The reliability of video fluoroscopy, ultrasound imaging, magnetic resonance imaging and radiography for measurements of lumbar spine segmental range of motion in-vivo: A review.

BACKGROUND: Lower back pain (LBP) is a principal cause of disability worldwide and is associated with a variety of spinal conditions. Individuals presenting with LBP may display changes in spinal motion. Despite this, the ability to measure lumbar segmental range of motion (ROM) non-invasively remains a challenge. OBJECTIVE: To review the reliability of four non-invasive modalities: Video Fluoroscopy (VF), Ultrasound imaging (US), Magnetic Resonance Imaging (MRI) and Radiography used for measuring segmental ROM in the lumbar spine in-vivo. METHODS: The methodological quality of seventeen eligible studies, identified through a systematic literature search, were appraised. RESULTS: The intra-rater reliability for VF is excellent in recumbent and upright positions but errors are larger for intra-rater repeated movements and inter-rater reliability shows larger variation. Excellent results for intra- and inter-rater reliability are seen in US studies and there is good reliability within- and between-day. There is a large degree of heterogeneity in MRI and radiography methodologies but reliable results are seen. CONCLUSIONS: Excellent reliability is seen across all modalities. However, VF and radiography are limited by radiation exposure and MRI is expensive. US offers a non-invasive, risk free method but further research must determine whether it yields truly consistent measurements.

Opposing patterns in self-reported and measured physical activity levels in middle-aged adults.

Physical activity brings significant health benefits to middle-aged adults, although the research to date has been focused on late adulthood. This study aims to examine how ageing affects the self-reported and accelerometer-derived measures of physical activity levels in middle-aged adults. We employed the data recorded in the UK Biobank and analysed the physical activity levels of 2,998 participants (1381 men and 1617 women), based on self-completion questionnaire and accelerometry measurement of physical activity. We also assessed the musculoskeletal health of the participants using the dual-energy X-ray absorptiometry (DXA) measurements provided by the UK Biobank. Participants were categorised into three groups according to their age: group I younger middle-aged (40 to 49 years), group II older middle-aged (50 to 59 years), and group III oldest middle-aged (60 to 69 years). Self-reported physical activity level increased with age and was the highest in group III, followed by group II and I (P < 0.05). On the contrary, physical activity measured by accelerometry decreased significantly with age from group I to III (P < 0.05), and the same pertained to the measurements of musculoskeletal health (P < 0.05). It was also shown that middle-aged adults mostly engaged in low and moderate intensity activities. The opposing trends of the self-reported and measured physical activity levels may suggest that middle-aged adults over-report their activity level as they age. They should be aware of the difference between their perceived and actual physical activity levels, and objective measures would be useful to prevent the decline in musculoskeletal health.

Recovery of the lumbopelvic movement and muscle recruitment patterns using motor control exercise program in people with chronic nonspecific low back pain: A prospective study.

This study aims to investigate the dysfunction and recovery of the lumbopelvic movement and motor control of people with chronic nonspecific low back pain after a structured rehabilitation which emphasizes on re-education and training of movement and motor control. The lumbopelvic movement and motor control pattern of 30 adults (15 with chronic low back pain, 15 healthy controls) were assessed using 3D motion and electromyographic analysis during the repeated forward bending test, in additional to the clinical outcome measures. Regional kinematics and muscle recruitment pattern of the symptomatic group was analysed before and after the 6-week rehabilitation, and compared to healthy controls. Significant improvement in back pain, functional capacity and self-efficacy of the symptomatic group was found after the rehabilitation. Patients with chronic nonspecific low back pain were capable to recover to a comparable level of the healthy controls in terms of their lumbopelvic movement and motor control pattern upon completion of a 6-week rehabilitation program, despite their dysfunction displayed at baseline. Phase specific motor control reorganization in which more profound and positive changes shown during the flexion phase. Our findings indicate that the recovery of the movement and motor control pattern in patients with chronic low back pain achieved to a comparable level of the healthy able-bodies. The improvement of both the physical outcome measures suggest that specific rehabilitation program which emphasizes on optimizing motor control during movements would help promoting the functional recovery of this specific low back pain subgroup.

Passive elastic contribution of hip extensors to joint moments during walking in people with low back pain.

BACKGROUND: It has been found that alterations in passive muscle properties may be associated with low back pain, and these may be responsible for the altered gait parameters often observed in subjects with back pain. The purpose of the present study was to assess total hip and passive hip extensor moments in people with or without low back pain during the hip flexion component of walking. METHODS: 52 subjects volunteered for this study (low back pain group, n = 25 (male n = 13, female n = 12), control group, n = 27 (male n = 15, female n = 12)). Passive hip moments were calculated using an adapted force transducer during supine testing. A biomechanical model and predictive equation were used to calculate passive hip moments during walking. Total hip moments were calculated with the use of a 9 camera, 3-D motion-capture system. FINDINGS: Independent samples t-tests demonstrated no significant differences between groups for gait parameters or hip or knee angles. Results of the ANOVAs demonstrated significant differences in passive hip flexor moments during the second half of hip flexion (P < 0.05).There were also significant differences in hip power and work done during peaks of power absorption and the second peak of power generation (P < 0.05). INTERPRETATION: The present data demonstrates that subjects with low back pain have altered passive hip extensor and total power and work done during walking compared with healthy controls. Biomechanical models should include individual measurements of passive joint moments.

Association of electromyographic activation patterns with pain and functional disability in people with chronic neck pain.

PURPOSE: This study examined the activation patterns of the cervical and thoracic muscles in people with and without chronic neck pain during functional activities and their associations with pain intensity and functional disability. METHODS: Thirty-four adults with chronic neck pain and 34 asymptomatic adults were recruited. They were requested to perform active cervical movements and an upper limb lifting task. Electromyographic activation patterns (EMG) of bilateral upper trapezius, cervical erector spinae, sternocleidomastoid, and thoracic erector spinae were recorded during these tasks. Correlation and multiple regression analysis were used to examine the associations between EMG variables and severity of pain and functional disability. RESULTS: When performing the cervical movements, the neck pain group displayed lower EMG activity levels, especially in the cervical and thoracic extensors. In addition, significantly prolonged activation was observed in seven of the ten muscles during the upper limb lifting task. The changes in EMG amplitude and activation duration were found to be significantly correlated with severity of pain (R2 = 0.716) and functional disability (R2 = 0.623). CONCLUSIONS: Significant differences in the activation patterns of multiple cervical and thoracic muscles were found in individuals with neck pain compared with those without neck pain. These were significantly associated with their degree of pain and functional limitation. The findings of this study highlight the importance of assessing and optimising the neuromuscular activation of these muscles in the rehabilitation of those suffering from chronic neck pain.

Effects of a ballet-based dance intervention on gait variability and balance confidence of people with Parkinson's.

BACKGROUND: Dance has shown to be beneficial for people with Parkinson's. However, there is a lack of research on ballet for this population. The present study aimed to determine the effect of weekly ballet classes on gait variability and balance confidence for people with Parkinson's. METHODS: The study follows a non-randomised, controlled project evaluation design. A group of 19 people with Parkinson's who were already involved in weekly ballet classes volunteered for this research. A control group of 13 people with Parkinson's were asked to not participate in dance classes across the duration of the study. RESULTS: The study did not demonstrate significant effects of weekly ballet classes on gait variability or balance confidence. CONCLUSIONS: These findings differ from recent studies that suggest dancing can improve balance and gait for this population. There is a need to examine the optimal ballet class frequency required to elicit any potential positive change.

The effects of bending speed on the lumbo-pelvic kinematics and movement pattern during forward bending in people with and without low back pain.

BACKGROUND: Impaired lumbo-pelvic movement in people with low back pain during bending task has been reported previously. However, the regional mobility and the pattern of the lumbo-pelvic movement were found to vary across studies. The inconsistency of the findings may partly be related to variations in the speed at which the task was executed. This study examined the effects of bending speeds on the kinematics and the coordination lumbo-pelvic movement during forward bending, and to compare the performance of individuals with and without low back pain. METHODS: The angular displacement, velocity and acceleration of the lumbo-pelvic movement during the repeated forward bending executed at five selected speeds were acquired using the three dimensional motion tracking system in seventeen males with low back pain and eighteen males who were asymptomatic. The regional kinematics and the degree of coordination of the lumbo-pelvic movement during bending was compared and analysed between two groups. RESULTS: Significantly compromised performance in velocity and acceleration of the lumbar spine and hip joint during bending task at various speed levels was shown in back pain group (p < 0.01). Both groups displayed a high degree of coordination of the lumbo-pelvic displacement during forward bending executed across the five levels of speed examined. Significant between-group difference was revealed in the coordination of the lumbo-pelvic velocity and acceleration (p < 0.01). Asymptomatic group moved with a progressively higher degree of lumbo-pelvic coordination for velocity and acceleration while the back pain group adopted a uniform lumbo-pelvic pattern across all the speed levels examined. CONCLUSIONS: The present findings show that bending speed imposes different levels of demand on the kinematics and pattern of the lumbo-pelvic movement. The ability to regulate the lumbo-pelvic movement pattern during the bending task that executed at various speed levels was shown only in pain-free individuals but not in those with low back pain. Individuals with low back pain moved with a stereotyped strategy at their lumbar spine and hip joints. This specific aberrant lumbo-pelvic movement pattern may have a crucial role in the maintenance of the chronicity in back pain.

Relationship between neck acceleration and muscle activation in people with chronic neck pain: Implications for functional disability.

BACKGROUND: Previous study has found that people with chronic neck pain moved with a consistently compromised acceleration/deceleration at their cervical and thoracic spines. This study examined the strength of the association between the electromyographic activities and the acceleration/deceleration of the cervical and thoracic spine, and its correlation with the functional disabilities in individuals with neck pain. METHODS: Time history of the cervical and thoracic acceleration/deceleration and EMG activity was acquired in thirty-four subjects with chronic neck pain and thirty-four age- and gender-matched asymptomatic subjects during active neck movements. The strength of the association between the electromyographic activity of spinal muscles and the cervical and thoracic acceleration/deceleration was determined using cross-correlation method. Relationship between the strength of this association and the severity of the functional disabilities in neck pain group was examined using correlation analysis. FINDINGS: The strength of the association between cervical and thoracic acceleration/deceleration and electromyographic activities was significantly lower in neck pain group. Significant negative correlations were found between the functional disability level and the strength of this defined association in the symptomatic group. INTERPRETATION: The compromised capability of the spinal muscles to produce acceleration/deceleration in the neck pain group may imply an impaired electromechanical coupling of these spinal muscles when performing neck movements. Significant negative correlation of the degree of functional disabilities suggests that the present approach can be used as an objective and specific evaluation of the dynamic performance of the spinal muscles and its relationship with the functional disabilities in neck pain subjects.

The role of trunk muscles in sitting balance control in people with low back pain.

The purpose of this study was to examine the muscular activities and kinetics of the trunk during unstable sitting in healthy and LBP subjects. Thirty-one healthy subjects and twenty-three LBP subjects were recruited. They were sat on a custom-made chair mounted on a force plate. Each subject was asked to regain balance after the chair was tilted backward at 20°, and then released. The motions of the trunk and trunk muscle activity were examined. The internal muscle moment and power at the hip and lumbar spine joints were calculated using the force plate and motion data. No significant differences were found in muscle moment and power between healthy and LBP subjects (p>0.05). The duration of contraction of various trunk muscles and co-contraction were significantly longer in the LBP subjects (p<0.05) when compared to healthy subjects, and the reaction times of the muscles were also significantly reduced in LBP subjects (p<0.05). LBP subjects altered their muscle strategies to maintain balance during unstable sitting, but these active mechanisms appear to be effective as trunk balance was not compromised and the internal moment pattern remained similar. The changes in muscle strategies may be the causes of LBP or the result of LBP with an attempt to protect the spine.

Stiffness properties of the trunk in people with low back pain.

The purpose of this study was to examine the dynamic properties of the trunk during unstable sitting and to determine differences between healthy and low back pain (LBP) participants. Participants sat on a custom-made chair that was able to swing freely in the sagittal plane. The chair was mounted on a force platform to measure loads acting at the trunk. Each participant was asked to find a balanced position after the chair was tilted backward and released. Movements of the trunk and chair were recorded. Effective moment of inertia, stiffness and damping coefficients were derived using a second order linear model. 10 participants were re-tested to assess reliability. Trunk stiffness was found increased for LBP subjects (p<.05) while no difference was found for damping coefficient. Gender and initial tilt angle did not affect viscoelastic properties of the spine. A second order linear model adequately described the biomechanical response of the trunk. It was shown that the trunk response was mainly elastic for all participants. The increase in trunk stiffness in LBP subjects could be a compensatory strategy to decrease pain and the risk of further injuries, but further investigations are needed to understand the nature of the viscoelastic alterations.

Dance for Parkinson's: a new framework for research on its physical, mental, emotional, and social benefits.

Parkinson's is a neurodegenerative disease commonly associated with symptoms such as tremor, rigidity, bradykinesia, freezing during gait, motor control deficits and instability. These physical symptoms can cause a myriad of psychological problems including depression, feelings of loneliness, and low self-esteem. Current research suggests pharmacological interventions do not sufficiently address all symptoms and thus alternative therapies have been deemed an important part of treatment for people with Parkinson's. Dance has shown to be a beneficial activity for this population. Upon reviewing recent dance for Parkinson's studies it is clear that there are developing trends with respect to overall approach. The tendency to place more emphasis on changes to clinical signs is creating a gap whereby research neglects to look at how dance is influencing a particular individual in all aspects of their life. There is a need for a framework that allows for and encourages the analysis of the dancing experience for people with Parkinson's on a variety of levels including physically, mentally, emotionally, and socially. With such a framework it would be possible to triangulate the information gathered to draw stronger conclusions that are more meaningful to the people with Parkinson's. This paper would like to propose the use of the World Health Organization's International Classification of Functioning, Disability, and Health as a possible framework for dance for Parkinson's research.

Altered spinal kinematics and muscle recruitment pattern of the cervical and thoracic spine in people with chronic neck pain during functional task.

Knowledge on the spinal kinematics and muscle activation of the cervical and thoracic spine during functional task would add to our understanding of the performance and interplay of these spinal regions during dynamic condition. The purpose of this study was to examine the influence of chronic neck pain on the three-dimensional kinematics and muscle recruitment pattern of the cervical and thoracic spine during an overhead reaching task involving a light weight transfer by the upper limb. Synchronized measurements of the three-dimensional spinal kinematics and electromyographic activities of cervical and thoracic spine were acquired in thirty individuals with chronic neck pain and thirty age- and gender-matched asymptomatic controls. Neck pain group showed a significantly decreased cervical velocity and acceleration while performing the task. They also displayed with a predominantly prolonged coactivation of cervical and thoracic muscles throughout the task cycle. The current findings highlighted the importance to examine differential kinematic variables of the spine which are associated with changes in the muscle recruitment in people with chronic neck pain. The results also provide an insight to the appropriate clinical intervention to promote the recovery of the functional disability commonly reported in patients with neck pain disorders.

Movement coordination and differential kinematics of the cervical and thoracic spines in people with chronic neck pain.

BACKGROUND: Research on the kinematics and inter-regional coordination of movements between the cervical and thoracic spines in motion adds to our understanding of the performance and interplay of these spinal regions. The purpose of this study was to examine the effects of chronic neck pain on the three-dimensional kinematics and coordination of the cervical and thoracic spines during active movements of the neck. METHODS: Three-dimensional spinal kinematics and movement coordination between the cervical, upper thoracic, and lower thoracic spines were examined by electromagnetic motion sensors in thirty-four individuals with chronic neck pain and thirty-four age- and gender-matched asymptomatic subjects. All subjects performed a set of free active neck movements in three anatomical planes in sitting position and at their own pace. Spinal kinematic variables (angular displacement, velocity, and acceleration) of the three defined regions, and movement coordination between regions were determined and compared between the two groups. FINDINGS: Subjects with chronic neck pain exhibited significantly decreased cervical angular velocity and acceleration of neck movement. Cross-correlation analysis revealed consistently lower degrees of coordination between the cervical and upper thoracic spines in the neck pain group. The loss of coordination was most apparent in angular velocity and acceleration of the spine. INTERPRETATION: Assessment of the range of motion of the neck is not sufficient to reveal movement dysfunctions in chronic neck pain subjects. Evaluation of angular velocity and acceleration and movement coordination should be included to help develop clinical intervention strategies to promote restoration of differential kinematics and movement coordination.

Normal kinematics of the neck: the interplay between the cervical and thoracic spines.

The movement coordination between the cervical and thoracic spine was examined in 34 asymptomatic participants (24 female and 10 male). Three-dimensional electromagnetic motion sensors were attached to the skin overlying the head, T1, T6, and T12 spinous processes to measure the angular displacement of the cervical, upper thoracic, and lower thoracic spine during active neck movements. These displacement measurements were found to have excellent reliability, with intraclass correlation coefficient ranging from 0.899 to 0.993. The angular displacement-time curves of the cervical and upper thoracic spine were also highly repeatable, with coefficient of multiple determinations ranging from 0.900 to 0.967. Both the cervical and thoracic spines were found to contribute to active neck motion, the greatest contribution being from the cervical region in all movement directions. The inter-regional movement coordination between the cervical spine and upper thoracic spine in all three planes of movement was found to be high, as determined by cross-correlation analysis of the movements of the regions. The current results suggest that the motion of the thoracic spine, in particular the upper thoracic spine, contributes to neck mobility, and that the upper thoracic spine should be included during clinical examination of neck dysfunction.

Measurement of transmission of vibration through the human spine using skin-mounted inertial sensors.

The purpose of this study was to examine the feasibility of measuring the transmission of vibration using skin mounted inertial sensors and to assess the dynamic properties of the human spine during activities of daily living. Two inertial sensors were attached to skin overlying the first thoracic vertebra (T1) and another one over the first sacral vertebra (S1) with double sided adhesive tape. Subjects walked along a straight line, and up and down stairs at a self selected, comfortable speed. Transmissibility of vertical vibration was calculated as the ratio of the power spectral density of the acceleration signal at T1 over that at S1, over the frequency range of 0.5-12Hz. Cross correlation and coherence of the acceleration signals between the two T1 sensors were performed to evaluate the similarity of the data after correction. Cross correlation of signals between trials was also performed to examine the repeatability of the signals. Cross correlation coefficients were found to be very high (>0.9). Inter-trial consistency of the signals of all sensors was also high (>0.9). It is concluded that skin measurement of transmission of vertical vibration is feasible with the inertial sensors and correction method presented. Different physical activities seem to elicit different frequency characteristics of vibration.

Detection of falls using accelerometers and mobile phone technology.

OBJECTIVES: to study the sensitivity and specificity of fall detection using mobile phone technology. DESIGN: an experimental investigation using motion signals detected by the mobile phone. SETTING AND PARTICIPANTS: the research was conducted in a laboratory setting, and 18 healthy adults (12 males and 6 females; age = 29 ± 8.7 years) were recruited. MEASUREMENT: each participant was requested to perform three trials of four different types of simulated falls (forwards, backwards, lateral left and lateral right) and eight other everyday activities (sit-to-stand, stand-to-sit, level walking, walking up- and downstairs, answering the phone, picking up an object and getting up from supine). Acceleration was measured using two devices, a mobile phone and an independent accelerometer attached to the waist of the participants. RESULTS: Bland-Altman analysis shows a higher degree of agreement between the data recorded by the two devices. Using individual upper and lower detection thresholds, the specificity and sensitivity for mobile phone were 0.81 and 0.77, respectively, and for external accelerometer they were 0.82 and 0.96, respectively. CONCLUSION: fall detection using a mobile phone is a feasible and highly attractive technology for older adults, especially those living alone. It may be best achieved with an accelerometer attached to the waist, which transmits signals wirelessly to a phone.

Ageing modifies the fibre angle and biomechanical function of the lumbar extensor muscles.

BACKGROUND: Ageing is associated with geometrical changes in muscle fascicles that may lead to deteriorations in physical functions. The purpose of this study was to study the effects of ageing on fibre orientation and strength of the lumbar extensor muscles. METHODS: Fifty two healthy, 26 younger (10 males and 16 females, aged from 20 to 35) and 26 older (10 males and 16 females, aged from 65 to 90) volunteers participated in this study. Ultrasound images of the lumbar extensor muscles were obtained with the participants in relaxed standing and half flexion (50% of the range of trunk flexion). The fibre angles at the mid-substance of the muscle were recorded. Lumbar extensor muscle strength was measured in the upright posture with a load cell. FINDINGS: The mean lumbar extensor fibre angles were found to significantly decrease in the half flexion posture when compared to upright stance (P<0.01). Both the fibre angle and the moment generation capability of the muscles decreased with ageing (P<0.01). There was a moderate correlation between the fibre angles in the upright posture and the muscle strength measured in this posture (r=0.40, P<0.01). INTERPRETATION: Age-related changes in muscle geometry and posture may partly account for the deterioration in muscle function in the elderly.

Back pain is associated with changes in loading pattern throughout forward and backward bending.

STUDY DESIGN: Experimental study to determine the kinetics of the lumbar spine (LS) and hips during forward and backward bending. OBJECTIVE: To investigate the effects of back pain, with and without a positive straight leg raise (SLR) sign, on the loading patterns in the LS and hip during forward and backward bending. SUMMARY OF BACKGROUND DATA: Forward and backward bending are important components of many functional activities and are part of routine clinical examination. However, there is a little information about the loading patterns during forward and backward bending in people with back pain with or without a positive SLR sign. METHODS: Twenty asymptomatic participants, 20 back pain participants, and 20 participants with back pain and a positive SLR sign performed 3 continuous cycles of forward and backward bending. Electromagnetic sensors were attached to body segments to measure their kinematics while 2 nonconductive force plates gathered ground reaction force data. A biomechanical model was used to determine the loading pattern in LS and hips. RESULTS: Although the loading on the LS at the end of the range decreased significantly, the loading at the early and middle ranges of forward bending actually increased significantly in people with back pain, especially in those with positive SLR sign. This suggests that resistance to movement is significantly increased in people with back pain during this movement. CONCLUSION: This study suggested that it is not sufficient to study the spine at the end of range only, but a complete description of the loading patterns throughout the range is required. Although the maximum range of motion of the spine is reduced in people with back pain, there is a significant increase in the moment acting through the range, particularly in those with a positive SLR sign.

Feasibility of using inertial sensors to assess human movement.

The aim of this study was to determine the suitability of inertial sensors for motion analysis research. Inertial sensors (Xsens Technologies, Netherlands) consisting of 3D gyroscopes, accelerometers and a magnetometer were compared against an electromagnetic motion tracking system (Fastrak, Polhemus, USA) for measuring motions of an artificial hinge joint and random 3D motions. Subsequently, to assess the feasibility of using inertial sensors for human motion analysis, the movements of the hip joint during walking were recorded in 20 normal asymptomatic subjects. The comparative study demonstrated good agreement between the inertial and electromagnetic systems. Measurements obtained for hip joint movement during walking (flexion, extension and step length) were similar to those reported in previous studies (flexion 38.8 degrees , extension 6.6 degrees , step frequency 1.02Hz). We conclude that the inertial sensors studied have the potential to be used for motion analysis and clinical research.

Kinematics of the lumbar spine in elderly subjects with decreased bone mineral density.

Lumbar spine kinematics was studied in subjects with normal bone mineral density, osteopenia and osteoporosis to determine the effect of bone mineral density and morphology on the flexion-extension movement patterns of the lumbar spine. Lateral radiographs and skin-mounted electromagnetic motion tracking sensors were employed to study lumbar spine kinematics using a Bayesian Belief Network model. The predicted angular displacement of the vertebrae had a high correlation (r = 0.91, p < 0.001) with the actual movements. The overall mean error was -0.51 degrees +/- 3.11 degrees. Intervertebral angular displacement and velocity consistently increased from L1/L2 to L5/S1. Differences were observed in the movement pattern between normal subjects and those with decreased bone density. In normal subjects, vertebral angular acceleration consistently decreased from the upper to the lower vertebrae but the same consistent predictable pattern was not observed in the subjects with decreased bone mineral density. It is possible that these changes in kinematic behaviours are related to morphological changes as well as altered neuromuscular functions.