Unsupervised machine learning for clustering forward head posture, protraction and retraction movement patterns based on craniocervical angle data in individuals with nonspecific neck pain.

OBJECTIVES: The traditional understanding of craniocervical alignment emphasizes specific anatomical landmarks. However, recent research has challenged the reliance on forward head posture as the primary diagnostic criterion for neck pain. An advanced relationship exists between neck pain and craniocervical alignment, which requires a deeper exploration of diverse postures and movement patterns using advanced techniques, such as clustering analysis. We aimed to explore the complex relationship between craniocervical alignment, and neck pain and to categorize alignment patterns in individuals with nonspecific neck pain using the K-means algorithm. METHODS: This study included 229 office workers with nonspecific neck pain who applied unsupervised machine learning techniques. The craniocervical angles (CCA) during rest, protraction, and retraction were measured using two-dimensional video analysis, and neck pain severity was assessed using the Northwick Park Neck Pain Questionnaire (NPQ). CCA during sitting upright in a comfortable position was assessed to evaluate the resting CCA. The average of midpoints between repeated protraction and retraction measures was considered as the midpoint CCA. The K-means algorithm helped categorize participants into alignment clusters based on age, sex and CCA data. RESULTS: We found no significant correlation between NPQ scores and CCA data, challenging the traditional understanding of neck pain and alignment. We observed a significant difference in age (F = 140.14, p < 0.001), NPQ total score (F = 115.83, p < 0.001), resting CCA (F = 79.22, p < 0.001), CCA during protraction (F = 33.98, p < 0.001), CCA during retraction (F = 40.40, p < 0.001), and midpoint CCA (F = 66.92, p < 0.001) among the three clusters and healthy controls. Cluster 1 was characterized by the lowest resting and midpoint CCA, and CCA during pro- and -retraction, indicating a significant forward head posture and a pattern of retraction restriction. Cluster 2, the oldest group, showed CCA measurements similar to healthy controls, yet reported the highest NPQ scores. Cluster 3 exhibited the highest CCA during protraction and retraction, suggesting a limitation in protraction movement. DISCUSSION: Analyzing 229 office workers, three distinct alignment patterns were identified, each with unique postural characteristics; therefore, treatments addressing posture should be individualized and not generalized across the population.

Relationship between cervical lordotic angle and cervical segmental motion during craniocervical flexion test: A cross-sectional study.

The craniocervical flexion test (CCFT) is commonly used for assessing the performance and function of the deep cervical flexor muscles; however, objective measurements of cervical segmental motion during craniocervical flexion (CCF) are lacking. Therefore, the purpose of this study aimed to investigate cervical segmental motions during CCFT and determine the relationship between changes of cervical segmental motions and the cervical lordotic angle. A cross-sectional study of prospectively collected data. Twenty healthy participants without neck pain underwent standing cervical radiography (lateral view) to measure the cervical lordotic angle, followed by radiography in supine position during the CCFT. The occipito-atlantal (OA) joint angle, atlantoaxial (AA) joint angle, and cervical spinous process posterior displacement (CSPPD) of the C1-C6 vertebrae were measured using lateral cervical radiographs taken during the initial (20 mm Hg) and low-stage (24 mm Hg) CCFT conditions. The CCF motion during the low-stage CCFT was characterized by a significantly increased OA joint angle, decreased AA joint angle, and increased C1-C6 CSPPD compared with the initial stage (P < .05). The change in the value of C1-C6 CSPPD at low-stage CCFT showed a significant positive correlation with the cervical lordotic angle. These results indicate that the cervical lordotic angle is important in minimizing CSPPD and performing appropriately-isolated CCF motion during CCFT.

Machine learning models for classifying non-specific neck pain using craniocervical posture and movement.

OBJECTIVE: Physical therapists and clinicians commonly confirm craniocervical posture (CCP), cervical retraction, and craniocervical flexion as screening tests because they contribute to non-specific neck pain (NSNP). We compared the predictive performance of statistical machine learning (ML) models for classifying individuals with and without NSNP using datasets containing CCP and cervical kinematics during pro- and retraction (CKdPR). DESIGN: Exploratory, cross-sectional design. SETTING AND PARTICIPANTS: In total, 773 public service office workers (PSOWs) were screened for eligibility (NSNP, 441; without NSNP, 332). METHODS: We set up five datasets (CCP, cervical kinematics during the protraction, cervical kinematics during the retraction, CKdPR and combination of the CCP and CKdPR). Four ML algorithms-random forest, logistic regression, Extreme Gradient boosting, and support vector machine-were trained. MAIN OUTCOME MEASURES: Model performance were assessed using area under the curve (AUC), accuracy, precision, recall and F1-score. To interpret the predictions, we used Feature permutation importance and SHapley Additive explanation values. RESULTS: The random forest model in the CKdPR dataset classified PSOWs with and without NSNP and achieved the best AUC among the five datasets using the test data (AUC, 0.892 [good]; F1, 0.832). The random forest model in the CCP dataset had the worst AUC among the five datasets using the test data [AUC, 0.738 (fair); F1, 0.715]. CONCLUSION: ML performance was higher for the CKdPR dataset than for the CCP dataset, suggesting that ML algorithms are more suitable than classical statistical methods for developing robust models for classifying PSOWs with and without NSNP.

Classification of chronic ankle instability using machine learning technique based on ankle kinematics during heel rise in delivery workers.

Objective: Ankle injuries in delivery workers (DWs) are often caused by trips, and high recurrence rates of ankle sprains are related to chronic ankle instability (CAI). Heel rise requires joint angles and moments similar to those of the terminal stance phase of walking that the foot supinates. Thus, our study aimed to develop, determine, and compare the predictive performance of statistical machine learning models to classify DWs with and without CAI using ankle kinematics during heel rise. Methods: In total, 203 DWs were screened for eligibility. Seven predictors were included in our study (age, work duration, body mass index, calcaneal stance position angle [CSPA] in the initial and terminal positions during heel rise, calcaneal movement during heel rise [CMHR], and plantar flexion angle during heel rise). Six machine learning algorithms, including logistic regression, decision tree, AdaBoost, Extreme Gradient boosting machines, random forest, and support vector machine, were trained. Results: The random forest model (area under the curve [AUC], 0.967 [excellent]; F1, 0.889; accuracy, 0.925) confirmed the best predictive performance in the test datasets among the six machine learning models. For Shapley Additive Explanations, old age, low CMHR, high CSPA in the initial position, high PFA, long work duration, low CSPA in the terminal position, and high body mass index were the most important predictors of CAI in the random forest model. Conclusion: Ankle kinematics during heel rise can be considered in the classification of DWs with and without CAI.

Effects of 4-week downhill treadmill walking on the vertebral angle and postural muscle activity in participants with thoracic kyphosis and forward head posture: A comparative longitudinal study.

BACKGROUND: Maintaining correct posture and optimal spine function has become an important issue due to the increased use of computers and smartphones. OBJECTIVE: To investigate the effect of a 4-week downhill treadmill exercise (DTWE) program on participants with thoracic kyphosis and forward head posture (FHP). METHODS: Twenty-eight male participants were randomly assigned to the DTWE (n= 14) or standard treadmill walking exercise (STWE) (n= 14) group. They performed 30-minute exercise three times a week for 4 weeks. The vertebral angle was measured using a three-dimensional (3D) motion analysis system. Surface electromyography (EMG) was performed to record muscle activity in the thoracic erector spinae (TES), sternocleidomastoid muscle (SCM), and cervical erector spinae (CES). RESULTS: The DTWE group showed significant increases in the craniovertebral angle (CVA) and TES EMG activity and significant decreases in the thoracic kyphosis angle and SCM and CES EMG activity compared with those shown by the STWE group following the intervention (p< 0.05). However, lumbar lordosis or pelvic tilt angles did not differ significantly between the groups after the intervention (p> 0.05). CONCLUSIONS: DTWE can be effective in reducing thoracic kyphosis and FHP without causing compensatory movements of the lumbar spine and pelvis.

Respiratory Parameters as Predictors of Balance and Gait Ability in Patients with Stroke at Discharge.

Pulmonary complications are frequent in stroke, contributing to both mortality and morbidity rates. Respiratory parameters in such patients encompass both pulmonary function and respiratory muscle strength. Identifying respiratory function variables that influence the balance and gait ability of patients with stroke is crucial for enhancing their recovery in these aspects. However, no study has assessed predictions for a comprehensive array of balance and gait abilities in such patients. We aimed to examine whether initial respiratory muscle strength and pulmonary function can predict balance and gait ability at discharge from a rehabilitation program. Thirty-one patients with stroke were included in this prospective observational study. Multiple regression models with a forward selection procedure were employed to identify respiratory parameters (including peak expiratory flow and maximal expiratory pressure) that contributed to the results of balance assessments and gait evaluations at the time of discharge. The peak expiratory flow (PEF) served as a predictor explaining 42.0% of the variance. Similarly, the maximal expiratory pressure (MEP) was a predictor variable explaining 32.0% of the variance. PEF and MEP assessments at the initial stage as predictive factors for both balance and gait ability are important in stroke management.

Prediction model of subacromial pain syndrome in assembly workers using shoulder range of motion and muscle strength based on support vector machine.

Subacromial pain syndrome (SAPS) is the most common upper-extremity musculoskeletal problem among workers. In this study, a machine learning model was built to predict and classify the presence or absence of SAPS in assembly workers with shoulder joint range of motion (ROM) and muscle strength data using support vector machine (SVM). Permutation importance was used to determine important variables for predicting workers with or without SAPS. The accuracy of the support vector classifier (SVC) polynomial model for classifying workers with SAPS was 82.4%. The important variables in model construction were internal rotation and abduction of shoulder ROM and internal rotation of shoulder muscle strength. It is possible to accurately perform SAPS classification of workers with relatively easy-to-obtain shoulder ROM and muscle strength data using this model. In addition, preventing SAPS in workers is possible by adjusting the factors affecting model building using exercise or rehabilitation programs.Practitioner summary: This study aimed to create a machine learning model that can predict and classify SAPS using shoulder ROM and muscle strength and identify the variables that are of high importance in model construction. This model could be used to predict or classify workers' SAPS and manage or prevent SAPS.

When all C-C breaks LO-Ose.

Organic peroxides are becoming popular intermediates for novel chemical transformations. The weak O-O bond is readily reduced by transition metals, including iron and copper, to initiate a radical cascade process that breaks C-C bonds. Great potential exists for the rapid generation of complexity, originating from the ability to couple the resulting free radicals with a wide range of partners. First, this review article discusses the history and synthesis of organic peroxides, providing the context necessary to understand this methodology. Then, it highlights 91 examples of recent applications of the radical functionalization of C-C bonds accessed through the transition metal-mediated reduction of organic peroxides. Finally, we provide some comments about safety when working with organic peroxides.

Aminodealkenylation: Ozonolysis and copper catalysis convert C(sp3)-C(sp2) bonds to C(sp3)-N bonds.

Great efforts have been directed toward alkene π bond amination. In contrast, analogous functionalization of the adjacent C(sp3)-C(sp2) σ bonds is much rarer. Here we report how ozonolysis and copper catalysis under mild reaction conditions enable alkene C(sp3)-C(sp2) σ bond-rupturing cross-coupling reactions for the construction of new C(sp3)-N bonds. We have used this unconventional transformation for late-stage modification of hormones, pharmaceutical reagents, peptides, and nucleosides. Furthermore, we have coupled abundantly available terpenes and terpenoids with nitrogen nucleophiles to access artificial terpenoid alkaloids and complex chiral amines. In addition, we applied a commodity chemical, α-methylstyrene, as a methylation reagent to prepare methylated nucleosides directly from canonical nucleosides in one synthetic step. Our mechanistic investigation implicates an unusual copper ion pair cooperative process.

Image-Based Dosimetry in Dogs and Cross-Reactivity with Human Tissues of IGF2R-Targeting Human Antibody.

BACKGROUND: Osteosarcoma (OS) represents the most common primary bone tumor in humans and in companion dogs, being practically phenotypically identical. There is a need for effective treatments to extend the survival of patients with OS. Here, we examine the dosimetry in beagle dogs and cross-reactivity with human tissues of a novel human antibody, IF3, that targets the insulin growth factor receptor type 2 (IGF2R), which is overexpressed on OS cells, making it a candidate for radioimmunotherapy of OS. METHODS: [89Zr]Zr-DFO-IF3 was injected into three healthy beagle dogs. PET/CT was conducted at 4, 24, 48, and 72 h. RAPID analysis was used to determine the dosimetry of [177Lu]Lu-CHXA"-IF3 for a clinical trial in companion dogs with OS. IF3 antibody was biotinylated, and a multitude of human tissues were assessed with immunohistochemistry. RESULTS: PET/CT revealed that only the liver, bone marrow, and adrenal glands had high uptake. Clearance was initially through renal and hepatobiliary excretion in the first 72 h followed by primarily physical decay. RAPID analysis showed bone marrow to be the dose-limiting organ with a therapeutic range for 177Lu calculated to be 0.487-0.583 GBq. Immunohistochemistry demonstrated the absence of IGF2R expression on the surface of healthy human cells, thus suggesting that radioimmunotherapy with [177Lu]Lu-CHXA"-IF3 will be well tolerated. CONCLUSIONS: Image-based dosimetry has defined a safe therapeutic range for canine clinical trials, while immunohistochemistry has suggested that the antibody will not cross-react with healthy human tissues.

Characteristic MR Imaging Features and Serial Changes in Adult-Onset Alexander Disease: A Case Report.

Adult-onset Alexander Disease (AOAD) is a rare genetically determined leukoencephalopathy that presents with ataxia, spastic paraparesis, or brain stem signs including speech abnormalities, swallowing difficulties, and frequent vomiting. The diagnosis of AOAD is frequently proposed based on the findings on MRI. We demonstrate two cases (37-year-old female and 61-year-old female) with characteristic imaging findings and changes in follow-up MRI in patients with AOAD, which were confirmed via glial fibrillary acidic protein (GFAP) mutation analysis. On MRI, the typical tadpole-like brainstem atrophy and periventricular white matter abnormalities were noted. The presumptive diagnoses were made based on the typical MRI appearances and, subsequently, confirmed via GFAP mutation analysis. Follow-up MRI demonstrated the progression of atrophy in the medulla and upper cervical spinal cord. Our report could help raise awareness of characteristic MRI findings of AOAD, thus helping clinicians use GFAP analysis for AOAD diagnosis confirmation.

Effect of electrical stimulation training and detraining on abdominal muscle function.

BACKGROUND: Electrical muscle stimulation (EMS) has been applied in many rehabilitation settings for muscle strengthening, facilitation of muscle contraction, re-education of muscle action, and maintenance of muscle strength and size during prolonged immobilization. OBJECTIVE: The purpose of this study was to investigate effect of 8 weeks of EMS training on abdominal muscle function and to determine whether the training effect could be maintained after 4 weeks of EMS detraining. METHODS: Twenty-five subjects performed EMS training for 8 weeks. Before and after 8 weeks of EMS training, and after 4 weeks of EMS detraining, muscle size (cross-sectional area [CSA] of the rectus abdominals [RA] and lateral abdominal wall [LAW]), strength, endurance, and lumbopelvic control (LC) were measured. RESULTS: There were significant increases in CSA [RA (p< 0.001); LAW (p< 0.001)], strength [trunk flexor (p= 0.005); side-bridge (p< 0.05)], endurance [trunk flexor (p= 0.010); side-bridge (p< 0.05)], and LC (p< 0.05) after 8 weeks of EMS training. The CSA of the RA (p< 0.05) and the LAW (p< 0.001) were measured after 4 weeks of detraining and they were greater than that of the baseline. There were no significant differences in abdominal strength, endurance, and LC between baseline measurements and post-detraining. CONCLUSION: The study indicates that there is less of a detraining effect on muscle size than on muscle strength, endurance, and LC.

Characteristics of Diverse Verbal Pain Descriptors in South Korean Patients With Peripheral Neuropathic Pain: 'Jeorim' (Tingling) and 'Sirim' (Cold) as Key Neuropathic Pain Descriptors.

BACKGROUND AND PURPOSE: The description of pain is the most-important indicator leading to the adequate treatment of patients with neuropathic pain (NeP). The purpose of this study was to identify and characterize the unique features of Korean verbal descriptions in patients with peripheral NeP. METHODS: This study included 400 patients (167 males and 233 females) and their 1,387 pain-description responses. Patients with peripheral NeP freely described their symptoms in Korean. Collected verbal descriptions were grouped according to terminologies with similar meanings. Participants completed validated patient-reported outcome scales including the neuropathic pain symptom inventory (NPSI) and painDETECT questionnaire (PD-Q). The frequencies of each verbal pain descriptor were compared between the NPSI and PD-Q scores. RESULTS: 'Jeorim' (tingling) was the most common among 17 types of organized verbal pain descriptors, and the 'Sirim' (cold) symptom had a significantly higher rate of use in the 2 high-severity groups when participants were classified by their total scores on the NPSI and PD-Q. CONCLUSIONS: Korean verbal NeP descriptors were significantly diverse. The Jeorim (tingling) and Sirim (cold) descriptors can be utilized in evaluations of Korean patients with NeP.

Degradation Analysis of Organic Light-Emitting Diodes through Dispersive Magneto-Electroluminescence Response.

Understanding the stability and degradation of organic light-emitting diodes (OLEDs) under working conditions is a significant area of research for developing more effective OLEDs and further improving their performance. However, studies of degradation processes by in situ noninvasive methods have not been adequately developed. In this work, tris-(8-hydroxyquinolino) aluminum (Alq3)-based OLED degradation processes have been analyzed through the investigation of the device dispersive magneto-electroluminescence (MEL(B)) response measured at room temperature. By studying the change in the MEL(B) response during the device degradation under different external stimuli, such as exposing the device to the atmosphere and prolonged illumination by a strong visible light source, we have gained insight into the microscopic spin-dependent phenomena that control the recombination of e-h polaron pairs in the device. We found that the device degradation leads to a shorter e-h polaron lifetime, smaller dispersive parameter, and broader lifetime distribution function that shows increased disorder in the active layer. This study could offer a potential tool that may be beneficial for assessing the degradation of OLED devices based on various active layers.

Comparison of shoulder functions between assembly workers with and without subacromial pain syndrome.

BACKGROUND: The occurrence of subacromial pain syndrome (SPS) is associated with the frequent handling and lifting of heavy loads and excessive repetitive work. Thus, assembly workers have a high prevalence of SPS. OBJECTIVE: The purpose of this study was to investigate differences in shoulder ROM, muscle strength, asymmetry ratio, function, productivity, and depression between workers with and without SPS. METHODS: Sixty-seven male workers (35 workers with SPS and 32 workers without SPS) participated in this study. Shoulder internal rotation (SIR), shoulder external rotation (SER), shoulder abduction (SAB), shoulder horizontal adduction ROM and SIR, SER, elbow flexion (EF), scapular depression and adduction, scapular protraction strength were measured. The asymmetry ratio was calculated using the asymmetry ratio formula; shoulder functions were measured using the shoulder pain and disability index (SPADI), disabilities of the arm, shoulder, and hand (DASH), and visual analogue scale (VAS); and Endicott work productivity scale (EWPS). RESULTS: The SPADI (p = 0.001), DASH (p = 0.001), and VAS (p = 0.001) values of workers with SPS were higher than those of workers without SPS. Also, workers with SPS had lower SIR (p = 0.001) and SAB (p = 0.002) ROM compared to workers without SPS. In addition, workers with SPS exhibited lower SIR (p = 0.012) strength than workers without SPS. Workers with SPS had higher asymmetry ratio in SIR (p = 0.015), SER (p = 0.005), and EF (p = 0.008) strength than workers without SPS. CONCLUSIONS: The SIR, SAB ROM, SIR strength, and the asymmetry ratio of SIR, SER, EF strengths could provide an important baseline comparison for the workers with SPS.

Clinical pitfalls and serological diagnostics of MuSK myasthenia gravis.

BACKGROUND: We aimed to evaluate the diagnostic accuracy of enzyme-linked immunosorbent assay (ELISA) for anti-muscle specific tyrosine kinase (MuSK) antibody (Ab) in a large cohort of anti-acetylcholine receptor (AChR) Ab-negative generalized myasthenia gravis (MG), and also to investigate clinical contexts for the diagnosis of MuSK MG. METHODS: A retrospective study of 160 patients with a clinical suspicion of AChR Ab-negative generalized MG was performed. The serum samples were tested for anti-clustered AChR Ab by cell-based assay (CBA), anti-MuSK Ab by ELISA, CBA and/or radioimmunoprecipitation assay (RIPA). Clinical data were compared between anti-MuSK Ab-positive MG and double seronegative (AChR and MuSK) MG groups. RESULTS: After excluding non-MG and clustered AChR Ab-positive patients, we identified 89 patients as a cohort of AChR Ab-negative generalized MG. Anti-MuSK Ab was positive by ELISA in 22 (24.7%) patients. While CBA identified five additional anti-MuSK Ab-positive patients, the results of ELISA were mostly consistent with CBA and RIPA with Cohen's kappa of 0.80 and 0.90, respectively (p < 0.001). The most frequent differential diagnosis was motor neuron disease particularly of bulbar onset which showed remarkably overlapping clinical and electrophysiological features with MuSK MG at presentation. CONCLUSION: While confirming the highest sensitivity of CBA for detecting anti-MuSK Ab, our results highlight the clinical pitfalls in making a diagnosis of MuSK MG and may support a diagnostic utility of MuSK-ELISA in clinical practice.

Comparison of acromiohumeral distance and glenohumeral internal rotation angle between the empty can test and modified empty can test: "thumb pointing down" versus "elbow pointing laterally".

BACKGROUND: During the empty can test, the direction of the thumb (downward) has been widely used as an instruction for producing glenohumeral internal rotation. However, the combination of forearm pronation and thumb motion as a compensatory movement could contribute to the lack of glenohumeral internal rotation during the empty can test. This study aimed to compare the glenohumeral internal rotation angle between the conventional empty can (with thumb direction) and modified empty can tests (with elbow direction), as well as the acromiohumeral distance between the full can, conventional empty can, and modified empty can tests. METHODS: In this laboratory study, we measured the glenohumeral internal rotation angle using a motion sensor and the acromiohumeral distance using ultrasonography during the following tests: full can test (thumb pointing up), conventional empty can test (thumb pointing down), and modified empty can test (elbow pointing laterally) in 20 healthy subjects. RESULTS: Compared with the conventional empty can test, the glenohumeral internal rotation angle was significantly greater during the modified empty can test (p < 0.05). Furthermore, the acromiohumeral distance measured in the modified empty can test was significantly less than that in the full can test (p < 0.001) and conventional empty can test (p < 0.001). However, there was no difference in the acromiohumeral distance between the full can test and the conventional empty can test (p > 0.017). CONCLUSIONS: During the empty can test, the instructions should be given to patients based on the elbow direction (elbow pointing laterally). The modified empty can test can produce full glenohumeral internal rotation, compared with instructions based on the thumb direction (thumb pointing down). Consequently, the modified empty can test can produce a more decreased subacromial space.

Effect of pelvic floor muscle electrical stimulation on lumbopelvic control in women with stress urinary incontinence: randomized controlled trial.

INTRODUCTION: The pelvic floor muscle (PFM) plays a role not only in lumbopelvic stabilization, but also in incontinence and sexual function. OBJECTIVE: This study aimed to determine the effectiveness of PFM training by electrical stimulation (ES) on urinary incontinence, PFM performance (i.e. strength and power), lumbopelvic control, and abdominal muscle thickness in women with stress urinary incontinence (SUI). METHODS: Participants were randomized into ES and control groups. The ES group underwent PFM ES for 8 weeks, whereas the control group underwent only a walking program. The impact of urinary incontinence on quality of life was assessed by the Incontinence Impact Questionnaire (IIQ)-7. PFM strength and power were measured using a perineometer. Lumbopelvic control was measured by one and double-leg-lowering tests. Abdominal muscle thickness was measured by sonography. RESULTS: The ES group showed significantly improved IIQ-7 scores and PFM performance, and had significantly higher values in both one and double-leg lowering tests (p < .05) after 8 weeks of training, indicating significant improvement from pre-session values (p < .005). There were no significant between- or within-group differences at rest in abdominal muscle thickness. CONCLUSION: PFM ES could improve lumbopelvic control and PFM performance, and reduce subjective symptoms of urinary incontinence in women with SUI.

Correlation between trunk rotation and lateral flexion range of motion, peak cough flow, and chest expansion in stroke patients.

INTRODUCTION: Stroke patients have problems with voluntary movement and trunk control. Moreover, the respiratory function in stroke patients is affected by neurological impairment, which increases the incidence of respiratory complications. OBJECTIVES: To determine the correlation between trunk rotation range of motion (TRROM) and trunk lateral flexion range of motion (TLFROM), peak cough flow (PCF), and chest expansion in stroke patients. METHODS: This was an observational study involving 21 patients with a clinical diagnosis of stroke from October 2021 to January 2022. TRROM and TLFROM were assessed using smartphone applications (Compass and Clinometer), respectively, PCF was assessed using a peak flow meter, and chest expansion was assessed using a tape measure. Pearson's correlation was used to analyze the relationships between the variables. RESULTS: Statistically significant correlations were found between TRROM and TLFROM (r = 0.91, p < 0.01) and between upper chest expansion and PCF (r = 0.59, p < 0.01). There were significant correlations between lower chest expansion and TRROM (r = 0.50, p < 0.05) and between lower chest expansion and TLFROM (r = 0.51, p < 0.05). CONCLUSION: This study demonstrates the relationship between upper chest expansion and PCF. Upper chest expansion exercises should be considered to improve the PCF in stroke patients. In addition, a very strong positive correlation between TRROM and TLFROM was demonstrated. TRROM and TLFROM exercises should be considered to improve the lower chest expansion in stroke patients.

Altered muscle recruitment patterns during isometric shoulder abduction in individuals with chronic upper trapezius pain: a cross sectional study.

BACKGROUND: Upper trapezius (UT) pain with myofascial trigger points (MTrPs) can affect movement at the glenohumeral joint as well as at the scapulothoracic joint. The investigation of muscle recruitment patterns can discern motor control strategies. The purpose of this study was to compare shoulder muscle recruitment patterns and muscle activity according to various loads between individuals with and without chronic UT pain. METHODS: In this cross-sectional study, twenty-four participants that had UT pain with MTrPs and sex, age, body weight matched 24 controls with no UT pain were recruited. Surface EMG electrodes were attached to the UT, the serratus anterior (SA), the lower trapezius (LT) and the middle deltoid (MD). All participants performed isometric shoulder abduction with a load of 25%, 50%, or 75% of the maximum strength at 60° of shoulder abduction. The EMG activity, the activity ratio (SA/UT, LT/UT, MD/UT), and the relative contribution of each muscle activity were calculated. RESULTS: MD activity was significantly decreased in the UT pain group compared to that in the control group (p < 0.05). The EMG activity ratio of SA/UT (p < 0.025) and the relative contribution of SA activity to shoulder abduction (p < 0.05) were significantly greater in the UT pain group than in the control group in the 25% loading condition. CONCLUSION: The results of present study showed that UT pain with MTrPs may increase the relative contribution of SA activity and decrease MD activity at low loads. Altered recruitment patterns of scapular upward rotators can be altered in the proper scapular position, which results in decreased MD activity. Clinicians should consider altered recruitment patterns when managing UT pain. TRIAL REGISTRATION: Clinical Research Information Service: Clinical Research Information Service (KCT0007370; 08/06/2022).