Evaluating cervical spine mobility and Fitt's law compliance: The DidRen laser test adapted for virtual reality with age and sex effects.

Cervical spine mobility assessment is crucial in rehabilitation to monitor patient progress. This study introduces the DidRen VR test, a virtual reality (VR) adaptation of the conventional DidRen laser test, aimed at evaluating cervical spine mobility. We conducted a cross-sectional study involving fifty healthy participants that underwent the DidRen VR test. The satisfaction of Fitts' law within this VR adaptation was examined and we analyzed the effects of age and sex on the sensorimotor performance metrics. Our findings confirm that Fitts' law is satisfied, demonstrating a predictable relationship between movement time and the index of difficulty, which suggest that the DidRen VR test can simulate real-world conditions. A clear influence of age and sex on performance was observed, highlighting significant differences in movement efficiency and accuracy across demographics, which may necessitate personalized assessment strategies in clinical rehabilitation practices. The DidRen VR test presents an effective tool for assessing cervical spine mobility, validated by Fitts' law. It offers a viable alternative to real-world method, providing precise control over test conditions and enhanced engagement for participants. Since age and sex significantly affect sensorimotor performance, personalized assessments are essential. Further research is recommended to explore the applicability of the DidRen VR test in clinical settings and among patients with neck pain.

Resonance tuning of rhythmic movements is disrupted at short time scales: A centrifuge study.

The human body exploits its neural mechanisms to optimize actions. Rhythmic movements are optimal when their frequency is close to the natural frequency of the system. In a pendulum, gravity modulates this spontaneous frequency. Participants unconsciously adjust their natural pace when cyclically moving the arm in altered gravity. However, the timescale of this adaptation is unexplored. Participants performed cyclic movements before, during, and after fast transitions between hypergravity levels (1g-3g and 3g-1g) induced by a human centrifuge. Movement periods were modulated with the average value of gravity during transitions. However, while participants increased movement pace on a cycle basis when gravity increased (1g-3g), they did not decrease pace when gravity decreased (3g-1g). We highlight asymmetric effects in the spontaneous adjustment of movement dynamics on short timescales, suggesting the involvement of cognitive factors, beyond standard dynamical models.

Occupational Risk Factors for Musculoskeletal Disorders among Workers in Dairy Diversification.

BACKGROUND: In a changing European agricultural context, diversification of dairy farms is gaining attention. This study seeks to (1) assess musculoskeletal pain prevalence associated with tasks such as butter, yogurt, and cheese production; and (2) analyze associated risks. METHODS: Observing 31, mostly female, workers, we utilized the ERGOROM questionnaire, a methodology adapted from the Institut National de Recherche et de Sécurité, and Key Indicator Method forms. RESULTS: Findings revealed that tasks like load carrying (42% of workers), manual work (17%), and awkward postures (14%) resulted in musculoskeletal pain, predominantly in the lower back (65%), neck (39%), and dominant upper limb areas (shoulder: 61%, elbow: 26%, and wrist: 65%). While psychosocial risks remained low, concerns arose from workload, hygiene standards, and resource unpredictability. CONCLUSIONS: As dairy farming evolves from artisanal to semi-industrial, our study emphasizes the importance of ergonomic adaptations to protect farmers' health and prevent musculoskeletal disorders during diversification.

Rethinking neck-related arm pain: hypothetical clinical scenarios to differentiate the underlying IASP-defined pain mechanisms.

Neck-related arm pain is frequently encountered in clinical settings, yet its underlying pain mechanisms remain elusive. While such pain radiating from the neck to the arm is often attributed to injuries or diseases of the nervous system (neuropathic pain), it can also arise from nociceptive (referred) or nociplastic sources. Regrettably, patients exhibiting this specific pain distribution are frequently diagnosed with varying terms, including 'cervicobrachialgia', 'cervicobrachial neuralgia', 'cervicobrachial pain syndrome', and 'cervical radiculopathy'. The ambiguity surrounding these diagnostic labels complicates the clinical reasoning process. It is imperative for clinicians to discern and comprehend the dominant pain mechanism. Three distinct hypothetical clinical scenarios depict patients with almost identical pain distribution but divergent dominant pain mechanisms. Within these scenarios, both subjective and objective examinations are employed to elucidate the dominant pain mechanism associated with neck-related arm pain: nociceptive, neuropathic, and nociplastic. Furthermore, clinicians must remain aware that the dominant pain mechanism can evolve over time.

CHECGAIT: A Functional Electrical Stimulation Clinical Pathway to Reduce Foot Drop during Walking in Adult Patients with Upper Motor Neuron Lesions.

Foot drop during the swing phase of gait and at initial foot contact is a current kinematic abnormality that can occur following an upper motor neuron (UMN) lesion. Functional electrical stimulation (FES) of the common peroneal nerve through an assistive device is often used in neuro-rehabilitation to help patients regain mobility. Although there are FES-specific guideline recommendations, it remains a challenge for clinicians to appropriately select patients eligible for the daily use of FES devices, as very few health insurance systems cover its cost in Europe. In Luxembourg, since 2018, successfully completing an FES clinical pathway called CHECGAIT is a prerequisite to receiving financial coverage for FES devices from the national health fund (Caisse Nationale de Santé-CNS). This study describes the structure and steps of CHECGAIT and reports our experience with a cohort of 100 patients enrolled over a three-year period. The clinical and gait outcomes of all patients were retrospectively quantified, and a specific analysis was performed to highlight differences between patients with and without an FES device prescription at the end of a CHECGAIT. Several significant gait differences were found between these groups. These results and CHECGAIT may help clinicians to better select patients who can most benefit from this technology in their daily lives. In addition, CHECGAIT could provide significant savings to public health systems by avoiding unnecessary deliveries of FES devices.

Description and rules of a new card game to learn clinical reasoning in musculoskeletal physiotherapy.

Teaching hypothetico-deductive clinical reasoning (CR) should be an essential part of the physiotherapy education system, but currently there are very few learning tools for teachers in the musculoskeletal discipline. The aim of this article was to describe and present the rules of a new game-based and structured didactic tool that can be used by teachers for 'players' (students and licensed clinicians) to learn systematic CR in musculoskeletal physiotherapy.Our tool is based on the 'Happy Families' card game, and we propose to use it as part of a classic musculoskeletal subjective examination-based hypothesis category framework and the International Classification of Functioning, Disability and Health model. It allows players to dynamically formulate hypotheses from clinical case studies. Each 'Family' of cards represents a hypothesis category. The game highlights the missing information and trains players to consider it in their CR.This game should efficiently structure all components of CR and is an interesting resource for all teachers. Its greatest strength is that it can be used with other category frameworks. Further studies are needed to assess the efficacy and efficiency of such a tool and to measure students' actual progress in learning the CR.

Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention.

BACKGROUND: Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently. METHODS: Twenty-two participants were recruited and non-randomly assigned to an intervention group ([Formula: see text]11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ([Formula: see text]11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA. RESULTS: Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ([Formula: see text]0.020) and 6-minute walking test ([Formula: see text]0.001) as well as for the Berg Balance Scale ([Formula: see text]0.041) and Mini motor test ([Formula: see text]0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ([Formula: see text]0.009 and [Formula: see text]0.001, respectively). No significant differences were found between the groups at the same time points. CONCLUSIONS: Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued. TRIAL REGISTRATION: Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.

Comparison of the movement behaviour of experienced and novice performers during the Cat exercise.

Two previous studies showed kinematic differences between novice and experienced performers during unchoreographed movements executed in standing position. However, no study explores if these kinematic differences holds during unchoreographed movements executed in quadrupedal position. The aim of this study is to compare the movement behaviour of experienced and novice performers during an exercise wherein they are challenged to use dynamic and largely unchoreographed movement patterns executed in quadrupedal position. The exercise studied was the Cat exercise, in which participants were asked to behave like a feline for 10 minutes. An inventory of the chosen movements and the assessment of their average and coefficient of variation of the ground contact temporal parameters, computed by analysing the tri-dimensional whole-body kinematics of 25 performers (n = 13 novices and n = 12 experienced), was compared according to their experience level. No significant difference was found between the groups for the number of chosen movements, and median or coefficient of variation of ground contact temporal parameters, except for a greater foot/ knee swing coefficient of variation in experienced performers. This suggests that biomechanical constraints induced by quadrupedal position "prevent" a different selection of motor strategies by experienced performers, although the latter can be more variable in their movements.

Wearable Sensors Applied in Movement Analysis.

Recent advances in the miniaturization of electronics have resulted in sensors whose sizes and weights are such that they can be attached to living systems without interfering with their natural movements and behaviors [...].

Classification of Stiff-Knee Gait Kinematic Severity after Stroke Using Retrospective k-Means Clustering Algorithm.

Nowadays, a classification system for unilateral stiff-knee gait (SKG) kinematic severity in hemiparetic adult patients after stroke does not exist. However, such classification would be useful to the clinicians. We proposed the use of the k-means method in order to define unilateral SKG severity clusters in hemiparetic adults after stroke. A retrospective k-means cluster analysis was applied to five selected knee kinematic parameters collected during gait in 96 hemiparetic adults and 19 healthy adults from our clinical gait analysis database. A total of five discrete knee kinematic clusters were determined. Three clusters of SKG were identified, based on which a three-level severity classification was defined: unbend-knee gait, braked-knee gait, and frozen-limb gait. Preliminary construct validity of the classification was obtained. All selected knee kinematic parameters defining the five clusters and the majority of usual kinematic parameters of the lower limbs showed statistically significant differences between the different clusters. We recommend diagnosing SKG for values strictly below 40° of knee flexion during the swing phase. Clinicians and researchers are now able to specify the level of kinematic severity of SKG in order to optimize treatment choices and future clinical trial eligibility criteria.

Adiabatic Invariant of Center-of-Mass Motion during Walking as a Dynamical Stability Constraint on Stride Interval Variability and Predictability.

Human walking exhibits properties of global stability, and local dynamic variability, predictability, and complexity. Global stability is typically assessed by quantifying the whole-body center-of-mass motion while local dynamic variability, predictability, and complexity are assessed using the stride interval. Recent arguments from general mechanics suggest that the global stability of gait can be assessed with adiabatic invariants, i.e., quantities that remain approximately constant, even under slow external changes. Twenty-five young healthy participants walked for 10 min at a comfortable pace, with and without a metronome indicating preferred step frequency. Stride interval variability was assessed by computing the coefficient of variation, predictability using the Hurst exponent, and complexity via the fractal dimension and sample entropy. Global stability of gait was assessed using the adiabatic invariant computed from averaged kinetic energy value related to whole-body center-of-mass vertical displacement. We show that the metronome alters the stride interval variability and predictability, from autocorrelated dynamics to almost random dynamics. However, despite these large local variability and predictability changes, the adiabatic invariant is preserved in both conditions, showing the global stability of gait. Thus, the adiabatic invariant theory reveals dynamical global stability constraints that are "hidden" behind apparent local walking variability and predictability.

Machine Learning Identifies Chronic Low Back Pain Patients from an Instrumented Trunk Bending and Return Test.

Nowadays, the better assessment of low back pain (LBP) is an important challenge, as it is the leading musculoskeletal condition worldwide in terms of years of disability. The objective of this study was to evaluate the relevance of various machine learning (ML) algorithms and Sample Entropy (SampEn), which assesses the complexity of motion variability in identifying the condition of low back pain. Twenty chronic low-back pain (CLBP) patients and 20 healthy non-LBP participants performed 1-min repetitive bending (flexion) and return (extension) trunk movements. Analysis was performed using the time series recorded by three inertial sensors attached to the participants. It was found that SampEn was significantly lower in CLBP patients, indicating a loss of movement complexity due to LBP. Gaussian Naive Bayes ML proved to be the best of the various tested algorithms, achieving 79% accuracy in identifying CLBP patients. Angular velocity of flexion movement was the most discriminative feature in the ML analysis. This study demonstrated that: supervised ML and a complexity assessment of trunk movement variability are useful in the identification of CLBP condition, and that simple kinematic indicators are sensitive to this condition. Therefore, ML could be progressively adopted by clinicians in the assessment of CLBP patients.

Head Pitch Angular Velocity Discriminates (Sub-)Acute Neck Pain Patients and Controls Assessed with the DidRen Laser Test.

Understanding neck pain is an important societal issue. Kinematic data from sensors may help to gain insight into the pathophysiological mechanisms associated with neck pain through a quantitative sensorimotor assessment of one patient. The objective of this study was to evaluate the potential usefulness of artificial intelligence with several machine learning (ML) algorithms in assessing neck sensorimotor performance. Angular velocity and acceleration measured by an inertial sensor placed on the forehead during the DidRen laser test in thirty-eight acute and subacute non-specific neck pain (ANSP) patients were compared to forty-two healthy control participants (HCP). Seven supervised ML algorithms were chosen for the predictions. The most informative kinematic features were computed using Sequential Feature Selection methods. The best performing algorithm is the Linear Support Vector Machine with an accuracy of 82% and Area Under Curve of 84%. The best discriminative kinematic feature between ANSP patients and HCP is the first quartile of head pitch angular velocity. This study has shown that supervised ML algorithms could be used to classify ANSP patients and identify discriminatory kinematic features potentially useful for clinicians in the assessment and monitoring of the neck sensorimotor performance in ANSP patients.

High Specificity of Single Inertial Sensor-Supplemented Timed Up and Go Test for Assessing Fall Risk in Elderly Nursing Home Residents.

The Timed Up and Go test (TUG) is commonly used to estimate the fall risk in the elderly. Several ways to improve the predictive accuracy of TUG (cameras, multiple sensors, other clinical tests) have already been proposed. Here, we added a single wearable inertial measurement unit (IMU) to capture the residents' body center-of-mass kinematics in view of improving TUG's predictive accuracy. The aim is to find out which kinematic variables and residents' characteristics are relevant for distinguishing faller from non-faller patients. Data were collected in 73 nursing home residents with the IMU placed on the lower back. Acceleration and angular velocity time series were analyzed during different subtasks of the TUG. Multiple logistic regressions showed that total time required, maximum angular velocity at the first half-turn, gender, and use of a walking aid were the parameters leading to the best predictive abilities of fall risk. The predictive accuracy of the proposed new test, called i + TUG, reached a value of 74.0%, with a specificity of 95.9% and a sensitivity of 29.2%. By adding a single wearable IMU to TUG, an accurate and highly specific test is therefore obtained. This method is quick, easy to perform and inexpensive. We recommend to integrate it into daily clinical practice in nursing homes.

Metabolic Energy Expenditure and Accelerometer-Determined Physical Activity Levels in Post-Stroke Hemiparetic Patients.

BACKGROUND: Assessment of metabolic energy expenditure in post-stroke patients using accelerometers is clinically important. However, understanding of the best placement of accelerometers on the body and methods for calculating activity counts are limited. METHODS: Thirty hemiparetic post-stroke patients participated in this cross-sectional study. Four triaxial accelerometers were attached to the hemiplegic and contralateral sides of the waist and ankles during various activities: lying, sitting, standing, stepping in place, and walking on a treadmill (1-5 kmh-1). Activity counts and metabolic energy expenditure of the patients were recorded simultaneously. Simple linear regression analyses were performed between the activity counts and energy expenditure. Activities were classified according to their intensity, using the definition of energetic sedentary behavior of post-stroke patients and a low fitness level group. RESULTS: The best estimate of energy expenditure was obtained when the accelerometer was worn on the contralateral ankle and the activity counts was calculated using the vertical and anteroposterior axes (R2=0.812). Six classes of activity intensity (sedentary: ≤1.5 METs, very light: 1.51-1.79, light: 1.80-2.59, moderate: 2.60-3.39, hard: 3.40-4.39, and very hard: ≥4.40) and corresponding activity counts cut-off points are presented. CONCLUSION: A triaxial accelerometer worn on the contralateral ankle and a method of calculating activity counts that includes at least the vertical and anteroposterior axes are recommended for estimating metabolic energy expenditure in post-stroke patients. The new activity counts cut-off points provide a significant advance in the interpretation of post-stroke monitoring in patients outside the hospital or rehabilitation center.

An interactive e-learning module to promote bio-psycho-social management of low back pain in healthcare professionals: a pilot study.

INTRODUCTION: Low back pain (LBP) is ranked as the first musculoskeletal disorder considering years lived with disability worldwide. Despite numerous guidelines promoting a bio-psycho-social (BPS) approach in the management of patients with LBP, many health care professionals (HCPs) still manage LBP patients mainly from a biomedical point of view. OBJECTIVE: The purpose of this pilot study was to evaluate the feasibility of implementing an interactive e-learning module on the management of LBP in HCPs. METHODS: n total 22 HCPs evaluated the feasibility of the e-learning module with a questionnaire and open questions. Participants filled in the Back Pain Attitude Questionnaire (Back-PAQ) before and after completing the module to evaluate their attitudes and beliefs about LBP. RESULTS: The module was structured and easy to complete (91%) and met the expectations of the participants (86%). A majority agreed that the module improved their knowledge (69%). Some participants (77%) identified specific topics that might be discussed in more detail in the module. HCPs knowledge, beliefs and attitudes about LBP significantly improved following module completion (t = -7.63, P < .001) with a very large effect size (ds = -1.63). CONCLUSION: I The module seems promising to change knowledge, attitudes and beliefs of the participants. There is an urgent need to develop and investigate the effect of educational interventions to favor best practice in LBP management and this type of e-learning support could promote the transition from a biomedical to a bio-psycho-social management of LBP in HCPs.

Sensorimotor performance in acute-subacute non-specific neck pain: a non-randomized prospective clinical trial with intervention.

BACKGROUND: The assessment of cervical spine kinematic axial rotation performance is of great importance in the context of the study of neck sensorimotor control. However, studies addressing the influence of the level of provocation of spinal pain and the potential benefit of passive manual therapy mobilizations in patients with acute-subacute non-specific neck pain are lacking. METHODS: A non-randomized prospective clinical trial with an intervention design was conducted. We investigated: (1) the test-retest reliability of kinematic variables during a fast axial head rotation task standardized with the DidRen laser test device in 42 Healthy pain-free Control Participants (HCP) (24.3 years ±6.8); (2) the differences in kinematic variables between HCP and 38 patients with Acute-subacute Non-Specific neck Pain (ANSP) assigned to two different groups according to whether their pain was localized in the upper or lower spine (46.2 years ±16.3); and (3) the effect of passive manual therapy mobilizations on kinematic variables of the neck during fast axial head rotation. RESULTS: (1) Intra-class correlation coefficients ranged from moderate (0.57 (0.06-0.80)) to excellent (0.96 (0.91-0.98)). (2) Kinematic performance during fast axial rotations of the head was significantly altered in ANSP compared to HCP (age-adjusted) for one variable: the time between peaks of acceleration and deceleration (p<0.019). No significant difference was observed between ANSP with upper vs lower spinal pain localization. (3) After the intervention, there was a significant effect on several kinematic variables, e.g., ANSP improved peak speed (p<0.007) and performance of the DidRen laser test (p<0.001), with effect sizes ranging from small to medium. CONCLUSION: (1) The DidRen laser test is reliable. (2) A significant reduction in time between acceleration and deceleration peaks was observed in ANSP compared to HCP, but with no significant effect of spinal pain location on kinematic variables was found. (3) We found that neck pain decreased after passive manual therapy mobilizations with improvements of several kinematic variables. TRIAL REGISTRATION: Registration Number: NCT04407637.

Perceived Usefulness of Telerehabilitation of Musculoskeletal Disorders: A Belgium-France Pilot Study during Second Wave of COVID-19 Pandemic.

BACKGROUND: COVID-19 has affected the practice of physiotherapy, and telerehabilitation (TR) may be seen as an alternative model of care if it is accepted by patients and physiotherapists. This study investigates the perceived usefulness of TR and the intention to use it among physiotherapists and patients from Belgium and France concerned with musculoskeletal disorders (MSDs) during the pandemic period. METHODS: An online questionnaire based on the technology-acceptance model was designed. Sociodemographic data were collected and Likert scales were proposed to assess perceived ease-of-use, perceived usefulness and intention to use TR. Data were collected between 17 January and 17 March 2021; 68 patients and 107 physiotherapists answered. RESULTS: In total, 88% of patients and 76% physiotherapists had not used TR at the time they answered. Only 12% of patients and 1% of physiotherapists are willing to use TR, and 50% of physiotherapists think they will never use TR compared to 25% of patients. A total of 98% of participants agreed that they had a good mastery of the technological tools requested. CONCLUSIONS: Physiotherapists are more reluctant to use TR than patients, regardless of convincing EBM results. This is related to their own representation of proper MSD management, which must include the use of hands-on techniques.

Fine adaptive precision grip control without maximum pinch strength changes after upper limb neurodynamic mobilization.

Before and immediately after passive upper limb neurodynamic mobilizations targeting the median nerve, grip ([Formula: see text]) and load ([Formula: see text]) forces applied by the thumb, index and major fingers (three-jaw chuck pinch) were collected using a manipulandum during three different grip precision tasks: grip-lift-hold-replace (GLHR), vertical oscillations (OSC), and vertical oscillations with up and down collisions (OSC/COLL/u, OSC/COLL/d). Several parameters were collected or computed from [Formula: see text] and [Formula: see text]. Maximum pinch strength and fingertips pressure sensation threshold were also examined. After the mobilizations, [Formula: see text] max changes from 3.2 ± 0.4 to 3.4 ± 0.4 N (p = 0.014), d[Formula: see text] from 89.0 ± 66.6 to 102.2 ± 59.6 [Formula: see text] (p = 0.009), and d[Formula: see text] from 43.6 ± 17.0 to 56.0 ± 17.9 [Formula: see text] ([Formula: see text]0.001) during GLHR. [Formula: see text] SD changes from 0.9 ± 0.3 to 1.0 ± 0.2 N (p = 0.004) during OSC. [Formula: see text] peak changes from 17.4 ± 8.3 to 15.1 ± 7.5 N ([Formula: see text]0.001), [Formula: see text] from 12.4 ± 6.7 to 11.3 ± 6.8 N (p = 0.033), and [Formula: see text] from 2.9 ± 0.4 to 3.00 ± 0.4 N (p = 0.018) during OSC/COLL/u. [Formula: see text] peak changes from 13.5 ± 7.4 to 12.3 ± 7.7 N (p = 0.030) and [Formula: see text] from 14.5 ± 6.0 to 13.6 ± 5.5 N (p = 0.018) during OSC/COLL/d. Sensation thresholds at index and thumb were reduced (p = 0.001, p = 0.008). Precision grip adaptations observed after the mobilizations could be partly explained by changes in cutaneous median-nerve pressure afferents from the thumb and index fingertips.