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【Objective】 To describe the distribution characteristics of knee and ankle joint range of motion and muscle atrophy related indexes in patients with Kashin-Beck disease (KBD) in Shaanxi Province so as to explore the correlation of knee and ankle joint range of motion (ROM) with muscle atrophy indexes and provide reference for clinical characteristics analysis of KBD patients. 【Methods】 To investigate the registered KBD patients from KBD areas in Shaanxi Province, we measured the general demographic data of the patients were collected and the ROM of the knee joint (flexion and extension), the ankle joint (dorsiflexion and plantar flexion), and the muscle atrophy related indexes such as the upper arm circumference, thigh circumference, calf circumference and grip strength. According to the population characteristics, i.e., gender, age, body mass index (BMI) and KBD grade, the median and quartile of joint ROM and muscle atrophy of KBD patients were reported, and then the differences in each index among different groups were analyzed. Partial correlation analysis was used to explore the correlation between indicators after controlling for variables such as gender, age and BMI. 【Results】 A total of 480 patients with KBD were investigated in this study, who consisted of 249 (51.9%) males and 231 (48.1%) females, with an average age of (63.10±7.32) years and an average BMI of (23.49±8.90) kg/m2. The knee flexion ROM, knee extension ROM, ankle dorsiflexion ROM and ankle plantar flexion ROM were [105.0 (95.0, 120.0)] °, [0.0 (-15.0, 0.0)] °, [5.0 (0.0, 15.0)] ° and [20.0 (15.0, 30.0)] °, respectively, in KBD patients in Shaanxi Province. The left thigh circumference, right thigh circumference, left calf circumference, right calf circumference, and upper arm circumference were [43.0 (40.0, 47.0)] cm, [43.0 (39.0, 47.0)] cm, [29.0 (27.0, 32.0)] cm, [29.5 (27.0, 32.0)] cm, [27.0 (25.0, 30.0)] cm, respectively. The left hand grip strength and right hand grip strength were [13.4 (9.5, 18.4)] kg and [13.9 (9.8, 18.2)] kg, respectively. With the increase of age, the extension range of the left and right knee joints of KBD patients showed a decreasing trend (H=31.499, 31.847; all P<0.001). The range of motion of bilateral knee flexion was higher in the normal BMI group than in the overweight or obese group, with statistically significant differences (H=7.753, 12.333; P=0.021, 0.002). The knee flexion, thigh circumference, and calf circumference of the left and right sides showed a decreasing trend under different KBD grades (H=14.345, 17.256, 8.000, 8.462, 8.558, 9.633; all P<0.05). Correlation analysis showed that knee flexion ROM was positively correlated with thigh circumference, calf circumference, and grip strength in patients with KBD (all P<0.05). There was a positive correlation between knee extension ROM and thigh circumference in patients with KBD (P<0.01). 【Conclusion】 The impaired joint ROM and muscle atrophy are serious in KBD patients in Shaanxi Province, and there is a correlation between joint motion and muscle atrophy.
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Objective To explore the effect of proprioceptive neuromuscular facilitation (PNF) rehabilitation training on functional recovery of athletic rotator cuff injury. Methods Twenty-two college students with athletic rotator cuff injuries were stratified according to their gender and randomly divided into resistance band + passive joint range of motion (ROM) training group (control group) and PNF training group (experimental group). The visual analog scale (VAS) was used to evaluate subjective pain intensity of the shoulder joint. Pain positive rate for each manipulation test of rotator cuff injury was observed, and active ROM and muscle strength of the shoulder joint were measured. Improved UCLA shoulder joint score was used to evaluate comprehensive function of the shoulder joint. Results After training, VAS scores and pain positive rate in two groups were lower than those before training, and VAS scores and pain positive rate in experimental group were lower than those in control group. Muscle strength, active ROM in all directions and improved UCLA score of the shoulder joint in two groups were also higher than those before training, and the internal rotation muscle strength, the internal rotation and external rotation active ROM, improved UCLA score of the shoulder joint in experimental group were higher than those in control group. Conclusions PNF rehabilitation training can reduce the pain of athletic rotator cuff injury, improve the active ROM, muscle strength and UCLA shoulder joint score. The function recovery effect of PNF training is better than that of resistance band + passive ROM training.
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Objective To evaluate the influence of dynamic fixation (rotating and sliding pedicle screws) on stability of the atlantoaxial joint. Methods A series of in vitro biomechanical tests were performed using six fresh adult cervical spines (occipital bone-C4 segment) to simulate different conditions in surgery， including the intact state, the injury state, rigid fixation, rotating pedicle screw fixation, sliding pedicle screw fixation. The repeated measurement design was employed, and under intact, injury and different fixation states, the pure moment of 1.5 N·m in flexion-extension, left-right lateral bending, left-right axial rotation directions were applied using the spinal testing machine. The movement of atlantoaxial spine was measured consecutively by three-dimensional （3D） measurement system in order to analyze the range of motion (ROM) and neutral zone (NZ) of atlantoaxial joints. Results Under injury state, ROM of atlantoaxial joints was significantly larger than that under intact state during flexion, extension, lateral bending and rotation, leading to the instability of atlantoaxial joints. ROM of fixation segments was significantly reduced during flexion, extension, lateral bending and rotation after rigid and dynamic fixation. Compared with rigid fixation, dynamic fixation showed a significant ROM increase during lateral bending. NZs of fixation segments after dynamic fixation were significantly reduced. There were no significant ROM differences between rigid fixation and dynamic fixation. Conclusions The stability of atlantoaxial joints by dynamic fixation during flexion, extension and rotation was comparable to that by rigid fixation, but weaker during lateral bending. Dynamic screw fixation can maintain the relative stability of atlantoaxial joints.
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Objective：The Japanese Orthopaedic Association Low Back Pain Evaluation Questionnaire (JOABPEQ) consists of 25 questions, which allows for the multifaceted evaluation of patients with low back pain. In this study, we aimed to investigate whether the JOABPEQ could be used to construct a regression model to quantify low back pain, lower limb symptoms, and hip range of motion (ROM) in patients with lumbar spinal stenosis.Methods：We evaluated 115 patients with lumbar spinal stenosis scheduled to undergo surgery at our hospital. We measured the degrees of low back pain, lower leg pain, and lower leg numbness using the visual analog scale before the surgery. In addition, we measured the ROM of the hip joint during flexion, external rotation, and internal rotation. All responses of the JOABPEQ and physical function data were subjected to a partial least-squares (PLS) regression analysis.Results：Low back pain, lower limb pain, lower limb numbness, and hip ROM during flexion could each be used for significant regression models with JOABPEQ items. However, the hip ROMs during external and internal rotation could not be used for regression models with the JOABPEQ.Conclusion：On the basis of the results of the PLS regression analysis in this study, the degree of pain symptoms in patients with lumbar spinal stenosis may be quantified with the JOABPEQ items. Furthermore, the flexion angle of the hip ROM was quantified using the JOABPEQ items. The results of this study may indicate an effective means for establishing treatment plans for physical therapy.
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Objective：The Japanese Orthopaedic Association Low Back Pain Evaluation Questionnaire (JOABPEQ) consists of 25 questions, which allows for the multifaceted evaluation of patients with low back pain. In this study, we aimed to investigate whether the JOABPEQ could be used to construct a regression model to quantify low back pain, lower limb symptoms, and hip range of motion (ROM) in patients with lumbar spinal stenosis.Methods：We evaluated 115 patients with lumbar spinal stenosis scheduled to undergo surgery at our hospital. We measured the degrees of low back pain, lower leg pain, and lower leg numbness using the visual analog scale before the surgery. In addition, we measured the ROM of the hip joint during flexion, external rotation, and internal rotation. All responses of the JOABPEQ and physical function data were subjected to a partial least-squares (PLS) regression analysis.Results：Low back pain, lower limb pain, lower limb numbness, and hip ROM during flexion could each be used for significant regression models with JOABPEQ items. However, the hip ROMs during external and internal rotation could not be used for regression models with the JOABPEQ.Conclusion：On the basis of the results of the PLS regression analysis in this study, the degree of pain symptoms in patients with lumbar spinal stenosis may be quantified with the JOABPEQ items. Furthermore, the flexion angle of the hip ROM was quantified using the JOABPEQ items. The results of this study may indicate an effective means for establishing treatment plans for physical therapy.
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Background: Neuromuscular electrical stimulation (NMES) has been noted as an effective pre-conditioning intervention for an increase of the rate of development (RFD). However, it is unknown whether NMES increases muscle flexibility. Therefore, the purpose of this study was to investigate whether neuromuscular electrical stimulation (NMES) at 20% of maximal voluntary isometric contraction (MVIC) torque level for 5 seconds used as a warm-up is effective for improving the range of motion (ROM) following increased tolerance for muscle extensibility with/without alteration of the MTU stiffness. Methods and Results: Maximum ROM and ROM with standardized torque (30N) were measured in both legs in thirteen healthy males before and after NMES intervention at a 20% MVIC level for 5 seconds. The maximum ROM increased after intervention compared with before intervention on the NMES side, while it was not changed on the non-NMES side. In addition, there were no significant differences in the ROM with standardized torque in any measurements. Conclusion: It is concluded that NMES at 20% MVIC for 5 seconds could be effective for improving ROM following an increased tolerance for muscle extensibility without alteration of the MTU stiffness.
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Background: Neuromuscular electrical stimulation (NMES) has been noted as an effective pre-conditioning intervention for an increase of the rate of development (RFD). However, it is unknown whether NMES increases muscle flexibility. Therefore, the purpose of this study was to investigate whether neuromuscular electrical stimulation (NMES) at 20% of maximal voluntary isometric contraction (MVIC) torque level for 5 seconds used as a warm-up is effective for improving the range of motion (ROM) following increased tolerance for muscle extensibility with/without alteration of the MTU stiffness. Methods and Results: Maximum ROM and ROM with standardized torque (30N) were measured in both legs in thirteen healthy males before and after NMES intervention at a 20% MVIC level for 5 seconds. The maximum ROM increased after intervention compared with before intervention on the NMES side, while it was not changed on the non-NMES side. In addition, there were no significant differences in the ROM with standardized torque in any measurements. Conclusion: It is concluded that NMES at 20% MVIC for 5 seconds could be effective for improving ROM following an increased tolerance for muscle extensibility without alteration of the MTU stiffness.
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Background: Proprioceptive Neuromuscular Facilitation (PNF) A wide range of treatment techniques and approaches from different philosophical backgrounds are utilized in Neurological Rehabilitation The aim of this study is to evaluate the effectiveness of proprioceptive neuromuscular facilitation technique and conventional therapy in treating the patients with Cervical Spondylosis by improving the pain and range of motion of neck. Subjects and methods: 40 cervical Spondylosis patients of both the sexes selected on the basis of inclusion and exclusion criteria were included in the study and randomly divided into two groups A and B each of 20 persons. Group A consisting of 10 males and 10 females received PNF (Hold –relax and Contract relax) exercise for 4 weeks, 5 days/ week once in a day and Group B consisting of 11males and 9 females received conventional therapy for 4 weeks, 5 days/ week once in a day. Variables are measured pre intervention and post intervention after 4 weeks. To evaluate changes in pain, a shortened version of the McGill Questionnaire was used, Range of motion is measured. Result: Group A shows more significant improvement in all variables (Pain, ROM) in cervical spondylosis subjects than Group B. Conclusion: Analysis of the results confirmed that both PNF and conventional therapy had a statistically significant impact on reducing pain and improving the range of motion of neck in subjects suffering from spondylosis, but PNF method proved to be more effective than conventional therapy and McGill score of PNF applied group were more significant.
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OBJECTIVE@#To observe the effect of electroacupuncture (EA) on the rehabilitation of knee joint function after anterior cruciate ligament (ACL) reconstruction.@*METHODS@#A total of 140 patients with ACL reconstruction were randomly divided into an observation group (58 cases recruited, 12 cases dropped out) and a control group (65 cases recruited, 5 cases dropped out). The patients in the control group were treated with routine rehabilitation treatment. The patients in the observation group, on the basis of the treatment in the control group, were treated with EA at Fengshi (GB 31), Futu (ST 32), Zusanli (ST 36), Shangjuxu (ST 37), Fenglong (ST 40), Xuanzhong (GB 39), Diji (SP 8) and Sanyinjiao (SP 6) on the affected side (2 Hz/100 Hz of dilatational wave, 2-5 mA). Each EA treatment lasted 20-30 min, twice a day for 7 days. The swelling degree (d), pain visual analogue scale (VAS), knee joint range of motion (ROM), scores of International Knee Documentation Committee (IKDC) subjective short form and scores of Lysholm were observed in the two groups 1 day, 1 month, 3 months, 6 months and 1 year after operation.@*RESULTS@#One month and 3 months after operation, the swelling degree (d) and VAS scores in the observation group were lower than those in the control group (0.05). One month, 3 months, 6 months and 1 year after operation, the ROM of the knee joint in the observation group was higher than that in the control group (<0.05), the IKDC score and Lysholm score were higher than those in the control group (<0.05). Within one year, there were no relaxations, fractures and other related complications in the two groups. The pivot shift test, anterior drawer test and the Lachman test were all negative.@*CONCLUSION@#EA combined with routine rehabilitation training could obviously reduce the pain of knee joint, improve the swelling degree, increase the ROM of knee joint, promote the functional recovery in patients with ACL reconstruction, which are superior to rehabilitation training alone.
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Objective To analyze the influence of ligaments surrounding sacroiliac joints (SIJs) on stability of SIJs by finite element method. Methods The finite element lumbar spine-pelvis-femur model was established. Based on this normal model, all SIJ ligaments in both sides were removed in turn, to establish models without iliolumbar ligaments, sacroiliac anterior ligaments, sacroiliac posterior ligament, sacrotuberous ligaments, sacrospinous ligaments, sacroiliac interosseous ligaments, respectively. The models were used to simulate physiological motions of the spine. The range of motion (ROM) and average stress on the left and right SIJs were analyzed and compared with the normal models. Results Compared with the normal SIJ model, no significant differences in the ROM of bilateral SIJs were found in the models without sacrotuberous ligaments, sacrospinous ligaments and sacroiliac posterior ligaments; for the model without acroiliacinterosseous ligaments, there was no significant difference in the ROM of the left SIJs under spinal right rotation and ROM of the right SIJs under spinal extension, but the ROM of bilateral SIJs increased significantly under the other spinal physiological activities. Under the physiological activities of the spine, the average stress of the SIJ surface in the left and right sides of the model without acroiliacinterosseous ligaments significantly decreased. Conclusions Of all the sacroiliac ligaments, the sacroiliac interosseous ligaments showed the maximum influences on the stability of SIJs. The research findings are helpful to investigate the mechanism of SIJ subluxation and provide certain theoretical basis for clinical treatment of SIJ subluxation.
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Objective To study biomechanical properties such as range of motion (ROM), intervertebral disc stress, ligament tension of inferior cervical spinal segment after the treatment of Discover, Prodisc-C artificial intervertebral disc replacement, and anterior cervical discectomy and fusion (ACDF), as well as mechanical property changes of the prosthesis after implantation. Methods Three kinds of operation plan on C5-6 cervical disc degeneration were established: Discover model, Prodisc-C model and ACDF model, as well as C4-7 segment original model of cervical vertebra. Biomechanical property changes after operation in cervical spine C4-7 segment in sagittal, coronal and transverse section were analyzed. Results ROM changes of cervical segment C5-C6 were as following: in Discover model it increased by 12.7%-73.1%, Prodisc-C model increased by 74%-98%, ACDF decreased by 55.8%-71.8%. The stress of C4-5 intervertebral disc after Discover artificial disc replacement showed no obvious increase, while the stress of C6-7 intervertebral disc decreased by 33.2%-54.2% under flexion, extension and axial rotation conditions. The amplification of ligament tension in Discover model decreased by 30%-40% as compared to that in Prodisc-C model. The maximum stress of Discover model (36.72 MPa) appeared under flexion condition, which was smaller than that in Prodisc-C model. Conclusions Artificial disc replacement can help to keep movement performance for segment after surgery. As a newly developed artificial intervertebral disc prosthesis, Discover makes some progress in the aspect of decreasing ligament stress and maintaining spinal stability. The research findings will provide theoretical basis for the clinical study on ACDF and artificial cervical intervertebral disc replacement surgeries.
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Objective To analyze biomechanical properties of cervical spine after anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR) surgery. Methods Twelve cadaveric cervical spines (C2-T1) were adopted, and the motion and load distributions of the cervical segments under intact state and after ACDF and TDR surgery were tested using a three-dimensional (3D) optoelectronics measurement system. All the tests were carried out with displacement control in directions of flexion (Flex), extension (Ext), left bending (LB), right bending (RB), left rotation (LR) and right rotation (RR). Motion characteristics of the normal cervical spine and the implant were also discussed. Results In TDR-treated specimens, range of motion (ROM) was well preserved and could restore to the normal ROM distributions, especially in Flex/Ext and LR/RR direction. While in ACDF-treated specimens, ROM presented a large decrease as much as to 73.41% under the same condition compared with TDR, and ROM distributions were also changed obviously in other motions for the segments. Significant changes of ROM in LB/RB direction occurred in both TDR and ACDF group, which were up to 45.92% and 108.06%, respectively. The experimental data indicated that the normal motion of cervical spines was a 3D coupled motion, especially in LB/RB direction, where a 35% rotation around X-axis existed. The cervical spine could recover close to normal coupled motion after TDR surgery. Conclusions TDR surgery can restore the physiological motion of cervical spines more close to the normal state, especially in Flex/Ext and LR/RR direction. The study provides a theoretical basis and quantitative reference for TDR and ACDF surgery in clinic.
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Objective To develop an improved DIC (digital image correlation) algorithm suitable for measuring large ROM (range of motion) of the cervical spine, as traditional DIC algorithm is not capable of accurately measuring ROM of the cervical spine due to its large rotation angles. Methods An algorithm which allowed rotation of the subset window was proposed to achieve robust correlation matching in the measurement. A new iterative variable, which represented the orientation of the subset, was introduced and incorporated in the Newton-Raphson iteration method together with the position variables (x,y). By assigning an initial guess to these variables individually, the precise location and rotation angle could be determined in the deformed image. The precision of the proposed method was evaluated by translation and rotation experiments. ResultsThe translation experiment confirmed that the proposed method had the same accuracy as the traditional DIC, and the displacement measurement accuracy was within 0.5%. While the rotation experiment indicated that the proposed method could measure the deformation at any angles with precision less than 0.5°. The method was then applied to the measurement of ROM of cervical spine subjected to compressive loads and received good results. Conclusions Compared with the traditional DIC algorithm, the proposed method can achieve accurate measurement with large ROM for cervical spine tests with different loads, and provide an effective means for assessing the stability and physiological activities of cervical spine.
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STUDY DESIGN: A retrospective study. OBJECTIVES: This study examined the cervical range of motion (ROM) of cervical spondylotic myelopathy patients, before and after open door laminoplasty. SUMMARY OF LITERATURE REVIEW: Majority of the cases regarding the change of cervical range of motion after cervical laminoplasty showed decreased range of motion, and the results were diverse. MATERIALS AND METHODS: Of the 487 patients, who underwent open door laminoplasty at our hospital from March 1997 to March 2008, 98 had been followed for at least 2 years and had cervical flexion-extension lateral x-rays. In all patients, open door laminoplasty involved at least three segments: three, four, and five segments in 11, 52, and 35 patients, respectively. In previous cases, fixation involved sutures using suture anchors. The lordosis or kyphosis between C2 and C7 was analyzed using cervical flexion-extension lateral radiographs before and 2 years after the operation. RESULTS: The average patient age was 62.7 (range 32-82) years; 65 patients were male and 33 were female. From preoperatively to postoperatively, the average kyphosis of cervical flexion decreased from 10.7degrees to 7.8degrees, average lordosis decreased from 21.2degrees to 14.2degrees, and cervical ROM decreased from 31.9degrees to 22.0degrees, respectively (mean 9.9degrees, 31.0%). CONCLUSIONS: We could observe decreased cervical range of motion after cervical laminoplasty for cervical spondylotic myelopathic patients. Thus, the treatment to prevent the postoperative decrease of cervical range of motion and further study to find a new treatment are thought to be essential.
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Animais , Feminino , Humanos , Masculino , Cifose , Lordose , Amplitude de Movimento Articular , Estudos Retrospectivos , Doenças da Medula Espinal , Coluna Vertebral , Âncoras de Sutura , SuturasRESUMO
Relative movement between the spine segments has close connection with spinal surgery. Understanding the spinal range of movement is crucial to advance our understanding about the biomechanical function of spine injury, spinal degeneration, and the development of new surgical treatments and implants for spinal disorders. The measurement of spinal movement has gone through the process from two dimensional plane to three dimensional measurement, from simple to complex, from rough estimation to precise calculation. This paper will describe the major achievements and deficiency of various methods of spinal movement measurement to provide reference and help for the research of spinal movement measurement.
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Objective: Although exercise therapy intervention for frail elderly people was not of great interest in the past, it has recently drawn attention as a method to prevent and improve conditions requiring care since the enforcement of the Long-Term Care Insurance Law and the revision of the long-term care insurance system. This randomized controlled trial was performed to evaluate the effects of exercise therapy using the Takizawa Program. Methods: In this randomized controlled trial, we evaluated the effects of exercise therapy on the frail elderly, including those who need a high level of care, in terms of two factors: the range of motion and the functional independence measure. The subjects were 145 females admitted to special nursing homes for the elderly. They were stratified according to their care levels and randomly assigned to either the exercise therapy intervention group or the control group. Results: The range of motion values in the flexions of both shoulders, the right knee extension, and the dorsal flexions of both ankles significantly increased only in the exercise therapy intervention group. The functional independence measure score did not improve in the exercise therapy intervention group. Conclusion: Exercise therapy should be used for the frail elderly requiring a high level of care.
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Terapia por Exercício , Idoso Fragilizado , Ensaio Clínico Controlado AleatórioRESUMO
<p><b>OBJECTIVE</b>Although exercise therapy intervention for frail elderly people was not of great interest in the past, it has recently drawn attention as a method to prevent and improve conditions requiring care since the enforcement of the Long-Term Care Insurance Law and the revision of the long-term care insurance system. This randomized controlled trial was performed to evaluate the effects of exercise therapy using the Takizawa Program.</p><p><b>METHODS</b>In this randomized controlled trial, we evaluated the effects of exercise therapy on the frail elderly, including those who need a high level of care, in terms of two factors: the range of motion and the functional independence measure. The subjects were 145 females admitted to special nursing homes for the elderly. They were stratified according to their care levels and randomly assigned to either the exercise therapy intervention group or the control group.</p><p><b>RESULTS</b>The range of motion values in the flexions of both shoulders, the right knee extension, and the dorsal flexions of both ankles significantly increased only in the exercise therapy intervention group. The functional independence measure score did not improve in the exercise therapy intervention group.</p><p><b>CONCLUSION</b>Exercise therapy should be used for the frail elderly requiring a high level of care.</p>
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OBJECTIVE: The purpose of this study was to determine the usefulness of manual medicine therapy in adhesive capsulitis of shoulder. METHOD: Twelve patients with adhesive capsulitis of shoulder were treated with the muscle energy technique of Greenman in manual medicine therapy. The muscle energy technique of Greenman was repeated 6 times for each subject. The therapeutic effect of manual medicine therapy was assessed by the shoulder range of motion (ROM) and visual analogue scale (VAS) before and after the treatment. Two patients took the fluoroscopic examination before and after the treatment. RESULTS: After the manual medicine therapy, active range of shoulder motion were increased by 30.0degrees in forward flexion, by 21.2degrees in abduction, by 11.2degrees in external rotation, and by 18.7degrees in internal rotation, respectively. The visual analogue scale was decreased after treatment. None of the subjects complained pain during treatment. The mobility of shoulder joint was improved and the rhythm of scapulohumeral joint was restored. CONCLUSION: The manual medicine therapy is an effective, tolerable and noninvasive treatment method for the painful adhesive capsulitis of shoulder.