Common Rehabilitation Exercises Research Articles

TELEREHABILITATION ASSESSMENT OF KNEE RANGE OF MOVEMENT; COMPARISON OF HUMAN POSE ESTIMATION TOOL, PHYSIOROM, VS 3D MOTION CAPTURE SYSTEM

INTRODUCTION AND AIMS Telerehabilitation is increasingly acknowledged, though uptake remains limited by an inability to accurately undertake objective measurement. This study sought to determine the validity of a human pose estimation tool (PhysioROM, Coviu) assessed via two-dimensional (2D) video to measure active knee flexion and extension movement during common rehabilitation exercises, versus gold-standard three-dimensional (3D) motion capture. METHODS Fifty participants were recruited (aged 18 to 30), each performing three common knee rehabilitation exercises; sit-to-stand, seated and reclined active knee flexion. Movements were recorded using the 12-camera, 3D Vicon motion capture system simultaneously with 2D video simulating a home telehealth consultation. Joint kinematics were calculated using the Vicon Plug-in Gait model (3D Vicon) or the human pose estimation tool within the PhysioROM algorithm (2D PhysioROM). RESULTS Mean peak knee flexion was 3.1°, 9.9° and 24.8° (p<0.001) greater for 3D Vicon versus 2D PhysioROM (sit-to-stand, seated flexion and reclined flexion, respectively). For peak knee extension, Vicon 3D was 2.4° and 1.93° greater than 2D PhysioROM in sit-to-stand (p=0.020) and seated flexion (p< 0.001), whilst 3.6° less than PhysioROM for reclined knee flexion (p=0.030). Statistical parametric mapping revealed significant differences between Vicon 3D and PhysioROM for 71% and 42% of timepoints (p<0.001) for seated and reclined movements, clustered around full knee flexion. Significant differences were also found at an additional 37% (p<0.001) of timepoints clustered around knee extension for reclined postures. Overall mean absolute deviation was 8.7°, 7.6° and 16.5° for sit-to-stand, seated flexion and reclined flexion, respectively. CONCLUSION Validity of PhysioROM to accurately measure knee flexion was high, less so in extension, during sit-to stand movements in a seated posture. Measurement in a reclined position were less accurate. PhysioROM may provide an effective method of accurately and objectively quantifying knee movement during a telerehabilitation session using 2D video.

REAL-TIME HIP RANGE OF MOVEMENT MEASUREMENT IN TELEREHABILITATION; COMPARISON OF HUMAN POSE ESTIMATION TOOL, PHYSIOROM, VS 3D MOTION CAPTURE SYSTEM

INTRODUCTION AND AIMS Telerehabilitation is widely acknowledged, but its adoption in musculoskeletal cohorts has been restricted due to challenges in accurately measuring objective parameters such as range of movement (ROM). This research assesses the accuracy of a human pose estimation tool utilising two-dimensional (2D) video (PhysioROM, Coviu) for evaluating active hip flexion and abduction ROM during common rehabilitation exercises, compared to three-dimensional (3D) motion capture. METHODS Fifty participants (18 to 80 years) were recruited, each performing three common hip movements; standing hip flexion, standing hip abduction and a sit-to-stand. The motions were captured using the 12-camera, 3D Vicon motion capture system in conjunction with simultaneous 2D video, simulating a home telehealth consultation scenario. Joint kinematics were computed using either the Vicon Plug-in Gait model (3D Vicon) or the human pose estimation tool integrated into the PhysioROM algorithm (2D PhysioROM). RESULTS No significant differences were observed in peak hip ROM measurements during the tasks undertaken. Mean peak hip flexion was 2.4° (p=1.0) less for 3D Vicon versus 2D PhysioROM in standing hip flexion, though 2.1° (p=0.46) greater during sit-to-stand movement. Hip abduction was 5.3° (p< 0.001) less for 3D Vicon versus 2D PhysioROM in standing hip abduction. Statistical parametric mapping revealed significant differences (p<0.001) in hip flexion between Vicon 3D and 2D PhysioROM for 32% of timepoints for both standing hip flexion and sit-to-stand movements, clustered around full hip extension. During standing hip abduction, significant differences (p<0.001) were found at 58% of timepoints clustered around neutral postures. Overall mean absolute deviation was 10.1°, 9.7° and 9.0° for hip flexion/extension, sit-to-stand, and hip abduction respectively. CONCLUSION Validity of PhysioROM to accurately measure peak hip flexion and peak hip abduction was high. PhysioROM may provide an effective method of accurately and objectively quantifying hip movement during a telerehabilitation session using 2D video.

Exercise quantification from single camera view markerless 3D pose estimation

Sports physiotherapists and coaches are tasked with evaluating the movement quality of athletes across the spectrum of ability and experience. However, the accuracy of visual observation is low and existing technology outside of expensive lab-based solutions has limited adoption, leading to an unmet need for an efficient and accurate means to measure static and dynamic joint angles during movement, converted to movement metrics useable by practitioners. This paper proposes a set of pose landmarks for computing frequently used joint angles as metrics of interest to sports physiotherapists and coaches in assessing common strength-building human exercise movements. It then proposes a set of rules for computing these metrics for a range of common exercises (single and double drop jumps and counter-movement jumps, deadlifts and various squats) from anatomical key-points detected using video, and evaluates the accuracy of these using a published 3D human pose model trained with ground truth data derived from VICON motion capture of common rehabilitation exercises. Results show a set of mathematically defined metrics which are derived from the chosen pose landmarks, and which are sufficient to compute the metrics for each of the exercises under consideration. Comparison to ground truth data showed that root mean square angle errors were within 10° for all exercises for the following metrics: shin angle, knee varus/valgus and left/right flexion, hip flexion and pelvic tilt, trunk angle, spinal flexion lower/upper/mid and rib flare. Larger errors (though still all within 15°) were observed for shoulder flexion and ASIS asymmetry in some exercises, notably front squats and drop-jumps. In conclusion, the contribution of this paper is that a set of sufficient key-points and associated metrics for exercise assessment from 3D human pose have been uniquely defined. Further, we found generally very good accuracy of the Strided Transformer 3D pose model in predicting these metrics for the chosen set of exercises from a single mobile device camera, when trained on a suitable set of functional exercises recorded using a VICON motion capture system. Future assessment of generalization is needed.

Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study

ObjectivesTo estimate Achilles tendon forces and their relationship with self-reported pain in runners with Achilles tendinopathy (AT) during common rehabilitation exercises. DesignCross-sectional. SettingLaboratory. Participants24 recreational male runners (45.92 (8.24) years old; 78.20 (8.01) kg; 177.17 (6.69) cm) with symptomatic AT. Main outcome measuresKinematic and kinetic data were collected to estimate Achilles tendon forces during 12 commonly prescribed exercises. Achilles tendon forces were estimated from biomechanical data and normalised to the participant's bodyweight. The secondary aim was to investigate the relationship between Achilles tendon forces and pain during these exercises. ResultsTwo exercise clusters were identified based on Achilles tendon forces. Cluster1 included various exercises including double heel raises, single heel raises, and walking (range: 1.10–2.76 BWs). Cluster2 included running, jumping and hopping exercises (range: 5.13–6.35 BWs). Correlation between tendon forces and pain was at best low for each exercise (range: −0.43 - 0.20). Higher force exercises lead to more tendon load for a given amount of pain (R2 = 0.7505; y = 0.2367x + 0.6191). ConclusionThis study proposes a hierarchical exercise progression based on Achilles tendon forces to guide treatment of runners with AT. Achilles tendon forces and pain are not correlated in runners with AT.

Brain Neuroplasticity Effects on the Occurrence of Anterior Cruciate Ligament Injury and the Effect of this Injury on Brain Function and Structure: A Systematic Review

Objective: The present study aimed to investigate the effect of brain neuroplasticity on the incidence of anterior cruciate ligament (ACL) injury and on brain function and structure before and after ligament reconstruction and after a period of rehabilitation exercises. Materials & Methods: In this review study, a search was conducted in PubMed, Scopus, Web of Science, Google Scholar, ScienceDirect, MedLine, Pedro, CINAHL, SPORTDiscus, and Cochrane Databases as well as national databases on related studies published from 1970 to 2021 using keywords in Persian and English related to the research topic. Results: The initial search yielded 65 articles. Based on the inclusion and exclusion criteria, 24 articles were selected for review of which 5 articles prospectively examined the effect of brain neuroplasticity on the incidence of ACL injury. Their results showed that the brains of people with ACL injury was different from the uninjured people, especially in the motor-sensory part of the cerebral cortex and cerebellum, which caused errors during movement planning of these persons. Ten articles examined the effect of ACL injury before reconstruction on brain function and structure and reported that changes occur in the level of motor-sensory cortex of the brain at least two weeks after the injury; after one year, these structural and functional changes were widely increased in injured people compared to healthy people. These studies also showed that the ligament dysfunction and the damage to mechanical receptors cause the reorganization of the central nervous system. In injured people, the control activity of motor-visual areas and their need for visual feedback have increased. Seven articles examined these changes after ligament reconstruction and showed that the brain neuroplasticity or functional and structural changes resulting from the injury not only did not return to normal conditions, but also increased after a while despite the reconstruction. Two articles examined these changes after a period of rehabilitation exercises and showed that functional and Conclusion: The changes in the brain after ACL injury not only persist after ligament reconstruction, but also increase after reconstruction. The common rehabilitation exercises whose main focus is not on eliminating these functional and structural changes in the brain cannot overdrive this negative neuroplasticity after injury which is one of the important causes of secondary injury and subsequent complications. In developing exercises to prevent ACL injury and for rehabilitation, it is better to use the new principles of motor learning and exercises related to visual feedback along with conventional exercises to overdrive negative neuroplasticity created in the brain and create positive neuroplasticity to support ACL.

Wireless Motion Capture System for Upper Limb Rehabilitation

This work is devoted to the presentation of a Wireless Sensor System implementation for upper limb rehabilitation to function as a complementary system for a patient’s progress supervision during rehabilitation exercises. A cost effective motion capture sensor node composed by a 9 Degrees-of-Freedom (DoF) Inertial Measurement Unit (IMU) is mounted on the patient’s upper limb segments and sends wirelessly the corresponding measured signals to a base station. The sensor orientation and the upper limb individual segments movement in 3-Dimensional (3D) space are derived by processing the sensors’ raw data. For the latter purpose, a biomechanical model which resembles that of a kinematic model of a robotic arm based on the Denavit-Hartenberg (DH) configuration is used to approximate in real time the upper limb movements. The joint angles of the upper limb model are estimated from the extracted sensor node’s orientation angles. The experimental results of a human performing common rehabilitation exercises using the proposed motion capture sensor node are compared with the ones using an off-the-shelf sensor. This comparison results to very low error rates with the root mean square error (RMSE) being about 0.02 m.

Electromyographic analysis of VMO and VL across straight leg raise, short arc quad, medial tibial rotation and hip adduction in normal individuals.

The lateral malalignment of patella is considered to be the main cause of patellofemoral pain syndrome (PFPS). PFPS, in an occupational setup, is aggravated by prolonged sitting, climbing stairs, squatting, and kneeling. Strengthening of vastus medialis oblique (VMO) opposes the lateral force produced by vastus lateralis (VL) and helps in stabilizing patella. The main objective was to compare six common rehabilitation exercises (REs) and to identify those which could possibly activate VMO selectively to alleviate PFPS of occupational workers. Ten subjects, having no history of PFPS, performed six REs, namely, straight leg raise with neutral hip position (SLRN), straight leg raise with externally rotated hip position (SLRER), short arc quad with neutral hip position (SAQN), short arc quad with externally rotated hip position (SAQER), medial tibial rotation and hip adduction (HA). REs were compared on the basis of integrated electromyographic activity of VMO and VL. Results demonstrated that VMO activity was more than that of VL during all REs. However, this difference was not statistically significant in any of the six REs. HA produced significantly higher VMO activity than SLRN, SLRER and SAQN. The results provided a wider range of options for selecting apposite REs for treating patients diagnosed with PFPS.

FES and Motor Assisted Cycling to Track Power and Cadence to Desired Voluntary Bounds

Abstract Cycling is a common rehabilitation exercise for people recovering from neurological impairments. Both functional electrical stimulation (FES) and a motor can assist a person in pedaling a cycle, and by switching amongst multiple muscle groups and a motor, a human-cycle system can track a desired power and cadence. However, with motivation to maximize physiological effects, the person should contribute volitionally as much as possible and be assisted only when necessary, which can be done by limiting cadence assistance to outside a desired region. Torque tracking to a single value is desired so that the muscle is being sufficiently exercised. In this paper, a human contributing torque through FES and volition works alongside an electric motor to instantaneously track cadence to a desired region and discretely track torque to a known bound for all time. Lyapunov methods are used to prove the stability of the switched system.

Effect of telerehabilitation on mobility in people after hip surgery: a pilot feasibility study.

The goal of this study was to evaluate the effects of telerehabilitation on mobility in people following hip surgery. This feasibility pilot randomized controlled trial included a sample of 40 participants, with 22 male and 18 female patients and mean age (SD) of 67.5 (7.8) years following a surgical intervention. Participants were equally divided and randomly assigned to a telerehabilitation or control intervention group (6 weeks, 3 sessions/week). Telerehabilitation was based on video clips of common rehabilitation exercises focusing on the lower limbs. The control group received an exercise booklet. Both groups participated in physical therapy sessions, twice a week. Outcome measures included the Timed Up and Go test, 2-min walk test, 10-m walk test, sit to stand test, walking speed, and mean step length. Measurements were completed at baseline, at termination of the intervention, and at a 4-week follow-up examination. Improvements in both groups were demonstrated in all outcome measures in the postintervention evaluation. Improvements in the telerehabilitation group were greater in five of six tests compared with those achieved by the controls. The telerehabilitation group showed greater improvements in the 2-min walking test (86.1%) and walking speed (65.6%). During follow-up, the telerehabilitation group continued to improve in all outcome measures in contrast to the control group, who showed no changes in five of the six outcome measures. Telerehabilitation, a complementary treatment to standard physical therapy, generates a positive effect on mobility in people following hip surgery.

Electromyographic activity of selected trunk, core, and thigh muscles in commonly used exercises for ACL rehabilitation.

[Purpose] Most of rehabilitation programmes for Anterior Cruciate Ligament (ACL) injury focus on quadriceps-hamstrings activation imbalances and less is known about kinetically linked muscles. This study investigated electromyographic activity of selected trunk, core, and thigh muscles during common rehabilitation exercises for ACL injury. [Subjects and Methods] Twelve active female volunteers participated in this cross-sectional laboratory study. Surface EMG was used to compare activation of eight trunk, hip/core, and lower limb muscles: Erector Spinae (ES), Rectus Abdominis (RA), Gluteus Maximus (GM), Vastus Lateralis (VL), Rectus Femoris (RF), Vastus Medialis (VM), Biceps Femoris (BF), and Semitendinosus (ST) during Forward Lunge, Double Leg Raise, Glute Bridge, Sit-Up, and Squat. [Results] Forward lunge produced significantly higher activation in the VM (61.1 ± 19.4), VL (59.2 ± 12.9), and RF (32.0 ± 2.6). Double leg raise generated highest activity in the RF (26.6 ± 2.8) and RA (43.3 ± 4.4); and Glute Bridge in the GM (44.5 ± 19.0) and BF (22.4 ± 4.3). Sit-up produced the highest activation in the RF (36.6 ± 4.7) followed by RA (18.9 ± 3.8). Squat produced a higher activation in VL (55.0 ± 12.9), VM (51.5 ± 18.2), and ES (40.4 ± 18.3). [Conclusion] This study provide further evidence for developing training programmes for ACL injury prevention and rehabilitation. A combination of exercises to reinstate quadriceps-hamstrings activation balance and enhance core stability is recommended.

Gluteus Minimus and Gluteus Medius Muscle Activity During Common Rehabilitation Exercises in Healthy Postmenopausal Women.

Study Design Controlled laboratory study, cross-sectional. Background The gluteus medius (GMed) and gluteus minimus (GMin) provide dynamic stability of the hip joint and pelvis. These muscles are susceptible to atrophy and injury in individuals during menopause, aging, and disease. Numerous studies have reported on the ability of exercises to elicit high levels of GMed activity; however, few studies have differentiated between the portions of the GMed, and none have examined the GMin. Objectives To quantify and rank the level of muscle activity of the 2 segments of the GMin (anterior and posterior fibers) and 3 segments of the GMed (anterior, middle, and posterior fibers) during 4 isometric and 3 dynamic exercises in a group of healthy, postmenopausal women. Methods Intramuscular electrodes were inserted into each segment of the GMed and GMin in 10 healthy, postmenopausal women. Participants completed 7 gluteal rehabilitation exercises, and average normalized muscle activity was used to rank the exercises from highest to lowest. Results The isometric standing hip hitch with contralateral hip swing was the highest-ranked exercise for all muscle segments except the anterior GMin, where it was ranked second. The highest-ranked dynamic exercise for all muscle segments was the dip test. Conclusion The hip hitch and its variations maximally activate the GMed and GMin muscle segments, and may be useful in hip muscle rehabilitation in postmenopausal women. J Orthop Sports Phys Ther 2017;47(12):914-922. Epub 15 Oct 2017. doi:10.2519/jospt.2017.7229.

Rule-Based Human Motion Tracking for Rehabilitation Exercises: Realtime Assessment, Feedback, and Guidance

In this paper, we report the design and implementation of a Kinect-based system for providing automated realtime assessment, feedback and guidance to users who are practicing rehabilitation exercises at home without the supervision of physical therapists. The foundation for the system is a rule-based framework that can be used to assess in realtime the quality and quantity of the exercises performed by the user. We demonstrate the capability of the rule-based framework by showing the detailed rules for three common rehabilitation exercises, including bowling, hip abduction, and sit to stand. To test its usability and accuracy, we have used the system in a human subject study with eight healthy users. The results show that with proper empirical parameters in the rules, the performance of these exercises can be reliably assessed in realtime.

Knee Extensor Power Relates to Mobility Performance in People With Knee Osteoarthritis: Cross-Sectional Analysis.

Quadriceps femoris muscle strengthening is a common rehabilitation exercise for knee osteoarthritis (OA). More information is needed to determine whether targeting muscle power is a useful adjunct to strengthening for people with knee OA. The purpose of this study was to identify the predictive ability of knee extensor strength and knee extensor power in the performance of physical tasks in adults with knee OA. This study used a cross-sectional design. Fifty-five participants with clinical knee OA were included (43 women; mean [SD] age=60.9 [6.9] years). Dependent variables were: timed stair ascent, timed stair descent, and the Six-Minute Walk Test (6MWT). Independent variables were: peak knee extensor strength and mean peak knee extensor power. Covariates were: age, body mass index, and self-efficacy. Multiple regression analyses were run for each dependent variable with just covariates, then a second model including strength, and then a third model including power. The R(2) values were compared between models. Power explained greater variance than strength in all models. Over and above the covariates, power explained an additional 6% of the variance in the 6MWT, increasing the R(2) value from .33 to .39; 8% in the stair ascent test, increasing the R(2) value from .52 to .60; and 3% in the stair descent test, increasing the R(2) value from .44 to .47. The sample demonstrated very good mobility and muscle function scores and may not be indicative of those with severe knee OA. In adults with knee OA, knee extensor power was a stronger determinant of walking and stair performance when compared with knee extensor strength. Clinicians should consider these results when advising patients on exercise to maintain or improve mobility.

Synergy analysis as a tool to design and assess an effective stroke rehabilitation.

The poor rehabilitation success rate, including the cases of ineffective and detrimental adaptations, make stroke a leading cause of disability. Thus, it is essential to recognize the mechanisms driving healthy motor recovery to improve such rate. Stroke alters the Synergy Architecture (SA), the modular muscle control system. So SA analysis may constitute a powerful tool to design and assess rehabilitation procedures. However, current impairment scales do not consider the patient's neuromuscular state. To gain insights into this hypothesis, we recorded multiple myoelectric signals from upper-limb muscles, in healthy subjects, while executing a set of common rehabilitation exercises. We found that SA reveals optimized motor control strategies and the positive effects of the use of visual feedback (VF) on motor control. Furthermore we demonstrate that the right and left arm's SA share the basic structure within the same subject, so we propose using the unaffected limb's SA as a reference motion pattern to be reached through rehabilitation.

EMG Activation of the Vastus Medialis Oblique and Vastus Lateralis During Four Rehabilitative Exercises

The purpose of this study was to compare four common rehabilitation exercises used in physical therapy clinics for activating the vastus medialis oblique (VMO) and vastus lateralis (VL). Thirty-four subjects, aged 22-28 years, without patellofemoral pain syndrome (PFPS) (18 females and 16 males) were recruited. Subjects performed four exercises—straight leg raise with neutral and externally rotated hip positions (SLRN, SLRER), and short arc quad with neutral and externally rotated hip positions (SAQN, SAQER). The integrated electromyographic (iEMG) activity of the VMO and VL and were recorded, with means of the VMO, VL and VMO/VL compared across exercises. No significant difference was found for the VMO/VL ratio across the four exercises (p=0.147). However, for the VMO and VL individually, a significant difference was found (p=0.0001), SAQER was significantly greater than SLRN and SLRER; SAQN was significantly greater than SLRN and SLRER. These findings suggest that exercises including short arc quad knee extensions are more effective for both the VMO and VL activation than those incorporating straight leg raises, and potentially more beneficial in the rehabilitation of patients with PFPS.

Current Concepts in the Scientific and Clinical Rationale Behind Exercises for Glenohumeral and Scapulothoracic Musculature

The biomechanical analysis of rehabilitation exercises has led to more scientifically based rehabilitation programs. Several investigators have sought to quantify the biomechanics and electromyographic data of common rehabilitation exercises in an attempt to fully understand their clinical indications and usefulness. Furthermore, the effect of pathology on normal shoulder biomechanics has been documented. It is important to consider the anatomical, biomechanical, and clinical implications when designing exercise programs. The purpose of this paper is to provide the clinician with a thorough overview of the availableliterature relevant to develop safe, effective, and appropriate exercise programs for injury rehabilitation and prevention of the glenohumeral and scapulothoracic joints. Level 5.

Electromyographic Analysis of the Supraspinatus and Deltoid Muscles During 3 Common Rehabilitation Exercises

Electromyographic Analysis of the Supraspinatus and Deltoid Muscles During 3 Common Rehabilitation Exercises

Sagittal tibial translation during exercises in the anterior cruciate ligament‐deficient knee

The aim of this study was to describe and compare the sagittal tibial translation and electromyographic activity of muscles v. medialis and lateralis, gastrocnemius and hamstrings, during common rehabilitation exercises, in patients with anterior cruciate ligament (ACL) deficiency and non-injured controls. Sagittal tibial translation was registered with the CA-4000 electrogoniometer, in 12 patients and 17 controls, during Lachman test (static translation) and five exercises (dynamic translation). The exercises were grouped according to muscle work and joint compression (active extension, heel raises, cycling, one-legged squat and chair squat). The non-weight-bearing exercise with isolated muscle work (active extension) produced a large amount of tibial translation. During weight bearing, the total anterior-posterior tibial motion was halved compared to the non-weight-bearing exercises, but tibia was anterior positioned. Heel raising resulted in equal translation as the one-legged squat and chair squat, whereas cycling produced the smallest amount of tibial translation. The subjects utilized different amounts of their individual joint play (static translation) during the exercises, which may explain why there are no correlation between static translation and the patients functional outcome. These results enhance understanding on tibial translation during activity and gives indications on which exercises can be used early after ACL injury and reconstruction.