ABSTRACT
Knowledge of musculoskeletal anatomy is fundamental to physical therapy education. Although detailed anatomy syllabi have been developed for medical and other health professional students, none are available for training physical therapists. Therefore, the aim of this project was to produce a core musculoskeletal anatomy syllabus specific to physical therapy students, utilizing a modified Delphi approach. An international Delphi panel (n = 53) composed of anatomists and clinicians involved in physical therapy education considered a total of 2193 anatomical items arranged in four categories (musculoskeletal concepts; vertebral column; pectoral girdle and upper limb; pelvic girdle and lower limb). Using specific criteria, items were rated on the basis of whether they were considered essential knowledge for a competent physical therapy student, and were categorized as core, recommended, not recommended or not core. Of the 2193 items, 1700 (77.5%) were rated as core or recommended. For musculoskeletal concepts, 70% (233/332) of items were categorized as core/recommended. Approximately 80% of items in the other three categories were considered core/recommended-vertebral column (355/440), pectoral girdle and upper limb (513/657), and pelvic girdle and lower limb (599/764). This project presents a detailed musculoskeletal anatomy syllabus which may be used within a physical therapy curriculum. A key difference compared to published musculoskeletal anatomy syllabi for medical students is that a greater number of items are considered core/recommended (approximately 80% vs. 50%). These findings will now be considered and deliberated in accordance with the International Federation of Associations of Anatomists modified Delphi approach.
Subject(s)
Anatomists , Anatomy , Education, Medical, Undergraduate , Students, Medical , Humans , Curriculum , Spine , Anatomy/educationABSTRACT
OBJECTIVE: The purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations. METHODS: A systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies. RESULTS: Of 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other. CONCLUSION: The reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position.
Subject(s)
Neck Pain , Whiplash Injuries , Adult , Humans , Neck Pain/diagnosis , Reproducibility of Results , Proprioception , MovementABSTRACT
The gluteal muscles act as stabilizers of the hip joint and are important for the maintenance of hip function. Atrophy and weakness of the gluteal muscles have been identified in people with hip OA, but it is not known whether these muscles also exhibit altered activity patterns. The aim of this study was to compare gluteal muscle activity in people with hip OA and healthy older adults. Fine-wire intramuscular electrodes were inserted into the three segments of gluteus medius (GMed) and two segments of gluteus minimus (GMin) in 20 participants with unilateral hip OA and 20 age- and gender-matched controls. Electromyographic activity of these muscle segments was examined during walking along a 10 m walkway. Peak amplitude, average amplitude, and time to peak were compared between groups during the stance phase of the gait cycle. During early stance, the OA group demonstrated a higher burst of activity in posterior GMin (P = 0.02) and trends toward a higher peak in anterior GMin. Both groups displayed peak activity in anterior GMin in the early stance phase in contrast to previous reports in young adults. This early burst of muscle activity was more pronounced with increasing severity of OA. No differences were identified in GMed activity. While altered GMin activity is associated with aging, these changes were more pronounced in participants with hip OA. To reduce disability associated with hip OA, future rehabilitation programs should consider targeted gait strategies and exercises for GMin.
Subject(s)
Buttocks/physiology , Gait , Muscle, Skeletal/physiology , Osteoarthritis, Hip/physiopathology , Thigh/physiology , Aged , Case-Control Studies , Electromyography , Female , Humans , Male , Middle Aged , WalkingABSTRACT
The study of human anatomy is fundamental to medical education globally. Knowledge of musculoskeletal anatomy is essential for safe and effective clinical practice, yet this topic often receives insufficient medical program time and perceptions differ regarding which knowledge is core. Given the lack of syllabuses specific to musculoskeletal anatomy, this article aims to provide a detailed syllabus for the vertebral column and limbs relevant to medical students. A Delphi panel comprising anatomists and clinicians rated 2,260 anatomical structures and concepts as "essential," "important," "acceptable," or "not required," with evaluations based around the core knowledge deemed acceptable for a competent medical student. Based on the percentage of panelist agreement for an item to be considered "essential," each item was then classified as core (≥60%), recommended (30%-59%), not recommended (20%-29%), or not core (<20%). Items not classified as core or recommended but rated important by greater than 50% of the panel were highlighted for future consideration. A total of 252/389 musculoskeletal concept items were categorized as core or recommended. The number of core or recommended items for the vertebral column, upper limb, and lower limb were 220/438, 322/663, and 318/770, respectively. Ninety-six items were recommended for future consideration. The results of this Delphi panel will be published on the International Federation of Associations of Anatomists website for continuing international consideration and deliberation by relevant stakeholders. The aim is to set an internationally recognized syllabus, that covers the minimum musculoskeletal content that is academically and clinically relevant. Clin. Anat. 32:974-1007, 2019. © 2019 Wiley Periodicals, Inc.
Subject(s)
Anatomy/education , Back Muscles/anatomy & histology , Education, Medical/standards , Spine/anatomy & histology , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
Osteoarthritis mainly affects weight-bearing joints such as the hip and knee and is the most common form of arthritis. Greater muscle atrophy with fatty infiltration of gluteal muscles and decreased hip abduction strength has previously been identified with increasing severity of radiological hip OA. However, it is well documented that radiographic findings of OA do not always correlate with clinical severity. The aim of this secondary analysis was to examine whether atrophy and strength of gluteus maximus (GMax), medius (GMed), minimus (GMin), and tensor fascia lata (TFL) is associated with the clinical severity of OA. Twenty participants with unilateral hip OA and 20 age- and sex-matched asymptomatic controls were classified on the basis of clinical severity (mild, moderate-severe and asymptomatic groups) using the Oxford hip score. Muscle volumes of GMax, GMed, GMin, and TFL were determined using magnetic resonance imaging and expressed as asymmetry between limbs. A hand-held dynamometer was used to identify hip rotation and abduction strength. Regression analyzes were used to identify the association between muscle asymmetry and patient-reported severity of hip OA. Both symptomatic groups (mild and moderate-severe) demonstrated significant asymmetry in GMax (P < 0.01) and GMin (P < 0.01). GMed asymmetry was associated with only the moderate-severe symptomatic group. Hip abduction strength was reduced in both symptomatic groups. Gluteal muscle atrophy was associated with the clinical severity of OA. Clinical severity could be a useful tool for clinicians interpreting likely gluteal muscle changes and planning rehabilitation strategies for hip OA patients. Clin. Anat. 31:507-513, 2018. © 2018 Wiley Periodicals, Inc.
Subject(s)
Muscle, Skeletal/diagnostic imaging , Muscular Atrophy/etiology , Osteoarthritis, Hip/complications , Aged , Cohort Studies , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Muscular Atrophy/diagnostic imaging , Osteoarthritis, Hip/diagnostic imaging , Severity of Illness IndexABSTRACT
The close proximity of the infraspinatus to the teres minor and their functional similarity in producing external rotation of the glenohumeral joint make accurate insertion of electromyographic (EMG) electrodes into the teres minor difficult and questionable even when published guidelines are followed. The primary aim of this study was to examine the anatomical support for the current guidelines for inserting intramuscular EMG electrodes into the teres minor muscle. The secondary aim was to provide a technical description for ultrasound-guided electrode insertion into the teres minor. Intramuscular electrodes were inserted into four cadaveric shoulders using markings based on the current guidelines. EMG electrodes were also inserted into the teres minor of four healthy male participants using real-time ultrasound (RTUS) guidance. Systematic dissections of the cadaver specimens revealed that the electrode had been successfully inserted into the teres minor muscle in only one out of the four. In the remaining three specimens, the needle lodged in the infraspinatus muscle belly at distances ranging from 3 to 17 mm medial to the teres minor. Using RTUS guidance, the electrodes were successfully inserted into the teres minor in all participants, as confirmed by visual inspection with RTUS. This study confirms that the current EMG electrode insertion guidelines for the teres minor are not accurate and RTUS ensures the placement of electrodes into the teres minor rather than the adjacent infraspinatus muscle.
Subject(s)
Electrodes , Electromyography/methods , Electromyography/standards , Rotator Cuff/physiology , Shoulder Joint/physiology , Aged , Aged, 80 and over , Cadaver , Female , Humans , Male , RotationABSTRACT
Cervicocephalic proprioception (CCP) is an important assessment item for people with a range of clinical conditions, where reduced CCP is associated with neck pain and imbalance. Reliability has been established for a range of positional and movements tests, but there is limited data regarding sense of force, particularly across three planes of movement. The current test-retest study assessed reliability when evaluating sense of force in healthy adults (8 males, 6 females, mean age 31.50 years [SD 10.14]) over two sessions, 4-7 days apart. A force matching protocol was used to evaluate reliability of absolute error (AE), constant error (CE), and variable error (VE) for 10 % and 25 % maximal voluntary contraction (MVC) target forces for flexion, extension, lateral flexion, and rotation. Participants were strapped to a chair to limit trunk movement and data was captured using a compressive force transducer fixed to an adjustable wall mount. Six trials were performed for each contraction-type, totaling 72 submaximal MVCs per session. ICC estimates for AE (0.15-0.77), CE (0.01-0.85), and VE (0.00-0.83) were varied and confidence intervals were mostly wide. Considering lower limits of confidence intervals, CE had best reliability values generally, but more specifically the most reliable contraction type and movement was 25 % MVC flexion (ICC 0.85, confidence interval 0.54-0.95). This study found that reliability for sense of force testing was dependent upon contraction, type of error, and target force utilized. Further reliability analysis should be performed when applying this test to measure validity outcomes in clinical populations.
ABSTRACT
Cervical active range of motion (AROM) is an important outcome measure for clinicians working with a range of patient populations, especially people with neck pain. Multi-sensor inertial measurement unit (IMU) devices demonstrate good validity in the research laboratory but are expensive and not easily accessible in clinical settings. The use of single-IMU devices has been proposed but their validity for measuring cervical AROM is unknown. A concurrent and content validity study was conducted, comparing accuracy of single-IMU NeckCare Pro™ with multi-IMU Xsens™ for measuring cervical AROM in healthy adults (8 males, 7 females, mean age 30.6 years [SD 10.4]). Cervical AROM was assessed for flexion, extension, rotation (right and left), and lateral flexion (right and left), whereby six repetitions were performed for each movement with the subjects strapped to a high-back chair. Regarding content validity, Xsens™ detected a small amount of thoracic movement that could not be detected by the NeckCare Pro™ during cervical AROM testing, with means ranging from 1.5° to 4.1°. However, this did not significantly impact concurrent validity, which was good for all movements (ICC 0.764 - 0.966). This paper found that single-IMU technology (NeckCare Pro™) had good validity for measuring cervical AROM in healthy adults when subjects were strapped to a chair to limit trunk movement.
Subject(s)
Cervical Vertebrae , Neck , Male , Adult , Female , Humans , Reproducibility of Results , Range of Motion, Articular , Neck Pain/diagnosisABSTRACT
OBJECTIVE: To determine the effect of exercise-based rehabilitation programs on hip and knee muscle function and size in people with hip osteoarthritis. METHODS: Seven databases were systematically searched in order to identify studies that assessed muscle function (strength or power) and size in people with hip osteoarthritis after exercise-based rehabilitation programs. Studies were screened for eligibility and assessed for quality of evidence using the GRADE approach. Data were pooled, and meta-analyses was completed on 7 of the 11 included studies. RESULTS: Six studies reported hip and/or knee function outcomes, and two reported muscle volumes that could be included in meta-analyses. Meta-analyses were conducted for four strength measures (hip abduction, hip extension, hip flexion, and knee extension) and muscle size (quadriceps femoris volume). For hip abduction, there was a low certainty of evidence with a small important effect (effect size = 0.28, 95% CI = 0.01, 0.54) favouring high-intensity resistance interventions compared to control. There were no other comparisons or overall meta-analyses that identified benefits for hip or knee muscle function or size. CONCLUSION: High-intensity resistance programs may increase hip abduction strength slightly when compared with a control group. No differences were identified in muscle function or size when comparing a high versus a low intensity group. It is unclear whether strength improvements identified in this review are associated with hypertrophy or other neuromuscular factors.
ABSTRACT
OBJECTIVE: To determine whether physical activity is associated with lower limb muscle size and strength within the general population. DATA SOURCES: Six databases were systematically searched from inception using 3 main constructs: lower extremity, muscle volume, and muscle strength. STUDY SELECTION: Studies that measured physical activity (using either objective or subjective measurements), lower limb muscle size, and strength were included. Available discrete group data were standardized using previously published age- and sex-specific normative values prior to analysis. DATA EXTRACTION: The final analysis included 47 studies from an initial yield of 5402 studies. Standardized scores for outcome measures were calculated for 97 discrete groups. DATA SYNTHESIS: As anticipated, lower limb muscle size was positively correlated with lower limb muscle strength (r=0.26, P<.01; n=4812). Objectively measured physical activity (ie, accelerometry, pedometry) (n=1944) was positively correlated with both lower limb muscle size (r=0.30, P<.01; n=1626) and lower limb strength (r=0.24, P<.01; n=1869). However, subjectively measured physical activity (ie, questionnaires) (n=3949) was negatively associated with lower limb muscle size (r=-0.59, P<.01; n=3243) and lower limb muscle strength (r=-0.48, P<. 01; n=3882). CONCLUSIONS: This review identified that objective measures of physical activity are moderately associated with lower limb muscle size and muscle strength and can, therefore, be used to predict muscle changes within the lower limbs associated with exercise-based rehabilitation programs.
ABSTRACT
Anatomy practical classes have traditionally been taught by a team of demonstrators (team-taught) in a large dissection room. More recently, particularly in nonmedical contexts, practical classes have been taught by one teacher (sole-taught) to smaller student groups. The aim of this study was to compare student outcomes when the same course was delivered with practical classes team-taught at one campus (metropolitan) and sole-taught at a second campus (regional) while maintaining similar staff to student ratios. This anatomy course, for physiotherapy and lower academically credentialed exercise science/physiology students, utilized blended delivery whereby most content was delivered online and practical classes comprised the main face-to-face teaching. In 2018, the metropolitan campus introduced team-teaching practical classes while the regional campus continued with sole-teaching. Student marks and engagement with online content were compared between campuses and to the previous year (2017) when both campuses had sole-taught practical classes. While final marks for the course increased overall in 2018 (P < 0.01), exercise science/physiology students at the metropolitan campus (team-taught) improved their final marks (53.5 ± 1.1%) compared to a slight decrease for the regional (sole-taught) campus (44.8 ± 1.4%) (P < 0.01). There were no differences between campuses for physiotherapy students in 2018. Student engagement with online content did not contribute to the improvement in marks for exercise science/physiology students. Introduction of a team-teaching format improved student marks, particularly for the lower academically credentialed students. Team-teaching should be considered as the preferred format for anatomy practical classes, particularly in courses involving students with diverse academic credentials.
Subject(s)
Anatomy , Anatomy/education , Dissection , Educational Measurement , Humans , StudentsABSTRACT
Background: The rotator cuff muscles are subject to age-related changes, but the effect of aging on glenohumeral joint stability is poorly understood. Objectives: This study aimed to compare glenohumeral joint translation in asymptomatic young and older people. Methods: Twenty young (23.6 ± 5.3 years) and twenty older (66.5 ± 7.8 years) participants with no symptomatic shoulder pathology were recruited. Anterior and posterior glenohumeral joint translations were measured using real-time ultrasound in two positions: (1) shoulder neutral; and (2) shoulder at 90 degrees' abduction and four testing conditions: (1) rest; (2) passive accessory motion testing (PAMT) force alone; (3) PAMT with isometric internal rotation contraction; and (4) PAMT with external rotation contraction. Results: In both groups, there were significant differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior PAMT force (p < 0.03), indicating rotator cuff activity-limited translation in a direction-specific manner. Young participants demonstrated increased passive posterior glenohumeral joint translation in the neutral shoulder position (p < 0.001) and their rotator cuff muscle contraction led to greater reductions in glenohumeral joint translation in the neutral shoulder position (p < 0.001), as compared with older participants. Conclusions: Rotator cuff contraction limits glenohumeral joint translation in a direction-specific manner in both young and older participants. However, younger age is associated with increased passive translation but greater ability to reduce glenohumeral joint translation with rotator cuff muscle contraction. Age-related changes should be considered when assessing and treating glenohumeral joint stability.
Subject(s)
Rotator Cuff/diagnostic imaging , Rotator Cuff/physiology , Shoulder Joint/diagnostic imaging , Shoulder Joint/physiology , Ultrasonography , Adult , Age Factors , Aged , Aged, 80 and over , Female , Healthy Volunteers , Humans , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: Altered gluteus minimus (GMin) activity has been identified in people with hip osteoarthritis (OA) during gait with some evidence of altered gluteus medius (GMed) activity in patients with advanced OA. It is not known whether these muscles also exhibit altered activity during other functional tasks. RESEARCH QUESTION: Does gluteal muscle activity during stepping tasks differ between people with hip OA and healthy older adults? METHODS: Participants included 20 people with unilateral hip OA and 20 age-and sex-matched controls. Muscle activity in the three segments within GMed and two segments of GMin were examined using intramuscular electromyography during step-up, step-down and side-step tasks. RESULTS: Participants in the OA group demonstrated reduced muscle activity early in the step-up task and a later time to peak activity in most muscle segments. Greater activity was identified in anterior GMin in people with hip OA during the side-step task. A delay in time to peak activity was identified in most muscle segments in people with OA during the side-step task. SIGNIFICANCE: For participants with OA, reduced activity in most muscle segments and increased time spent in double limb stance during the step-up task could reflect the decreased strength and pain associated with single limb stance on the affected limb. This study provides further evidence of altered function of the deep gluteal muscles in people with hip OA and highlights the importance of addressing these muscles in rehabilitation.
Subject(s)
Buttocks/physiology , Muscle, Skeletal/physiology , Osteoarthritis, Hip/physiopathology , Thigh/physiology , Adult , Case-Control Studies , Electromyography , Female , Gait , Hip Joint/physiology , Humans , MaleABSTRACT
Functional brown adipose tissue (BAT) was identified in adult humans only in 2007 with the use of fluorodeoxyglucose positron emission tomography imaging. Previous studies have demonstrated a negative correlation between obesity and BAT presence in humans. It is proposed that BAT possesses the capacity to increase metabolism and aid weight loss. In rodents it is well established that BAT is stimulated by the sympathetic nervous system with the interscapular BAT being innervated via branches of intercostal nerves. Whilst there is evidence to suggest that BAT possesses beta-3 adrenoceptors, no studies have identified the specific nerve branch that carries sympathetic innervation to BAT in humans. The aim of this study was to identify and trace the peripheral nerve or nerves that innervate human BAT in the supraclavicular region. The posterior triangle region of the neck of cadaveric specimens were dissected in order to identify any peripheral nerve branches piercing and/or terminating in supraclavicular BAT. A previously undescribed branch of the cervical plexus terminating in a supraclavicular adipose depot was identified in all specimens. This was typically an independent branch of the plexus, from the third cervical spinal nerve, but in one specimen was a branch of the supraclavicular nerve. Histological analysis revealed the supraclavicular adipose depot contained tyrosine hydroxylase immunoreactive structures, which likely represent sympathetic axons. This is the first study that identifies a nerve branch to supraclavicular BAT-like tissue. This finding opens new avenues for the investigation of neural regulation of fat metabolism in humans.
Subject(s)
Adipose Tissue/innervation , Clavicle/innervation , Adipocytes/cytology , Adipose Tissue/anatomy & histology , Aged , Cadaver , Cell Shape , Clavicle/anatomy & histology , Dissection , Humans , Tyrosine 3-Monooxygenase/metabolismABSTRACT
Australian and New Zealand universities commenced a new academic year in February/March 2020 largely with "business as usual." The subsequent Covid-19 pandemic imposed unexpected disruptions to anatomical educational practice. Rapid change occurred due to government-imposed physical distancing regulations from March 2020 that increasingly restricted anatomy laboratory teaching practices. Anatomy educators in both these countries were mobilized to adjust their teaching approaches. This study on anatomy education disruption at pandemic onset within Australia and New Zealand adopts a social constructivist lens. The research question was "What are the perceived disruptions and changes made to anatomy education in Australia and New Zealand during the initial period of the Covid-19 pandemic, as reflected on by anatomy educators?." Thematic analysis to elucidate "the what and why" of anatomy education was applied to these reflections. About 18 anatomy academics from ten institutions participated in this exercise. The analysis revealed loss of integrated "hands-on" experiences, and impacts on workload, traditional roles, students, pedagogy, and anatomists' personal educational philosophies. The key opportunities recognized for anatomy education included: enabling synchronous teaching across remote sites, expanding offerings into the remote learning space, and embracing new pedagogies. In managing anatomy education's transition in response to the pandemic, six critical elements were identified: community care, clear communications, clarified expectations, constructive alignment, community of practice, ability to compromise, and adapt and continuity planning. There is no doubt that anatomy education has stepped into a yet unknown future in the island countries of Australia and New Zealand.
Subject(s)
Anatomy/education , Communicable Disease Control , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Australia/epidemiology , COVID-19 , Curriculum , Education, Distance , Humans , New Zealand/epidemiology , Pandemics , Schools, Medical , TeachingABSTRACT
The majority of clinical tests used to diagnose superior labral anterior to posterior (SLAP) lesions of the shoulder have poor diagnostic accuracy, possibly related to a lack of anatomical validity for test procedures. The resisted supination external rotation (RSER) test is suggested to reproduce symptoms associated with a SLAP lesion by placing stress on the labrum through increasing tension in biceps brachii long head. The test requires supination of the forearm against resistance, while the shoulder is externally rotated passively. It was hypothesized that the RSER would increase activity in biceps brachii long head, thereby providing evidence of the anatomical validity of the test. Electromyography (EMG) was used to measure activity in biceps brachii long head and five other muscles potentially recruited during the RSER test in 12 healthy subjects. EMG amplitude was normalized against maximum voluntary isometric contraction for each muscle. Muscle activity values were averaged across five RSER trials and graded descriptively. Moderately strong activity was recorded in biceps brachii long head and supinator muscle throughout all phases of the RSER test. Brachialis was minimally active throughout the test. The results provide support for the anatomical basis of the RSER test, with the resisted forearm supination component of the test recruiting moderately strong levels of activity in biceps brachii long head throughout the test. Although the evidence of anatomical validity provides support for the RSER test as a clinical test for SLAP lesions of the shoulder, further tests of diagnostic accuracy are required.
Subject(s)
Joint Dislocations/diagnosis , Shoulder Injuries , Adolescent , Adult , Arthroscopy , Diagnostic Techniques and Procedures , Electromyography , Exercise Test , Female , Humans , Joint Dislocations/physiopathology , Male , Muscle, Skeletal/pathology , Muscle, Skeletal/physiopathology , Rotation , Shoulder Joint/pathology , Shoulder Joint/physiopathology , Young AdultABSTRACT
Pharmacological interventions to aid weight loss have historically targeted either appetite suppression or increased metabolic rate. Brown adipose tissue (BAT) possesses the capacity to expend energy in a futile cycle, thus increasing basal metabolic rate. In animal models, oestrogen has been implicated in the regulation of body weight, and it is hypothesized that oestrogen is acting by modulating BAT metabolism. A systematic search was performed, to identify research articles implementing in vivo oestrogen-related interventions and reporting outcome measures that provide direct or indirect measures of BAT metabolism. Meta-analyses were conducted where sufficient data were available. The final library of 67 articles were predominantly in rodent models and provided mostly indirect measures of BAT metabolism. Results of this review found that oestrogen's effects on body weight, in rats and possibly mice, are likely facilitated by both metabolic and appetitive mechanisms but are largely only found in ovariectomized models. There is a need for further studies to clarify the potential effects of oestrogen on BAT metabolism in gonad-intact and castrated male animal models.
ABSTRACT
Blended learning has become increasingly common in higher education. Recent findings suggest that blended learning achieves better student outcomes than traditional face-to-face teaching in gross anatomy courses. While face-to-face content is perceived as important to learning there is less evidence for the significance of online content in improving student outcomes. Students enrolled in a second-year anatomy course from the physiotherapy (PT), exercise physiology (EP), and exercise science (ES) programs across two campuses were included (n = 500). A structural equation model was used to evaluate the relationship of prior student ability (represented by grade in prerequisite anatomy course) and final course grade and whether the relationship was mediated by program, campus or engagement with the online elements of the learning management system (LMS; proportion of documents and video segments viewed and number of interactions with discussion forums). PT students obtained higher grades and were more likely to engage with online course materials than EP and ES students. Prerequisite grade made a direct contribution to course final grade (P < 0.001) but was also mediated by engagement with LMS videos and discussion forums (P < 0.001). Student learning outcomes in a blended anatomy course can be predicted the by level of engagement with online content. Anat Sci Educ 11: 471-477. © 2017 American Association of Anatomists.
Subject(s)
Academic Performance/statistics & numerical data , Anatomy/education , Computer-Assisted Instruction/statistics & numerical data , Education, Distance/statistics & numerical data , Students, Health Occupations/psychology , Curriculum , Health Occupations/education , Humans , Learning , Retrospective Studies , Students, Health Occupations/statistics & numerical dataABSTRACT
OBJECTIVES: To determine whether patients with symptomatic rotator cuff pathology had more glenohumeral joint translation and different patterns of rotator cuff muscle activity compared to controls. DESIGN: Repeated measurements of glenohumeral translation and muscle activity in two positions and six testing conditions in two groups. METHODS: Twenty participants with a symptomatic and diagnosed rotator cuff tear and 20 age, and gender matched controls were included. Neuromuscular activity was tested by inserting intramuscular electrodes in the rotator cuff muscles. Anterior and posterior glenohumeral translations were measured using real time ultrasound in testing conditions (with and without translation force, with and without isometric internal and external rotation), in two positions (shoulder neutral, 90° of abduction) and two force directions (anterior, posterior). RESULTS: Symptomatic pathology group demonstrated increased passive glenohumeral translation with posterior translation force (p<0.05). Overall, rotator cuff muscle contraction in the pathology group limited joint translation in a similar manner to the control group, but they did not show the normal direction specific pattern in the neutral posterior position (p<0.03). The pathology group demonstrated reduced EMG activity in the upper infraspinatus muscle relative to the reference position (p<0.02) with anterior translation force and in the supraspinatus (p<0.05) muscle with anterior and posterior translation force in the abducted position. CONCLUSIONS: Symptomatic pathology resulted in increased passive glenohumeral joint translation. Although there were some reductions in muscle activity with injury, their rotator cuff still controlled glenohumeral translation. These results highlight the need to consider joint translation in the assessment and management of patients with rotator cuff injury.
Subject(s)
Rotator Cuff Injuries/physiopathology , Rotator Cuff/physiopathology , Shoulder Joint/physiopathology , Aged , Case-Control Studies , Female , Humans , Male , Middle Aged , Range of Motion, Articular , Rotation , Rotator Cuff/diagnostic imaging , UltrasonographyABSTRACT
Subscapularis muscle is divided into two independent segments, upper and lower (USUB and LSUB), but the role of each segment in glenohumeral functioning is unclear. We compared the electromyographic (EMG) activity of USUB and LSUB during a variety of shoulder movements, with and without an external translation force. Intramuscular electrodes were inserted in USUB and LSUB segments of 20 adults without pathology and EMG activity was measured in stabilization trials (with and without an anterior or posterior directed force at the humerus and isometric rotations) and two shoulder positions (shoulder neutral, abduction). Maximal voluntary isometric contraction (MVIC) trials were performed in abduction, internal and external rotation of the shoulder. In MVIC trials, USUB showed higher activity during internal rotation (p=0.03), whereas LSUB showed higher activity during external rotation (p<0.01). In stabilization trials, the interaction effects were significant for muscle segment×condition (p<0.01), and approached significance for muscle segment×position (p=0.06). In the neutral position, the pattern of activity for LSUB was similar to USUB. In the abducted position the LSUB, unlike USUB, was more active during external rotation (p=0.06) and also showed increased activity in response to the posterior directed force at the humerus (p=0.04). Our results suggest that USUB primarily acts asan agonist for internal rotation. In contrast LSUB was particularly active in external rotation in the abducted position and demonstrated increased EMG activity in response to the posteriorly directed force at the humerus in that position, suggesting more of a role in glenohumeral stabilization.