Cervical occupational hazards in ophthalmic plastic surgery.

PURPOSE OF REVIEW: To increase awareness of cervical musculoskeletal disorders (cMSD) in ophthalmic plastic surgeons (OPS) and review strategies for management and prevention. RECENT FINDINGS: There are objective data that show OPS spend the majority of their time operating in awkward, prolonged, static, asymmetric postures. These postures increase cervical load and cMSD. Loupes and headlamps further increase this cervical loading by 40%. Risk for cMSD is not limited to the operating room. Muscular demands in the anterior deltoid and cervical trapezius are increased in slit lamp biomicroscopy and indirect ophthalmoscopy. Furthermore, the majority of the office visit is spent keyboarding into the electronic medical record which is associated with cMSD. Habitual postural faults result from these cumulative exposures. These must be addressed to prevent further insult and debilitating injury. Successful management requires education in neutral posture, therapeutic exercise, environmental adjustments in the workplace and home, and supported neutral sleep posture. SUMMARY: The risks of cMSD in OPS are well established, and nearly 10% of cervical injury will end a career. Neck pain must not be ignored, and experienced professional help is critical. A long-term approach that incorporates exercise, manual therapy, and education is essential for management and prevention.

Automated extraction and validation of children's gait parameters with the Kinect.

BACKGROUND: Gait analysis for therapy regimen prescription and monitoring requires patients to physically access clinics with specialized equipment. The timely availability of such infrastructure at the right frequency is especially important for small children. Besides being very costly, this is a challenge for many children living in rural areas. This is why this work develops a low-cost, portable, and automated approach for in-home gait analysis, based on the Microsoft Kinect. METHODS: A robust and efficient method for extracting gait parameters is introduced, which copes with the high variability of noisy Kinect skeleton tracking data experienced across the population of young children. This is achieved by temporally segmenting the data with an approach based on coupling a probabilistic matching of stride template models, learned offline, with the estimation of their global and local temporal scaling. A preliminary study conducted on healthy children between 2 and 4 years of age is performed to analyze the accuracy, precision, repeatability, and concurrent validity of the proposed method against the GAITRite when measuring several spatial and temporal children's gait parameters. RESULTS: The method has excellent accuracy and good precision, with segmenting temporal sequences of body joint locations into stride and step cycles. Also, the spatial and temporal gait parameters, estimated automatically, exhibit good concurrent validity with those provided by the GAITRite, as well as very good repeatability. In particular, on a range of nine gait parameters, the relative and absolute agreements were found to be good and excellent, and the overall agreements were found to be good and moderate. CONCLUSION: This work enables and validates the automated use of the Kinect for children's gait analysis in healthy subjects. In particular, the approach makes a step forward towards developing a low-cost, portable, parent-operated in-home tool for clinicians assisting young children.

Falls and Fall-Related Injuries in an Evidence-Based Tai Ji Quan Intervention in Rural West Virginia Churches.

Background: This paper identifies the independent predictors of falls in an implementation study of Tai Ji Quan: Moving for Better Balance® (TJQMBB) in older adults in rural West Virginia churches. Methods: Falls and injuries were identified via calendars, questionnaire, and verbal reports. Results: Fall predictors were gait speed (OR 0.27; 95% CI 0.08, 0.90); low back pain (OR 8.04; 95% CI 1.71, 37.79); and pain, stiffness, or swelling limiting activity (OR 2.44; 95% CI 1.09, 5.45). Conclusions: Determining differences between fallers and non-fallers may identify people with different fall risk profiles and ultimately better tailor fall-prevention programming to individual needs.

Variables associated with level of disability in working individuals with nonacute low back pain: a cross-sectional investigation.

STUDY DESIGN: Single-site, exploratory, cross-sectional design. OBJECTIVE: To identify variables associated with disability related to low back pain (LBP), as measured by the modified Oswestry Low Back Pain Disability Questionnaire (mOSW), in a sample of working adults with nonacute LBP. BACKGROUND: Compared to acute LBP, there is little information available in the literature to identify variables associated with LBP-related disability in working individuals with stage 2 and stage 3 LBP. METHODS: Data analyzed were from working individuals with nonacute LBP (n = 235). The response variable was dichotomized by mOSW score (less than 20 or 20 or greater), and the regressor variables included 27 self-report, sociodemographic, impairment-based, and kinematic measures used to assess individuals with LBP. Logistic regression was used to identify variables associated with mOSW. RESULTS: One hundred eleven subjects had a mOSW score of 20 or greater, and 124 subjects had a mOSW score of less than 20. Logistic regression analysis identified 4 variables associated with LBP-related disability (mOSW): duration of LBP (P = .006), numeric pain rating (P<.0001), Fear-Avoidance Beliefs Questionnaire physical activity subscale (P = .0007), and limits of stability movement velocity in the forward direction (P = .02). The best model had an R2(u) of 0.25. CONCLUSION: The odds of LBP-related disability (mOSW) in this sample of nonacute working individuals were found to increase with longer duration of LBP, higher numeric pain rating scores, higher Fear-Avoidance Beliefs Questionnaire physical activity subscale scores, and slower limits of stability movement velocity in the forward direction. The identification of limits of stability movement velocity is a novel finding that may support a link between sensorimotor balance deficits and disability in working individuals with nonacute LBP.

The relationship of body segment length and vertical jump displacement in recreational athletes.

The purpose of this study was to determine if segmental skeletal length contributes to vertical jump (VJ) displacement in recreational athletes. Skeletal length measurements of the trunk, femur, tibia, and foot were obtained by palpation of bony landmarks and a standard tape measure. A pilot study (n = 10) examined the intratester and intertester reliability for each skeletal measure. The pilot investigation revealed fair to excellent intratester and intertester reliability. Seventy-eight recreational athletes (55 men and 23 women) with a mean age of 21.9 +/- 2.9 years participated in the investigation. Multiple regression analysis with gender as a categorical indicator variable revealed a significant gender difference; therefore, men and women were analyzed separately. Regression analysis for men identified foot length (p < 0.033, R(2) = 0.08) as the only significant skeletal length predictor of VJ displacement. None of the skeletal length measures was predictive of VJ displacement in women. Based on the results of this investigation, intrinsic skeletal length is not a strong predictor of VJ displacement in young adult recreational athletes.

Kinematics of the human knee using an open chain cadaver model.

There continues to be controversy about the kinematics of the human knee. This study used seven knees from cadavers moved by pulling on the quadriceps tendon in an open chain fashion using video motion analysis to determine the instantaneous helical axis of movement. Computed tomography scans of the specimens allowed the axes to be related to condyles. The parameter beta was defined by the relationship of the helical axis to the center of the condyle (pure spinning motion) and the contact point of the condyle on the tibia (pure rolling motion). Axes above the center of the condyle represent countertranslation, those between the center and the contact point combined spinning and rolling, and those below represent concordant translation. If the motion of the knee is guided by the crossed four-bar link then this model, that allows the knee to 'seek its own path' throughout the range of motion, should show the rollback that commonly is thought to be an important feature of knee motion. The results of this study show that the medial side of the knee stays stable in spinning kinematics whereas the lateral side has a rolling motion in full flexion progressing to a spinning motion in midflexion and counter-translation near full extension. The kinematics that would be expected from rollback were not observed.