[Sincerity of effort: isokinetic evaluation of knee extension]. / Sincerità dello sforzo: valutazione isocinetica nell'estensione del ginocchio.

The aim of this study was to find a reliable method to evaluate the sincerity of the muscular maximal effort performed in a dynamometric isokinetic test of knee flexion-extension. The coefficient of variation of the peak torque (CV) and 3 new indices were analysed: (1) the average coefficient of variation calculated on the complete peak torque curve (CVM); (2) the slope of the regression line in an endurance test (PRR); (3) the correlation coefficient of the peak torques in the same endurance test (CCR). Twenty healthy subjects underwent assessment in two different trials, maximal (MX) and 50% submaximal (SMX), with 20 minutes of rest between trials. Each trial consisted of 4 tests, each of 3 repetitions, at angular speed of 30, 180, 30, and 180 degrees/s, respectively, and 1 test of 15 repetitions at 240 degrees/s. Our findings confirmed the ability of CV to detect a high percentage of sincere efforts: at 30 degrees/s Sensibility (Sns)=100% and Specificity (Spc)=70%; at 180 degrees/s Sns=75%, Spc=95%. The 3 new indices here proposed showed high characteristics of Sns and Spc, generally better than those of CV. CVM showed at 180 degrees/s Sns=90% and Spc=100%, while at 30 degrees/s Sns=90%, Spc=75%. PRR was the best index identifying all the efforts, except one (Sns=100%, Spc=95%). The CCR coefficient showed Sns and Spc values both of 90%.

[Cycle ergometers in rehabilitation medicine: technical characteristics and selection criteria]. / I cicloergometri in medicina riabilitativa: caratteristiche tecniche e criteri di selezione.

The cycle ergometer is a commonly used means of testing and training patients with energetic disabilities (particularly in the area of cardiopulmonary diseases). Recent evidence suggests that cycle ergometers can also be useful in patients with subacute and chronic stroke, brain injury, chronic degenerative neurological conditions, and in spinal cord injury. Commercially available cycle ergometers show wide differences in terms of structure and function that have a direct impact on the specific rehabilitation protocols. The aims of this review paper are: a) to briefly review the physiology and biomechanics of exercise on a cycle ergometer; b) to review and discuss the technical specifications of the cycle ergometers suited to rehabilitation settings; c) to provide guidelines for selecting appropriate cycle ergometers for the different categories of rehabilitation patients. First, the physiology of exercise on the cycle ergometer and its biomechanical features are discussed, including the patterns of muscular activity during down- and up-stroke. Upright and recumbent ergometers and their specific clinical indications are compared. Finally, the technical characteristics of the cycle ergometers (load, motor, resistance, flywheel, belt, resilience, pedals, frame, display) are described and the specific requisites for the different patient categories undergoing rehabilitation are discussed in detail. Finally, guidelines are offered for identifying the main technical requisites for appropriate cycle ergometer selection in the different disabilities.

[Work-related musculoskeletal diseases in dental professionals. 1. Prevalence and risk factors]. / Disturbi muscolo-scheletrici di natura lavorativa negli operatori sanitari dentali. 1--Prevalenza e fattori di rischio.

The past two decades have witnessed a sharp rise in the incidence of work-related musculoskeletal disorders (WMSD). All occupations are involved; in dental professionals (dentists, dental hygienists and dental auxiliaries) this problem occurs in 54-93% of subjects, with higher risk in elderly subjects and women. Spine, shoulder, elbow and hand are mostly involved. Prevention of WMSD is becoming crucial and requires the identification and modification of risk factors. Individual characteristics of the worker--such as gender, age, stature, physical condition, strength, etc.--may contribute to the occurrence of these musculoskeletal disorders. Moreover, the specific occupation and work organisation may be the source of ergonomic hazards. Awkward postures, prolonged repetitive movements, intense work schedules or fast work pace represent important risk factors for WMSD. Sometimes the dentist's workstation is not suited to the specific professional characteristics and an ergonomic improvement is needed. Finally, factors connected with professional equipment (such as vibrations, or sharp and hard surfaces causing pressure points) may also contribute to generating WMSD in dental professionals.

[Work-related musculoskeletal disorders in dentistry professionals. 2. Prevention, ergonomic strategies and therapeutic programs]. / Disturbi muscolo-scheletrici di natura lavorativa negli operatori sanitari dentali. 2--Prevenzione, strategie ergonomiche e programmi terapeutici.

In dental professionals the risk of developing work-related musculoskeletal disorders (WMSD) can be minimized through a combination of prevention, ergonomic strategies, and specific therapeutic programs. Prevention includes early identification of symptoms, analysis of working posture and activity, and the evaluation of equipment (such as dental instruments, position of the dental unit, patient and operator chairs, and lighting). The ergonomic strategies are based on identifying the best daily timetable (including periodic pauses) and most efficient team organization, as well as establishing the correct position that should be held at the patient chair. Finally specific therapeutic programs are very important in preventing or treating WMSD. In fact, fitness exercises such as mobilization, stretching or muscular and cardiovascular training are recognized as fundamental for dental professionals, and when WMSD occurs physiatric care and physical therapy are recommended.

A new thermoplastic splint for proximal interphalangeal joint flexion contractures.

BACKGROUND: Aim of this technical note is to describe the fabrication procedure of a new thermoplastic static-progressive hand-based splint for PIP joint flexion contractures, and report its effects in the treatment of a small group of sportsmen. METHODS: The serial-static splint consists of a short metacarpal gauntlet base, with a hole for the thumb and a dorsal finger gutter that extends to the distal extremity. A low-temperature thermoplastic material, two loop fastener straps, three small pieces of self-adhesive hook fastener and cooling spray are required. The orthosis has been tested on four professional volleyball players (3 females and 1 male), aged 18-24 years, suffering from PIP joint flexion contractures after traumatic hand injuries occurred 2 to 3 months before. Patients wore the splint for 1 hour followed by 1 hour of rest (6 times per day), for 2 to 3 weeks. During the resting periods patients performed a few sets of active ROM exercises at their PIP joint. RESULTS: This new splint design demonstrated to be effective in early recovery of complete PIP joint extension and subjects resumed soon their sports activity. CONCLUSIONS: Our device is easy to fabricate and to use and comfortable for patients.

[Reliability and validity of the analysis of hand grip and pinch force in isometric and isokinetic conditions]. / Affidabilità e validità dell' analisi della forza nella presa palmare e nelle pinze in prestazioni isometriche e isocinetiche.

Strength measurement of the hand grip is at the core of most protocols of functional assessment of the upper limb and in rehabilitation plays a major role in the analysis of treatment efficacy and patients' occupational ability. The aims of this study were to: a) verify the repeatability of strength measurements made during performance of the hand grip and three types of pinch, carried out under isometric and isokinetic conditions; b) compare maximal isometric strength with the corresponding isokinetic value for each of the manoeuvres studied; c) investigate the correlations between the strength expressed in the different manoeuvres, under both isometric and isokinetic conditions. We studied 14 voluntary subjects over three sessions conducted at 48-hr intervals, employing a computerized isokinetic dynamometer Lido WorkSet equipped with device N(o) 21 for the study of pinch (lateral pinch, pulp pinch, chuck pinch) and device N(o) 52 for the grip study. Isometric contractions resulted stronger than isokinetic ones, and the hand grip was found to be the manoeuvre able to produce most strength. The repeatability of each strength measurement test over the three days was high (Intraclass Correlation Coefficients: 0.89-0.93). Correlations between the isometric and isokinetic performance for each of the manoeuvres examined were always high (Pearson's r coefficients: 0.89-0.95) as were those between the different manoeuvres, whether performed in isometric or isokinetic modality (r: 0.60-0.94).

Evaluation of a thermoplastic splint to protect the proximal interphalangeal joints of volleyball players.

Due to the extreme forces to which they are exposed, hand injuries are common in volleyball players. This paper evaluates the effectiveness and physical tolerance of a thermoplastic splint developed to prevent proximal interphalangeal (PIP) joint hyperextension during play. The PIP-joint splint was tested by 20 semiprofessional volleyball players (12 women and eight men), all of whom had been using functional taping, and whose court positions exposed them to possible PIP-joint injuries. After four consecutive training sessions and one match, effectiveness (rigidity and durability) of the splint was assessed by measuring any variation of its angle and subjective acceptance of the orthosis was investigated by a questionnaire. After three months, the athletes were asked whether they still used the splint, and, if so, how often. The results indicate that this inexpensive device is effective, does not hinder any volleyball maneuver, and resolves the drawbacks of taping.