The Female Thumb Carpometacarpal Joint: Motion and Force Changes Due to Arthritis and Surgical Intervention.

Thumb carpometacarpal (CMC) osteoarthritis (OA) has been one of the most common locations of hand OA. CMC OA disproportionately occurs in females over males. In severe cases, surgical intervention may be needed. However, to determine the effects of surgical treatment, normative, pre-, and postsurgery function must be understood. The goals of this work were to compare the thumb motion and force abilities of older healthy (OH) females without CMC OA to those of females with CMC OA and who received ligament reconstruction with tendon interposition (LRTI) surgery at time points presurgery, 3- and 6-months postsurgery. On average, CMC OA participants 3- and 6-months postsurgery showed 35.6% and 32.9% less overall metacarpal motion compared to presurgery, 31.9% and 29.1% less than OH, and exhibited altered motion. Metacarpal flexion/extension and abduction/adduction ranges were 51.9 deg and 43.4 deg for OH, 52.9 deg and 40.3 deg presurgery, 39.9 deg and 33.5 deg at 3-months, and 42.6 deg and 32.7 deg at 6-months postsurgery. On average, participants had increased force generation at 6-months postsurgery compared to presurgery, and 20% of participants returned to the level of OH females. These data sets highlight changes in thumb metacarpal movement and thumb force generation due to disease and surgical intervention. This work has the ability to support both surgeons and patients through improved outcome assessments as well as additional data to inform the decision process on intervention.

Kinematic Investigation of Healthy, Arthritic, and Postsurgery Thumbs: Is the Metacarpophalangeal Joint the Gateway to Carpometacarpal Arthritis?

The thumb carpometacarpal (CMC) joint is one of the most likely joints to develop osteoarthritis (OA). If conservative treatments fail to alleviate symptoms, surgery may be pursued. Kinematic outcomes of CMC surgery techniques have been described, but current tools have limitations in capturing motion abilities. The goals of this study were (1) develop a new and robust set of kinematic outcome measures, and apply them to (2) a cohort of younger and older control individuals without CMC OA to determine age and sex-related changes, and (3) a cohort of participants with CMC OA before, 3 months, and 6 months after undergoing thumb ligament reconstruction with tendon interposition surgery to detect the impacts of surgery. 52 (26 males, 26 females) control and 18 (3 males, 15 females) surgical participants were tested. Kinematics were investigated using motion capture by mapping the three-dimensional motion space of the whole thumb, and two-dimensional motion boundaries of the metacarpal (MC) and proximal phalange (PP). Visual analog pain score was recorded. Older control participants had shifted regions of motion compared to younger participants (p ≤ 0.027), suggesting asymptomatic CMC wear. Control females had 31% more metacarpophalangeal (MCP) motion than control males (p = 0.013), which could alter loading paths through the CMC joint and increase OA risk. Pain at 6 months postsurgery was 72% less than presurgery (p < 0.001), but motion abilities were 20-28% less than presurgery (p ≤ 0.074) and 24-40% less than control participants (p ≤ 0.066). These techniques have the possibility of identifying presymptomatic motion changes, including those at the metacarpophalangeal joint in CMC OA progression.

A review of the characterizations of soft tissues used in human body modeling: Scope, limitations, and the path forward.

Soft tissue material properties are vital to human body models that evaluate interactions between the human body and its environment. Such models evaluate internal stress/strain responses in soft tissues to investigate issues like pressure injuries. Numerous constitutive models and parameters have been used to represent mechanical behavior of soft tissues in biomechanical models under quasi-static loading. However, researchers reported that generic material properties cannot accurately represent specific target populations due to large inter-individual variability. Two challenges that exist are experimental mechanical characterization and constitutive modeling of biological soft tissues and personalization of constitutive parameters using non-invasive, non-destructive bedside testing methods. It is imperative to understand the scope and appropriate applications for reported material properties. Thus, the goal of this paper was to compile studies from which soft tissue material properties were obtained and categorize them by source of tissue samples, methods used to quantify deformation, and material models used to describe tissues. The collected studies displayed wide ranges of material properties, and factors that affected the properties included whether tissue samples were in vivo or ex vivo, from humans or animals, the body region tested, body position during in vivo studies, deformation measurements, and material models used to describe tissues. Because of the factors that affected reported material properties, it is clear that much progress has been made in understanding soft tissue responses to loading, yet there is a need to broaden the scope of reported soft tissue material properties and better match reported properties to appropriate human body models.

Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies.

STUDY DESIGN: Invited review. BACKGROUND: Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments. PURPOSE: The purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder. METHODS: A search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review. RESULTS: This review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation. CONCLUSIONS: The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.

Shifting loads as a result of chair articulations and associated perfusion responses in the context of pressure injuries: An investigation with able-bodied individuals.

Wheelchair users with spinal cord injuries experience pressure injuries at high rates, causing a decrease in quality of life and an increased financial burden. The soft tissue in the buttocks (beneath the ischial tuberosities) and lower back (behind the sacrum) experience large interface pressures over long periods while seated, putting them at high risk of pressure injury development. The goals of this research were to evaluate the ability of an articulating chair design to redistribute pressures on the body and to affect blood perfusion in the buttocks tissue over the ischial tuberosities. Using a unique, custom-designed chair developed for this research, pressure and blood perfusion were obtained for numerous seated positions that included recline, seat pan tilt, and back articulations. Reclining the chair back increased maximum pressures in the buttocks and lower back regions, while it decreased maximum pressures in the upper back and thigh regions. Increasing seat pan tilt, or rotating the anterior edge of the seat pan above the posterior edge, decreased maximum pressures in the buttocks and lower back regions and increased perfusion in the buttocks. Results suggested that using back recline and seat pan tilt together to create a whole-body tilt increased pressures in the back and decreased pressures in the buttocks. Changes in back articulation redistributed pressure in all back regions. Thus, the articulating chair design redistributed pressures in all areas of the body and promoted blood perfusion in the buttocks while seated. Pressure redistribution and perfusion promotion are fundamental to reducing pressure injury risk.

Key Components Related to Pressure Injury Formation: An Initial Investigation Into Pressure Distribution and Blood Perfusion Responses in Wheelchair Users.

Soft tissue around bony prominences in the buttocks and back are high-risk areas prone to the development of pressure injuries. From a clinical perspective, prevention of pressure injuries all together is the ideal situation. Unfortunately, prevalence rates still reach 47% with recurrence rates even higher. The goals of this study were to evaluate the effects of a series of wheelchair movements, some that currently exist in commercial wheelchairs and some new, on interface pressures and perfusion under the buttocks. Twenty-seven chair positions were obtained by varying back recline, seat pan tilt, and articulation of two supports along the back. Although back recline is commonly taught by therapists to be used as a pressure relieving posture, results indicated an increase in pressures under the ischial tuberosities and sacral areas in reclined positions. Articulation of the back supports produced changes in posture moving from an "erect" to "slouched" position. These movements successfully shifted pressures across back regions. Seat pan tilt was effective in shifting pressures off the ischial tuberosity regions. Additionally, in a portion of the participants, seat pan tilt consistently increased perfusion under the ischial tuberosity region. The findings of this research suggest that movements other than back recline should be considered to more effectively alter interface pressures, particularly in high-risk regions like the sacrum and ischial tuberosities.

Determining Isolated Thumb Forces in Osteoarthritic and Healthy Persons.

Carpometacarpal (CMC) osteoarthritis (OA) can dramatically impair thumb function resulting in the inability to complete basic tasks. Development of a method to detect thumb forces changes is essential to understand of the progression of carpometacarpal osteoarthritis and the effects of treatment. The goals of this study were to (1) develop a method to measure thumb forces in multiple directions, (2) perform an initial demonstration of this method on three populations, young healthy (YH), older healthy (OH), and older participants with carpometacarpal osteoarthritis, and (3) determine the effects of short-term exercises on thumb force production in these pilot groups. A multi-axis load cell with a custom-built apparatus and a hand grip dynamometer were used to measure thumb and grip forces. Forces were collected in four directions: radial abduction and adduction, and palmar abduction and adduction. All participants completed thumb and grip testing prior to (week 0), during (week 2), and following (week 6), a hand exercise regimen. Group differences and the effects of exercise on force production were determined. Hand exercises improved thumb forces in young healthy female participants during radial (p = 0.017) and palmar abduction (p = 0.031) and female participants with osteoarthritis during palmar abduction (p = 0.010). Exercise improved grip strength in young healthy males (p = 0.028), young healthy females (p = 0.041), and females with osteoarthritis (p = 0.027). This research demonstrates the successful use of a new device to determine isolated thumb forces, and its clinical utility to identify changes after a short exercise regimen.

Mapping Together Kinetic and Kinematic Abilities of the Hand.

Millions of people have reduced hand function; this loss of function can be due to injury, disease, or aging. Loss of hand function is identified as reduced motion abilities in the fingers or a decrease in the ability of the fingers to generate force. Unfortunately, there are limited data available regarding each finger's ability to produce force and how those force characteristics vary with changes in finger posture. To relate motion and force abilities of the fingers, first, an approach to measure and map them together is needed. The goal of this work was to develop and demonstrate a method to quantify the force abilities of the fingers and map these forces to the kinematic space associated with each finger. Using motion capture and multiaxis load cells, finger forces were quantified at different positions over their ranges of motion. These two sets of data were then converted to the same coordinate space and mapped together. Further, the data were normalized for the index finger and mapped as a population space model. The ability to quantify motion and force data for each finger and map them together will provide an improved understanding of the effects of treatments and rehabilitation, identifying functional loss due to injury or disease, and device design.

The Role of Environmental Factors in the Etiology of Nonsyndromic Orofacial Clefts.

BACKGROUND: Nonsyndromic orofacial clefts (NSOFCs) represent the most common congenital anomalies in the head and neck region. Multiple factors contribute to the occurrence of this anomaly. The etiology of NSOFCs in the Ethiopian population has not been investigated prior to this study. AIMS OF THE STUDY: To assess the role of maternal environmental factors in the occurrence of NSOFCs in the Ethiopian Population. METHODS: The authors used unmatched case control study design and evaluated the role of environmental factors to the occurrence of NSOFCs in the Ethiopian population. The participants were recruited from the same institution (Yekatit 12 Hospital Medical College). The authors studied 760 mothers (359 mothers of children born with NSOFCs and 401 mothers of children born without any congenital anomalies). Univariate and multivariate logistic regression analyses were used to calculate relative risk by odds ratio and 95% confidence interval. RESULTS: Mothers who gave history of bronchial asthma and mothers who were admitted for threatened abortion had a higher risk of delivering a child with NSOFCS P value=0.013; AOR=0.194, 95% CI [0.053-0.712], P value <0.001; AOR= 0.179, 95% CI [0.091-0.352] respectively. Higher number of children with NSOFCs were born to mothers who were exposed to diagnostic X-ray investigation during early pregnancy than those who were not exposed P value 0.048; AOR=0.375, 95% CI [0.142-0.990]. CONCLUSION: Maternal exposure to diagnostic x-ray, maternal chronic illness like bronchial asthma and threatened abortion were found to be associated with the occurrence of NSOFCS in the studied population.

A Potential Tool for the Study of Venous Ulcers: Blood Flow Responses to Load.

Venous ulcers are deep wounds that are located predominantly on the lower leg. They are prone to infection and once healed have a high probability of recurrence. Currently, there are no effective measures to predict and prevent venous ulcers from formation. Hence, the goal of this work was to develop a Windkessel-based model that can be used to identify hemodynamic parameters that change between healthy individuals and those with wounds. Once identified, these parameters have the potential to be used as indicators of when internal conditions change, putting the patient at higher risk for wound formation. In order to achieve this goal, blood flow responses in lower legs were measured experimentally by a laser Doppler perfusion monitor (LDPM) and simulated with a modeling approach. A circuit model was developed on the basis of the Windkessel theory. The hemodynamic parameters were extracted for three groups: legs with ulcers ("wounded"), legs without ulcers but from ulcer patients ("nonwounded"), and legs without vascular disease ("healthy"). The model was executed by two independent operators, and both operators reported significant differences between wounded and healthy legs in localized vascular resistance and compliance. The model successfully replicated the experimental blood flow profile. The global and local vascular resistances and compliance parameters rendered quantifiable differences between a population with venous ulcers and healthy individuals. This work supports that the Windkessel modeling approach has the potential to determine patient specific parameters that can be used to identify when conditions change making venous ulcer formation more likely.

Comparison between healthy and reduced hand function using ranges of motion and a weighted fingertip space model.

Detection and quantification of changes in hand function are important for patients with loss of function and clinicians who are treating them. A recently developed model, the weighted fingertip space (WFS) quantifies the hand function of individuals in three-dimensional space and applies kinematic weighting parameters to identify regions of reachable space with high and low hand function. The goal of this research was to use the WFS model to compare and contrast the functional abilities of healthy individuals with the abilities of individuals with reduced functionality due to arthritis (RFA). Twenty two individuals with no reported issues with hand function and 21 individuals with arthritis affecting the hand were included in the research. Functional models were calculated from the ranges of motion and hand dimension data for each individual. Each model showed the volume of reachable space for each fingertip of each hand, the number of ways to reach a point in space, the range of fingertip orientations possible at each point, and the range of possible force application directions (FADs) at each point. In addition, two group models were developed that showed how many individuals in both the healthy and RFA groups were able to reach the same points in space. The results showed differences between the two groups for the range of motion (ROM) measurements, the individual model calculations, and the group models. The ROM measurements showed significant differences for the joints of the thumb, extension of the nonthumb metacarpophalangeal (MCP) joints, and flexion of the distal interphalangeal (DIP) joints. Comparing the models, the two groups qualitatively showed similar patterns of functional measures in space, but with the RFA group able to reach a smaller volume of space. Quantitatively, the RFA group showed trends of smaller values for all of the calculated functional weighting parameters and significantly smaller reachable volume for all of the fingers. The group models showed that all healthy individuals were able to reach an overlapping space, while 18 of 21 RFA individuals were able to reach similar spaces. Combined, the results showed that the WFS model presents the abilities of the hand in ways that can be quantitatively and qualitatively compared. Thus, the potential of this hand model is that it could be used to assess and document the changes that occur in hand function due to rehabilitation or surgery, or as a guide to determine areas most accessible by various populations.

A Comparison of Pressure Mapping Between Two Pressure-Reducing Methods for the Sacral Region.

PURPOSE: The objective of this study was to quantify tissue interface pressures that occurred in the sacrum, shoulder, and buttock/thigh regions while using (1) pillows or (2) a wedge system for off-loading of sacral pressures. SUBJECTS AND SETTING: Twenty-one volunteers (11 females and 10 males) residing near a Midwestern, university community consented to participate in the study. Testing was conducted in a hospital bed with pillows and a commercially available wedge system. METHODS: Pressures were measured under 3 test conditions: (1) bed alone, (2) pillows positioned above and below the sacral region, and (3) wedges positioned above and below the sacral region. Each condition was tested with the elevation of the head of the bed at 3 different angles with respect to the foot of the bed (0°, 20°, and 30°). Two pressure mats were used to capture data; one was located in the shoulder region and the other in the sacral/buttocks/thigh region. RESULTS: Between the pillows and the wedge, the wedge system was the most effective in reducing pressures on the sacral area. In comparison to the bed condition, both the pillow and wedge conditions produced significantly lower mean sacral pressures than the bed alone (P < .05). Because the pillow and wedge systems tilted the body onto one side, higher pressures were identified on the buttock/thigh when compared to the bed alone (P < .05). CONCLUSIONS: Pressure reduction occurred in the sacral region with the pillow and wedge systems; however, this reduction resulted in increased pressures in the posterior-lateral regions of the buttocks and thighs. When using off-loading devices, consideration should be given to all factors, including tissue interface pressures on the sacrum, increased pressures on other body locations, and the likelihood that these increased pressures will result in tissue damage.

Determining functional finger capabilities of healthy adults: comparing experimental data to a biomechanical model.

The human hand has a wide range of possible functional abilities that can change with age, disease, and injury, and can vary from individual to individual and subsequently can affect a person's quality of life. The objective of this work was to develop a theoretical model of the space that is reachable by the hand, weighted to represent three types of functionality, and to compare this model to an experimental data set obtained from a healthy hand population. A theoretical model, termed the Weighted Fingertip Space, was developed using 50th percentile published hand data and ranges of finger motion. The functional abilities calculated in the model were the abilities to position the fingertip pad, orient the fingertip pad, and apply directional forces through the fingertip pad at all the reachable points in space with respect to the palm. Following the development of this theoretical model, experimental data sets from nine individuals with healthy hands were obtained through motion capture techniques. The experimental data were then compared to the theoretical model. Comparisons between a 50th percentile theoretical model and a subject with a similar sized hand showed good agreement in weighting parameters and overall size and shape of the model spaces. The experimental data set from the entire sample, which ranged from the 2nd to 95th percentile hand sizes, showed resultant models that, on average, reached smaller volumes of space, but yielded higher values of the functional measures within those volumes. Additionally, in comparison to the theoretical model, the variability of the experimental models showed that small changes in hand dimensions and ranges of motion of the finger joints had a large influence in the functional measures of the model. Combined, these results suggest that the modeling technique can calculate functional ability of the hand, but should be used on an individualized basis for evaluating changes in function (e.g., rehabilitation). Further, scaling to hand size has the potential to yield "average" models for larger population samples.

3D octopus kinematics of complex postures: Translation to long, thin, soft devices and their potential for clinical use.

INTRO/BACKGROUND: Octopuses are capable of complex arm movements. Unfortunately, experimental barriers and lack of a robust analysis method made it difficult to quantify the three-dimensional (3D) kinematics of soft, flexible bodies, such as the octopus arm. This information is not only crucial for understanding the posture of the animal's arm but also for the development of similarly designed soft, flexible devices. OBJ/GOAL: The primary goal of this work was to create a method to comprehensively quantify complex, 3D postures of octopus (Octopus Bimaculoides) arms in a manner that is conducive and translatable to octopus arm-inspired devices for health monitoring and rehabilitation. METHODS: In this study, 3D underwater motion capture was used to collect kinematic data on both live octopuses and disembodied arms that still had neural activity. A new method was developed to define how arm curvature and regional segments were oriented relative to each other in 3D. This included identification of the bend within a segment along with the computation of the relative orientation between segments, thus permitting the complete quantification of complex arm motions. RESULTS: By comparing vector-based and radius of curvature-based approaches to magnitude of curvature, it was clear that the vector-based approach was less dependent on the length of a segment and that its reported ranges of motion were translatable for outcome measures associated with clinical use. The new approach for the relative orientation of each segment of the octopus arm resulted in the capability of describing the octopus arm in many unique postures, such as straight, simple bending, and complex bending as it utilized the three rotational angles. OUTCOME/IMPACT: This method and its application to octopus arms will yield new information that can be used to better communicate and track not only octopus arm movements but in the development of complex, segmented, soft-bodied devices that can be used in health monitoring and rehabilitation.

Comparing Isolated Thumb Force Generation, Wrist Rotation, and Clinical Measurements in Healthy and Osteoarthritic Individuals before and after Surgery.

Thumb carpometacarpal (CMC) osteoarthritis (OA) is caused by the degeneration of joint surfaces at the base of the thumb. If conservative treatments have failed, surgery may be needed to improve symptoms. Typically, standard clinical tools, such as the pinch gauge, are used to measure thumb force. However, these devices have utilized multiple digits and do not represent forces specifically generated by the thumb. Therefore, different devices are necessary to accurately measure isolated thumb force. The primary objective was to research the effect of thumb force after ligament reconstruction with tendon interposition surgery. To accomplish this, several sub-objectives were implemented: (1) create a testing device to collect isolated thumb forces, (2) collect a normative thumb force data set of males and females to compare the impact of aging and surgery, (3) collect and compare clinical data to see if these data sets matched isolated thumb forces, (4) determine the effect of wrist position on isolated thumb force data in different wrist positions, and (5) collect thumb force in directions that mimic daily activities, a directional force downward (push) and inward (pull). On average, older participants generated statistically larger forces than younger participants. Additionally, only 50% of CMC OA participants showed greater than 5 N of improvement at 6-months post-surgery compared to pre-surgery, but did not reach healthy force levels. When evaluating wrist rotation, OA participants' push and pull decreased by 8 N and 7 N in the horizontal wrist position, and their push and pull increased by 2 N and 5 N in the vertical wrist position. Evaluation and results with standard clinical tools showed different post-surgery trends than isolated force data, which suggested the clinical approach has mixed results and may be under- or over-estimating the recovery process. These data sets allow surgeons and hand therapists to identify changes in isolated thumb force generation to create specialized therapies and treatment options, which is an improvement upon current clinical measurement tools.

Differences in human cervical spine kinematics for active and passive motions of symptomatic and asymptomatic subject groups.

Most musculoskeletal disorders of the head and neck regions cannot be identified through imaging techniques; therefore clinician-conducted assessments (passive motions) are used to evaluate the functional ability of these regions. Although active motions do not require interaction with a clinician, these movements can also provide diagnostic indicators of dysfunction. The purpose of this research was to determine whether kinematic measures differed between active and passive movements of participants in symptomatic and asymptomatic groups. Data obtained on cervical lateral flexion range of motion (ROM), coupled axial rotation, and the angular velocity of lateral flexion were statistically analyzed and demonstrated differences between active and passive motions for symptomatic and asymptomatic subjects. Active motions had higher angular velocities (P < .001) and larger ROMs, with greater lateral flexions (P < .05). The asymptomatic group produced a larger average lateral flexion of 7.9° at an average angular velocity of 2 deg/s greater than the symptomatic group. Trends with regard to group assignment were the same for active and passive motions. This work demonstrates the potential for using kinematic measures of active and passive motions to develop an objective standard for diagnoses of cervical dysfunction and supports validity of the clinician-based analysis to distinguish between participant groups.

Determining frictional properties of pants and cushion cover materials using human soft tissue and a rigid sled and how they affect seated shear forces.

Shear forces on the buttocks while seated are directly linked to friction, yet the frictional properties at the seat interface are unknown. Shear forces are one of the factors related to increase risk of pressure injury formation. The goals of this study included determining coefficients of friction between three cushion covers and two clothing fabrics using a mechanical system as well as human participants and to evaluate the impact of the cushion covers on shear loading on the buttocks while seated. A chair with separate seat pan tilt and back recline movements was built and instrumented with reflective markers and a load cell. A motion capture system and load cell were used to determine the angles of seat pan tilt at which the sled and participants started sliding, as well as shear forces at three recline angles for three cushion covers (vinyl, one-layer nylon, and two-layer nylon). Results showed the vinyl and two-layer nylon cushion covers respectively had the largest and smallest coefficients of friction for both pants materials. The coefficients of friction calculated with the human participants and rigid sled were within 10% of each other, demonstrating similar results. Further, increasing back recline increased shear load on the buttocks, while the two-layer nylon cover reduced shear forces seen on the buttocks. This work furthers the understanding of shear loading on the buttocks, will aid in the protocols for reducing pressure injuries, and suggests that coefficients of friction found using rigid bodies may be applied to deformable bodies.

Evaluating the biomechanics of an in-between posture to create a multi-posture office environment.

BACKGROUND: Prolonged sitting during work is common and has been shown to cause health issues. However, changing working postures has been reported to reduce musculoskeletal issues and impact other health issues; thus, there is a need for an office environment with multiple choices of working postures. OBJECTIVE: The purpose of this study was to evaluate changes in body position, body loading, and blood perfusion while in a seated, standing, and new office seating position, termed the in-between position. METHODS: Ground reaction forces, joint angles, pelvic tilt, openness angle (angle between the pelvis plane and thorax), and blood perfusion were evaluated for three positions. A motion capture system with markers was used to capture the position of anatomical landmarks. A six-axis force plate was used to collect the ground reaction forces, and a laser doppler perfusion monitor was used to obtain the blood perfusion. RESULTS: Data showed that the in-between position articulated the hips, which provided a hip and lumbar position closer to a standing posture than a seated posture. The average vertical ground reaction force in the in-between position was larger than the seated position but significantly smaller than during standing (p < 0.0001). There were no significant differences in anterior/posterior ground reaction forces between the seated and the in-between positions (p = 0.4934). Lastly, blood perfusion increased during the dynamic transitions between positions indicating changes in blood flow. CONCLUSION: The in-between position provides benefits of both standing (larger pelvic tilt and increased lumbar lordosis) and sitting (reduction in ground reaction forces).

Complex motions embedded in a hand exercise regimen - effects on thumb function in participants with carpometacarpal osteoarthritis: A pilot study.

Objective: The goal of this pilot study was to identify changes associated with completion of a unique six-week hand exercise program in persons with carpometacarpal osteoarthritis. Methods: Twenty-four individuals, aged 55-80, with doctor-diagnosed carpometacarpal osteoarthritis participated in the study. Movement data from standard clinical motions and complex multi-planar motions were obtained using a motion capture system at three-time points: an initial visit, after two weeks of hand exercises, and after completion of the six-week exercise program. Results: This exercise program produced trends of improvement in complex multi-planar motions. Specifically, joint angle changes were seen during opposition and the formation of an "okay sign" that was included as part of the exercise program. Conclusion: Through the use of motion capture, changes were identified in thumb joint function after exercise. Specifically, motions associated with the more complex multi-planar tasks showed changes in individual joint contributions following the six-week exercise intervention. The results suggest that further exploration of this exercise program, particularly the inclusion of complex multi-planar tasks during osteoarthritis treatment and associated evaluations, should be considered in future clinical studies.

A methodology for quantifying seated lumbar curvatures.

To understand the role seating plays in the support of posture and spinal articulation, it is necessary to study the interface between a human and the seat. However, a method to quantify lumbar curvature in commercially available unmodified seats does not currently exist. This work sought to determine if the lumbar curvature for normal ranges of seated posture could be documented by using body landmarks located on the anterior portion of the body. The development of such a methodology will allow researchers to evaluate spinal articulation of a seated subject while in standard, commercially available seats and chairs. Anterior measurements of boney landmarks were used to quantify the relative positions of the ribcage and pelvis while simultaneous posterior measurements were made of lumbar curvature. The relationship between the anterior and the posterior measures was compared. The predictive capacity of this approach was evaluated by determining linear and second-order regressions for each of the four postures across all subjects and conducting a leave-one-out cross validation. The relationships between the anterior and posterior measures were approximated by linear and second-order polynomial regressions (r(2 ) = 0.829, 0.935 respectively) across all postures. The quantitative analysis showed that openness had a significant relationship with lumbar curvature, and a first-order regression was superior to a second-order regression. Average standard errors in the prediction were 5.9° for the maximum kyphotic posture, 9.9° for the comfortable posture, 12.8° for the straight and tall, and 22.2° for the maximum lordotic posture. These results show predictions of lumbar curvature are possible in seated postures by using a motion capture system and anterior measures. This method of lumbar curvature prediction shows potential for use in the assessment of seated spinal curvatures and the corresponding design of seating to accommodate those curvatures; however, additional inputs will be necessary to better predict the postures as lordosis is increased.