Lip-closing pressure during food intake from a spoon in normal children.

BACKGROUND: Understanding the refinement of self-feeding skills is useful for the assessment of oral functional development in children. OBJECTIVES: To determine normative data on lip closing during food intake in the development of independent spoon-feeding in normal children, we tested the hypothesis that lip-closing pressure and spoon operation differ depending on food type. METHODS: Fifteen normal children (eight boys, seven girls; mean age: 6.5 years) were asked to eat test foods (2, 3 and 5 g of yogurt and cream cheese) freely with a spoon. Lip-closing pressures and kinematic data on spoon operation were recorded simultaneously with a strain gauge transducer embedded in the spoon and Vicon motion analysis, respectively. RESULTS: In the most common lip-pressure pattern, only positive pressure was generated. In the second most common pattern, negative pressure occurred first, followed by positive pressure; this pattern was seen infrequently. Positive pressure (P < .001), pressure duration (P < .001) and spoon intra-oral time (P < .05) during intake of cream cheese (an adhesive food) were significantly greater than those during intake of yogurt (a non-adhesive food). Pressure onset occurred at the beginning of the spoon withdrawal period or at the turning point from spoon insertion to withdrawal, depending on the food. CONCLUSIONS: Lip-closing force and spoon operation varied depending on food type in preschool and early elementary school children. Our findings suggest the need to consider the importance of food diversity and to pay attention to the spoon withdrawal period when assessing the development and maturation of lip function.

Recent advances in sensing oropharyngeal swallowing function in Japan.

Dysphagia (difficulty in swallowing) is an important issue in the elderly because it causes aspiration pneumonia, which is the second largest cause of death in this group. It also causes decline in activities of daily living and quality of life. The oral phase of swallowing has been neglected, despite its importance in the evaluation of dysphagia, because adequate protocols and measuring devices are unavailable. However, recent advances in sensor technology have enabled straightforward, non-invasive measurement of the movement of important swallowing-related organs such as the lips and tongue, as well as the larynx. In this article, we report the present state and possibility of clinical application of such systems developed in Japan.

Stride-Phase Kinematic Parameters That Predict Peak Elbow Varus Torque.

BACKGROUND: During baseball pitching, a high amount of elbow varus torque in the arm cocking-to-acceleration phase is thought to be a biomechanical risk factor for medial elbow pain and injury. The biomechanics of the stride phase may provide preparation for the arm cocking-to-acceleration phase that follows it. PURPOSE: To determine the kinematic parameters that predict peak elbow varus torque during the stride phase of pitching. STUDY DESIGN: Descriptive laboratory study. METHODS: Participants were 107 high school baseball pitchers (age range, 15-18 years) without shoulder or elbow problems. Whole-body kinematics and kinetics during fastball pitching were analyzed using 3-dimensional measurements from 36 retroreflective markers. A total of 26 kinematic parameters of the upper and lower limbs during the stride phase leading up to the stride foot contact were extracted for multiple regression analysis to assess their combined effect on the magnitude of peak elbow varus torque. RESULTS: Increased wrist extension, elbow pronation, knee flexion on the leading leg, knee extension on the trailing leg at stride foot contact, and upward displacement of the body's center of mass in the stride phase were significantly correlated with decreased peak elbow varus torque (all P < .05). Moreover, 38% of the variance in peak elbow varus torque was explained by a combination of these 5 significant kinematic variables (P < .001). CONCLUSION: We found that 5 kinematic parameters during the stride phase and the combination of these parameters were associated with peak elbow varus torque. The stride phase provides biomechanical preparation for pitching and plays a key role in peak elbow varus torque in subsequent pitching phases. CLINICAL RELEVANCE: The present data can be used to screen pitching mechanics with motion capture assessment to reduce peak elbow varus torque. Decreased peak elbow varus torque is expected to reduce the risk of elbow medial pain and injury.

Influence of food adhesivity and quantity in lip closing pressure.

Lip closing is an important motor act in food acquisition. Appropriate food capture in anticipatory and early oral stages of feeding is essential for mastication and swallowing. The aim of this study was to investigate the effect of food type and quantity on lip closing pressure during food capture with a spoon, and to identify normal lip function during food acquisition in healthy young adults. Twenty young healthy males (age range: 22-30 years) participated in this study. They were asked to eat the test food freely with a spoon. Test foods were yogurt and cream cheese, which were given in quantities of 3, 5 and 10 g in weight; 3 ml water was included as a reference. A strain gauge transducer was embedded in the spoon in advance, and lip closing pressures during food capture were measured and recorded. The Vicon motion analysis system was used to collect three-dimensional kinematic data of spoon operation. Positive pressure with lip closing during capture of adhesive food, such as cream cheese, significantly increased (P < 0.001). Moreover, positive pressure significantly decreased when food quantity increased (P < 0.01), irrespective of food type. Negative pressure that preceded positive pressure appeared more frequently during cream cheese intake and increased when food quantity on the spoon increased (P < 0.001). These findings indicated that participants sucked or squeezed the spoon further during capture of adhesive food. Maximum mouth opening occurred predominantly during the spoon insertion period, while mouth closing occurred predominantly during the spoon withdrawal period. After mouth closing, all subsequent lip pressure events appeared in the withdrawal period. Our results may be useful for comprehending normal lip function during food acquisition in healthy young adults. They may also aid in the diagnosis and management of abnormal lip function in oral hypofunction and dysfunction, which can be examined in future studies.

The effect of geometry of the tibial polyethylene insert on the tibiofemoral contact kinematics in Advance Medial Pivot total knee arthroplasty.

BACKGROUND: In modern total knee arthroplasty (TKA), it is important to reproduce both medial pivot motion and posterior femoral rollback to obtain greater postoperative knee flexion. Several studies have reported the factors affecting knee motion and range of motion after TKA. The purpose of this study was to evaluate the effect of the tibial insert geometry on the tibiofemoral contact kinematics, especially focusing on the medial pivot motion and posterior femoral rollback. METHODS: Seven cadaveric knees were replaced with the Advance Medial Pivot TKA, and two different geometries of polyethylene tibial insert, the standard medial pivot design (MP-design) and double high design (DH-design), were biomechanically compared. Four experimental configurations were evaluated in each specimen in this order: (1) the MP-design with posterior cruciate ligament (PCL) retaining, (2) the DH-design with PCL retaining, (3) the MP-design with PCL sacrificing, and (4) the DH-design with PCL sacrificing. RESULTS: Under the PCL-retaining condition, both designs showed no medial pivot but bicondylar femoral rollback more than 60 degrees of knee flexion. In the MP-design, tibiofemoral contact point (estimated contact point, ECP) of the medial compartment was located on the posterior lip of the ball-insocket structure while demonstrating greater than 120 degrees of knee flexion. The posterior translation was also the same in both designs. On the other hand, ECP of the MP-design and the DH-design showed only medial pivot pattern under the PCL-sacrificing condition. In the DH-design, ECP of the lateral compartment showed paradoxical anterior translation from 0 degrees to 60 degrees of knee flexion. Total posterior translation was significantly greater in the lateral compartment than that in the medial compartment. CONCLUSIONS: The results of this study suggest that in this type of TKA system the ball-in-socket geometry in the MP-design has an advantage for reproducing medial pivot motion in the PCL-sacrificing condition, and the flexion path structure in the DH-design is considered to be both effective and safe for femoral rollback in the PCL-retaining condition. However, neither design is sufficient to reproduce medial pivot motion and posterior femoral rollback. Therefore, a different design of tibial insert is needed for more physiological kinematics after TKA.

Comparison of scapular upward rotation during arm elevation in the scapular plane in healthy volunteers and patients with rotator cuff tears pre- and post-surgery.

BACKGROUND: Function loss caused by rotator cuff tears alters the scapular orientation, however, few prior studies have reported on scapular movements after rotator cuff repair. The purpose was to determine the scapular orientations before and after rotator cuff repair. METHODS: We recruited 14 healthy controls, 10 small and six massive rotator cuff tear in patients. The scapular upward rotation during arm elevation was analyzed using fluoroscopic imaging. FINDINGS: Before surgery, both rotator cuff groups demonstrated greater scapular upward rotation compared to healthy controls. Two months postoperation, the analyses showed significant differences between the patients with small rotator cuff tears and healthy controls at arm elevations of 90°, and between patients with both rotator cuff tear groups and healthy controls at arm elevations of 120°. At five months post-operation, significant differences still existed between the healthy controls and both rotator cuff groups. In regard to the temporal effects in the patients with small rotator cuff tears, the scapular upward rotation decreased significantly over time (2-5 months postoperation) at arm elevations of 120°. We did not identify a main effect owing to time in the patients with massive rotator cuff tears. INTERPRETATION: In patients with small rotator cuff tears, scapular upward rotation was reduced over the period of 2-5 months postoperation, however, the patients with massive rotator cuff tears showed greater scapular upward rotation throughout the experimental period. The results suggested that the execution of the rehabilitation program should consider that the tear size could affect scapular motion.

A precise and useful method for coordinating computed tomography and jaw movement frames of reference.

PURPOSE: The aim of this study was to develop a means of coordinating helical computed tomography (CT)- based morphological data in 3 dimensions (3-D) with that pertaining to jaw movement as recorded by a device that measures jaw movement in six-degrees-of-freedom (6-DOF), thus producing multi-point movement analysis of the condyle. METHODS: The study sample was two volunteers. One of the subjects had erosive bony changes in both condyles, while the other had healthy condyles. We employed a customized facebow, which enabled us to coordinate jaw movement data and morphological volume data from CT. Total uncertainty of the coordination was computed, according to International Organization for Standardization (ISO). In order to demonstrate the effects of multi-point analysis for complex condylar movement, we tried to visualize the trajectory of the working condyle in lateral excursion. RESULTS: The overall uncertainty at a condylar center chosen as an example to illustrate the method was 0.38 mm, 0.19 mm, and 0.50 mm in antero-posterior, lateromedial, and supero-inferior directions, respectively, in terms of 95% coverage as defined by the ISO. CONCLUSION: We developed facebow-based X-ray markers with high clinical operability, which could correlate the helical CT's coordinate system with our 6-DOF jaw movement measuring system for precise analysis of 3-D condylar movements. In motion analysis of rotational condyle, even a small amount of measurement error cannot necessarily be neglected. Then, a multi-point approach such as that realized by our system presents the best option.

Estimation of Shoulder Behavior From the Viewpoint of Minimized Shoulder Joint Load Among Adolescent Baseball Pitchers.

BACKGROUND: During pitching, an overloaded joint reaction force exerted on the shoulder and excessive shoulder horizontal abduction at ball release are considered risk factors causing anterior shoulder pain for young baseball pitchers. Hypothesis/Purpose: The first aim was to examine the relationship between shoulder horizontal abduction position and force on the shoulder at ball release. The second was to identify the relative rotational position of the shoulder and the range of shoulder motion at ball release that minimize force on the shoulder. It was hypothesized that the amount of force on the shoulder would be exacerbated by excessive shoulder horizontal abduction. STUDY DESIGN: Descriptive laboratory study. METHODS: Participants were 183 adolescent baseball pitchers (mean ± SD age, 15.5 ± 1.2 years) without shoulder/elbow problems. Each pitcher threw 5 fastballs to a catcher behind a home plate. The kinematics and kinetics of the throwing shoulder during fastball pitching were calculated with 3-dimensional measurements from 36 reflective markers. In data analysis, the correlations were calculated between the relative rotational positions of the shoulder (abduction, horizontal adduction-abduction) and the forces on the shoulder (anterior-posterior, proximal, and superior-inferior) at ball release. Subsequently, the specific rotational position and range of motion of the shoulder at ball release that minimized forces on the shoulder were determined. RESULTS: Statistically significant correlations were identified between the magnitude of superior-inferior force on the shoulder and shoulder abduction position ( R2 = 0.44, P < .001) as well as between the magnitude of anterior-posterior force on the shoulder and shoulder horizontal adduction-abduction position ( R2 = 0.72, P < .001). Minimal anterior-posterior and superior-inferior forces were obtained with a combination of 80.6° of shoulder abduction and 10.7° of shoulder horizontal adduction. Any deviation >5° from this position significantly increased the anterior-posterior and superior-inferior forces on the shoulder. CONCLUSION: Increasing shoulder horizontal abduction position significantly increased the magnitude of anterior force on the shoulder at ball release. The combination of 80.6° of shoulder abduction and 10.7° of horizontal shoulder adduction minimized the shear forces on the shoulder at this point. CLINICAL RELEVANCE: The present data can be useful for screening pitching technique to prevent shoulder pain and injury with motion capture assessment.

[Development of a new device for continuous measurement of vertical dimension using Magneto-Impedance (MI) sensors].

PURPOSE: The purpose of this study was to develop a new device to measure continuously the vertical dimension of the human jaw relation using magnetic sensors. METHODS: A sensor unit was made of six MI (Magneto-Impedance) sensors (AMI302 4.0 x 3.5 x 1.4 mm, Aichi Steel Corp.) placed in a line at intervals of 4 mm. The unit was positioned to the head by a glasses-type sensor holder. A target magnet (3 mm in diameter, 12 mm in length) was set in a resin board positioned on the mentum with adhesive tape. 1) In vitro experiments using a precision-movement stage were conducted. 2) One healthy volunteer (age: 25 years) was instructed to perform a jaw opening-closing task with 10 mm range of motion. Before and after the task his jaw position in the intercuspal position was measured for five minutes. The jaw movements were recorded simultaneously using a 6-degree-of-freedom jaw-tracking device. RESULTS: The mean square error of the in vitro experiment was 0.06 mm under the worst conditions. The mean square error of the positional accuracy was 0.35 mm. The reproducibility of the intercuspal position was 0.33 mm. These values correspond to about 16% of the value of the shift phenomenon of the resting position (approximately 2.2 mm). CONCLUSION: Our new device using an MI sensor enables the vertical dimension to be recorded continuously with sufficient accuracy.

Computer-aided determination of occlusal contact points for dental 3-D CAD.

Present dental CAD systems enable us to design functional occlusal tooth surfaces which harmonize with the patient's stomatognathic function. In order to avoid occlusal interferences during tooth excursions, currently available systems usually use the patient's functional occlusal impressions for the design of occlusal contact points. Previous interfere-free design, however, has been done on a trial-and-error basis by using visual inspection. To improve this time-consuming procedure, this paper proposes a computer-aided system for assisting in the determination of the occlusal contact points by visualizing the appropriate regions of the opposing surface. The system can designate such regions from data of the opposing occlusal surfaces and their relative movements can be simulated by using a virtual articulator. Experiments for designing the crown of a lower first molar demonstrated that all contact points selected within the designated regions completely satisfied the required contact or separation during tooth excursions, confirming the effectiveness of our computer-aided procedure.

Intraoperative measurements of knee motion in total knee arthroplasty.

A photostereometric technology-based knee motion analysis system was developed and intraoperative kinematics during total knee arthroplasty (TKA) was investigated. Ten knees were evaluated and two different types of posterior-cruciate-retaining TKA (Genesis-I and Genesis-II) were used. Both TKA showed posterior translation of the medial and lateral femoral condyle with knee flexion. The motion pattern of the estimated contact point of Genesis-II was small initial rollback followed by sliding motion, then rollback again more than 60 degrees. In Genesis-II, the amount of translation of the medial condyle was significantly larger than that of the lateral, suggesting that the lateral condyle acted as a rotational pivot. Our developed knee motion analysis system was non-contact, high resolution and can evaluate both kinematics and estimated contact pattern. The results of this study suggest that intraoperative measurement using this analysis system has advantages for the investigation of in-vivo kinematics and contact condition in TKA.

Experimental device for detecting laryngeal movement during swallowing.

It has been reported that swallowing is a rhythmic movement, in which the onset of the oro-pharyngeal stage of swallowing starts from the mylohyoid muscle, followed by movement of the oral and pharyngeal muscles, and reaching the superior esophageal sphincter muscle. This is defined as the oro-pharyngeal stage of swallowing. It has also been reported that along with this movement, the larynx elevates in an antero-superior direction. To investigate the swallowing movement, it would be useful to be able to detect the start of swallowing movements from the body surface. Such a device was designed in this study to investigate the relationships between the onset of laryngeal movement and the EMG initiation of the anterior digastric muscle. Although experimental conditions must be further examined, we were able to record the reproducible movement and the position of larynx using our device provides another tool for studying the swallowing movement.