCOME MEASUREMENTS Maximal lumbar excursion and lumbar excursion at 0% to 50% and 50% to 100% of movement time were examined. RESULTS Significant associations were present between the two movement tests for both back-healthy people and people with LBP (r = 0.47-0.73). In people with LBP the amount of lumbar motion in the 0% to 50% of movement time interval for both tests was significantly associated with functional limitation (r = 0.43-0.62). CONCLUSION Lumbar movement patterns were similar between the two tests, and lumbar motion early in the movement of a functional test was related to self-report of functional limitation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andrej V Marich
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Ching-Ting Hwang
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Christopher J Sorensen
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Linda R van Dillen
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, St. Louis, MO
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Oikonomidis S, Sobottke R, Wilke HJ, Herren C, Beckmann A, Zarghooni K, Siewe J. Material failure in dynamic spine implants: are the standardized implant tests before market launch sufficient? 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 2019; 28:872-882. [PMID: 30649613 DOI: 10.1007/s00586-019-05880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/06/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE International Standards Organization (ISO) 12189 and American Society for Testing and Materials F2624 are two standard material specification and test methods for spinal implant devices. The aim of this study was to assess whether the existing and required tests before market launch are sufficient. METHODS In three prospective studies, patients were treated due to degenerative disease of the lumbar spine or spondylolisthesis with lumbar interbody fusion and dynamic stabilization of the cranial adjacent level. The CD HORIZON BalanC rod and S4 Dynamic rod were implanted in 45 and 11 patients, respectively. RESULTS A fatigue fracture of the material of the topping off system has been found in five cases (11%) for the group fitted with the CD HORIZON BalanC rod. In the group using the S4 Dynamic rod group, a material failure of the dynamic part was demonstrated in seven patients (64%). All three studies were interrupted due to these results, and a report to the Federal Institute for Drugs and Medical Devices was generated. CONCLUSION Spinal implants have to be checked by a notified body before market launch. The notified body verifies whether the implants fulfil the requirements of the current standards. These declared studies suggest that the current standards for the testing of load bearing capacity and stand ability of dynamic spine implants might be insufficient. Revised standards depicting sufficient deformation and load pattern have to be developed and counted as a requirement for the market launch of an implant. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Stavros Oikonomidis
- Department of Orthopedics and Trauma Surgery, Rhein-Maas Klinikum GmbH, Mauerfeldchen 25, 52146, Wuerselen, Germany. .,Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany.
| | - Rolf Sobottke
- Department of Orthopedics and Trauma Surgery, Rhein-Maas Klinikum GmbH, Mauerfeldchen 25, 52146, Wuerselen, Germany.,Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Helmholtzstr. 14, 89081, Ulm, Germany
| | - Christian Herren
- Department for Trauma and Reconstructive Surgery, University Hospital RWTH, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Agnes Beckmann
- Institute of General Mechanics, RWTH Aachen University, Templergraben 64, 52062, Aachen, Germany
| | - Kourosh Zarghooni
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany
| | - Jan Siewe
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany
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Gale NC, Zeigler SL, Towler C, Mondal S, Issen KA, Mesfin A, Michalek AJ, Kuxhaus L. Increased lumbar spinal column laxity due to low-angle, low-load cyclic flexion may predispose to acute injury. JOR Spine 2018; 1:e1038. [PMID: 31463453 PMCID: PMC6686791 DOI: 10.1002/jsp2.1038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 09/10/2018] [Accepted: 10/29/2018] [Indexed: 11/05/2022] Open
Abstract
Lumbar spinal column laxity contributes to instability, increasing the risk of low back injury and pain. Until the laxity increase due to the cyclic loads of daily living can be quantified, the associated injury risk cannot be predicted clinically. This work cyclically loaded 5-vertebra lumbar motion segments (7 skeletally-mature cervine specimens, 5 osteoporotic human cadaver specimens) for 20 000 cycles of low-load low-angle (15°) flexion. The normalized neutral zone lengths and slopes of the load-displacement hysteresis loops showed a similar increase in spinal column laxity across species. The intervertebral kinematics also changes with cyclic loading. Differences in the location and magnitude of surface strain on the vertebral bodies (0.34% ± 0.11% in the cervine specimens, and 3.13% ± 1.69% in the human cadaver specimens) are consistent with expected fracture modes in these populations. Together, these results provide biomechanical evidence of spinal column damage during high-cycle low-load low-angle loading.
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Affiliation(s)
- Nicole C. Gale
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
| | | | | | - Sumona Mondal
- Department of MathematicsClarkson UniversityPotsdamNew York
| | - Kathleen A. Issen
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
| | - Addisu Mesfin
- Departments of Orthopaedic Surgery and NeurosurgeryUniversity of RochesterRochesterNew York
| | - Arthur J. Michalek
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
| | - Laurel Kuxhaus
- Department of Mechanical and Aeronautical EngineeringClarkson UniversityPotsdamNew York
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Marich AV, Lanier VM, Salsich GB, Lang CE, Van Dillen LR. Immediate Effects of a Single Session of Motor Skill Training on the Lumbar Movement Pattern During a Functional Activity in People With Low Back Pain: A Repeated-Measures Study. Phys Ther 2018; 98:605-615. [PMID: 29660077 PMCID: PMC6692703 DOI: 10.1093/ptj/pzy044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 04/04/2018] [Indexed: 11/13/2022]
Abstract
Background People with low back pain (LBP) may display an altered lumbar movement pattern of early lumbar motion compared to people with healthy backs. Modifying this movement pattern during a clinical test decreases pain. It is unknown whether similar effects would be seen during a functional activity. Objective The objective of this study was to examine the lumbar movement patterns before and after motor skill training, effects on pain, and characteristics that influenced the ability to modify movement patterns. Design The design consisted of a repeated-measures study examining early-phase lumbar excursion in people with LBP during a functional activity test. Methods Twenty-six people with chronic LBP received motor skill training, and 16 people with healthy backs were recruited as a reference standard. Twenty minutes of motor skill training to decrease early-phase lumbar excursion during the performance of a functional activity were used as a treatment intervention. Early-phase lumbar excursion was measured before and after training. Participants verbally reported increased pain, decreased pain, or no change in pain during performance of the functional activity test movement in relation to their baseline pain. The characteristics of people with LBP that influenced the ability to decrease early-phase lumbar excursion were examined. Results People with LBP displayed greater early-phase lumbar excursion before training than people with healthy backs (LBP: mean = 11.2°, 95% CI = 9.3°-13.1°; healthy backs: mean = 7.1°, 95% CI = 5.8°-8.4°). Following training, the LBP group showed a decrease in the amount of early-phase lumbar excursion (mean change = 4.1°, 95% CI = 2.4°-5.8°); 91% of people with LBP reported that their pain decreased from baseline following training. The longer the duration of LBP (β = - 0.22) and the more early-phase lumbar excursion before training (β = - 0.82), the greater the change in early-phase lumbar excursion following training. Limitations The long-term implications of modifying the movement pattern and whether the decrease in pain attained was clinically significant are unknown. Conclusions People with LBP were able to modify their lumbar movement pattern and decrease their pain with the movement pattern within a single session of motor skill training.
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Affiliation(s)
- Andrej V Marich
- Program in Physical Therapy, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Vanessa M Lanier
- Program in Physical Therapy, School of Medicine, Washington University in St Louis
| | - Gretchen B Salsich
- Department of Physical Therapy and Athletic Training, Saint Louis University, St Louis, Missouri
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, School of Medicine, Washington University in St Louis
| | - Linda R Van Dillen
- Program in Physical Therapy and Department of Orthopaedic Surgery, School of Medicine, Washington University in St Louis, 4444 Forest Park Blvd, Campus Box 8502, St Louis, MO 63108 (USA)
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17
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Anterior Trunk Mobility Does Not Predict Disability in Elderly Women With Acute Low Back Pain: Brazilian Back Complaints in the Elders (BACE-Brazil) Study Results. Spine (Phila Pa 1976) 2017; 42:1552-1558. [PMID: 28296815 DOI: 10.1097/brs.0000000000002151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional, ancillary study of an international multicenter epidemiological study. OBJECTIVE To investigate the relationship of the anterior trunk mobility with self-report and physical performance measures in elderly women with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA LBP is one of the most prevalent pain complaints in the elderly population. It is postulated that the increased range of motion of limited joints of the trunk may improve LBP and functionality of patients. Recent studies have, however, questioned the association between trunk range of motion and the functional status. METHODS The present study included a convenience sample of elderly women from the community aged 60 years and older who presented with a new (acute) episode of LBP. Volunteers with severe diseases and visual, hearing and mobility losses, or cognitive impairment were excluded. Trunk mobility was assessed by the fingertip-to-floor test. Functionality was assessed by the Roland-Morris Questionnaire (RMQ) and gait speed test. Statistical analysis was performed by using hierarchical linear regression model. RESULTS Data from 459 elderly women, mean age of 69.0 (6.1) years old, were used to describe this report. The additional predictive value for the inclusion of independent variable trunk mobility was only 4.4% in the RMQ score and 1.5% in the gait speed test, respectively. A reduced hierarchical linear regression model showed that the significant predictors for RMQ and gait speed test were body mass index, pain intensity, and trunk mobility. CONCLUSION This was the first study to investigate the relationship between trunk mobility and functionality in elderly women with acute LBP. The results suggest that these clinical parameters are independent from each other. LEVEL OF EVIDENCE N/A.
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Rondoni A, Rossettini G, Ristori D, Gallo F, Strobe M, Giaretta F, Battistin A, Testa M. Intrarater and Inter-rater Reliability of Active Cervical Range of Motion in Patients With Nonspecific Neck Pain Measured With Technological and Common Use Devices: A Systematic Review With Meta-regression. J Manipulative Physiol Ther 2017; 40:597-608. [PMID: 29187311 DOI: 10.1016/j.jmpt.2017.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/07/2017] [Accepted: 07/20/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The purpose of this systematic review was to compare intrarater and inter-rater reliability of active cervical range of motion (ACROM) measures obtained with technological devices to those assessed with low-cost devices in patients with nonspecific neck pain. As a secondary outcome, we investigated if ACROM reliability is influenced by the plane of the assessed movement. METHODS Medline, Scopus, Embase, the Cochrane Library, CINHAL, PEDro, and gray literature were searched until August 2016. Inclusion criteria were reliability design, population of adults with nonspecific neck pain, examiners of any level of experience, measures repeated at least twice, and statistical indexes on reliability. A device was considered inexpensive if it cost less than €500. The risk of bias of included studies was assessed by Quality Appraisal of Reliability Studies. RESULTS The search yielded 35 151 records. Nine studies met all eligibility criteria. Their Quality Appraisal of Reliability Studies mean score was 3.7 of 11. No significant effect of the type of device (inexpensive vs expensive) on intraclass correlation coefficient (ICC) was identified for intrarater (ICC = 0.93 vs 0.91; P > .99) and inter-rater reliability (ICC = 0.80 vs 0.87; P > .99). The plane of movement did not affect inter-rater reliability (P = .11). Significant influences were identified with intrarater reliability (P = .0001) of inexpensive devices, where intrarater reliability decreased (P = .01) in side bending, compared with flexion-extension. CONCLUSIONS The use of expensive devices to measure ACROM in adults with nonspecific neck pain does not seem to improve the reliability of the assessment. Side bending had a lower level of intrarater reliability.
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Affiliation(s)
- Angie Rondoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova-Campus of Savona, Savona, Italy
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova-Campus of Savona, Savona, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova-Campus of Savona, Savona, Italy
| | - Fabio Gallo
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Marco Strobe
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova-Campus of Savona, Savona, Italy
| | | | | | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova-Campus of Savona, Savona, Italy.
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The Effect of Lumbar Disc Herniation on Spine Loading Characteristics during Trunk Flexion and Two Types of Picking Up Activities. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:6294503. [PMID: 29065628 PMCID: PMC5485332 DOI: 10.1155/2017/6294503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/16/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022]
Abstract
The main purpose of this study was to investigate the compensatory response of the muscle activities of seventeen major muscle groups in the spinal region, intradiscal forces of the five lumbar motion segment units (MSUs), and facet forces acting on the ten lumbar facet joints in patients with lumbar disc herniation (LDH). Twenty-six healthy adults and seven LDH patients performed trunk flexion, ipsilateral picking up, and contralateral picking up in sequence. Eight optical markers were placed on the landmarks of the pelvis and spinal process. The coordinates of these markers were captured to drive a musculoskeletal model to calculate the muscle activities, intradiscal forces, and facet forces. The muscle activities of the majority of the seventeen major muscle groups were found increases in LDH patients. In addition, the LDH patients displayed larger compressive forces and anteroposterior forces on all the five lumbar MSUs and more lumbar facet inventions on most facet joints. These findings suggest that the LDH patients demonstrate compensatory increases in the most trunk muscle activities and all spinal loads. These negative compensatory responses increase the risk of the aggravation of disc herniation. Therefore, treatment should intervene as earlier as possible for the severe LDH patients.
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20
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Minhas SV, Mazmudar AS, Patel AA. Pre-operative functional status as a predictor of morbidity and mortality after elective cervical spine surgery. Bone Joint J 2017; 99-B:824-828. [DOI: 10.1302/0301-620x.99b6.bjj-2016-1149.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/02/2017] [Indexed: 11/05/2022]
Abstract
Aims Patients seeking cervical spine surgery are thought to be increasing in age, comorbidities and functional debilitation. The changing demographics of this population may significantly impact the outcomes of their care, specifically with regards to complications. In this study, our goals were to determine the rates of functionally dependent patients undergoing elective cervical spine procedures and to assess the effect of functional dependence on 30-day morbidity and mortality using a large, validated national cohort. Patients and Methods A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program data files from 2006 to 2013 was conducted to identify patients undergoing common cervical spine procedures. Multivariate logistic regression models were generated to analyse the independent association of functional dependence with 30-day outcomes of interest. Results Patients with lower functional status had significantly higher rates of medical comorbidities. Even after accounting for these comorbidities, type of procedure and pre-operative diagnosis, analyses demonstrated that functional dependence was independently associated with significantly increased odds of sepsis (odds ratio (OR) 5.04), pulmonary (OR 4.61), renal (OR 3.33) and cardiac complications (OR 4.35) as well as mortality (OR 11.08). Conclusions Spine surgeons should be aware of the inherent risks of these procedures with the functionally dependent patient population when deciding on whether to perform cervical spine surgery, delivering pre-operative patient counselling, and providing peri-operative management and surveillance. Cite this article: Bone Joint J 2017;99-B:824–8.
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Affiliation(s)
- S. V. Minhas
- NYU Langone Hospital for Joint Diseases, Department
of Orthopaedic Surgery, New York, NY, USA
| | - A. S. Mazmudar
- Feinberg School of Medicine, Northwestern
University, Department of Orthopaedic Surgery, Chicago, IL, USA
| | - A. A. Patel
- Feinberg School of Medicine, Northwestern
University, Department of Orthopaedic Surgery, Chicago, IL, USA
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21
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Marich AV, Hwang CT, Salsich GB, Lang CE, Van Dillen LR. Consistency of a lumbar movement pattern across functional activities in people with low back pain. Clin Biomech (Bristol, Avon) 2017; 44:45-51. [PMID: 28324797 PMCID: PMC5432007 DOI: 10.1016/j.clinbiomech.2017.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limitation in function is a primary reason people with low back pain seek medical treatment. Specific lumbar movement patterns, repeated throughout the day, have been proposed to contribute to the development and course of low back pain. Varying the demands of a functional activity test may provide some insight into whether people display consistent lumbar movement patterns during functional activities. Our purpose was to examine the consistency of the lumbar movement pattern during variations of a functional activity test in people with low back pain and back-healthy people. METHODS 16 back-healthy adults and 32 people with low back pain participated. Low back pain participants were classified based on the level of self-reported functional limitations. Participants performed 5 different conditions of a functional activity test. Lumbar excursion in the early phase of movement was examined. The association between functional limitations and early phase lumbar excursion for each test condition was examined. FINDINGS People with low back pain and high levels of functional limitation demonstrated a consistent pattern of greater early phase lumbar excursion across test conditions (p<0.05). For each test condition, the amount of early phase lumbar excursion was associated with functional limitation (r=0.28-0.62). INTERPRETATION Our research provides preliminary evidence that people with low back pain adopt consistent movement patterns during the performance of functional activities. Our findings indicate that the lumbar spine consistently moves more readily into its available range in people with low back pain and high levels of functional limitation. How the lumbar spine moves during a functional activity may contribute to functional limitations.
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Affiliation(s)
- Andrej V Marich
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, 4444 Forest Park Ave, St. Louis, MO. 63108, USA.
| | - Ching-Ting Hwang
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, 4444 Forest Park Ave, St. Louis, MO. 63108, USA.
| | - Gretchen B Salsich
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline St, St. Louis, MO 63104, USA.
| | - Catherine E Lang
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, 4444 Forest Park Ave, St. Louis, MO. 63108, USA.
| | - Linda R Van Dillen
- Program in Physical Therapy, Washington University in St. Louis, School of Medicine, 4444 Forest Park Ave, St. Louis, MO. 63108, USA.
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Analysis of 3D multi-segment lumbar spine motion during gait and prone hip extension. J Electromyogr Kinesiol 2017; 33:111-117. [DOI: 10.1016/j.jelekin.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022] Open
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Longitudinal Study of the Six Degrees of Freedom Cervical Spine Range of Motion During Dynamic Flexion, Extension, and Rotation After Single-level Anterior Arthrodesis. Spine (Phila Pa 1976) 2016; 41:E1319-E1327. [PMID: 27831986 PMCID: PMC5119762 DOI: 10.1097/brs.0000000000001629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A longitudinal study using biplane radiography to measure in vivo intervertebral range of motion (ROM) during dynamic flexion/extension, and rotation. OBJECTIVE To longitudinally compare intervertebral maximal ROM and midrange motion in asymptomatic control subjects and single-level arthrodesis patients. SUMMARY OF BACKGROUND DATA In vitro studies consistently report that adjacent segment maximal ROM increases superior and inferior to cervical arthrodesis. Previous in vivo results have been conflicting, indicating that maximal ROM may or may not increase superior and/or inferior to the arthrodesis. There are no previous reports of midrange motion in arthrodesis patients and similar-aged controls. METHODS Eight single-level (C5/C6) anterior arthrodesis patients (tested 7 ± 1 months and 28 ± 6 months postsurgery) and six asymptomatic control subjects (tested twice, 58 ± 6 months apart) performed dynamic full ROM flexion/extension and axial rotation whereas biplane radiographs were collected at 30 images per second. A previously validated tracking process determined three-dimensional vertebral position from each pair of radiographs with submillimeter accuracy. The intervertebral maximal ROM and midrange motion in flexion/extension, rotation, lateral bending, and anterior-posterior translation were compared between test dates and between groups. RESULTS Adjacent segment maximal ROM did not increase over time during flexion/extension, or rotation movements. Adjacent segment maximal rotational ROM was not significantly greater in arthrodesis patients than in corresponding motion segments of similar-aged controls. C4/C5 adjacent segment rotation during the midrange of head motion and maximal anterior-posterior translation were significantly greater in arthrodesis patients than in the corresponding motion segment in controls on the second test date. CONCLUSION C5/C6 arthrodesis appears to significantly affect midrange, but not end-range, adjacent segment motions. The effects of arthrodesis on adjacent segment motion may be best evaluated by longitudinal studies that compare maximal and midrange adjacent segment motion to corresponding motion segments of similar-aged controls to determine if the adjacent segment motion is truly excessive. LEVEL OF EVIDENCE 3.
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Corbiere NC, Zeigler SL, Issen KA, Michalek AJ, Kuxhaus L. Ring apophysis fractures induced by low-load low-angle repetitive flexion in an ex-vivo cervine model. J Biomech 2016; 49:1477-1481. [PMID: 27036072 DOI: 10.1016/j.jbiomech.2016.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/09/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
Ring apophysis fractures of the spine occur in physically-active adolescents causing low back pain and the potential for chronic pain. Many of these fractures occur without memorable trauma, suggesting that the fractures occur during everyday movements and activities. The benign nature of this poorly understood potential mechanism of injury hampers appropriate diagnosis and early treatment. The purpose of this study was to establish an ex-vivo model of ring apophysis fracture and demonstrate that these fractures can be initiated by repetitive non-traumatic loading. Six 5-vertebra cervine lumbar (L1-L5) motion segments were cyclically loaded in low-angle low-load flexion (to 15° flexion, with peak load of 230±50N), a representative movement component of daily activities for both human and deer lumbar spines. Pinned end conditions replicated physiologically realistic loading. Ring apophysis fractures were created under low-load low-angle conditions in healthy vertebrae of similar bone mineral density and a similar degree of skeletal maturity to adolescent humans. All specimens developed ring apophysis fractures, some as early as 1400 cycles. The load-displacement data, and hysteresis loops during the cyclic loading, suggest that the fractures occurred gradually, i.e., without trauma. The ease at which these fractures were created suggests that ring apophysis fractures may be more prevalent than current diagnosis rates. Therefore, clinically, healthcare providers should include the potential for ring apophysis fracture in the differential diagnosis of all physically-active adolescents who present with back pain.
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Affiliation(s)
- Nicole C Corbiere
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
| | - Stacey L Zeigler
- Department of Physical Therapy, Clarkson University, Potsdam, NY, USA
| | - Kathleen A Issen
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
| | - Arthur J Michalek
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
| | - Laurel Kuxhaus
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY, USA
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Felício DC, Pereira DS, de Queiroz BZ, da Silva JP, Leopoldino AAO, Pereira LSM. Kinesiophobia is not associated with disability in elderly women with acute low back pain: Back Complaints in the Elders (BACE) Brazil study results. Spine J 2016; 16:619-25. [PMID: 26780753 DOI: 10.1016/j.spinee.2016.01.004] [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: 08/06/2015] [Revised: 12/01/2015] [Accepted: 01/01/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The study of low back pain (LBP) is complex, and the physical and psychological aspects, including kinesiophobia, should be considered. Several studies have investigated the relationship between kinesiophobia and functionality in patients with chronic LBP. However, to the best of the authors' knowledge, no studies have investigated the association between kinesiophobia and self-reported assessments of disability and physical performance in elderly patients with acute LBP. PURPOSE The study aimed to investigate the association between kinesiophobia and self-reported and physical performance measures among the elderly with acute LBP. DESIGN This was an observational, cross-sectional, ancillary study of the Back Complaints in the Elders study, a longitudinal observational epidemiologic research project by an international consortium involving Brazil, the Netherlands, and Australia. PATIENT SAMPLE Sample selection was carried out by convenience. The study included women from the community aged 60 years old and older who presented with a new episode of LBP. Volunteers with severe diseases, as well as visual, hearing, and mobility losses, or cognitive dysfunction, were excluded. Four hundred fifty nine elderly women (mean age: 69.0±6.1 years) were included. OUTCOME MEASURES Kinesiophobia was evaluated by Fear Avoidance Beliefs Questionnaire (FABQ), subscale FABQ-Phys. Functionality was investigated by the Roland-Morris Questionnaire and the gait speed test. METHODS Statistical analysis was performed using hierarchical linear regression model. Statistical significance was established at the level of .05. RESULTS The additional predictive value because of the inclusion of the FABQ-Phys was 0.1%, using the Roland-Morris score, and 0.2% for the gait speed test. CONCLUSIONS This was the first study to investigate the association between the FABQ-Phys and functionality in elderly patients with acute LBP. The results provide preliminary evidence that kinesiophobia assessed by the FABQ-Phys cannot be generalized to disability.
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Affiliation(s)
- Diogo C Felício
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil; Universidade Federal de Juiz de Fora, São Pedro, 36036-900 Juiz de Fora, MG, Brazil.
| | - Daniele S Pereira
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Barbara Z de Queiroz
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Juscelio P da Silva
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Amanda A O Leopoldino
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
| | - Leani S M Pereira
- Department of Physical Therapy, Post Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Antônio Carlos, 31270-901 Belo Horizonte, MG, Brazil
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Influence of the Number of Cervical Fusion Levels on Cervical Spine Motion and Health-Related Quality of Life. Spine (Phila Pa 1976) 2016; 41:E474-80. [PMID: 26630418 DOI: 10.1097/brs.0000000000001299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To analyze the influence of the number of cervical fusion levels on total cervical motion and health-related quality of life (HRQoL) in patients with solid anterior cervical fusions (ACFs). SUMMARY OF BACKGROUND DATA Few studies have analyzed the degree to which cervical range of motion (ROM) and HRQoL are affected by the number of cervical fusion segments. METHODS We analyzed a cohort of patients who underwent ACF for degenerative disc disease. To assess the clinical outcomes and HRQoL, preoperative, 1- and 2-year postoperative neck and arm pain, visual-analogue scale, neck disability index, and short form-36 were analyzed. Radiographically, C2-7 and C0-2 ROM, C2-7 sagittal vertical axis (SVA), and Kellgren grade of radiographic adjacent segment pathology (RASP) were evaluated. RESULTS A total of 105 patients (M:F = 46:59, mean age of 51.4 yr) were enrolled. There were 36 patients who underwent single-level ACF (group 1), 41 patients who had a double level ACF (group 2), and 28 patients who underwent ACF involving 3 or more levels (group 3). There was no decrease in C2-7 motion in group 1, a mean 7-degree decrease in group 2, a mean 18-degree decrease in those who underwent a 3-level ACF, and a mean 22-degree decrease after 4-level ACF. The grade of RASP was not influenced by the number of fusion levels. All HRQoL parameters showed no significant correlation between number of fusion levels, cervical ROM, and SVA. CONCLUSION Single-level ACF showed no decrease in total cervical motion; multilevel ACF decreased cervical motion by a mean of 7.8 degrees per segment of fusion. Progression of RASP showed no correlation with the number of fusion levels. HRQoLs were not influenced by the number of fusion levels, cervical ROM, or SVA after solid ACF. LEVEL OF EVIDENCE 3.
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Niederer D, Vogt L, Pippig T, Wall R, Banzer W. Local Muscle Fatigue and 3D Kinematics of the Cervical Spine in Healthy Subjects. J Mot Behav 2015; 48:155-63. [PMID: 26180902 DOI: 10.1080/00222895.2015.1058241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authors aimed to further explore the effects of local muscle fatigue on cervical 3D kinematics and the interrelationship between these kinematic characteristics and local muscle endurance capacity in the unimpaired cervical spine. Twenty healthy subjects (38 ± 10 years; 5 women) performed 2 × 10 maximal cervical flexion-extension movements. Isometric muscle endurance tests (prone/supine lying) were applied between sets to induce local muscle fatigue quantified by Borg scale rates of perceived exertion (RPE) and slope in mean power frequency (MPF; surface electromyography; m. sternocleidomastoideus, m. splenius capitis). Cervical motion characteristics (maximal range of motion [ROM], coefficient of variation of the 10 repetitive movements, mean angular velocity, conjunct movements in transversal and frontal plane) were calculated from raw 3D ultrasonic movement data. Average isometric strength testing duration for flexion and extension correlated to the cervical ROM (r = .49/r = .48; p < .05). However, Student's t test demonstrated no significant alterations in any kinematic parameter following local muscle fatigue (p > .05). Although subjects' cervical muscle endurance capacity and motor output seems to be conjugated, no impact of local cervical muscle fatigue on motor function was shown. These findings underline the importance of complementary measures to address muscular performance and kinematic characteristics in outcome assessment and functional rehabilitation of the cervical spine.
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Affiliation(s)
- Daniel Niederer
- a Department of Sports Medicine , Goethe-University Frankfurt/Main , Germany
| | - Lutz Vogt
- a Department of Sports Medicine , Goethe-University Frankfurt/Main , Germany
| | - Torsten Pippig
- b Department of Clinical Aviation Medicine , German Air Force Institute for Aviation Medicine , Fürstenfeldbruck , Germany
| | - Rudolf Wall
- a Department of Sports Medicine , Goethe-University Frankfurt/Main , Germany
| | - Winfried Banzer
- a Department of Sports Medicine , Goethe-University Frankfurt/Main , Germany
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Measurement of the number of lumbar spinal movements in the sagittal plane in a 24-hour period. 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 2014; 23:2375-84. [DOI: 10.1007/s00586-014-3588-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
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