Wrist electrogoniometry: are current mathematical correction procedures effective in reducing crosstalk in functional assessment? / Eletrogoniometria de punho: procedimentos matemáticos usuais de correção são eficazes para reduzir crosstalk em avaliação funcional?

BACKGROUND: The recording of human movement is an essential requirement for biomechanical, clinical, and occupational analysis, allowing assessment of postural variation, occupational risks, and preventive programs in physical therapy and rehabilitation. The flexible electrogoniometer (EGM), considered a reliable and accurate device, is used for dynamic recordings of different joints. Despite these advantages, the EGM is susceptible to measurement errors, known as crosstalk. There are two known types of crosstalk: crosstalk due to sensor rotation and inherent crosstalk. Correction procedures have been proposed to correct these errors; however no study has used both procedures in clinical measures for wrist movements with the aim to optimize the correction. OBJECTIVE: To evaluate the effects of mathematical correction procedures on: 1) crosstalk due to forearm rotation, 2) inherent sensor crosstalk; and 3) the combination of these two procedures. METHOD: 43 healthy subjects had their maximum range of motion of wrist flexion/extension and ulnar/radials deviation recorded by EGM. The results were analyzed descriptively, and procedures were compared by differences. RESULTS: There was no significant difference in measurements before and after the application of correction procedures (P<0.05). Furthermore, the differences between the correction procedures were less than 5° in most cases, having little impact on the measurements. CONCLUSIONS: Considering the time-consuming data analysis, the specific technical knowledge involved, and the inefficient results, the correction procedures are not recommended for wrist recordings by EGM.

CONTEXTUALIZAÇÃO: O registro do movimento humano é requisito fundamental para análises biomecânicas, clínicas e ocupacionais, permitindo avaliar variações posturais, riscos e aprimoramento de programas preventivos e de reabilitação em Fisioterapia. O eletrogoniômetro flexível (EGM), considerado um equipamento confiável e acurado, é utilizado para o registro dinâmico de diferentes articulações. Apesar das vantagens, o EGM é suscetível de erros de medida, denominados crosstalk. Atualmente, são conhecidos dois tipos de crosstalk, o crosstalk devido à rotação do sensor e o crosstalk inerente. Procedimentos de correção foram propostos para a correção desses erros, no entanto nenhum estudo utilizou ambos os procedimentos em medidas clínicas dos movimentos do punho, visando otimizar a correção. OBJETIVO: Avaliar o efeito de procedimentos matemáticos atualmente empregados para correção do: 1) crosstalk devido à rotação do antebraço; 2) crosstalk inerente aos sensores e 3) combinação desses dois procedimentos. MÉTODO: Quarenta e três indivíduos saudáveis tiveram as amplitudes máximas dos movimentos de flexão/extensão e desvios ulnar/radial do punho registrados pelos EGM. Os resultados foram analisados de forma descritiva, e os procedimentos foram comparados por diferenças. RESULTADOS: Não houve alteração significativa nas medidas após a aplicação dos procedimentos de correção (P<0,05). Além disso, as diferenças entre os procedimentos de correção foram inferiores a 5° para a maioria dos casos, indicando pouco impacto sobre as medidas. CONCLUSÕES: Considerando o tempo de processamento, o conhecimento técnico específico exigido e os ineficazes resultados obtidos, desaconselha-se a aplicação desses procedimentos na correção de registros eletrogoniométricos do punho.

Four-Dimensional Real-Time Cine Images of Wrist Joint Kinematics Using Dual Source CT with Minimal Time Increment Scanning

PURPOSE: To validate the feasibility of real time kinematography with four-dimensional (4D) dynamic functional wrist joint imaging using dual source CT. MATERIALS AND METHODS: Two healthy volunteers performed radioulnar deviation and pronation-supination wrist motions for 10 s and 4 s per cycle in a dual source CT scanner. Scan and reconstruction protocols were set to optimize temporal resolution. Cine images of the reconstructed carpal bone of the moving wrist were recorded. The quality of the images and radiation dosage were evaluated. RESULTS: The 4D cine images obtained during 4 s and 10 s of radioulnar motion showed a smooth stream of movement with good quality and little noise or artifact. Images from the pronation-supination motion showed noise with a masked surface contour. The temporal resolution was optimized at 0.28 s. CONCLUSION: Using dual source CT, 4D cine images of in vivo kinematics of wrist joint movement were obtained and found to have a shorter scan time, improved temporal resolution and lower radiation dosages compared with those previously reported.

Effects of Passive Upper Arm Exercise on Range of Motion, Muscle Strength, and Muscle Spasticity in Hemiplegic Patients with Cerebral Vascular Disease

PURPOSE: The purpose of this study was to investigate the effects of passive upper arm exercise on range of motion, muscle strength, and muscle spasticity in hemiplegic patients with cerebral vascular disease. METHODS: A quasi-experimental design with nonequivalent control group was utilized. According to inclusion criteria, 25 patients were assigned to the control group with routine care, followed by 25 to the intervention group with passive exercise for 30 minutes per session, twice a day for 2 weeks. Eighteen patients in the intervention group and 17 in the control group completed the posttest measurement, including range of motion for upper arm joints, manual muscle test, and Modified Ashworth Scale for muscle spasticity. RESULTS: The intervention group had a significantly improved range of motion in the shoulder and wrist joints. No interaction effect was found for the elbow joint. No significant differences were found in muscle strength or muscle spasticity between the groups. CONCLUSION: Results of the study indicate that passive exercise safely applied for two weeks improves range of motion in joints of the upper arm in these patients. Further study with long-term follow-up is needed to verify the role of passive exercise in preventing muscle spasticity in this population.

Upper extremity joint stresses during walkerassisted ambulation in post-surgical patients / Estresse articular no membro superior durante marcha assistida por andador em pacientes pós-cirúrgicos

BACKGROUND: A walker is a common device prescribed for ambulatory assistance for individuals with balance difficulties or to reduce lower extremity demands following injury or surgery. The long-term use of a walker imposes significant demands on the patient's upper extremities that may lead to increased risk for development of secondary conditions such as wrist, elbow or shoulder pain. OBJECTIVE: To describe the joint kinematics, forces and moments of the wrist, elbow and shoulder in a sample of twenty patients that were using a walker as a result of total joint surgery of the hips and knees. METHODS: Three-dimensional upper extremity kinematics were recorded using a motion capture system synchronized with forces and torques transmitted through a walker instrumented with force transducers in the handles. RESULTS: Compressive forces were found to be nearly 20 percent of the body weight at each of the upper extremity joints, both surgical and non-surgical sides, being the greatest force at the wrist and decreasing proximally. Compression forces were greater in the non-surgical side limb at the wrist and at the elbow. CONCLUSION: Our findings indicated that loads on upper extremity joints associated with the use of a walker for assisted ambulation are high and further studies are needed to address the cause-effect relationship between the actual joint loading and the development of secondary musculoskeletal upper extremity complaints in more frail patients.

CONTEXTUALIZAÇÃO: Um andador é um dispositivo frequentemente prescrito para auxiliar a marcha de indivíduos com dificuldades de equilíbrio ou para reduzir demandas à extremidade inferior após cirurgia ou lesão. O uso prolongado de um andador impõe significante demanda para a extremidade superior do paciente, o que pode levar a um risco aumentado de desenvolver condições secundárias, como dor no punho, cotovelo e ombro. OBJETIVO: Descrever a cinemática articular, forças e momentos do punho, cotovelo e ombro de uma amostra de 20 pacientes que faziam uso de um andador após cirurgia de substituição articular do joelho ou quadril. MÉTODOS: A cinemática tridimensional foi registrada usando um sistema de captura de movimento sincronizado com o registro de transdutores de força, que mediam a força transmitida através do andador. RESULTADOS: Este estudo revelou forças de até 20 por cento do peso corporal nos transdutores, com forças compressivas maiores do lado do membro inferior não operado, no punho e no cotovelo. CONCLUSÃO: Os achados indicam que demandas no membro superior associadas ao uso de andador como dispositivo auxiliar da marcha são grandes, e mais estudos são necessários para averiguar relações de causa-efeito entre as reais sobrecargas articulares e o desenvolvimento de queixas musculoesqueléticas no membro de pacientes em condições de debilidade.

Artrodesis semiluno-grande-piramido-ganchosa: influencia de la posicion del semilunar en el rango de movilidad posoperatorio. Estudio en cadaveres / Four-corner arthrodesis: influence of the position of the lunate over postoperative wrist motion. A cadaver study

Introduccion: El objetivo de este estudio cadaverico fue evaluar la influencia de la posicion del semilunar sobre la movilidad posoperatoria de la muñeca luego de la artrodesis semiluno-grande-piramido-ganchosa (SGPG) o “artrodesis de las cuatro esquinas”. Materiales y metodos: Se evaluaron seis miembros superiores cadavericos y se analizo en cada una de las muñecas el rango de movilidad pasiva en flexion-extension y desviacion radiocubital luego de simular una artrodesis SGPG fijando el semilunar en tres posiciones: neutra (SN), flexion (SF) y extension (SE). Se realizo un analisis estadistico (ANOVA-Bonferroni) para establecer si existian diferencias significativas en la movilidad articular entre las tres situaciones propuestas.Resultados: Se observaron diferencias estadisticamente significativas en el grado de extension maxima de la muñeca: SN = 57,4º, SF = 35,3º y SE = 64,5º, p = 0,005; yflexion maxima: SN = 56,7º, SF = 65º, SE = 41,7º, p = 0,002. No se detectaron diferencias significativas en el arco total de movilidad en flexion-extension SN = 114,5º; SF = 100,8º; SE = 106,2º; p = 0,2 ni en la movilidad lateral: desviacion radial (p = 0,1) y cubital (p = 0,2). Conclusiones: La posición del semilunar representa un factor determinante de la movilidad posoperatoria en flexion-extension de la muñeca luego de la artrodesis SGPG. La posicion flexionada aumenta la extension articular, mientras la posicion extendida favorece la flexion, manteniendose en ambas situaciones el arco total de movilidad de la muñeca artrodesada.