Asymmetric Posture Research Articles

An assessment of musculoskeletal disorders and physical activity levels in dentists: Across-sectional study.

Dentistry is a physically and mentally demanding profession that involves long periods of muscle imbalance and asymmetrical postures when performing delicate procedures. This can lead to a high incidence of work-related diseases. However, physical activity may prevent or minimize the incidence of musculoskeletal discomfort and pain. The present study aimed to determine the association between musculoskeletal disorders and physical activity levels in dentists practicing in Turkey. This cross-sectional study was conducted between March and June 2023 with dentists from Turkey actively practicing dentistry. The short form of the International Physical Activity Questionnaire was used to determine dentists' physical activity levels, and the Extended Nordic Musculoskeletal Questionnaire was used to assess musculoskeletal disorders. IBM SPSS 20 software was used for statistical analysis. Data were presented as mean, standard deviation, median, minimum, maximum, percentage, and number. Chi-square, Mann-Whitney U, One-Sample Chi-Square tests, and an ordinal logistic regression test were used. The statistical significance level was taken as p < 0.05. A total of 116 dentists (63 females 53 males) between the ages of 24 and 60 (36.37±7.32) were included in the study. Forty-eight participants had a low level of physical activity, 56 had a moderate level of physical activity (MLPA), and 12 had a high level of physical activity (HLPA). There was no significant difference between the gender (p = 0.224) and age (p = 0.469) of the participants and levels of physical activity. Musculoskeletal discomfort was reported by 93.1% (n = 108) of the participants in one or more body parts (p < 0.001) and 55.6% (n = 60) of them were female. The number of dentists with neck (p < 0.001) and shoulder (p = 0.05) problems was significantly higher. There was no significant effect of gender (p > 0.05) on musculoskeletal conditions. However, the relationship between musculoskeletal conditions and physical activity levels was inconsistent. The HLPA group reported the lowest discomfort for all body parts, except the elbows and knees (p < 0.05). The MLPA group reported higher discomfort in the neck, shoulder, upper back, wrists/hands, lower back, and knees. The group with the lowest physical activity exhibited the highest discomfort in the elbow and ankle/feet regions. This study found that the prevalence of musculoskeletal disorders was high among dentists, many of whom reported either low or moderate physical activity levels. The results of this study may enhance dentists' understanding of work-related musculoskeletal diseases and promote their participation in physical activities.

Spinal Apophyses Localization in Discretized Models of Human Backs by Shape Index Analysis.

The paper proposes a non-invasive original methodology to directly and automatically identify the spine line from the external position of vertebral apophyses, which are key anatomical landmarks. Apophyses are detected directly on discrete high-density geometric models of human backs acquired by a 3D scanner. The methodology is inspired by the posturologist's approach that detects the spine line through the identification, by manual palpation, of the spinal apophyses. For this purpose, an appropriate shape index is used to identify vertebral positions. The shape index estimates the local differential geometric properties of the back surface. This index is very discriminating in locating both pronounced and blurred apophyses. To validate the method, the research involved the analysis of 21 healthy human backs acquired in both standing and asymmetric postures. For each of them, a skilled operator detected the spinal apophyses by tactile investigation and located them through cutaneous marking. Markers have been used as the reference for spinal apophyses' positions. A comparison of the proposed approach with state-of-the-art methods has been conducted. This study evidences the high accuracy of the methodology proposed here and the capability to recognize also blurred apophyses. The method automatically performs the spine line identification and accurately locates apophyses along both vertical and coronal directions. The proposed inexpensive and easy-to-use approach significantly advances over other non-invasive methods. Its ability to detect the apophyses' location potentially offers new capabilities in detecting, diagnosing, and monitoring spinal disorders.

Effects of a mat Pilates-based exercise program for low back pain in helicopter pilots of the Brazilian Air Force: Randomized controlled trial

IntroductionHelicopter pilots may present chronic low back pain due to vibration exposure and asymmetric posture during flight. ObjectivesTo analyze the effects of a Pilates-based exercise program on low back pain of helicopter pilots of the Brazilian Air Force. MethodsThis is a randomized controlled trial with fifteen helicopter pilots of the Brazilian Air Force, who were assessed for pain intensity (Numerical Pain Rating Scale), disability associated with low back pain, and spine muscle endurance in three positions: trunk extension (Ito test) and left and right lateral bridge. Individuals were randomly distributed into the regular exercises group (REG) (n = 7), oriented to maintain their exercise routine, and Pilates group (PG) (n = 8), which performed an exercise program based on Pilates method twice a week for 12 weeks. Reassessments occurred after 6 and 12 weeks. Data were analyzed on SPSS 20.0 software using a significance level of 5%. ResultsPG showed a significant reduction in low back pain after 12 weeks of training compared with REG (mean difference of 3.5 points, p < 0.0001). We also observed increased endurance of trunk extensors (p = 0.002) and right (p = 0.001) and left lateral muscles (p = 0.001) in the PG compared with REG. However, the indexes of disability did not change between groups. ConclusionPain intensity was significantly reduced while spine muscle endurance increased in PG compared with REG after intervention; thus, Pilates-based exercises should be considered in physical conditioning programs for helicopter pilots.

Computational Fluid Dynamics Simulation Study on Aerodynamic Characteristics under Unfavorable Conditions during Flight Phase in Ski Jumping

Objective: The stability of the flight phase in ski jumping is crucial for athletes’ performance and safety. This study aims to investigate the influence of unfavorable conditions on aerodynamic characteristics and flight stability through computational fluid dynamics (CFD) numerical simulations. Methods: The ski jumper and the skis are considered a multi-body system. A detailed three-dimensional (3D) model of this multi-body system under a commonly observed posture during flight is established. The Partially Averaged Navier–Stokes (PANS) turbulence model is employed, and CFD simulations are conducted to predict the aerodynamic characteristics of the multi-body system under lateral environmental wind and asymmetric postures during the flight phase. The conditions of asymmetric postures include yaw rotation and roll rotation. Results: (1) Lateral environmental wind generated a yaw force, yaw moment, and roll moment, which influenced the lift, drag, and pitch moment of the athlete. These forces and moments were relatively small at lower wind speeds (less than 3 m/s) and became more significant at higher wind speeds (greater than 4.5 m/s). (2) Under the influence of yaw rotation or roll rotation, the multi-body system exhibited a noticeable yaw force, yaw moment, and roll moment, all showing a monotonic increasing trend. Moreover, they had a significant impact on the lift, drag, and pitch moment of the multi-body system. Conclusion: (1) The influence of unfavorable conditions was complex, resulting in a significant yaw force, yaw moment, and roll moment on the multi-body system. The adverse effects of roll rotation were generally greater than those of yaw rotation. (2) The multi-body system exhibited self-stabilizing tendencies in yaw and roll. This phenomenon can provide a solution to maintain flight stability by employing appropriate yaw or (and) roll rotation angles, effectively compensating for or even eliminating the adverse effects of lateral environmental wind. (3) Understanding the mechanisms of how unfavorable conditions affect aerodynamic characteristics and stability during flight in ski jumping can provide valuable assistance for real-time prediction and decision making during competitions, as well as scientific guidance for training athletes’ stable flight control and techniques for improving their sport performance.

Novel Multi-View RGB Sensor for Continuous Motion Analysis in Kinetic Chain Exercises: A Pilot Study for Simultaneous Validity and Intra-Test Reliability.

As the number of musculoskeletal disorders caused by smartphone usage, sedentary lifestyles, and active sports activities increases, there is a growing demand for precise and accurate measurement and evaluation of issues such as incorrect compensation patterns, asymmetrical posture, and limited joint operation range. Urgent development of new inspection equipment is necessary to address issues such as convenience, economic feasibility, and post-processing difficulties. Using 4DEYE®, a new multi-view red, green, and blue (RGB) sensor-based motion analysis equipment, and the VICON® ratio, which are infrared-based markers, we conducted a comparative analysis of the simultaneous validity of the joint angle (trajectory) and reliability. In this study, five healthy participants who could perform movements were selected for the pilot study and two movements (Y-balance and side dip) were analyzed. In addition, the ICC (Intraclass Correlation Coefficient) was analyzed using the SPSS (Statistical Package for the Social Sciences) V.18 while the number of data frames of each equipment was equalized using the MATLAB program. The results revealed that side dips, which are open kinetic chain exercises (intraclass correlation coefficient ICC(2.1), 0.895-0.996), showed very high concordance with the Y-balance test, a closed kinetic chain exercise (ICC(2.1), 0.678-0.990). The joint measurement results were similar regardless of the movement in the open or closed kinetic chain exercise, confirming the high reliability of the newly developed multiview RGB sensor. This is of great significance because we obtained important and fundamental results that can be used in various patterns of exercise movements in the future.

Focal tonic seizures with asymmetrical posturing could allow voluntary movements: a lesson to not be misled for a non-epileptic event.

This report documents the clinical features of supplementary motor area seizures with voluntary movements in two patients. The first case describes a 13-year-old boy with a 2-year history of nocturnal seizures, characterized by an asymmetrical brief tonic posture followed by bilateral rapid hand shaking, but without impaired awareness. Magnetic resonance imaging revealed no abnormalities. Video electroencephalogram indicated interictal focal spikes and ictal activity 2 s before clinical onset in the frontal midline area. The patient stated that he purposely shook his hands to lessen the seizure-induced upper limb stiffness. The second case describes a 43-year-old man with a 33-year history of nocturnal seizures, characterized by an asymmetric brief tonic posture, with the right hand grabbing to hold this posture, but without impaired awareness. Video electroencephalogram indicated that he voluntarily moved his right hand during the latter part of the seizures; however, no clear ictal electroencephalogram change was noted. Magnetic resonance imaging revealed a mass lesion in the right medial superior frontal gyrus. Fluorodeoxyglucose-positron emission tomography and ictal single-photon emission computed tomography indicated ictal focus in the mesial frontal area, as confirmed by invasive electroencephalogram and seizure freedom after surgery. Both patients had typical supplementary motor area seizures, except they could perform voluntary movements in the body parts. The co-occurrence of supplementary motor area seizures and voluntary movements is clinically useful, as it may help avoid the inaccurate and misleading diagnosis of non-epileptic events such as psychogenic non-epileptic seizures.

Saphenous neuropathy in a string musician

Instrumental musicians are prone to numerous musculoskeletal issues due to the asymmetric posture and repetitive movements maintained through long periods of practice. In this case report, the authors present an 18-year-old female cello player who complained of neuropathic pain in her left lower extremity from the medial aspect of her knee down to the medial malleolus.

IoT System for Real-Time Posture Asymmetry Detection

The rise of the Internet of Things (IoT) has enabled the development of measurement systems dedicated to preventing health issues and monitoring conditions in smart homes and workplaces. IoT systems can support monitoring people doing computer-based work and avoid the insurgence of common musculoskeletal disorders related to the persistence of incorrect sitting postures during work hours. This work proposes a low-cost IoT measurement system for monitoring the sitting posture symmetry and generating a visual alert to warn the worker when an asymmetric position is detected. The system employs four force sensing resistors (FSR) embedded in a cushion and a microcontroller-based read-out circuit for monitoring the pressure exerted on the chair seat. Java-based software performs the real-time monitoring of the sensors’ measurements and implements an uncertainty-driven asymmetry detection algorithm. The shifts from a symmetric to an asymmetric posture and vice versa generate and close a pop-up warning message, respectively. In this way, the user is promptly notified when an asymmetric posture is detected and invited to adjust the sitting position. Every position shift is recorded in a web database for further analysis of the sitting behavior.

Effect of Lifting Weight, Height and Asymmetry on Biomechanical Loading during Manual Lifting

Introduction: In India, physical manual activities in asymmetrical postures overtax the human musculoskeletal system, which may exceed workers' physical limitations. Thus the purpose of this study was to examine the physical stresses experienced by the subject, based on subjective and biomechanical loading estimates while lifting weights to various heights, in an asymmetric direction and propose the safe limit for manual lifting. Methods: A laboratory experiment was conducted utilizing twelve male subjects in the age group of 20 to 25 years who lifted 5 different weights between 10 to 20 kg from below the knee to various lifting heights (below the knee to ear level). The lifting task was performed in three asymmetric angles (45, 90, and 135-degree) using free-style lifting techniques. An ANOVA technique was used to analyze the influence of three parameters (Lifting weight, lifting height and asymmetric angle) on two responses; subjective estimates and biomechanical loading. The subjective estimate was obtained using workload assessment by body discomfort chart. The biomechanical loading (loading rate) was estimated from ground reaction force data, obtained from the force plate. Results: Both the responses; subjective estimates and biomechanical loading followed a consistent pattern in predicting physical stress. The result revealed that lifting weights with higher destination heights and asymmetry angles increased the physiological workload and discomfort. Experiments have shown that the loading rate is reduced by 8 to 10% for each increase in the 45-degree angle of asymmetry. Conclusion: In general, safe lifting of 15 kg weight up to ear level and 15 kg weight up to shoulder level are recommended for 45- and 90-degree asymmetry respectively to prevent any chronic injuries. A maximum of 12.5 kg lifting weight up to shoulder level is also proposed.

Effects of Pilates exercises on idiopathic scoliosis: a scoping review of the literature.

Scoliosis is a deformity involving changes in three planes. These changes include lateral curvature in the frontal plane, changes in physiological thoracic kyphosis and lumbar lordosis angles in the sagittal plane, and rotation of the vertebrae in the transverse plane. The aim of this scoping review was to review and summarize the available literature to determine whether Pilates exercises are an effective treatment for scoliosis. The Cochrane Library (reviews, protocols, trials), PubMed, Web of Science, Ovid, Scopus, PEDro, Medline, CINAHL (EBSCO), ProQuest, and Google Scholar electronic databases were used to search for published articles from inception to February 2022. All the searches included English language studies. Keywords were determined as "scoliosis and Pilates" or "idiopathic scoliosis and Pilates", "curve and Pilates", "spinal deformity and Pilates." Seven studies were included; one study was a meta-analysis study, three studies compared Pilates and Schroth exercises, and three applied Pilates exercises in combined therapy. The studies included in this review used outcome measurements of Cobb angle, ATR, chest expansion, SRS-22r, posture assessment, weight distribution, and psychological factors such as depression. The results of this review suggest that the level of evidence regarding the effect of Pilates exercises on scoliosis-related deformity is very limited. Pilates exercises can be applied to reduce asymmetrical posture in individuals with mild scoliosis with reduced growth potential and progression risk.

Estimating lumbar spine loading when using back-support exoskeletons in lifting tasks

Low-back pain (LBP) continues as the leading cause of work-related musculoskeletal disorders, and the high LBP burden is attributed largely to physical risk factors prevalent in manual material handling tasks. Industrial back-support exoskeletons (BSEs) are a promising ergonomic intervention to help control/prevent exposures to such risk factors. While earlier research has demonstrated beneficial effects of BSEs in terms of reductions in superficial back muscle activity, limited evidence is available regarding the impacts of these devices on spine loads. We evaluated the effects of two passive BSEs (BackX™ AC and Laevo™ V2.5) on lumbosacral compression and shear forces during repetitive lifting using an optimization-based model. Eighteen participants (gender-balanced) completed four minutes of repetitive lifting in nine different conditions, involving symmetric and asymmetric postures when using the BSEs (along with no BSE as a control condition). Using both BSEs reduced estimated peak compression and anteroposterior shear forces (by ∼8–15%). Such reductions, however, were task-specific and depended on the BSE design. Laevo™ use reduced mediolateral shear forces during asymmetric lifting (by ∼35%). We also found that reductions in composite measures of trunk muscle activity may not correspond well with changes in spine forces when using a BSE. These results can help guide the proper selection and application of BSEs during repetitive lifting tasks. Future work is recommended to explore the viability of different biomechanical models to assess changes in spine mechanical loads when using BSEs and whether reasonable estimates would be obtained using such models.

Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study.

Adolescents with unilateral cerebral palsy (U-CP) experience an asymmetrical posture because the less-affected lower limb is preferred for bodyweight support as a strategy of compensating for the paretic side’s muscular weakness. This study was designed to compare the effect of 12 weeks of paretic-limb-only plyometric training (PLPT) and volume-matched double-limb training (DLPT) on balance capability and gait symmetry in adolescents with U-CP. Sixty-nine adolescents with U-CP were randomly assigned to PLPT, DLPT, or a control group (n = 23 each). Treatment was delivered twice/week (with at least 48 h recovery intervals) for 12 weeks in succession. The directional (LoSdirectional) and overall (LoSoverall) limits of stability in addition to the temporal (T-GSI) and spatial (S-GSI) gait symmetry indicis were assessed pre- and post-treatment. The LoSdirectional improved significantly in the PLPT group compared to either the DLPT or control group (for the forward (p = 0.027 and <0.001, respectively), backward (p = 0.037 and <0.001, respectively), affected-side (p = 0.038 and 0.004, respectively), and less-affected-side (p = 0.018 and 0.016, respectively)), and this was also the case for the LoSoverall (p < 0.001). Additionally, The T-GSI and S-GSI scores decreased significantly in the PLPT group compared to the DLPT (p = 0.003 and 0.047, respectively) or control (p = 0.003 and 0.036, respectively) group, indicating the development more symmetrical gait patterns. In conclusion, PLPT is likely more effective for enhancing balance capabilities and promoting symmetrical gait patterns than DLPT. Thereupon, it is worthwhile for physical rehabilitation practitioners to include the PLPT paradigm into the intervention plans for adolescents with U-CP.

State of the temporomandibular joint of professional flute players according to clinical examination and vibrography

BACKGROUND: When playing the flute, flautists take an asymmetrical posture, involve their masseter muscles extraordinarily, and experience stress. All these factors can affect the temporomandibular joint.&#x0D; AIM: To identify pathognomonic signs of temporomandibular dysfunction in professional musicians playing the flute by analyzing clinical examination data in combination with joint vibration.&#x0D; MATERIAL AND METHODS: Thirty professional flautists and 30 asymptomatic control subjects were examined. A standard clinical examination, a questionnaire survey based on the OHIP-14 questionnaire with additional questions, and a simple Hamburg test were conducted. We also conducted joint vibration analysis in both flautists and control subjects using the BioJVA device from the BioPAK complex (BioResearch, USA).&#x0D; RESULTS: The survey showed that flautists experience clicks and pain in the temporomandibular joint and pain in the muscles of the head and neck significantly more often than the control group. According to the results of the Hamburg test, symptoms of temporomandibular joint dysfunction were detected much more often among the musicians than among the control subjects. These were clicks in the joint and pain during palpation of the masticatory and temporal muscles. Joint vibration analysis showed that the total integral in flautists tracks exceeded 20 PaHz, which was three times more often than that in the control group and indicates a pathology in the temporomandibular joint.&#x0D; CONCLUSIONS: Clinical examination and joint vibration analysis revealed that the symptoms of temporomandibular dysfunction are more common in flute players than in the control participants; however, no pathognomonic signs of dysfunction were found.

ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ ЖЕВАТЕЛЬНЫХ И ВИСОЧНЫХ МЫШЦ МУЗЫКАНТОВ, ПРОФЕССИОНАЛЬНО ИГРАЮЩИХ НА ПОПЕРЕЧНОЙ ФЛЕЙТЕ, ПО ДАННЫМ ЭЛЕКТРОМИОГРАФИИ

Flautists are at risk of developing muscular and joint pain. While playing the flute muscles of the maxillofacial region do not work physiologically. In addition, the musicians stay in an asymmetrical posture for a long time and often experience stress during performance. All these factors can affect masseter and temporal muscles and consequently lead to temporomandibular joint dysfunction (TMD).&#x0D; The aim of research was to investigate the state of the temporal and masseter muscles of flautists by means of electromyography in comparison to the control group.&#x0D; Electromyography of the temporal and masseter muscles was performed in 30 flautists and 30 control subjects aged 18 to 35 with the BioEMG from the BioPAK complex (BioResearch, USA). Electromyography at rest registered increased bioelectric potential of the temporal and/or masseter muscles in a subgroup of flautists who play more than 3 hours a day in 37.5% of cases. In a clench test both musicians and control subjects showed asymmetrical work of masticatory and temporal muscles, while in the control group, symmetry below 50% was noted only in the work of the temporal muscles. Synergy between temporal and masseter muscles less then 50% was 1.3 times more common in the control group than among flute players though right-sided disorders were more common in flute players.&#x0D; Electromyography of masticatory muscles is an important stage in a comprehensive examination of the TMJ condition, however, this method cannot be used as the single one or decisive one to diagnose the professional pathology of flautists.

Providing physical relief for nurses by collaborative robotics

Manual patient handling is one of the most significant challenges leading to musculoskeletal burden among healthcare workers. Traditional working techniques could be enhanced by innovations that can be individually adapted to the physical capacity of nurses. We evaluated the use of a robotic system providing physical relief by collaboratively assisting nurses in manual patient handling tasks. By quantifying kinetic and muscle activity data, it was possible to distinguish two kinds of movement patterns. Highly asymmetric postures and movements corresponded to distinct extremes in lower limb and spine muscle activity data. The use of collaborative robotics significantly reduced maximum force exertion in the caregiving process by up to 51%. Lateral flexion and torsion of the trunk were reduced by up to 54% and 87%, respectively, leading to a significant reduction in mean spine muscle activity of up to 55%. These findings indicate the feasibility of collaborative robot-assisted patient handling and emphasize the need for future individual intervention programs to prevent physical burden in care.

Effects of Vibrotactile Biofeedback Providing Real-Time Pressure Information on Static Balance Ability and Weight Distribution Symmetry Index in Patients with Chronic Stroke.

Training with visual and auditory biofeedback, in patients with stroke, improved balance ability and asymmetric posture. We developed a new biofeedback training device to prevent falls and improve balance ability in patients with stroke. This device corrects motion errors by collecting the pressure information of patients in real-time. This randomized crossover study aimed to investigate the effect of this biofeedback training on the static balance ability and weight distribution symmetry index in 24 patients with chronic stroke. Pressure sensor-based vibrotactile biofeedback, visual biofeedback providing posture information, and standing without biofeedback were randomly applied for 1 d each with 24 h washout intervals to minimize adaptation. The static balance ability was measured for each biofeedback training type, and the weight distribution symmetry index was calculated using the collected weight-bearing rate data. The static balance ability and weight distribution symmetry index differed significantly according to the type of biofeedback training used. Post-hoc analysis revealed significant differences in the order of newly developed vibrotactile biofeedback, visual biofeedback, and standing without biofeedback. These findings provide evidence that pressure sensor-based vibrotactile biofeedback improves static balance ability and weight support rates by proposing better intervention for patients with chronic stroke in the clinical environment.

Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing.

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16–76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5–100% GMFCS levels I–V), 42% in lying (4–92% levels I-V), and 32% in standing (2–70% levels II–V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35–100% levels I–V), sitting (81%; 50–99% levels I–V) and standing (88%; 65–100% levels I–V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inability to change or maintain position.

Effect of Cognitive Dual Task Training Versus Motor Dual Task Training on Balance in Post Stroke Patients

OBJECTIVE: This study aims to compare the effects of cognitive dual task training and motor dual task training on balance in post stroke patients. INTRODUCTION : Stroke is a disease caused by lack of blood supply to the brain following ischemia or haemorrhage. The reduced motility following stroke results in a body imbalance that appears as asymmetric posture, proprioception disorder and abnormal muscle tone that lead to the degeneration of balancing ability. Dual tasks training is a training in which two or more tasks are performed at the same time continuously. The motor dual tasks requires performance of a motor task and a postural control task at the same time and cognition dual tasks requires performance of a cognition task and postural control task simultaneously. MATERIALS AND METHODS: Thirty participants fulfilling the inclusion criteria were selected and divided into 2 groups with 15 participants each. Participants in CDTT or MDTT practiced the cognitive and motor dual tasks respectively while standing on wobble board. The intervention was for 45 minute / session, 5 days/week for 4 weeks Participants were tested before and after the intervention for balance function under cognitive and motor dual task conditions using berg balance scale, stroop test and standing balance test. RESULTS: Mean values of Group A and Group B on berg balance scale, were (49.47) and (47.40) respectively. Mean values of Group A and Group B on standing balance test were (30.07) and (28.80), and the mean values of Group A and Group B on stroop test were (16.73) and (11.47). On comparing pre test and post test values within Group A and Group B on berg balance scale, standing balance test and stroop test shows highly significant difference in mean values at p ≤ 0.001. CONCLUSION: This study concluded that cognitive dual task training is more effective in improving balance in acute stroke patients with balance impairment, when compared to motor dual task training.

Evaluation of 3D vertebral and pelvic position by surface topography in asymptomatic females: presentation of normative reference data

BackgroundDeviations from a conventional physiologic posture are often a cause of complaint. According to current literature, the upright physiological spine posture exhibits inclinations in the sagittal plane but not in the coronal and transverse planes, but individual vertebral body positions of asymptomatic adults have rarely been described using surface topography. Therefore, this work aims to form a normative reference dataset for the thoracic and lumbar vertebral bodies and for the pelvis in all three planes in asymptomatic women.MethodsIn a prospective, cross-sectional, monocentric study, 100 pain-free asymptomatic women, aged 20–64 years were enrolled. Habitual standing positions of the trunk were measured using surface topography. Data were analyzed in all three planes. Age sub-analysis was: 1) ages ≤ 40 years and 2) ages ≥ 41 years. Two-sample t-tests were used for age comparisons of the vertebral bodies, vertebra prominence (VP)–L4, and global parameters. One-sample t-tests were used to test deviations from symmetrical zero positions of VP–L4.ResultsCoronal plane: on average, the vertebral bodies were tilted to the right between the VP and T4 (maximum: T2 − 1.8° ± 3.2), while between T6 and T11 they were tilted to the left (maximum: T7 1.1° ± 1.9). T5 and L2 were in a neutral position, overall depicting a mean right-sided lateral flexion from T2 to T7 (apex at T5). Sagittal plane: the kyphotic apex resided at T8 with − 0.5° ± 3.6 and the lumbar lordotic apex at L3 with − 2.1° ± 7.4. Transverse plane: participants had a mean vertebral body rotation to the right ranging from T6 to L4 (maximum: T11 − 2.2° ± 3.5). Age-specific differences were seen in the sagittal plane and had little effect on overall posture.ConclusionsAsymptomatic female volunteers standing in a habitual posture displayed an average vertebral rotation and lateral flexion to the right in vertebral segments T2–T7. The physiological asymmetrical posture of women could be considered in spinal therapies. With regard to spinal surgery, it should be clarified whether an approximation to an absolutely symmetrical posture is desirable from a biomechanical point of view? This data set can also be used as a reference in clinical practice.Trial registration: This study was registered with WHO (INT: DRKS00010834) and approved by the responsible ethics committee at the Rhineland–Palatinate Medical Association (837.194.16).

Tailored patient therapeutic educational interventions: A patient-centred communication model.

BackgroundTailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions.ObjectivesWe used a data‐driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization.DesignIndividual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria.ResultsWhy individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions.ConclusionFrom our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions.Short InformativeTailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient‐centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient‐centred communication model for tailoring patient education intervention.