Validity and Reliability of OpenPose-Based Motion Analysis in Measuring Knee Valgus during Drop Vertical Jump Test.

OpenPose-based motion analysis (OpenPose-MA), utilizing deep learning methods, has emerged as a compelling technique for estimating human motion. It addresses the drawbacks associated with conventional three-dimensional motion analysis (3D-MA) and human visual detection-based motion analysis (Human-MA), including costly equipment, time-consuming analysis, and restricted experimental settings. This study aims to assess the precision of OpenPose-MA in comparison to Human-MA, using 3D-MA as the reference standard. The study involved a cohort of 21 young and healthy adults. OpenPose-MA employed the OpenPose algorithm, a deep learning-based open-source two-dimensional (2D) pose estimation method. Human-MA was conducted by a skilled physiotherapist. The knee valgus angle during a drop vertical jump task was computed by OpenPose-MA and Human-MA using the same frontal-plane video image, with 3D-MA serving as the reference standard. Various metrics were utilized to assess the reproducibility, accuracy and similarity of the knee valgus angle between the different methods, including the intraclass correlation coefficient (ICC) (1, 3), mean absolute error (MAE), coefficient of multiple correlation (CMC) for waveform pattern similarity, and Pearson's correlation coefficients (OpenPose-MA vs. 3D-MA, Human-MA vs. 3D-MA). Unpaired t-tests were conducted to compare MAEs and CMCs between OpenPose-MA and Human-MA. The ICCs (1,3) for OpenPose-MA, Human-MA, and 3D-MA demonstrated excellent reproducibility in the DVJ trial. No significant difference between OpenPose-MA and Human-MA was observed in terms of the MAEs (OpenPose: 2.4° [95%CI: 1.9-3.0°], Human: 3.2° [95%CI: 2.1-4.4°]) or CMCs (OpenPose: 0.83 [range: 0.99-0.53], Human: 0.87 [range: 0.24-0.98]) of knee valgus angles. The Pearson's correlation coefficients of OpenPose-MA and Human-MA relative to that of 3D-MA were 0.97 and 0.98, respectively. This study demonstrated that OpenPose-MA achieved satisfactory reproducibility, accuracy and exhibited waveform similarity comparable to 3D-MA, similar to Human-MA. Both OpenPose-MA and Human-MA showed a strong correlation with 3D-MA in terms of knee valgus angle excursion.

Proprioceptive neuromuscular facilitation therapy versus manual therapy in patients with neck pain: a randomised controlled trial.

OBJECTIVE: To compare the effects of proprioceptive neuromuscular facilitation therapy with manual therapy in improving the range of motion, decreasing pain, and improving activity of daily living in patients with neck pain. DESIGN: Double-blinded, randomized, experimental study. PATIENTS: Women aged 45-65 with cervical pain due to osteoarthritis of the vertebral body and intervertebral disc. METHODS: A total of 93 randomly selected females were included in the study. They were randomly divided into 2 groups. One received proprioceptive neuromuscular facilitation treatment and the other received manual therapy. To evaluate functional capabilities, the Oswestry Disability Index and range of motion measure were used. To evaluate changes in subjective experience of pain the Visual Analogue Scale was used. RESULTS: In terms of the activities of daily living, pain, and range of motion of flexion, extension, lateral flexion to the right and left, and rotation to the right and left improvement in group I compared with group II was statistically significant (p < 0.05) at 2 weeks and 3 months' follow-up. CONCLUSION: Treatment according to proprioceptive neuromuscular facilitation is a better method in comparison with manual therapy regarding improvement of pain, range of motion, and daily functioning in patients with cervical pain.

Evaluation of Ankle Joint Position Sense in Patients with Type 2 Diabetes Mellitus with Peripheral Neuropathy by Isokinetic Dynamometer.

BACKGROUND: Proprioceptive disorders may occur when thick fibers are affected in diabetic neuropathy. This can lead to impaired joint stabilization and increased risk of falls and fractures. We evaluated joint position sense (JPS) in diabetic patients to detect those at risk for neuropathy earlier. METHODS: Sixty diabetic patients and 30 healthy individuals aged 30 to 60 years were included in the study and divided into three groups: 30 diabetic patients with peripheral neuropathy, 30 diabetic patients without peripheral neuropathy, and 30 nondiabetic control patients. Presence of neuropathy was determined electrophysiologically. Passive ankle JPS was evaluated by an isokinetic system in all three groups. Both 10° and 30° plantarflexion and 10° dorsiflexion were determined as target angles. The mean absolute angular error (MAAE) values for three trials with each angle were assessed by Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The MAAEs with all of the angles were significantly higher in diabetic patients with peripheral neuropathy compared with diabetic patients without peripheral neuropathy and the control group (P < .001 for all of the comparisons). The MAAEs with right ankle 10° plantarflexion (P = .004) and 10° dorsiflexion (P = .007) and left ankle 10° plantarflexion (P = .008) were significantly higher in diabetic patients without peripheral neuropathy than in the control group. CONCLUSIONS: According to these results, ankle JPS may be deteriorated before determination of neuropathy electrophysiologically.Therefore, we believe that prophylactic programs in terms of the risk of falls and fractures by evaluating JPS need to be developed in the early stages of diabetes.

Efficacy of selective neurotomy for focal lower limb spasticity: a systematic review.

OBJECTIVE: Selective neurotomy has been suggested as a permanent treatment for focal spasticity. A systematic literature review was performed to investigate the efficacy of selective neurotomy regarding focal lower limb spasticity. METHODS: A systematic search in PubMed, Medline, Cochrane, and Embase databases was carried out. Studies were included if they reported on the following outcomes: muscle tone, muscle strength, pain, ankle range of motion and/or walking speed, after selective lower limb neurotomy in any type of upper motor neuron syndrome. RESULTS: A total of 25 non-randomized and/or uncontrolled studies and 1 randomized controlled study were selected. The included studies reported improvements in terms of leg muscle tone, pain, passive range of ankle motion, and walking speed. CONCLUSION: The results suggest that selective neurotomy is effective for reducing lower limb spasticity, without any negative effects on walking speed. However, this conclusion is primarily based on uncontrolled case series, whereas conclusions on clinical efficacy should preferably be based on comparison with a reference treatment through (randomized) controlled trials. Future studies should also include quantitative, validated functional assessment tools to further establish the efficacy of selective neurotomy as long-lasting treatment for patients with focal lower limb spasticity.

A new method called MiKneeSoTA to minimize knee soft-tissue artifacts in kinematic analysis.

The use of marker-based optical motion capture to estimate joint kinematics during gait is currently limited by errors associated with soft-tissue-induced motion artefacts (STIMA) and ambiguity in landmark palpation. This study therefore presents a novel protocol aiming to Minimize Knee Soft-Tissue Artefacts (MiKneeSoTA) and their effect on kinematic estimates. Relying on an augmented marker set and a new inverse kinematics approach, our method leverages frame-by-frame optimization to adjust best-fit cylinders that have been automatically generated based on the relative position of lower limb markers during an initial static trial. Tibiofemoral rotations and translations are then calculated along the anatomical joint axes based on the relative 3D motion of these cylinders. When compared against the conventional Helen-Hayes approach, in vivo assessment of fifteen healthy subjects revealed the MiKneeSoTA approach led to kinematic profiles with significantly lower standard deviations in joint rotations across trials, and even visibly reduced the presence of high frequency fluctuations presumably associated with e.g. soft-tissue vibration. In addition to agreeing with previously published bone pin and fluoroscopy datasets, our results illustrate MiKneeSoTA's ability to abate the effect of STIMA induced by lateral knee ligaments. Our findings indicate that MiKneeSoTA is in fact a promising approach to mitigate knee joint STIMA and thus enable the previously unattainable accurate estimation of translational knee joint motion with an optoelectronic system.

Association between movement speed and instability catch kinematics and the differences between individuals with and without chronic low back pain.

Studies reported the existence of instability catch (IC) during trunk flexion in patients with chronic low back pain (CLBP). However, different movement speeds can cause different neuromuscular demands resulting in altered kinematic patterns. In addition, kinematic characterization corresponding to clinical observation of IC is still limited. Therefore, this study aimed to determine (1) the association between movement speed and kinematic parameters representing IC during trunk flexion and (2) the differences in kinematic parameters between individuals with and without CLBP. Fifteen no low back pain (NoLBP) and 15 CLBP individuals were recruited. Inertial measurement units (IMU) were attached to T3, L1, and S2 spinous processes. Participants performed active trunk flexion while IMU data were simultaneously collected. Total trunk, lumbar, and pelvic mean angular velocity (T_MV, L_MV, and P_MV), as well as number of zero-crossings, peak-to-peak, and area of sudden deceleration and acceleration (Num, P2P, and Area), were derived. Pearson's correlation tests were used to determine the association between T_MV and L_MV, P_MV, Num, P2P, and Area. An ANCOVA was performed to determine the difference in kinematic parameters between groups using movement speed as a covariate. Significant associations (P < 0.05) were found between movement speed and other kinematic parameters, except for Area. Results showed that L_MV significantly differed from the P_MV (P = 0.002) in the CLBP group, while a significant between-group difference (P = 0.037) was found in the P_MV. Additionally, significant between-group differences (P < 0.05) in P2P and Area were observed. The associations between movement speed and kinematic parameters suggest that movement speed changes can alter kinematic patterns. Therefore, clinicians may challenge lumbopelvic neuromuscular control by modifying movement speed to elicit greater change in kinematic patterns. In addition, the NoLBP group used shared lumbar and pelvic contributions, while the CLBP group used less pelvic contribution. Finally, P2P and Area appeared to offer the greatest sensitivity to differentiate between the groups. Overall, these findings may enhance the understanding of the mechanism underlying IC in CLBP.

An arm swing enhances the proximal-to-distal delay in joint extension during a countermovement jump.

An abundance of degrees of freedom (DOF) exist when executing a countermovement jump (CMJ). This research aims to simplify the understanding of this complex system by comparing jump performance and independent functional DOF (fDOF) present in CMJs without (CMJNoArms) and with (CMJArms) an arm swing. Principal component analysis was used on 39 muscle forces and 15 3-dimensional joint contact forces obtained from kinematic and kinetic data, analyzed in FreeBody (a segment-based musculoskeletal model). Jump performance was greater in CMJArms with the increased ground contact time resulting in higher external (p = 0.012), hip (p < 0.001) and ankle (p = 0.009) vertical impulses, and slower hip extension enhancing the proximal-to-distal joint extension strategy. This allowed the hip muscles to generate higher forces and greater time-normalized hip vertical impulse (p = 0.006). Three fDOF were found for the muscle forces and 3-dimensional joint contact forces during CMJNoArms, while four fDOF were present for CMJArms. This suggests that the underlying anatomy provides mechanical constraints during a CMJ, reducing the demand on the control system. The additional fDOF present in CMJArms suggests that the arms are not mechanically coupled with the lower extremity, resulting in additional variation within individual motor strategies.

Segmental vertebral three-dimensional motion in patients with L4 isthmic spondylolisthesis under weight-bearing conditions.

OBJECTIVE: To investigate in vivo 6-degree-of-freedom (DOF) vertebral motion in patients with isthmic spondylolisthesis (IS) during various functional weight-bearing activities. METHODS: Fifteen asymptomatic volunteers (mean age 54.8 years) and fourteen patients with IS at L4-5 (mean age 53.4 years) were recruited. The positions of the vertebrae (L4-L5) in the supine, standing, flexion-extension, left-right twisting and left-right bending positions were determined using previously described CT-based models and dual fluoroscopic imaging techniques. Local coordinate systems were established at the center of the anterior vertebra of L4 isthmic spondylolisthesis (AIS), the posterior lamina of L4 isthmic spondylolisthesis (PIS) and the center of the L5 vertebra to obtain the 6DOF range of motion (ROM) at L4-L5 and the range of motion (ROM) between the AIS and the PIS. RESULTS: The translation along the anteroposterior axis at L4-L5 during flexion-extension, left-right bending and left-right twisting was significantly greater than that of the healthy participants. However, the translation along the mediolateral axis at L4-L5 presented paradoxical motion under different positions: the ROM increased in the supine-standing and flexion-extension positions but decreased in the left-right bending and left-right twisting positions. The separation along the anteroposterior axis during flexion was significantly greater than that during standing, on average, reaching more than 1 mm. The separation along the mediolateral axis during standing, flexion and extension was significantly greater than that in the supine position. CONCLUSIONS: This study revealed the occurrence of displacement between the AIS and PIS, primarily in the form of separation during flexion. Symptomatic patients with isthmic spondylolisthesis exhibit intervertebral instability, which might be underestimated by flexion-extension radiographs.

Comparison of Effects Between Telerehabilitation and In-Person Rehabilitation After Breast Cancer Surgery: A Randomized Controlled Study.

OBJECTIVE: To compare the effects between telerehabilitation and in-person rehabilitation on physical function, pain and quality of life in patients with breast cancer after surgery. DESIGN: Randomized, controlled, and parallel study that involved post-surgical oncological breast surgery patients who were female and aged between 18 and 70 years. The study was conducted in an outpatient environment, and the participants were randomized using a computer system. Population was divided into 2 groups: G1 (n = 20), who received face-to-face care, and G2 (n = 24), who received telerehabilitation. Participants were followed for 15 and 45 days postoperatively. The study's primary outcomes were based on 44 patients (n = 44). Values of changes in quality of life, range of motion (ROM), muscle strength, and upper limb functionality were compared for both groups during the 15 to 45 day postoperative. RESULTS: Both groups exhibited progressive improvements in range of motion, muscle strength, functionality, and quality of life over time (15- and 45-days post-operatively [PO]), indicating a positive response to treatment. Patients in G2 demonstrated more significant improvements in range of motion and muscle strength, as well as better functionality and quality of life compared to G1, particularly after 45 days PO. Additionally, G2 exhibited a more significant reduction in fatigue after 45 days PO. CONCLUSIONS: Telerehabilitation is a viable option with good usability, and has been shown to produce results similar to in-person physiotherapy in most cases, and even superior in some. Long-term intervention studies are needed for the development of telerehabilitation.

Effect of Upper Limb Repetitive Facilitative Exercise on Gait of Stroke Patients based on Artificial Intelligence and Computer Vision Evaluation.

OBJECTIVE: This study aims to assess how enhancing upper limb function on the affected side of stroke influences the gait of the lower limb. METHODS: Forty eligible stroke patients were randomly assigned to either a control group or a treatment group, with 20 patients in each group. Both groups underwent dynamic evaluation using artificial intelligence and computer vision before treatment. This evaluation focused on analyzing the range of motion of the shoulder and elbow during the gait cycle, as well as various gait parameters (such as step length, step speed, and percentage of stance phase) on the affected side. Following evaluation, the control group received routine rehabilitation treatment. RESULTS: The results indicated that there was no significant difference between the two groups before treatment. However, following treatment, there was a notable improvement in the motion of the shoulder and elbow joints on the affected side among patients in the treatment group (p<0.05), whereas the control group showed only slight improvement, which was not statistically significant (p>0.05). CONCLUSION: The improvement in upper limb function on the affected side also appears to positively influence gait recovery. However, it's important to note that the observation period was relatively short. Further studies are needed to confirm whether this effect is sustained over the long term.

Monitoring Everyday Upper Extremity Function in Patients with Complex Regional Pain Syndrome: A Secondary, Retrospective Analysis from ncRNAPain.

Objective: Complex regional pain syndrome (CRPS) represents a rare complication following injury to a limb. The DASH questionnaire (disability of arm, shoulder, and hand) evaluates everyday arm function. We assessed the DASH and its subitems in comparison to patients with brachial plexus lesions or fracture controls, analysed it over time, and in relation to active range of motion (ROM), to determine patients' impairment and trajectory. Methods: The dataset included 193 patients with upper extremity CRPS from the noncoding RNA (ncRNA) Pain cohort, 36 fracture controls, and 12 patients with traumatic brachial plexus lesions. For the clinical and psychological characterisation, questionnaires and a goniometer for the measurement of ROM were utilized. Thirty-three patients were followed up after approximately 2.5 years of guideline treatment. Results: CRPS patients had a similar mean DASH of 54.7 (standard deviation (S.D.) ±21) as brachial plexus lesion patients (M = 51.4, S.D. ± 16.1) but different significantly from fracture controls (M = 21.2, S.D. ± 21.1). Pain and older age were predictors of the DASH. Activities requiring force or impact on the arm, shoulder, or hand were mostly affected in patients with CRPS. After 2.5 years of standard treatment, the mean DASH score fell to 41.3 (S.D. ± 25.2), weakness in leisure activities was recuperated, pain feelings were lessened, and ROM, e.g., wrist flexion, recovered by 36°. Two-thirds of patients improved in both the DASH and the ROM. Conclusions: CRPS is as disabling as a complete loss of arm function in brachial plexus lesions and exhibits only partial recovery. Developing QuickDASH versions for CRPS patients could reduce the load of questions in clinical studies. It would be prudent to consider the unexpected age dependency of the DASH in future studies. This trial is registered with DRKS00008964.

Comparative analysis of biomechanical characteristics between the new Tai Chi elastic band exercise for opening and closing movement and elastic band resistance training for the reverse fly movement.

Background: The objective of this study was to compare and analyze the representative opening and closing movement of Tai Chi elastic band exercise with the reverse fly movement of elastic band resistance training. The aim was to explore the biomechanical differences between the two exercises and provide theoretical support for the application of Tai Chi elastic band exercise in health intervention. Methods: A total of 26 male participants were recruited and randomly divided into two groups in a 1:1 ratio. There were 13 participants in each Tai Chi elastic band exercise group and elastic band resistance training group. Both groups of participants used an elastic band to perform movement in the experiment. Experimental data were collected using the Vicon infrared motion capture system and Delsys surface EMG system. The AnyBody software was utilized to simulate the creation of a musculoskeletal model for both exercises. Result: The study found that the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angle and flexion angle of the shoulder joint, as well as normalized RMS of the anterior deltoid and triceps brachii, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited greater elbow flexion angle, elbow flexion torque, and muscle strength of the infraspinatus, coracobrachialis, biceps brachii, brachialis and brachioradialis, compared to the elastic band resistance training group (P < 0.01); the Tai Chi elastic band exercise group exhibited smaller horizontal abduction angular velocity of the shoulder joint and a lower normalized RMS of the posterior deltoid, compared to the elastic band resistance training group (P < 0.05). Conclusion: (1) The opening and closing movement of Tai Chi elastic band exercise is characterized by a large elbow flexion angle, a small shoulder joint horizontal angle and flexion angle, and a slow and uniform speed of movement. The reverse fly movement of elastic band resistance training is characterized by a large horizontal abduction angle of the shoulder joint, a large flexion angle of the shoulder joint, a small flexion angle of the elbow joint, and a fast and uneven speed. (2) The opening and closing movement exerts a greater torque on the elbow flexion, while the reverse fly movement exerts a greater torque on the shoulder joint horizontal abduction and external rotation. (3) The opening and closing movement provide greater stimulation to the infraspinatus, coracobrachialis, and elbow flexor, while the reverse fly movement provides greater stimulation to the posterior deltoid, anterior deltoid, subscapularis, and elbow extensor. In summary, the variation in joint angle, joint angular velocity, and hand position could be the factor contributing to the differences in joint torque and muscle activity between the opening and closing movement of Tai Chi elastic band exercise and the reverse fly movement of elastic band resistance training.

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion.

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

Acute effects of voluntary isometric contractions at maximal shortening vs. ballistic stretching on flexibility, strength and jump.

Background: Isometric training is used in sport, conventional physical activity and rehabilitation. Understandably, there is a great deal of research related to its effect on performance. It is known that the length of the muscle at the moment of contraction is a determinant of strength levels. In the literature we find research on isometric training in short muscle lengths, although it has not been studied in maximally shortened positions or the acute effects that occur after its application. Ballistic stretching (BS) is also popular in sport. Their execution involves actively reaching maximally shortened muscle positions. So far, isometric training has not been compared with protocols involving ballistic stretching. Considering the above, the aim of the present study was to investigate the effects of BS and voluntary isometric contraction at maximal shortening (VICAMS) on range of motion, strength and vertical jump. Methods: The study involved 60 healthy, physically active individuals (40 and 52 years old) who were randomly assigned to three groups: BS, VICAMS and a control group (CG). To assess acute effects, before and after the intervention, active range of motion (AROM), maximal voluntary isometric force (MVIF) and countermovement jump height (CMJ) were determined. Results: Time main effects and time*group interactions were found for all variables (p < 0.001). Between-group differences were shown for the VICAMS group after the intervention, with statistically significant higher AROM values compared to the other groups. MVIF values were also higher in the VICAMS group. Intra-group differences were observed for the VICAMS and Ballistic groups, as values on all variables increased from baseline. For the CMJ, intra-group differences showed that both the VICAMS and BS groups improved values compared to baseline values. Conclusions: The application of VICAMS induced acute improvements over BS in AROM, MVIF and CMJ. These results are important for coaches seeking immediate performance improvement and offer an optimal solution to the warm-up protocol.

Prevalence of Forward head posture among car and bike drivers and its relation with neck and cardiopulmonary health parameters- a cross-sectional study.

OBJECTIVES: This study aimed to evaluate and compare the prevalence of Forward Head Posture (FHP) in car and bike drivers, and its potential correlation with neck and cardiopulmonary parameters. METHODS: This cross-sectional study involved 400 participants from urban and suburban areas around Lucknow, Uttar Pradesh, India, including 200 car drivers and 200 bike drivers aged 18-65 years with a minimum five-year driving history. Neck health was assessed using measurements such as cervical range of motion and Neck Disability Index (NDI), cardiopulmonary parameters were evaluated through resting heart rate, blood pressure, and pulmonary function tests using the spirometry test, and FHP was assessed using Surgimap application. Statistical analysis was performed using IBM SPSS Statistics software (version 26.0) and included descriptive statistics, hypothesis testing, Chi-square or Fisher's exact test for binary data, and correlation analyses. RESULTS: The result show that difference in the mean FHP between car and bike drivers was statistically significant (p = 0.0001), indicating a higher prevalence of FHP among car drivers than among bike drivers. Correlation analyses revealed significant associations between FHP and neck health metrics, especially cervical flexion (r = 0.71, p<0.05), (r = 0.78, p<0.05) and left-side rotation (r = 0.56, p<0.05), (r = 0.61, p<0.05) in car and bike drivers. Among the cardiopulmonary parameters, significant correlations with FHP were observed in resting heart rate (r = 0.33, p<0.05), (r = 0.42, p<0.05), spirometry results FVC (r = 0.29, p<0.05), FEV1 (r = 0.22, p<0.05), and FVC (r = 0.31, p<0.05) for car and bike drivers. CONCLUSION: We observed a higher incidence of FHP in car drivers, indicating that a prolonged static posture may lead to greater postural deviation than dynamic movement during biking. This association suggests that FHP could have wide-reaching implications for systemic health, beyond musculoskeletal issues. These findings have the potential to influence preventative strategies and interventions aimed at improving the overall health outcomes for drivers.

Is Posterior Cervical Foraminotomy Better Than Fusion for Warfighters?: A Biomechanical Study.

INTRODUCTION: Cervical spondylosis in the warfighter is a common musculoskeletal problem and can be career-ending especially if it requires fusion. Head-mounted equipment and increased biomechanical forces on the cervical spine have resulted in accelerated cervical spine degeneration. Current surgical gold standard is anterior cervical discectomy and fusion (ACDF). Posterior cervical foraminotomy (PCF) is a nonfusion surgical alternative, and this can be effective in alleviating radiculopathy from foraminal stenosis caused by disc-osteophyte complex. Biomechanical studies have not been done to analyze motion associated with military aircrew personnel following PCF. The aim of this study was to compare the biomechanical responses of the effects of ACDF and PCF with different grades of facet resection under simulated military aircrew conditions using range of motion, disc pressure, and facet loads at the index and adjacent levels. MATERIALS AND METHODS: A validated 3D finite element model of the human cervical spinal column was used to simulate various graded PCF and ACDF. All surgical simulations were performed at the most commonly operated level (C5-C6) in warfighters. Pure moment loading under flexion, extension, and lateral bending, and in vivo follower force of 75 N were applied to the intact spine. Hybrid loading protocol was used to achieve 134 degrees of combined flexion-extension and 83 degrees of lateral bending in intact and surgical models to reflect military loading conditions. Segmental motions, disc pressure, and facet load were obtained and normalized with respect to the intact model to quantify the biomechanical effect. RESULTS: Anterior cervical discectomy and fusion decreased range of motion at the index and increased motion at the adjacent levels, while all graded PCF responses had an opposite trend: increased motion at the index and decreased motion at adjacent levels. The magnitude of changes depended on the level of resection, spinal level, and loading mode. Disc pressure increased at the index level and decreased at the adjacent levels after PCF. These changes were exaggerated with increasing extent of facet resection. Facet load increased at the index level after PCF especially with extension and right (contralateral) lateral bending. Complete facetectomy led to facet load increases greater than ACDF at the adjacent levels in both flexion and extension. CONCLUSIONS: Posterior cervical foraminotomy is a motion-preserving implant-free surgical alternative to ACDF for warfighters with cervical radiculopathy after failure of conservative management. The treating surgeon must pay close attention to the extent of facet resection to avoid potential spinal instability and future disc and facet degeneration after PCF. Posterior cervical foraminotomy can be more advantageous than ACDF in terms of adjacent segment degeneration, motion preservation, reoperation rate, surgical cost, and retention of warfighters.

Handheld dynamometry: Validity and reliability of measuring hip joint rate of torque development and peak torque.

INTRODUCTION: Measuring rate of torque development (RTD) and peak torque (PT) for hip muscle performance presents challenges in clinical practice. This study investigated the construct validity of a handheld dynamometer (HHD) versus an isokinetic dynamometer (IKD), and intra-rater repeated reliability for RTD and PT and their relationship in hip joint movements. METHODS: Thirty healthy individuals (mean age = 30 ± 8 years, 13 males) underwent two test sessions in a single day. RTD (0-50, 0-100, 0-150, 0-200ms) and PT normalised to body mass in maximal voluntary isometric contractions were measured using a HHD and an IKD in hip flexion, extension, abduction, adduction, internal and external rotation. RESULTS: For validity between the devices, RTD0-50 exhibited the largest significant systematic bias in all hip movements (3.41-11.99 Nm·s-1 kg-1) and widest limits-of-agreement, while RTD0-200 had the lowest bias (-1.33-3.99 Nm·s-1 kg-1) and narrowest limits-of-agreement. For PT, agreement between dynamometers was observed for hip flexion (0.08 Nm·kg-1), abduction (-0.09 Nm·kg-1), internal (-0.01 Nm·kg-1), and external rotation (0.05 Nm·kg-1). For reliability, intra-rater intraclass correlation coefficient (ICC2,1) ranged from moderate to good in RTD0-50 and RTD0-100 (0.5-0.88), and good to excellent in RTD0-150 and RTD0-200 (0.87-0.95) in all movements. The HHD displayed excellent intra-rater, relative reliability values (ICC2,1) in all movements (0.85-0.95). Pearson's correlation revealed good linear correlation between PT and RTD0-150 and RTD0-200 in all movements (r = .7 to .87, p = < .001). CONCLUSION: Validity analysis demonstrated significant systematic bias and lack of agreement in RTD measures between the HHD and IKD. However, the HHD displays excellent to moderate intra-rater, relative reliability for RTD and PT measures in hip movements. Clinicians may use the HHD for hip muscle PT assessment but note, late phase RTD measures are more reliable, valid, and relate to PT than early phase RTD. Additionally, the correlation between RTD and PT at various time epochs was examined to better understand the relationship between these measures.

Effects of ankle Kinesio taping on knee and ankle joint biomechanics during unanticipated jumps in collegiate athletes.

OBJECTIVE: Most biomechanical research on the application of Kinesio taping (KT) to the ankle joint focused on testing anticipated movements. However, ankle sprains frequently occur in real life in unanticipated situations, where individuals are unprepared and face sudden external stimuli. This situation is completely different from the anticipated situation. The aim of the present study was to investigate the effects of ankle KT application on the kinematic and kinetic characteristics of the knee and ankle joints during unanticipated jump tasks in collegiate athletes. METHODS: Eighteen healthy collegiate athletes experienced three taping conditions in a randomized order: no taping (NT), placebo taping (PT), and KT, and performed unanticipated jump tasks. A 9-camera infrared high-speed motion capture system was employed to collect knee and ankle kinematic data, and a 3-dimensional force plate was utilized to collect knee and ankle kinetic data during the tasks. RESULTS: During the right jumps, KT significantly increased peak knee flexion angle (P = 0.031) compared to NT and significantly decreased peak vertical ground reaction force (P < 0.001, P = 0.001) compared to NT and PT. During the left jumps, KT significantly reduced peak ankle inversion angle (P = 0.022, P < 0.001) and peak ankle inversion moment (P = 0.002, P = 0.001) compared to NT and PT. CONCLUSION: During unanticipated jump maneuvers, KT reduced peak ankle inversion angle, peak vertical ground reaction force, and peak ankle inversion moment and increased peak knee flexion angle in collegiate athletes.

Validation of the Kinematic Assessment Protocol Used in the Technology-Supported Neurorehabilitation System, Rehabilitation Technologies for Hand and Arm (R3THA™), in Children and Teenagers with Cerebral Palsy.

This study evaluates the R3THA™ assessment protocol (R3THA-AP™), a technology-supported testing module for personalized rehabilitation in children with cerebral palsy (CP). It focuses on the reliability and validity of the R3THA-AP in assessing hand and arm function, by comparing kinematic assessments with standard clinical assessments. Conducted during a 4-week summer camp, the study assessed the functional and impairment levels of children with CP aged 3-18. The findings suggest that R3THA is more reliable for children aged 8 and older, indicating that age significantly influences the protocol's effectiveness. The results also showed that the R3THA-AP's kinematic measurements of hand and wrist movements are positively correlated with the Box and Blocks Test Index (BBTI), reflecting hand function and dexterity. Additionally, the R3THA-AP's accuracy metrics for hand and wrist activities align with the Melbourne Assessment 2's Range of Motion (MA2-ROM) scores, suggesting a meaningful relationship between R3THA-AP data and clinical assessments of motor skills. However, no significant correlations were observed between the R3THA-AP and MA2's accuracy and dexterity measurements, indicating areas for further research. These findings validate the R3THA-AP's utility in assessing motor abilities in CP patients, supporting its integration into clinical practice.

Can a Novel Light Weight Minimal Support Lifting Exoskeleton Modify Lifting Movement in People without Low Back Pain?

Low back pain (LBP) is a major contributor to lifting-related disabilities. To minimize the risk of back pain, emerging technologies known as lifting exoskeletons were designed to optimize lifting movements. However, it is currently unknown whether a minimally supportive exoskeleton can alter the lifting movement in people without LBP. This study aims to investigate if wearing a novel lightweight exoskeleton that minimally supports the back, hip, and knee can alter the lifting range of motion and movement variations in people without LBP. This study also aims to investigate if wearing this novel exoskeleton can result in a reliable between-day lifting movement. In two separate sessions (each one week apart), fourteen participants lifted a box (that weighed 10% of their body weight) ten times, once while wearing an exoskeleton and once while not wearing an exoskeleton. Wearing the novel exoskeleton during lifting produced moderate-high, test-retest reliability (Trunk: ICC3,1 = 0.89, 95% CI [0.67, 0.96], SEM = 9.34°; Hip: ICC3,1 = 0.63, 95% CI [0.22, 0.88], SEM = 2.57°; Knee: ICC3,1 = 0.61, 95% CI [0.23, 0.87], SEM = 2.50°). Wearing an exoskeleton significantly decreased the range of motion of the knee (F1,4 = 4.83, p = 0.031, ηp2 = 0.06). Additionally, wearing an exoskeleton significantly decreased hip (diff = 8.38, p = 0.045) and knee (diff = -8.57, p = 0.038) movement variability; however, wearing an exoskeleton did not decrease the movement variability of the body's trunk (diff = 0.60, p = 1.00). Therefore, minimally supported lifting through the use of exoskeletons can modify movement in people without LBP and produce reliable lifting movements. Wearing the novel exoskeleton is also desirable for monitoring lifting movements. Future studies should investigate the use of sensors and IMU to monitor lifting movement at work with the least amount of intrusion on an individual's movement.