Disruptive Engagements With Technologies, Robotics, and Caring: Advancing the Transactive Relationship Theory of Nursing.

Human caring, founded on a Japanese caring perspective and nursing theory, fosters innovative and creative ideas for an aging society. The growing reality of health care dependency on technology presents a temptation to give robots utility as partners in nursing practice. Human caring expressed in human-to-human relationships, and also between humans and nonhumans, is a futuristic model for health care, with humanoid robots as major supporters. The purpose of this article is to explore this disruptive technology, along with its functions and characteristics. Tanioka's Transactive Relationship Theory of Nursing is shared along with its relevance for addressing technological disruptions in health care.

Relationship Between Muscle Strength Asymmetry and Body Sway in Older Adults.

The purpose of this study was to investigate the relationship between muscle strength asymmetry and body sway while walking. We studied 63 older adult women. Strong side and weak side of knee extension strength, toe grip strength, hand grip strength, and body sway while walking were measured. The relationship between muscle strength asymmetry for each muscle and body sway while walking was evaluated using Pearson's correlation coefficient. Regarding the muscles recognized to have significant correlation with body sway, the asymmetry cutoff value causing an increased sway was calculated. Toe grip strength asymmetry was significantly correlated with body sway. Toe grip strength asymmetry causing an increased body sway had a cutoff value of 23.5%. Our findings suggest toe grip strength asymmetry may be a target for improving gait stability.

Strength and muscle activities during the toe-gripping action: comparison of ankle angle in the horizontal plane between the sitting upright and standing positions.

[Purpose] The aim of this study was to investigate whether toe grip strength and muscle activities are affected by the ankle angle in the horizontal plane in the sitting upright and standing positions. [Subjects] The subjects were 16 healthy young women. [Methods] We measured toe grip strength and the maximum voluntary contraction activities of the rectus femoris, biceps femoris, anterior tibialis, and medial head of the gastrocnemius. In addition, we calculated the percent integrated electromyography during foot gripping in 3 different ankle joint positions between the long axis of the foot and the line of progression on the horizontal plane, namely 10° of internal rotation, 0°, and 10° of external rotation. [Results] Two-way analysis of variance revealed significant differences. A significant main effect was observed in the measurement conditions for the percent integrated electromyography of the rectus femoris muscle and long head of the biceps femoris. However, two-way analysis of variance did not reveal any significant difference, and a significant main effect was not observed in toe grip strength. [Conclusion] These findings suggest that exerted toe grip strength is only slightly affected by the ankle angle in the horizontal plane in the sitting upright and standing positions. Therefore, the current measurement positions were shown to be optimal for measurement.

Analysis of scapular kinematics during active and passive arm elevation.

[Purpose] Early postoperative passive motion exercise after arthroscopic rotator cuff repair remains controversial. To better understand this issue, this study was aimed at evaluating scapular kinematics and muscle activities during passive arm elevation in healthy subjects. [Subjects and Methods] The dominant shoulders of 27 healthy subjects were examined. Electromagnetic sensors attached to the scapula, thorax, and humerus were used to determine three-dimensional scapular kinematics during active arm elevation with or without external loads and passive arm elevation. Simultaneously, the activities of seven shoulder muscles were recorded with surface and intramuscular fine-wire electrodes. [Results] Compared with active arm elevation, passive elevation between 30° and 100° significantly decreased the scapular upward rotation and increased the glenohumeral elevation angle. However, no significant differences in scapular posterior tilt and external rotation were observed between active and passive arm elevation, and scapular plane kinematics were not affected by muscle activity. [Conclusion] Unlike active motion with or without an external load, passive arm elevation significantly decreased the scapular upward rotation and significantly increased the mid-range glenohumeral elevation. These data, which suggest that passive arm elevation should be avoided during the early postoperative period, may expand the understanding of rehabilitation after arthroscopic rotator cuff repair.

Examinations of factors influencing toe grip strength.

[Purpose] This study examined the relationship between toe grip strength and its associated factors by focusing on factors that were suggested to have a relationship with toe grip strength in previous studies, aiming to clarify the factors influencing the toe grip strength of healthy women. [Subjects and Methods] Twelve healthy young women were selected for this study. Their toe grip strength, angular changes in their ankle joint during toe grip, maximum voluntary contraction activities of the rectus femoris, biceps femoris, and tibialis anterior muscles, and the medial head of the gastrocnemius muscles were measured using electromyography. Their toe curl ability, foot-arch height ratio, and weight were also measured. [Results] Multiple regression analysis demonstrated that the predictors of toe grip strength in the resulting model were foot-arch height ratio and the percentage of integrated electromyography (%IEMG) of the tibialis anterior muscle, as the dependent variables. This reveals that women whose tibialis anterior muscle %IEMG values and foot-arch height ratio are high have greater %IEMG values have greater toe grip strength. [Conclusion] These findings suggest a significant relationship between foot-arch height ratio and toe grip strength, with a reciprocal interaction. These findings further indicate that the risk of falls by the elderly could be decreased if toe grip strength were enhanced, by increasing the height of a low foot-arch with the help of an inserted insole.

Comparison of toe grip strength and muscle activities during maximal toe grip strength exertion according to the presence/absence of an ankle immobilization belt.

[Purpose] The aim of this study was to compare toe grip strength and muscle activity during toe grip strength exertion according to the presence/absence of an ankle immobilization belt and to examine the relationship between the differences in muscle activity and toe grip strength. [Subjects] The Subjects were 13 healthy young women. [Methods] We measured toe grip strength and muscle activity during toe grip strength exertion in the presence and absence of an ankle immobilization belt using electromyography. Activity in the following leg muscles was recorded: rectus femoris, biceps femoris, medial head of the gastrocnemius, and tibialis anterior. We then calculated the percent integrated electromyography during toe gripping. [Results] Toe grip strength and percent integrated electromyography of the medial head of the gastrocnemius muscle were significantly higher with ankle belt immobilization compared with without ankle belt immobilization. In addition, in the presence of ankle belt immobilization, the percent integrated electromyography of the tibialis anterior muscle and medial head of the gastrocnemius muscle demonstrated a positive correlation with toe grip strength (r = 0.75 and r = 0.65, respectively). [Conclusion] These findings suggest that greater toe grip strength could be exerted in the presence of ankle belt immobilization. The measured values reflect the percent integrated electromyography of the crural muscles. Therefore, it was shown that toe grip strength should be measured in the presence of an immobilization belt.

Kinematic analysis during toe-gripping strength exertion: angular changes in the ankle joint and leg muscle activities.

[Purposes] To investigate angular changes in the ankle joint and leg muscle activities during toe-gripping, and to examine the relationship between these changes and toe-gripping strength. [Subjects] Eleven healthy young women were selected. [Methods] We measured the toe-gripping strength, angular changes in the ankle joint, and leg muscle activities of all patients during toe-gripping. [Results] The mean change in the ankle angle in dorsiflexion from a neutral position was 3°, and a positive correlation was observed between this angle and toe-gripping strength (r = 0.61). Thus, toe-gripping strength increased with the angle of dorsiflexion. Regarding the leg muscle activities, activities of the tibialis anterior muscle and medial head of the gastrocnemius muscle demonstrated positive correlations with toe-gripping strength (r = 0.75 and r = 0.72, respectively). [Conclusion] These findings suggest that the ankle dorsiflexes in order to exert great toe-gripping strength, and the crural muscles contract simultaneously because of ankle fixation.

Activity of the Femoral Muscles during Toe-gripping Action.

[Purpose] In the present study, we investigated femoral muscle activity during toe-gripping, and the role of the femoral muscles in toe-gripping strength. [Subjects] Fourteen healthy young women were selected. [Methods] We measured the maximum voluntary contraction of the rectus femoris and long head of the biceps femoris muscles. We then calculated the percent integrated EMG (%IEMG) during the toe-gripping action. [Results] We found that the %IEMG of the biceps femoris was significantly higher than that of the rectus femoris. Moreover, a significant positive correlation was found between the %IEMG of the rectus femoris and that of the biceps femoris. [Conclusion] These results suggest that femoral muscles co-contract during the toe-gripping action, and thus possibly contribute to knee joint stability.

An Examination of Limb Position for Measuring Toe-grip Strength.

[Purpose] The purpose of the present study was to investigate the limb position at which the maximum toe-grip strength could be exerted as well as measurement reproducibility. [Subjects] Twenty healthy young women were selected. [Methods] We measured toe-grip strength under three conditions: 90° hip and knee flexion while sitting, 90° hip flexion and knee extension while sitting, and a standing position. [Results] We found that toe-grip strength was significantly lower in the 90° hip flexion and knee extension sitting position than in the 90° hip and knee flexion sitting position and standing position. Moreover, the 90° hip and knee flexion sitting position produced the best intraclass correlation coefficient (r = 0.813). [Conclusion] The results suggest that 90° hip and knee flexion while sitting is the most suitable limb position for measuring toe-grip strength, as this position allows maximum strength to be exerted and allows measurements to be repeated.

Agreement in the Postural Assessment of Older Adults by Physical Therapists Using Clinical and Imaging Methods.

Postural assessment is one of the indicators of health status in older adults. Since the number of older adults is on the rise, it is essential to assess simpler methods and automated ones in the future. Therefore, we focused on a visual method (imaging method). The purpose of this study is to determine the degree of agreement between the imaging method and the palpation and visual methods (clinical method). In addition, the influence of differences in the information content of the sagittal plane images on the assessment was also investigated. In this experiment, 28 sagittal photographs of older adults whose posture had already been assessed using the clinical method were used. Furthermore, based on these photographs, 28 gray and silhouette images (G and S images) were generated, respectively. The G and S images were assessed by 28 physical therapists (PTs) using the imaging method. The assessment was based on the Kendall classification, with one of four categories selected for each image: ideal, kyphosis lordosis, sway back, and flat back. Cross-tabulation matrices of the assessments using the clinical method and imaging method were created. In this table, four categories and two categories of ideal and non-ideal (KL, SB, and FB) were created. The agreement was evaluated using the prevalence-adjusted bias-adjusted kappa (PABAK). In addition, sensitivity and specificity were calculated to confirm the reliability. When comparing the clinical and imaging methods in the four posture categories, the PABAK values were -0.14 and -0.29 for the S and G images, respectively. In the case of the two categories, the PABAK values were 0.57 and 0.5 for the S and G images, respectively. The sensitivity and specificity were 86% and 57% for the S images and 76% and 71% for the G images, respectively. The four categories show that the imaging method is difficult to assess regardless of the image processing. However, in the case of the two categories, the same assessment of the clinical method applied to the imaging method for both the S and G images. Therefore, no differences in image processing were observed, suggesting that PTs can identify posture using the visual method.

Relationship between Tilt Sensation Ability and Lower Limb Injuries in Junior Athletes.

The purpose of this study was to devise a tilt sensation measurement method to evaluate ankle proprioception and to examine its reliability. It was also used to determine the relationship among tilt sensation abilities, physical development, and lower limb injuries in junior athletes. In this study, a step platform created tilt angles. Participants with eye masks answered "yes" or "no" to sensing a tilt, evaluated over nine or seven trials. Experiment 1 involved 22 university students (20.6 ± 0.9 years). The minimum angle at which a tilt could be sensed while standing on both feet was determined, and measurements were taken again to examine reliability. Experiment 2 involved 40 junior athletes (12.3 ± 2.0 years), where the minimum angle for tilt sensation was obtained, and medical checks were conducted to assess injuries in the knee, lower leg, and foot. Reliability studies showed a moderately significant correlation between the first and second sessions (r = 0.504, p = 0.017), suggesting the reliability of the experimental method. The proportion capable of sensing a tilt of 1.1° and 1.6° was significantly higher in junior high school students than in elementary school students (1.1°; χ2 = 8.839, p = 0.003. 1.6°; χ2 = 4.038, p = 0.044). The group unable to sense a tilt of 1.6° and 2.1° had a significantly higher positive rate of knee injuries compared to the sensed group among junior high school students (1.6°; χ2 = 4.622, p = 0.032. 2.1°; χ2 = 4.622, p = 0.032). Our findings suggested that a reduced tilt sensation ability was associated with knee injuries in junior high school students. Utilizing our devised tilt sensation assessment could play a crucial role in preventing and detecting early injuries in junior high school students.

The Activities of the Muscles around the Ankle Joint during Foot-gripping are Affected by the Angle of the Ankle.

[Purpose] The purpose of this study was to determine the activities of the muscles around the ankle joint during foot gripping. [Subjects] The subjects of this study were 17 healthy females. [Methods] We measured the maximum voluntary contraction (MVC) activities of the soleus muscle, the medial head of the gastrocnemius muscle, and the tibialis anterior muscle, and calculated %IEMG during foot gripping in 3 different ankle joint positions: 10° of plantar flexion, 0°, and 10° of dorsiflexion. [Results] The maximal force of foot gripping achived by the crural muscles in any ankle position was 30-50% IMEG of the MVC. Repeated analysis of variance showed that the %IEMG was significantly lower in 10°of dorsiflexion than in the other 2 positions for all muscles. [Conclusion] These results suggested that the crural muscles help the ankle joint by co-contracting during foot gripping.

Spinal alignment measurement with Kinect sensor is valid for thoracic kyphosis but not for lumbar lordosis.

BACKGROUND: Spinal alignment evaluation is commonly performed in the clinical setting during rehabilitation. However, there is no simple method for its quantitative measurement. Recently, the depth cameras in Kinect sensors have been employed in various commercial and research projects in the healthcare field. We hypothesized that the time-of-flight technology of the Kinect sensor could be applied to quantitatively evaluate spinal alignment. The purpose of this study was to develop a simple and noninvasive evaluation for spinal alignment using the Kinect sensor and to investigate its validity. METHODS: Twenty-four healthy men participated in the study. Measurement outcomes were the thoracic kyphosis and lumbar lordosis angles in the standing position, using a Spinal Mouse, the validity of which has been previously reported, and the Kinect sensor. In the measurement by the Kinect sensor, a program was created to obtain the three-dimensional coordinates of each point within an area marked on the monitor, and the sums of the angles at each vertebral level were calculated for the thoracic and lumbar areas. Pearson's correlation coefficient was used to analyze the relationship between the Kinect sensor and Spinal Mouse measurements of thoracic kyphosis and lumbar lordosis angles. RESULTS: There was a significant positive and moderate correlation between the thoracic kyphosis measurements taken by each device. Contrarily, there was no significant correlation in the lordosis angle between measurements using the Kinect sensor and Spinal Mouse. CONCLUSIONS: Our results demonstrated the validity of measuring the thoracic kyphosis angle using the Kinect sensor. This indicates that the depth camera in the Kinect sensor is able to perform accurate thoracic alignment measurements quickly and noninvasively.

Validating Knee Varus Alignment Measurements Using Markerless Motion Capture.

This study aimed to determine the validity of specific knee varus alignment measurement methods. We measured the femorotibial angle (FTA) using radiography and optical motion capture and validated the FTA measurement using markerless motion capture. The subjects included 34 legs of 19 patients with knee osteoarthritis (OA). One-way analysis of variance and multiple comparison tests were used to compare the FTA values between the Kellgren-Lawrence classification (KL) and Pearson's correlation coefficient for validity. The analysis showed that the FTA measured by markerless motion capture had a significant correlation to the FTA measured by radiography (r = 0.869, p < 0.01) and significantly increased with increasing KL (p < 0.05). These results indicate that markerless motion capture is a valid outcome measure for varus alignment in patients with knee OA.

Effects of neurofeedback on standing postural control task with combined imagined and executed movements.

Introduction: Motor imagery (MI) is a method of imagining movement without actual movement, and its use in combination with motor execution (ME) enhances the effects of motor learning. Neurofeedback (NFB) is another method that promotes the effects of MI. This study aimed to investigate the effects of NFB on combined MI and ME (MIME) training in a standing postural control task. Methods: Sixteen participants were randomly divided into MIME and MIME + NFB groups and performed 10 trials of a postural control task on an unstable board, with nine trials of MI in between. Electroencephalogram was assessed during MI, and the MIME + NFB group received neurofeedback on the degree of MI via auditory stimulation. A postural control task using an unstable board was performed before and after the MIME task, during which postural instability was evaluated. Results: Postural instability was reduced after the MIME task in both groups. In addition, the root mean square, which indicates the sway of the unstable board, was significantly reduced in the MIME + NFB group compared to that in the MIME group. Conclusion: Our results indicate that MIME training is effective for motor learning of standing postural control. Furthermore, when MI and ME are combined, the feedback on the degree of MI enhances the learning effect.

Infraspinatus fatigue during resisted arm elevation with isometric contraction: an electromyographic study.

BACKGROUND: Various forms of resistance are used in rotator cuff training programs. However, the muscular activity of the infraspinatus during arm elevation has not been clarified in detail. We aimed to evaluate infraspinatus fatigue during resisted arm elevation in various positions. METHODS: The dominant (right) shoulders of 39 healthy subjects were examined. Average mean power frequency shifts of the infraspinatus and deltoid were evaluated electromyographically when the subjects performed isometric contractions equivalent to 30% of the maximal voluntary isometric contraction force for 60 s during 90° arm elevation in the sagittal and scapular planes, prone and side-lying external rotations, and repeated side-lying external rotation exercise. Further, the arm-elevation force was measured before and after the repeated external rotation exercise. Analysis of variance and paired t tests were used for statistical analyses; differences at P < .05 were considered significant. RESULTS: The infraspinatus was fatigued easily during resisted arm elevation in the sagittal plane compared with the scapular plane (P < .01). Comparisons of sagittal-plane elevation with side-lying and prone external rotations revealed no significant differences in the fatigue levels. The arm-elevation force after the repeated external rotations was significantly decreased in the sagittal plane compared with the scapular plane (P < .01). CONCLUSION: In clinical settings, this data may be helpful in knowing how to helpful to protect the infraspinatus after surgical repair. Therefore, therapeutic exercise regimes with resisted arm elevation should avoid infraspinatus overfatigue in the sagittal plane in the early postoperative period.

Usefulness of 2D Video Analysis for Evaluation of Shoulder Range of Motion during Upper Limb Exercise in Patients with Psychiatric Disorders.

Aging and its associated problems related to movement impacts the care of people with psychiatric disorders. This study sought to clarify the usefulness of 2D video analysis for evaluating shoulder range of motion (ROM) during upper limb exercises in patients with psychiatric disorders. Subjects (N=54) were patients with psychiatric disorders categorized as the following:having either a high or low activities of daily living (ADL) score using the Barthel Index;experiencing shoulder ROM limitation, and whether or not compensatory movements were exhibited. Compensatory movement was also considered in patients with Parkinsonism, cerebrovascular disease, and cognitive dysfunction. Shoulder joint ROM was measured using a goniometer and active ROM was captured using ImageJ. No significant difference between passive ROM measured by a goniometer and active ROM measured by ImageJ considering disease groups, ADL level, and shoulder ROM limitation was found. Factoring in compensatory movements, however, significant differences were found between passive and active ROM:existence compensatory movement group, left side (z=-2.30, p=0.02);nonexistence compensatory movement group, right side (z=-2.63, p<0.001). Image-evaluating devices help assess ROM in patients with psychiatric disorders, enhancing the development of physical rehabilitation programs to regain critical ADL, sustaining self-care capabilities. J. Med. Invest. 69 : 70-79, February, 2022.

Dynamic three-dimensional shoulder kinematics in patients with massive rotator cuff tears: a comparison of patients with and without subscapularis tears.

BACKGROUND: Massive rotator cuff tears (MRCTs) with subscapularis (SSC) tears cause severe shoulder dysfunction. In the present study, the influence of SSC tears on three-dimensional (3D) shoulder kinematics during scapular plane abduction in patients with MRCTs was examined. METHODS: This study included 15 patients who were divided into two groups: supraspinatus (SSP) and infraspinatus (ISP) tears with SSC tear (torn SSC group: 10 shoulders) or without SSC tear (intact SSC group: 5 shoulders). Single-plane fluoroscopic images during scapular plane elevation and computed tomography (CT)-derived 3D bone models were matched to the fluoroscopic images using two-dimensional (2D)/3D registration techniques. Changes in 3D kinematic results were compared. RESULTS: The humeral head center at the beginning of arm elevation was significantly higher in the torn SSC group than in the intact SSC group (1.8±3.4 mm vs. -1.1±1.6 mm, p<0.05). In the torn SSC group, the center of the humeral head migrated superiorly, then significantly downward at 60° arm elevation (p<0.05). In the intact SSC group, significant difference was not observed in the superior-inferior translation of the humeral head between the elevation angles. CONCLUSIONS: In cases of MRCTs with a torn SSC, the center of the humeral head showed a superior translation at the initial phase of scapular plane abduction followed by inferior translation. These findings indicate the SSC muscle plays an important role in determining the dynamic stability of the glenohumeral joint in a superior-inferior direction in patients with MRCTs.

Remote-Controlled Drone System through Eye Movements of Patients Who Need Long-Term Care: An Intermediary's Role.

The use of a remote-controlled drone system (RDS) by eye movements was studied to assist patients in psychiatric long-term care (PLTC) to allow them to view the environment outside the hospital, hoping that this will bring them some enjoyment. However, successfully applying this system requires human intermediaries in facilitating the interactions between patients and RDS operators. The aim of the study was to describe the role of nurses as intermediaries in the application of an RDS through eye movements of patients PLTC. This study employed the Intentional Observational Clinical Research Design. Data collection was performed in November 2021 at a psychiatric hospital with selected patients in PLTC. Seventeen patients took part in the indoor experiment, whereas 23 patients took part in the outdoor experiment. Fifteen of the 23 patients in the outdoor experiment were the same patients who took part in the indoor experiment. Most of the patients in the indoor and outdoor test arenas could successfully, delightfully, and safely fly the drone. This study demonstrated that RDS using just eye movements could increase the quality of life in older patients with psychiatric problems in PLTC. For the successful use of this drone system, nurse intermediaries assumed critically significant roles.

Investigation of Methods to Create Future Multimodal Emotional Data for Robot Interactions in Patients with Schizophrenia: A Case Study.

Rapid progress in humanoid robot investigations offers possibilities for improving the competencies of people with social disorders, although this improvement of humanoid robots remains unexplored for schizophrenic people. Methods for creating future multimodal emotional data for robot interactions were studied in this case study of a 40-year-old male patient with disorganized schizophrenia without comorbidities. The qualitative data included heart rate variability (HRV), video-audio recordings, and field notes. HRV, Haar cascade classifier (HCC), and Empath API© were evaluated during conversations between the patient and robot. Two expert nurses and one psychiatrist evaluated facial expressions. The research hypothesis questioned whether HRV, HCC, and Empath API© are useful for creating future multimodal emotional data about robot-patient interactions. The HRV analysis showed persistent sympathetic dominance, matching the human-robot conversational situation. The result of HCC was in agreement with that of human observation, in the case of rough consensus. In the case of observed results disagreed upon by experts, the HCC result was also different. However, emotional assessments by experts using Empath API© were also found to be inconsistent. We believe that with further investigation, a clearer identification of methods for multimodal emotional data for robot interactions can be achieved for patients with schizophrenia.