Properties of tests for knee joint threshold to detect passive motion following anterior cruciate ligament injury: a systematic review and meta-analysis.

BACKGROUND: Threshold to detect passive motion (TTDPM) tests of the knee joint are commonly implemented among individuals with anterior cruciate ligament (ACL) injury to assess proprioceptive acuity. Their psychometric properties (PMPs), i.e. reliability, validity and responsiveness, are however unclear. This systematic review aimed to establish the PMPs of existing knee joint TTDPM tests among individuals with ACL injury. METHODS: The databases PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL and ProQuest were searched to identify studies that assessed the properties of knee joint TTDPM tests in individuals with ACL injury. The risk of bias for each included study was assessed at the outcome level for each test. Overall quality and levels of evidence for each property were rated according to established criteria. Meta-analyses with mean differences were conducted using random-effects models when adequate data were available. RESULTS: Fifty-one studies covering 108 TTDPM tests and 1632 individuals with unilateral ACL injury were included. A moderate-to-strong level of evidence indicated insufficient quality for all of the following: convergent validity, known-groups validity, discriminative validity, responsiveness between subgroups, and responsiveness to intervention. Subgroup meta-analyses for known-groups validity did however find that a starting angle of 15° resulted in significantly worse TTDPM for knees with ACL injury compared to those of asymptomatic persons (mean difference 0.28°; 95% CI 0.03 to 0.53; P = 0.03), albeit based on only three studies. Due to the lack of evidence, it was not possible to estimate the quality of reliability, measurement error, and criterion validity, nor responsiveness from a criterion and construct approach. CONCLUSIONS: Among persons with ACL injury, existing tests of knee joint TTDPM lack either sufficient quality or evidence for their reliability, validity and responsiveness. Significantly worse thresholds for ACL-injured knees compared to those of asymptomatic controls from a 15° starting angle and trends towards significance for some validity measures nevertheless encourage the development of standardised tests. Further research investigating the influence of modifiable test components (e.g. starting angle and motion direction) on the PMPs of knee joint TTDPM tests following ACL injury is warranted.

The Effect of Kinesthetic and Artificial Tactile Noise and Variability on Stiffness Perception.

Robot-assisted minimally invasive surgeries (RAMIS) have many benefits. A disadvantage, however, is the lack of haptic feedback. Haptic feedback is comprised of kinesthetic and tactile information, and we use both to form stiffness perception. Applying both kinesthetic and tactile feedback can enable more precise feedback than kinesthetic feedback alone. However, during remote surgeries, haptic noises and variations can be present. Therefore, toward designing haptic feedback for RAMIS, it is important to understand the effect of haptic manipulations on stiffness perception. We assessed the effect of two manipulations using stiffness discrimination tasks in which participants received force feedback and artificial skin stretch. In Experiment 1, we added sinusoidal noise to the artificial tactile signal, and found that the noise did not affect participants' stiffness perception or uncertainty. In Experiment 2, we varied either the kinesthetic or the artificial tactile information between consecutive interactions with an object. We found that the both forms of variability did not affect stiffness perception, but kinesthetic variability increased participants' uncertainty. We show that haptic feedback, comprised of force feedback and artificial skin stretch, provides robust haptic information even in the presence of noise and variability, and hence can potentially be both beneficial and viable in RAMIS.

[Kinaesthetics competence in specialized palliative care: Process evaluation of a quasi-experimental study]. / Kinästhetikkompetenz in der spezialisierten Palliative Care.

Kinaesthetics competence in specialized palliative care: Process evaluation of a quasi-experimental study Abstract. Background: To ensure professional symptom control in the context of palliative care, specific nursing skills are required. "Advanced Kinaesthetics in Palliative Care" (AdKinPal) is an education program intending to promote nurses' kinaesthetics competence in order to improve symptom management by means of nursing interventions. Aim: The aim of this article is to illuminate the process of the AdKinPal study in order to check the program's feasibility and to determine possible outcomes. Results may serve as a basis for revising the program with regard to further implementation. Methods: The process evaluation was part of a quasi-experimental study. We collected qualitative and quantitative data (interviews, observation protocols, questionnaire). For data interpretation, we used qualitative content analysis and descriptive quantitative analysis. Results: Overall, the participants valued the workshops and practical support as beneficial. Nevertheless, there were also inhibiting factors, such as workshop scheduling and location as well as working material. The participants questioned sustainable skills development. Conclusions: The first run of the education program was successful. To ensure sustainable competence development, adjustments are necessary for further implementation.

Analysis of the effects of subthalamic nucleus deep brain stimulation on somatosensation in Parkinson's disease patients.

OBJECTIVE: Despite the subthalamic nucleus (STN) deep brain stimulation (DBS) is a treatment commonly used to ameliorate the motor symptoms of Parkinson's disease (PD), its effects on somatosensation is unclear. The purpose of this study was to investigate the potential effects of DBS on temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification in PD patients. METHODS: The study included 14 patients (with a mean age of 59.78 ± 11.03 years; range, 44-70 years) with idiopathic PD who underwent DBS surgery for movement disorders caused by PD at the same Neurosurgery Department. All patients were tested while DBS was turned on (DBS-ON) and off (DBS-OFF). To clearly observe the effect of removing stimulation off, DBS devices were turned off by experimental clinical personnel for a minimum duration of 30 min prior to examination. Temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification were examined. RESULTS: We found that two-point discrimination was significantly lower during DBS-ON than DBS-OFF (p = 0.031). Tactile sensation and kinesthesia deviation degree were lower during DBS-ON than DBS-OFF, but were non-significant (p > 0.05). The number of correct answers on an assessment of graphesthesia was higher during DBS-ON, but was non-significant as well (p > 0.05). Odor identification was better during DBS-OFF. CONCLUSIONS: DBS may have an effective role to improve somatosensation and DBS-related benefits may not be explained by improvements in motor function alone, but rather by enhanced somatosensory processing. Further studies with larger study groups are needed.

Does Personal Learning Style Predict the Ability to Learn Laparoscopic Surgery? A Pilot Study.

PURPOSE: Acquiring laparoscopic skills occurs at different rates among trainees. We conducted a pilot study to determine whether variation in laparoscopic skill acquisition was associated with subject's learning styles. MATERIALS AND METHODS: Nineteen medical students performed 10 repetitions of the object transfer task over a period of 4 weeks using a validated laparoscopic simulator. The main exposure was participants' learning style categorized according to the Fleming VARK-learning style inventory. VARK (V = visual, A = aural, R = read/write, K = kinesthetic) is a validated learning style model that identifies four different learning styles. The main outcome measures that reflected laparoscopic skill acquisition were task completion time (<107 seconds) and total instrument distance (<2.03 m) obtained from SurgTrac® motion analysis software. To determine whether participants' laparoscopic proficiency was associated with learning style we used chi-square tests for categorical variables and t-tests for continuous variables. RESULTS: Nineteen participants completed the inventory, 37% (7) were classified as kinesthetic and/or visual style learners, while 63% (12) were considered multimodal or reading/writing style learners. Participants classified as visual/kinesthetic were ∼4 years older than participants classified as multimodal or reading/writing style learners. No gender differences were observed between the groups. Eighty-five percent (6) of participants with a kinesthetic and/or visual learning style reached the proficiency level for task completion time while only 17% (2) of participants with multimodal or read/write learning style performed the task in <107 seconds (χ2 = 8.7; P = .003). Regarding total instrument distance, 85% (6) of participants classified as kinesthetic and/or visual learners and 67% (8) of participants classified as multimodal or read/write learners performed the task in <2.03 m (P = .36). CONCLUSIONS: This is the first study to investigate the correlation between trainees' VARK-learning style and their ability to acquire laparoscopic skills. This pilot study suggests that trainees' learning style may affect the ability to acquire laparoscopic skill proficiency. Larger studies are needed to confirm these preliminary observations.

Effect of stochastic resonance on proprioception and kinesthesia in anterior cruciate ligament reconstructed patients.

Low amplitude mechanical noise vibration has been shown to improve somatosensory acuity in various clinical groups with comparable deficiencies through a phenomenon known as Stochastic Resonance (SR). This technology showed promising outcomes in improving somatosensory acuity in other clinical patients (e.g., Parkinson's disease and osteoarthritis). Some degree of chronic somatosensory deficiency in the knee has been reported following anterior cruciate ligament (ACL) reconstruction surgery. In this study, the effect of the SR phenomenon on improving knee somatosensory acuity (proprioception and kinesthesia) in female ACL reconstructed (ACLR) participants (n = 19) was tested at three months post-surgery, and the results were compared to healthy controls (n = 28). Proprioception was quantified by the measure of joint position sense (JPS) and kinesthesia with the threshold to detection of passive movement (TDPM). The results based on the statistical analysis demonstrated an overall difference between the somatosensory acuity in the ACLR limb compared to healthy controls (p = 0.007). A larger TDPM was observed in the ACLR limb compared to the healthy controls (p = 0.002). However, the JPS between the ACLR and healthy limbs were not statistically significantly different (p = 0.365). SR significantly improved JPS (p = 0.006) while the effect was more pronounced in the ACLR cohort. The effect on the TDPM did not reach statistical significance (p = 0.681) in either group. In conclusion, deficient kinesthesia in the ACLR limb was observed at three months post-surgery. Also, the positive effects of SR on somatosensory acuity in the ACL reconstructed group warrant further investigation into the use of this phenomenon to improve proprioception in ACLR and healthy groups.

A Biomechatronic EPP upper-limb prosthesis teleoperation system implementation using Bluetooth Low Energy.

In this paper a real time, stand-alone wireless Biomechatronic Extended Physiological Proprioception (EPP) teleoperation system was implemented using two Bluetooth Low Energy (BLE) wireless Systems on Chip (SoCs). This system is designed to achieve kinesthetic coupling between the amputee and prosthetic arm without the use of the classic EPP mechanical linkage, but with the use of a wireless implementation of a Master/Slave teleoperation topology. The experimental real-time implementation achieved a high level of transparency with minuscule time delays.

A Brazilian-Portuguese version of the Kinesthetic and Visual Motor Imagery Questionnaire / Versão brasileira do Questionário de Imagética Motora Cinestésica e Visual

ABSTRACT Motor imagery has emerged as a potential rehabilitation tool in stroke. The goals of this study were: 1) to develop a translated and culturally-adapted Brazilian-Portugese version of the Kinesthetic and Visual Motor Imagery Questionnaire (KVIQ20-P); 2) to evaluate the psychometric characteristics of the scale in a group of patients with stroke and in an age-matched control group; 3) to compare the KVIQ20 performance between the two groups. Methods Test-retest, inter-rater reliabilities, and internal consistencies were evaluated in 40 patients with stroke and 31 healthy participants. Results In the stroke group, ICC confidence intervals showed excellent test-retest and inter-rater reliabilities. Cronbach's alpha also indicated excellent internal consistency. Results for controls were comparable to those obtained in persons with stroke. Conclusions The excellent psychometric properties of the KVIQ20-P should be considered during the design of studies of motor imagery interventions for stroke rehabilitation.

RESUMO A Imagética Mental é uma ferramenta em potencial para a reabilitação de indivíduos com doenças cerebrovasculares. Os objetivos desse estudo foram: 1) Desenvolver uma versão traduzida e adaptada culturalmente do Questionário de Imagética Motora Cinestésica e Visual (KVIQ20-P); 2) Avaliar as características psicométricas da escala nesse grupo e em controles; 3) Comparar o desempenho na escala entre os dois grupos. Métodos Confiabilidades teste-reteste, interexaminador, assim como consistências internas da KVIQ20-P foram avaliadas em 40 indivíduos com AVC e em 31 controles. Resultados No grupo de pacientes, os intervalos de confiança mostraram excelentes confiabilidades teste-reteste e interexaminador. O alfa de Cronbach indicou uma excelente consistência interna. Os resultados no grupo controle foram comparáveis aos obtidos nos pacientes. Conclusões As excelentes propriedades psicométricas da KVIQ20-P devem ser consideradas durante o desenho de estudos de Imagética Mental para a reabilitação de indivíduos com doenças cerebrovasculares.

Superselective Thalamotomy in the Most Lateral Part of the Ventralis Intermedius Nucleus for Controlling Essential and Parkinsonian Tremor.

OBJECTIVE: The minimum and essential thalamic areas for reducing tremor were investigated in cases treated by superselective thalamotomy in the most lateral part of the ventralis intermedius nucleus (mlp-VIM). METHODS: Stereotactic superselective VIM thalamotomy with depth microrecording was performed in 21 patients with essential tremor (ET) and 15 patients with tremor-dominant Parkinson disease (PD). A very small and narrow (axial plane) therapeutic lesion was formed as a square on the sagittal plane and inverse V on the axial plane in the mlp-VIM, which covered the kinesthetic response area topographically related to tremor. Patients with ET were followed up for 4.7 ± 3.0 years and patients with PD for 7.9 ± 3.9 years. RESULTS: Almost complete tremor control was achieved in all patients immediately after surgery and continued for up to 8 years. A few adverse events were recognized but disappeared within 1 month without 1 patient with thalamic hemorrhage. The medial border of the therapeutic lesion was significantly more lateral in both patients with ET and patients with PD than the calculated standard target point and was in patients with PD than in patients with ET. The mean width was only about 2.4 mm. The individual differences of the adequate location of the therapeutic lesion were significantly greater in the ET than in the PD group. CONCLUSIONS: The important area for reducing tremor was small and narrow and was located in the mlp-VIM, where the proprioceptive ascending signals from the tremor-dominant body part are conducted. Superselective thalamotomy in the mlp-VIM was safe and effective for the long-term in patients with ET and PD.

Effects of illusory kinesthesia by tendon vibratory stimulation on the postoperative neural activities of distal radius fracture patients.

Activation of motor-related regions with illusory kinesthesia had been suspected to contribute toward pain alleviation. We used electroencephalography (EEG) to assess the sensorimotor cortex activation during illusory kinesthesia by vibratory tendon stimulation in patients who were in pain. We investigated the relationship between the sensorimotor cortex and postoperative pain to clarify the analgesia mechanism. Patients who had undergone distal radius fracture surgery were studied. A hand massager provided the vibration stimulus for the illusory kinesthesia on the extensor digitorum muscle at the nonaffected hand's wrist joint on 7 consecutive days starting 1 day after surgery. The main outcomes were pain intensity and EEG activity. EEG activity was recorded during illusory kinesthesia. We also analyzed the high α rhythm (10-12 Hz) event-related desynchronization/event-related synchronization. The pain intensity was reduced. Attenuation of the high α wave was observed in the bilateral sensorimotor cortex (C3ch, C4ch) areas during illusory kinesthesia. A significant negative correlation was also observed in the C3 and the C4 of event-related desynchronization/event-related synchronization% values and the variation of pain amelioration at rest. Activation of the sensorimotor cortex by illusory kinesthesia might have influenced parts of the descending pain-inhibitory system. The postoperative pain in the patients might have been alleviated by the descending pain-inhibitory system.

Capacidade explicativa dos componentes da aptidão física para a proficiência motora e inteligência corporal-cinestésica em adolescentes / Explicative capacity of the physical fitness components for motor proficiency and bodilykinesthetic intelligence in adolescents

Este estudo objetivou investigar como ocorreu a introdução do Karate-Do Shotokan no estado do Rio Grande do Sul, por meio da reconstrução das memórias do sensei Luiz Tasuke Watanabe. Tendo como perspectiva teórico-metodológica a História Oral recuperou-se as memórias deste sensei, que foi um dos precursores do estilo Shotokan de Karate-Do no estado. Para tanto, foi gravada e transcrita uma entrevista com o sensei Watanabe. Além desta fonte oral, também foram analisadas fontes documentais, bem como, realizada a revisão bibliográfica sobre o assunto. As análises empreendidas nas fontes acessadas revelaram que Watanabe, ainda criança, emigrou do Japão para o Brasil com sua família e teve sua iniciação no Karate-Do por intermédio de seu irmão, que havia sido praticante no Japão. A prática do Karate-Do intensificou-se quando prestou o serviço militar ao ser aluno do sensei Yasutaka Tanaka, que ministrava aulas no exército. Posteriormente, em 1970, a convite do sensei Teruo Obata, Watanabe foi designado para dar aulas em Porto Alegre, onde atuou em diversas localidades, colaborando mais tarde para a criação do Departamento de Karate da Federação de Pugilismo do Rio Grande do Sul. Watanabe, na época, atuava como professor, mas também participou de competições. No ano de 1972, conquistou o primeiro lugar no Campeonato Mundial de Karate e alcançou destaque a nível nacional, contribuindo para a divulgação desta prática. Após uma década na cidade, em 1981, Watanabe partiu de Porto Alegre por designação do exército, retornando a cidade somente 30 anos depois para ministrar um curso...(AU)

This study aimed to investigate how occurred the introduction of Karate-Do Shotokan in Rio Grande do Sul state, through the reconstruction of memories of Luiz Tasuke Watanabe sensei. Having as theoretical and methodological perspective of the Oral History recovered the memories of this sensei, one of Shotokan karate style precursors in the state. For that was was recorded and transcribed an interview with Watanabe sensei. In addition to this oral source were analyzed documentary sources and was performed a bibliographic review about the subject. The analyzes undertaken in the accessed sources revealed that Watanabe, as a child, along with his family migrated from Japan to Brazil and had its initiation in karate, through his brother, who had been practicing in Japan. The practice of Karate-Do was intensified when paid military service and was a student of sensei Yasutaka Tanaka, who ministered classes in the army. After, in 1970 at the invitation of sensei Teruo Obata, Watanabe was appointed to teach in Porto Alegre, where he served in several places and also colaborated to creation of Karate Department of Pugilism Federation of Rio Grande Sul. Watanabe worked as a teacher and participated in competitions, and in 1972 won first place at the World Karate Championships. So, gained prominence in national level and contributes to the dissemination of Karate. After a decade in the city in 1981, Watanabe left Porto Alegre, by appointment of the army, returning the city only 30 years later to minister a course...(AU)

Impacto do treinamento funcional no equilíbrio e funcionalidade de idosos não institucionalizados / Functional training impact on balance and elderly functionality not institutionalized

As perdas funcionais progressivas que a população idosa enfrenta com o avançar da idade, causam importantes déficits, que com o tempo se tornam mais significativos e no intuito de minimizá-los; o treinamento funcional tem proporcionado ganho de propriocepção, força, resistência, flexibilidade, coordenação motora e condicionamento cardiovascular. Assim como auxilia na obtenção de funcionalidade, contribuindo para a manutenção da independência e qualidade de vida. O estudo teve como objetivo verificar a influência da aplicação de um protocolo de treinamento funcional sobre o equilíbrio e funcionalidade de idosos não institucionalizados. Selecionou-se vinte e um idosos não institucionalizados, com idade média de 69,04 ± 6,4 anos que foram avaliados pela Escala de Equilíbrio de Berg, Escala de Equilíbrio e Marcha de Tinetti e Índex de Independência de Atividades de Vida Diária de Katz antes e após serem submetidos a um programa de treinamento funcional dividido em quatro fases que consistiram em aquecimento, exercícios de equilíbrio, fortalecimento muscular e alongamentos durante uma hora, com frequência de 3 vezes na semana, totalizando 24 sessões. Utilizou-se o teste de normalidade Shapiro-Wilk seguido do teste T student para análise das Escalas de Equilíbrio de Berg, Tinetti e funcionalidade pré e pós-treinamento (p≤0,05). Observou-se melhora de 100% na avaliação do equilíbrio pela Escala de Berg, 85,71% e 77,77% na avaliação da Escala de Tinetti marcha e equilíbrio respectivamente, no pós-treinamento se comparados ao pré-treinamento (p<0,0001). Entretanto na funcionalidade não foram encontradas diferenças entre os momentos avaliados (p>0,05). Conclui-se que o protocolo de treinamento funcional utilizado no estudo foi eficaz na melhora do equilíbrio estático e dinâmico dos idosos, o que favorece a redução do risco de quedas e consequentemente a redução da inabilidade desta população...(AU)

Progressive functional losses that the elderly population faces with advancing age, causing major deficits, which over time become more significant and in order to minimize; them functional training has provided gain proprioception, strength, endurance, flexibility, coordination and cardiovascular conditioning. As well as assists in obtaining feature, helping to maintain independence and quality of life. The study aimed to assess the effect of applying a functional training protocol on balance of oninstitutionalized elderly. Twenty one elderly non-institutionalized were selected, mean age: 69,04 ± 6,4 years, were evaluated by the Berg Balance Scale, Balance Scale and Tinetti Gait and Index of Activities of Daily Living of Independence Katz before and after they underwent functional training program divided into four phases that consisted of heating, balance exercises, muscle strengthening and stretching for one hour, with a frequency of three times a week, totaling 24 sessions. In the statistical analysis we used the Shapiro-Wilk normality test for all variables and the Student t test for analysis of variance of the Berg Balance Scale, Tinetti and functionality. There was 100% improvement in the balance of the assessment by the Berg Scale, 85,71% and 77,77% in the evaluation of Tinetti gait and balance scale respectively, in the post-training compared to pre-training (p <0 ,0001). However in functionality were no differences between the evaluated moments (p>0.05). It concludes that functional training protocol used in the study was effective in improving the static and dynamic balance o felderly, which helps reduce the risk of falls and consequently ther eduction of disability in this population...(AU)

Effect of illusory kinesthesia on hand function in patients with distal radius fractures: a quasi-randomized controlled study.

OBJECTIVES: We investigated the effects of the illusion of motion through tendon vibration on hand function in patients with distal radius fractures. SETTING: Kawachi General Hospital, Japan. SUBJECTS: A total of 22 patients with distal radius fractures were divided into either an illusory kinesthesia group ( n = 11) or a control group ( n = 11). INTERVENTION: We performed the intervention for seven consecutive days after surgery. Evaluations were performed at one day, seven days, one month, and two months postsurgery. MAIN MEASURES: Data were collected on pain at rest and pain during movement. The Patient-Rated Wrist Evaluation and Pain Catastrophizing Scale were also used. RESULTS: The illusory kinesthesia group showed significantly better scores on Patient-Rated Wrist Evaluation ( p < 0.01) compared with the control group at seven days, one month, and two months postsurgery. The mean (SD) of the Patient-Rated Wrist Evaluation total score was 97.6 (2.2) at one day postsurgery and 9.1 (5.3) at seven days postsurgery in the illusory kinesthesia group, while the Patient-Rated Wrist Evaluation total score was 96.3 (4.4) at one day postsurgery and 20.1 (17.0) at seven days postsurgery in the control group. CONCLUSION: Our results indicate that illusory kinesthesia is an effective postsurgery management strategy not only for pain alleviation, but also hand function in patients with distal radius fractures. Furthermore, the significant improvements persisted for up to two months after intervention in the illusory kinesthesia group, but not in the control group. In addition, patients in the kinesthetic illusions group showed increased use of the affected limb in daily living.

Skill learning from kinesthetic feedback.

BACKGROUND: It is important for a surgeon to perform surgical tasks under appropriate guidance from visual and kinesthetic feedback. However, our knowledge on kinesthetic (muscle) memory and its role in learning motor skills remains elementary. OBJECTIVES: To discover the effect of exclusive kinesthetic training on kinesthetic memory in both performance and learning. METHODS: In Phase 1, a total of twenty participants duplicated five 2 dimensional movements of increasing complexity via passive kinesthetic guidance, without visual or auditory stimuli. Five participants were asked to repeat the task in the Phase 2 over a period of three weeks, for a total of nine sessions. RESULTS: Subjects accurately recalled movement direction using kinesthetic memory, but recalling movement length was less precise. Over the nine training sessions, error occurrence dropped after the sixth session. CONCLUSIONS: Muscle memory constructs the foundation for kinesthetic training. Knowledge gained helps surgeons learn skills from kinesthetic information in the condition where visual feedback is limited.

Proprioceptive evaluation in healthy women undergoing Infrared Low Level Laser Therapy

Abstract Aim To evaluate if the application of infrared low-level laser therapy (LLLT) alters proprioception in young women. Methods 26 female volunteers were evaluated statically and dynamically by means of electronic baropodometry in the variables: distance from the foot center, maximum and medium pressure, and surface. Proprioception was also functionally assessed by the Star Excursion Balance Test (SEBT). The intervention occurred in two distinct periods, separated by one week apart, as this was a crossover study, so volunteers were submitted to placebo or LLLT (830 nm, 8 J/cm2), on the muscles: gastrocnemius, soleus, tibialis previous and long and short fibular. Results the analysis of baropodometry for both dynamic and static found no significant differences for the intervention group and the control group. Similar results were observed for SEBT. Conclusion The application of the LLLT, in the proposed parameters, did not influence the proprioception in young women.(AU)

[THE SPLEEN FIXING AS IMPORTANT ELEMENT OF PERFORMANCE OF LAPAROSCOPIC LEFT-SIDED ADRENALECTOMY].

Abstract The necessity of performance of orthotopic fixing of spleen after main stage of a left-sided laparoscopic adrenalectomy was substantiated. The majority of patients, first of all ordinary or with a lean stature, are complaining on a temporary discomfort and pain in abdomen of various degree, what is connected with transition of a mobilized spleen in early postoperative period. A simple method of surgical fixation of spleen is putting of 2 or 3 sutures on dissected sheets of parietal peritoneum in region of mobilization of spleen and pancreatic tail, what is securely prevents such an unwanted signs and facilitate a postoperative period course.

The Brief Kinesthesia test is feasible and sensitive: a study in stroke

BACKGROUND: Clinicians lack a quantitative measure of kinesthetic sense, an important contributor to sensorimotor control of the hand and arm. OBJECTIVES: The objective here was to determine the feasibility of administering the Brief Kinesthesia Test (BKT) and begin to validate it by 1) reporting BKT scores from persons with chronic stroke and a healthy comparison group and 2) examining the relationship between the BKT scores and other valid sensory and motor measures. METHOD: Adults with stroke and mild to moderate hemiparesis (N=12) and an age-, gender-, and handedness-matched healthy comparison group (N=12) completed the BKT by reproducing three targeted reaching movements per hand with vision occluded. OTHER MEASURES: the Hand Active Sensation Test (HASTe), Touch-Test(tm) monofilament aesthesiometer, 6-item Wolf Motor Function Test (Wolf), the Motor Activity Log (MAL), and the Box and Blocks Test (BBT). A paired t-test compared BKT scores between groups. Pearson product-moment correlation coefficients assessed the relationship between BKT scores and other measures. RESULTS: Post-stroke participants performed more poorly on the BKT than comparison participants with their contralesional and ipsilesional upper extremity. The mean difference for the contralesional upper extremity was 3.7 cm (SE=1.1, t=3.34; p<0.008). The BKT score for the contralesional limb was strongly correlated with the MAL-how much (r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf (r=0.69, p=0.02), and the BBT (r=0.77, p=0.006). CONCLUSIONS: The BKT was feasible to administer and sensitive to differences in reaching accuracy between persons with stroke and a comparison group. With further refinement, The BKT may become a valuable clinical measure of post-stroke kinesthetic impairment.

Conservative management of midcarpal instability.

Midcarpal instability is a complex condition that can present in various forms, from mild pain to debilitating subluxation. Once diagnosed, treatment guidelines for hand therapy are limited by the scarcity of high-level evidence. Evidence does exist for use of proprioceptive awareness and neuromuscular rehabilitation for instability of the knee, shoulder and ankle joint, but studies of similar programmes for the wrist joint have not been published. The purpose of this review is to examine the evidence supporting current concepts in the non-operative management of midcarpal instability, and to provide recommendations for the management of this condition with hand therapy.

Design of a haptic device with grasp and push-pull force feedback for a master-slave surgical robot.

PURPOSE: We propose a portable haptic device providing grasp (kinesthetic) and push-pull (cutaneous) sensations for optical-motion-capture master interfaces. METHODS: Although optical-motion-capture master interfaces for surgical robot systems can overcome the stiffness, friction, and coupling problems of mechanical master interfaces, it is difficult to add haptic feedback to an optical-motion-capture master interface without constraining the free motion of the operator's hands. Therefore, we utilized a Bowden cable-driven mechanism to provide the grasp and push-pull sensation while retaining the free hand motion of the optical-motion capture master interface. To evaluate the haptic device, we construct a 2-DOF force sensing/force feedback system. We compare the sensed force and the reproduced force of the haptic device. Finally, a needle insertion test was done to evaluate the performance of the haptic interface in the master-slave system. RESULTS: The results demonstrate that both the grasp force feedback and the push-pull force feedback provided by the haptic interface closely matched with the sensed forces of the slave robot. We successfully apply our haptic interface in the optical-motion-capture master-slave system. The results of the needle insertion test showed that our haptic feedback can provide more safety than merely visual observation. CONCLUSIONS: We develop a suitable haptic device to produce both kinesthetic grasp force feedback and cutaneous push-pull force feedback. Our future research will include further objective performance evaluations of the optical-motion-capture master-slave robot system with our haptic interface in surgical scenarios.

Efeito da caminhada em esteira na acuidade proprioceptiva do tornozelo em mulheres jovens saudáveis: ensaio clínico randomizado / Effect of treadmill walking on ankle proprioceptive acuity in healthy young women: a randomized clinical trial

OBJETIVOS: Avaliar o efeito da caminhada em esteira na acuidade proprioceptiva do tornozelo de mulheres jovens saudáveis. MÉTODOS: Para este ensaio clínico randomizado foram selecionadas 20 mulheres entre 18 e 30 anos com um nível baixo de atividade física segundo a classificação IPAQ (Questionário Internacional de Nível de Atividade Física). As participantes foram divididas em dois grupos de 10 componentes, o Grupo Exercício, que realizou 10 sessões de caminhada em esteira, e o Grupo Controle, que não foi submetido a nenhuma intervenção. A acuidade proprioceptiva do tornozelo foi avaliada pré e pós-intervenção por meio do Star Excursion Balance Test. Após ser confirmada a normalidade dos dados, foi utilizada a análise de variância com delineamento misto para comparação entre os grupos e entre as avaliações pré e pós-intervenção. RESULTADOS: Não foram encontradas diferenças significativas na execução do Star Excursion Balance Test comparando as avaliações pré e pós-intervanção em ambos os grupos. Também não foram encontradas diferenças entre os dois grupos comparando as variações percentuais entre as duas avaliações. CONCLUSÕES: Nas condições testadas, um programa de 10 sessões de caminhada em esteira não foi capaz de promover adaptações na acuidade proprioceptiva do tornozelo em mulheres jovens saudáveis.

AIMS: To evaluate the effect of treadmill walking on ankle proprioceptive acuity in healthy young women. METHODS: This randomized clinical trial included 20 women aged 18 to 30 years with a low level of physical activity according to the International Physical Activity Questionnaire classification. The participants were assigned to two groups with 10 components: the exercise group, which performed 10 treadmill walking sessions, and the control group, which was not submitted to any kind of intervention. Ankle proprioceptive acuity was assessed before and after the Star Excursion Balance Test. After confirming the normality of data, a mixed analysis of variance was used to compare the groups and the assessments before and after the intervention. RESULTS: There were no significant differences in the Star Excursion Balance Test between groups either before or after the intervention. In addition, intergroup differences were not found when percentage variations were compared in both groups. CONCLUSIONS: Under the tested conditions, 10 treadmill walking sessions were not able to produce proprioceptive adaptations in healthy young women.