Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission.

Background: Impaired physical activity and functional ability is a significant problem in critical illness survivors. Measurement of physical functioning through intensive care unit (ICU) stay determines patients at risk of poor physical outcomes, monitors efficacy of intervention, and informs recovery trajectories. Objectives: Study objective was to assess physical function trajectory and identify residual functional limitations in critically ill patients admitted to ICU at the point of discharge from the hospital using robust clinical measures. Materials and methods: Following ethical approval, 100 patients (78 males and 22 females) admitted to medical and surgical ICUs were recruited. Scores on Functional Status Score in ICU (FSS-ICU), Physical Function ICU Test (PFIT), and Functional Independence Measure (FIM) were recorded. Day of physiotherapy reference in the ICU was considered as day of ICU admission. Data were collected at three points, namely ICU admission, ICU discharge, and hospital discharge. Results: Scores on all outcome measures increased linearly, and an upward functional trajectory was observed in patients from the point of ICU admission till hospital discharge (p >0.001). Conclusion: Deficits in functional recovery exist until hospital discharge, substantiating the need to implement home-based rehabilitation to recover optimum physical function and independence in activities of daily living. How to cite this article: Aglawe DR, Agarwal BM, Sawant BD. Physical Function in Critically Ill Patients during the Duration of ICU and Hospital Admission. Indian J Crit Care Med 2022;26(3):314-318.

Evaluation of Early Knee Osteoarthritis Using Biomechanical and Biochemical Markers.

Altered cellular mechano-transduction and biochemistry lead to degeneration of articular cartilage in people with knee osteoarthritis. However, the influence of low-moderate exposure to weight-bearing activity such as squatting on cartilage metabolism has not been adequately studied. The current study explored associations between knee adduction moment (KAM) during walking, biochemical markers and daily squat exposure. 3D gait analysis was used to determine external loads acting on the knee as indicators of joint compressive forces whereas biomarkers-Urine type-II-collagen-telopeptide (uCTxII), antioxidant and phospholipase A2 (PLA2) activity reflected on articular cartilage status. Following ethical approval, 66 participants with varying daily squat exposure (non-squatters [n = 21, exposure = 0 min]; activity of daily living [ADL] squatters [n = 16, exposure = 34 min]; occupational squatters [n = 13, exposure = 102 min]) and people with grade 2-3 knee osteoarthritis (n = 16, exposure = 28 min) were evaluated using 3D gait and biomarker analysis. The PLA2 activity was lowest in ADL squatters while occupational squatters demonstrated highest activity (p < 0.05). KAM and urine biomarker were similar among the groups. Moderate-strong positive association was observed between sweat PLA2 activity and age (r = 0.819, p = 0.004), daily squat exposure and biomarker uCTxII (r = 0.604, p = 0.013), antioxidant activity and Right-KAM (r = -0.917, p = 0.001), and Left-KAM (r = -0.767, p = 0.016), in people with knee OA. Healthy people demonstrated weak positive associations between KAM, uCTxII, and BMI. Associations between non-invasive biomechanical and biochemical markers indicate their potential use to identify early knee osteoarthritis. Studies with larger sample size are necessary to support prescription of body weight joint loading activities such as squatting in moderation, to delay functional decline caused by knee OA.

Exploration of Muscle Activity Using Surface Electromyography While Performing Surya Namaskar.

BACKGROUND: Limited information is available to understand the muscular demands of composite yogasanas such as Surya Namaskar, which is essential to guide prescription of Surya Namaskar in management of commonly prevalent musculoskeletal disorders such as back and knee pain. AIM: Therefore, muscle activation pattern in prime accessible muscles of the trunk and lower extremity, namely lower trapezius, latissimus dorsi, erector spinae, rectus abdominis, gluteus maximus, vastus lateralis, and gastrocnemius, was explored during the traditional 12-pose sequence of Surya Namaskar. METHODOLOGY: Muscle activity of 8 healthy trained yoga practitioners (5 females and 3 males) was recorded using wireless, eight-channel surface electromyography (sEMG) system at a sampling rate of 2000 Hz and bandwidth of 20-450 Hz. Data were processed using EMGworks analysis software, and root mean square values were normalized against muscle activity during maximal voluntary contraction (MVC). RESULTS: The 12-pose sequence of Surya Namaskar activated muscles of the trunk, upper and lower extremities to a varying extent, in each pose. During sustenance, erector spinae demonstrated the highest muscle activation in Hastapadasana (64.7% MVC in Pose 3and 64.3% MVC in Pose 11), lower trapezius during Hastapadasana (41.9% MVC in Pose 3and 39.2% in Pose 11); latissimus dorsi during Bhujangasana (37.4% MVC), Ashtangasana (34.9% MVC), and Parvatasana (34.6% MVC in Pose 8,); gluteus maximus in Ashwa Sanchalanasana (38.5% MVC in Poses 9 and 4); and vastus lateralis in Ashwa Sanchalanasana (34.9% MVC). Rectus abdominis demonstrated low activation throughout Surya Namaskar, presenting the highest activation during Parvatasana (22.8% MVC). All recorded muscles demonstrated greater activation during transition compared to sustenance of pose. CONCLUSION: Surya Namaskar elicited high-to-moderate muscle activation of major postural muscles of the trunk and lower extremity during alternating flexion-extension movements of the spine, supporting its prescription in prevention and management of mechanical low back pain among vulnerable groups of people.

Kinematics of Suryanamaskar Using Three-Dimensional Motion Capture.

BACKGROUND: Suryanamaskar, a composite yogasana consisting of a sequence of 12-consecutive poses, producing a balance between flexion and extension is known to have positive health benefits for obesity and physical fitness management, upper limb muscle endurance, and body flexibility. However, limited information is available on biomechanical demands of Suryanamaskar, i.e., kinematic and kinetic. AIMS: The present study aimed to explore the kinematics of spine, upper, and lower extremity during Suryanamaskar to enhance greater understanding of Suryanamaskar required for safe and precise prescription in the management of musculoskeletal disorders. METHODS: Three-dimensional motion capture of Suryanamaskar was performed on 10 healthy trained yoga practitioners with 12-camera Vicon System (Oxford Metrics Group, UK) at a sampling frequency of 100 Hz using 39 retro-reflective markers. Data were processed using plug-in-gait model. Analog data were filtered at 10Hz. Joint angles of the spine, upper, and lower extremities during 12-subsequent poses were computed within Vicon Nexus. RESULTS: Joint motion was largely symmetrical in all poses except pose 4 and 9. The spine moved through a range of 58° flexion to 44° extension. In the lower quadrant, hip moved from 134° flexion to 15° extension, knee flexed to a maximum of 140°, and 3° hyperextension. Ankle moved in a closed kinematic chain through 40° dorsiflexion to 10° plantarflexion. In the upper quadrant, maximum neck extension was76°, shoulder moved through the overhead extension of 183°-56° flexion, elbow through 22°-116° flexion, and wrist from 85° to 3° wrist extension. CONCLUSIONS: Alternating wide range of transition between flexion and extension during Suryanamaskar holds potential to increase the mobility of almost all body joints, with stretch on anterior and posterior soft tissues and challenge postural balance mechanisms through a varying base of support.