Horizontal Abduction Research Articles

Effect of shoulder immobilization position and activities of daily living on the stiffness of the repaired supraspinatus tendon

BackgroundAlthough tension on the supraspinatus tendon may be increased by wearing an abduction brace in an improper position or activities of daily living with the operated arm in the brace, the amount of tension has not been objectively evaluated. MethodsEighteen patients who underwent arthroscopic rotator cuff repair were enrolled. The stiffness of the repaired supraspinatus tendon was measured with ultrasound elastography to estimate the tension on the repaired tendon. Measurements were performed in 5 immobilization positions (0°, 30°, and 45° of arm elevation in the scapular plane; 30° of arm elevation in the scapular plane+60° (horizontal adduction) and −60° (horizontal abduction)) and 3 static positions simulating drinking, brushing teeth, and dressing. FindingsStiffness at 30° of scapular plane elevation was lower than 0° of scapular plane elevation (P = 0.034), 30° of elevation in the scapular plane+60° (P < 0.001), and −60° (P < 0.001). There was no significant difference in the stiffness between 30° and 45° of scapular plane elevation (P = 1.000). The stiffness was the greatest at 30° of elevation in the scapular plane−60° among the 5 immobilization positions. The stiffnesses at drinking and brushing teeth were greater than 30° of scapular plane elevation (P < 0.001). InterpretationImmobilization with the arm ≥30° of elevation in the scapular plane may be an optimal position for minimizing stiffness or tension on the repaired tendon. Drinking and brushing teeth may need to be performed using the non-operated arm to protect the repaired tendon.

Validation of pitchAITM markerless motion capture using marker-based 3D motion capture

ABSTRACT This study sought to compare and validate baseball pitching mechanics, including joint angles and spatiotemporal parameters, from a single camera markerless motion capture solution with a 3D optical marker-based system. Ten healthy pitchers threw 2–3 maximum effort fastballs while concurrently using marker-based optical capture and pitchAITM (markerless) motion capture. Time-series measures were compared using R-squared (r2), and root mean square error (RMSE). Discrete kinematic measures at foot plant, maximal shoulder external rotation, and ball release, plus four spatiotemporal parameters were evaluated using descriptive statistics, Bland-Altman analyses, Pearson’s correlation coefficients, p-values, r2, and RMSE. For time-series angles, r2 ranged from 0.69 (glove arm shoulder external rotation) to 0.98 (trunk and pelvis rotation), and RMSE ranged from 4.37° (trunk lateral tilt) to 20.78° (glove arm shoulder external rotation). Bias for individual joint angle and spatiotemporal parameters ranged from −11.31 (glove arm shoulder horizontal abduction; MER) to 12.01 (ball visible). RMSE was 3.62 m/s for arm speed, 5.75% height for stride length and 21.75 ms for the ball visible metric. pitchAITM can be recommended as a markerless alternative to marker-based motion capture for quantifying pitching kinematics. A database of pitchAITM ranges should be established for comparison between systems.

Anterior glenohumeral capsular ligament reconstruction with hamstring autograft for internal impingement with anterior instability of the shoulder in baseball players: preliminary surgical outcomes.

Shoulder pain and dysfunction are common in baseball players, and although "internal impingement" is recognized as one of the most common pathologies of shoulder dysfunction, the optimal surgical treatment for internal impingement with anterior instability of the shoulder remains controversial. This study evaluated baseball players' preliminary outcomes following anterior glenohumeral capsular ligament reconstruction for internal impingement with anterior instability of the shoulder. Twelve baseball players (all male; mean age, 20.5±2.2years) with internal impingement and anterior instability managed via anterior glenohumeral capsular ligament reconstruction were examined. The mean follow-up period was 25.3±4.6months. Anterior glenohumeral capsular ligament reconstruction was performed with a knee hamstring autograft for balanced stability and laxity with two major targets: to prevent hyperangulation and translation in horizontal abduction and to mimic the individual arm cocking position at the final decision of tension. Preoperative and final follow-up evaluations were performed using Jobe's postoperative grading system; the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score; Disabilities of the Arm, Shoulder and Hand sports module; plain radiographs; and magnetic resonance imaging. Jobe's postoperative grading system score, the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score, and the Disabilities of the Arm, Shoulder and Hand sports module score improved significantly from 20.4±12.2, 28.4±8.3, and 80.2±11.1 points preoperatively to 88.8±13.6, 80.8±7.7, and 22.4±18.7 points postoperatively, respectively (P<.001, .0025, <0.001, respectively). Both clinical and imaging evaluations revealed improved internal impingement with anterior instability after anterior glenohumeral capsular ligament reconstruction. The mean external rotation at abduction significantly decreased from 113° preoperatively to 104° postoperatively. At follow-up, 10 of the 12 athletes (83.3%) returned to their prior competitive level. Plain radiographs and magnetic resonance imaging revealed no obvious loosening of the graft or screws. Anterior glenohumeral capsular ligament reconstruction resulted in preferable clinical outcomes for young baseball players who experienced pain during the throwing motion. Stabilization of the glenohumeral joint with autografting of the knee hamstring may thus represent a solution for internal impingement with anterior instability in overhead throwing athletes.

Paper 10: Influence of Arm Path on Elbow Varus Torque in Professional Baseball Pitchers

Objectives:Arm path, or the distance the hand travels from the glove to ball release, has become an increasingly discussed topic within the baseball community. Arm path is a combination of elbow flexion, shoulder external rotation, shoulder abduction, forearm pronation, and wrist flexion movements. Traditionally, pitchers have been taught to throw with a longer arm path during the first part of the pitching motion, which includes extending the throwing arm away from the body and delaying shoulder external rotation. Advocates of the shorter arm path have recently made a push to get pitchers to shorten up as it is thought that it results in a more efficient motion and this in turn may decrease injury risk. By shortening the arm path, the throwing arm is closer to the body in a more loaded position theoretically creating less torque on the elbow. However, there is a lack of published data to support either claim of the benefits of a shorter or longer arm path. The purpose of this study was to determine if there was a relationship between arm path and elbow varus torque in professional pitchers.Methods:Data from 285 professional pitchers were included in this study (189.9±5.9 cm, 95.1±9.8 kg). Pitchers were tested pitching 8-12 fastballs at 480 Hz using a 3D motion capture system (Motion Analysis Corp., Santa Rosa, CA). The fastest pitch from each pitcher was used in the analysis. Arm path was measured as the total path the hand marker traveled during the entire pitch. Arm path was also normalized as a percentage of arm length (%AL). The pitch was broken down into four time points: maximum knee height (MKH), foot contact (FC), maximum external rotation (MER), ball release (BR). Linear regressions were calculated to evaluate the relationship between arm path and elbow varus torque at each time point. Significance was set at p<0.05.Results:There was no significant relationship between arm path and elbow varus torque (Figure 1). Arm path did not have a significant effect on elbow varus torque for MKH to BR (r2=.04, p<0.001), MKH to FC (r2=.05, p<0.001), and FC to BR (r2=0.00, p=0.207). Furthermore, there was no significant effect on elbow varus torque for MKH to BR, MKH to FC, and FC to BR when arm path was normalized by the pitcher’s arm length (r2=0.00 p=0.262; r2=0.02 p=0.018; r2=0.01 p=0.081 respectively).Conclusions:Recent anecdotal trends towards a shorter arm path in pitchers does not alter elbow varus torque as compared to both average and longer arm paths in a sample of professional pitchers. None of the studied time periods within the pitching motion revealed correlations between elbow varus torque and shorter arm paths. This suggests that total distance travelled by the arm during the pitching motion may not be a significant risk factor for injury in professional level pitchers. However, it is possible that components of arm path (i.e. elbow flexion, shoulder rotation, and shoulder horizontal abduction) play a larger role in the influence on elbow varus torque than simply arm path. Future studies should investigate the combined effects of arm path and arm path’s components on elbow varus torque.Figure 1.Correlations of arm path to elbow varus torque during a pitch. The left hand column measures arm path in centimeters and the right hand column uses arm path normalized to pitcher’s arm length. There were no correlations in arm path to elbow varus torque. Maximum knee height. MKII; FC. foot contact; BR. ball release.

The Relationship Between Maximum Shoulder Horizontal Abduction and Adduction on Peak Shoulder Kinetics in Professional Pitchers.

Repetitive horizontal shoulder abduction during pitching can cause increased contact between the posterosuperior aspect of the glenoid and the greater tuberosity of the humeral head, theoretically putting baseball pitchers at increased risk of shoulder internal impingement and other shoulder pathologies. Increased shoulder horizontal abduction is associated with increased shoulder anterior force, while increased horizontal adduction is associated with increased shoulder distraction force. Descriptive laboratory study. Level 4. A total of 339 professional baseball pitchers threw 8 to 10 fastball pitches using 3D motion capture (480 Hz). Pitchers were divided into 2 sets of quartiles based on maximum shoulder horizontal abduction and adduction. Elbow flexion, shoulder external rotation, and peak shoulder kinetics were compared between quartiles with post hoc linear regressions conducted for the entire cohort. At maximum shoulder horizontal abduction, there was no difference in ball velocity between quartiles (P = 0.76). For every 10º increase in maximum shoulder horizontal abduction, shoulder anterior force decreased by 2.2% body weight (BW) (P < 0.01, B = -0.22, β = -0.38), shoulder adduction torque decreased by 0.5%BW × body height (BH) (P < 0.01, B = -0.05, β = -0.19), and shoulder horizontal adduction torque decreased by 0.4%BW × BH (P < 0.01, B = -0.04, β = -0.48). For every 10º increase in maximum shoulder horizontal adduction, shoulder anterior force increased by 2%BW and ball velocity decreased by 1.2 m/s (2.7 MPH). Professional pitchers with the least amount of maximum horizontal adduction had faster ball velocity and decreased shoulder anterior force. Pitchers with greater maximum shoulder horizontal abduction had decreased shoulder anterior force, shoulder adduction torque, and shoulder horizontal adduction torque. To maximize ball velocity as a performance metric while minimizing shoulder anterior force, pitchers can consider decreasing maximum shoulder adduction angles at later stages of the pitch. Identifying risk factors for increased throwing shoulder kinetics (ie, shoulder anterior force, shoulder adduction torque) has potential implications in injury prevention. Specifically, mitigating shoulder anterior forces may be beneficial in reducing risk of injury.

Relationship between isometric force-time curve variables and serve velocity in young tennis players

ABSTRACT This study aimed to investigate the associations between serve velocity (SV), maximal absolute and relative isometric voluntary contraction (MVC and RMVC), peak rate of force development (PRFD), rate of force development (RFD) and impulse (IMP) at different stages of contraction (≤200 ms). Sixteen players performed four maximum isometric tests in positions involved in the tennis serve motion. Variables tested included MVC, PRFD, RFD and IMP at 50, 100, 150 and 200 ms while performing a 90º shoulder internal rotation (SHIR), shoulder flexion (SHF), horizontal shoulder abduction (SHABD) and an isometric mid-thigh pull (IMTP). Significant (p ≤ 0.05) moderate-to-very-large correlations were found between SV, MVC and PRFD. RFD at different time intervals showed positive associations with SV, except in the SHF0-200 ms and IMTP0-200 ms. Accordingly, IMP values positively correlated with SV in all positions except in the SHIR0-50 ms and the IMTP in late contraction stages. Results indicate that the combination of maximum isometric strength in several body positions involved in the serve kinetic chain alongside RFD and IMP in short periods of time (≤200 ms) positively influences SV in young participants.

Is early trunk rotation really hazardous for shoulder biomechanics in baseball throwing?

Early trunk rotation (ETR), which is a unique kinematics of the trunk that occurs during baseball throwing, is thought to be related to shoulder injuries. Pelvic rotation is a confounder when studying the effects of trunk rotation on shoulder biomechanics. The purpose of this study was to understand the "pure" effects of trunk rotation on shoulder biomechanics, with pelvic rotation under control. Our hypotheses were as follows: (1) throwers with ETR have a different shoulder kinematics pattern compared with throwers without ETR; (2) throwers with ETR have a lower ball speed performance than do throwers without ETR; and (3) throwers with ETR have a greater value of shoulder forces and moments, which may increase risks of shoulder injury, than do throwers without ETR. Fifty-seven elite throwers were enrolled and divided into 2 groups (non-ETR and ETR) using an outdoor motion analysis. Several kinematics and kinetics parameters of the shoulder were analyzed and compared between the 2 groups. Ball velocity was faster in the non-ETR group (127 km/h) compared with the ETR group (120 km/h). The shoulders of throwers in the ETR group showed pathokinematics of "horizontal adduction lag" and "dropped elbow." The increases in maximal posterior force, inferior force, horizontal abduction moment, and vertical adduction moment were 9.2%, 13.6%, 21.3%, and 24.3%, respectively, in the shoulders of throwers in the ETR group. These results indicate that ETR may be hazardous for the throwing shoulder. With lower ball velocity and higher shoulder joint loading, ETR is not a proper pitching pattern for kinetic energy transfer. Improper pitching mechanics among baseball throwers, such as ETR, may result in higher shoulder joint loading and increased risk of shoulder injuries. When treating throwers with shoulder injuries, it is important not only to address shoulder anatomy and pathology but also to understand the possible pathomechanics and pathogenesis of the shoulder caused by ETR. Furthermore, special training programs focusing on trunk flexibility and core muscle strengthening should be implemented to prevent ETR and decrease the risk of shoulder injuries. Motion analysis is useful for the screening and early detection of improper pitching mechanics in throwers.

Three-muscle surgery for large-angle esotropia in chronic sixth nerve palsy: comparison of two approaches

AimsTo report the effect of two three-muscle surgeries, inferior rectus belly transposition plus augmented superior rectus transposition plus medial rectus recession (ISM) and modified vertical rectus belly transposition plus medial...

Force-Time Curve Variable Outcomes Following a Simulated Tennis Match in Junior Players.

This study examined the alterations induced by a simulated tennis competition on maximal isometric voluntary contraction (MVC), peak rate of force development (PRFD) and rate of force development (RFD) at different stages of contraction. Twenty junior tennis players performed an 80-minute simulated tennis match and two (pre and post) muscular performance tests. Variables tested included MVC, PRFD and RFD at 50, 100, 150 and 200 ms while performing a 90º shoulder internal rotation (IR90), 90º shoulder external rotation (ER90), shoulder horizontal adduction (ADD), shoulder horizontal abduction (ABD) and isometric mid-thigh pull (IMTP). Serve velocity (SV) was also registered. No significant changes were found regarding MVC, PRFD or SV. Non-significant moderate effect size (ES) towards a decrease in the IR90 RFD at 50 ms could be observed (16%; ES = 0.5) alongside an increase in the ADD and IMTP RFD at 150 ms (-15.8%, -8.2%; ES = -0.53, -0.54) and IMTP RFD at 200 ms (-13%; ES = -0.54). Results indicate that MVC, PRFD, RFD at different time intervals and SV are unaltered following an 80-minute simulated match, possibly due to insufficient alterations triggered on key factors affecting the tested variables.

Long head of biceps transfer to augment Bankart repair in chronic anterior shoulder instability with and without subcritical bone loss: a biomechanical study.

Treating recurrent anterior shoulder instability in participants in collision sports, patients with capsulolabral defects, and patients with bipolar bone loss remains challenging. The study purpose was to investigate the effect of long head of the biceps transfer (LHBT) on load-to-dislocation biomechanics in a repetitive serial shoulder dislocation cadaveric model comparing LHBT with the Latarjet and Bankart procedures-the first-line treatment methods for chronic traumatic anterior shoulder instability with and without anterior glenoid bone loss, respectively. In this controlled laboratory study, 8 fresh-frozen cadaveric shoulders with different conditions were dislocated in sequence using a custom test frame. The muscle loading configuration simulated the arm in the apprehension position, and biceps loads of 20 N and 40 N were used for the static glenohumeral position analysis to evaluate the sling effect. Sequential experimental conditions consisted of the intact state, second and third dislocations, chronic instability, Bankart repair, first LHBT, subcritical glenoid bone loss, second LHBT, and Latarjet procedure. The pectoralis major and joint reaction loads to dislocation sequentially decreased with serial dislocations in all specimens, with the lowest value in the subcritical glenoid bone defect condition. In the setting of chronic instability, the pectoralis load to dislocation was significantly higher with the Bankart repair (P = .031) and LHBT (P < .001), at 71% and 85% of the intact value, respectively. Direct comparison of the pectoralis load to dislocation favored LHBT over Bankart repair (P = .015). In the subcritical defect scenario, LHBT did not significantly increase the load to dislocate, and the Latarjet procedure demonstrated a higher load to dislocate than LHBT (P < .001). All 3 surgical procedures tested significantly increased the angle of horizontal abduction at the time of dislocation and restored the glenohumeral position to closer to the intact state. Doubling the biceps load leveraged the sling effect, pulling the humeral head farther posterior-superiorly, but this was not enough to overcome the effect of a 20% subcritical glenoid bone defect. In a serial dislocation model, LHBT effectively stabilized the glenohumeral joint in a simulated chronic instability scenario, increasing the pectoralis major load-to-dislocate and glenohumeral joint reaction force components at the time of dislocation and restoring relative glenohumeral positioning to close to the intact state. The Latarjet procedure outperformed LHBT in stabilizing shoulders in the 20% subcritical glenoid bone defect condition.

The Clinician's Guide to Baseball Pitching Biomechanics.

Improper baseball pitching biomechanics are associated with increased stresses on the throwing elbow and shoulder as well as an increased risk of injury. Previous studies quantifying pitching kinematics and kinetics were reviewed. Clinical review. Level 5. At the instant of lead foot contact, the elbow should be flexed approximately 90° with the shoulder at about 90° abduction, 20° horizontal abduction, and 45° external rotation. The stride length should be about 85% of the pitcher's height with the lead foot in a slightly closed position. The pelvis should be rotated slightly open toward home plate with the upper torso in line with the pitching direction. Improper shoulder external rotation at foot contact is associated with increased elbow and shoulder torques and forces and may be corrected by changing the stride length and/or arm path. From foot contact to maximum shoulder external rotation to ball release, the pitcher should demonstrate a kinematic chain of lead knee extension, pelvis rotation, upper trunk rotation, elbow extension, and shoulder internal rotation. The lead knee should be flexed about 45° at foot contact and 30° at ball release. Corrective strategies for insufficient knee extension may involve technical issues (stride length, lead foot position, lead foot orientation) and/or strength and conditioning of the lower body. Improper pelvis and upper trunk rotation often indicate the need for core strength and flexibility. Maximum shoulder external rotation should be about 170°. Insufficient external rotation leads to low shoulder internal rotation velocity and low ball velocity. Deviation from 90° abduction decreases the ability to achieve maximum external rotation, increases elbow torque, and decreases the dynamic stability in the glenohumeral joint. Improved pitching biomechanics can increase performance and reduce risk of injury. Level C.

EFFECT OF DYNAMIC EXERCISE (AEROBIC+RESISTANCE), MORE STATIC STRETCHING ON FLEXIBILITY IN WOMEN WITH BREAST CANCER

Objective. was to assess flexibility in women with breast cancer who underwent combined training (CT) (static stretching, more aerobic+resistance). &#x0D; Methods. This was a controlled pilot study, with 31 women (age 30 to 59) under breast cancer treatment, 14 women were allocated to a training group (TG) who underwent CT, concomitant to hospital treatment and 17 women for the control group (CG) who only underwent hospital treatment. The CT was performed in 12 weeks with 5 sessions per week, three sessions (aerobic+resistance) and two sessions (stretching exercises) on alternate days. The flexibility of the shoulder was measured by means of the 360º Sanny pendulum goniometer. &#x0D; Results. The TG presented increased flexibility in the horizontal abduction of the right shoulder (p=0.001) and in the lower limbs (p

Dancers utilize a ‘whip-like effect’ to increase arm angular momentum during multiple-revolution pirouette en dehors

ABSTRACT A pirouette en dehors (PeDh) is multiple turns using the angular momentum generated by swinging the arms with both feet on the ground. The purpose of this study was to investigate how the arm swing facilitates increasing peak angular momenta of both arms during multiple PeDh. Upper body movements in single to six-revolutions clockwise (as seen from above) PeDhs were analysed to determine arm’s angular momentum induced by the individual joint torque, gravitational force and motion-dependent terms. The horizontal abduction and adduction torques of the right and left shoulder joints, respectively, and clockwise torsional torque of the upper torso induced the clockwise angular momentum (CWAM) of the arms in the horizontal plane, about the vertically upward axis. The motion-dependent term induced the CWAMs after joint torques and contributed to the maximum total CWAM of both arms substantially. The CWAMs induced by the motion-dependent term increased with joint torques up to the triple PeDh in the right arm but independently from the left shoulder joint torque up to the sextuple PeDh in the left arm. Using a whip-like motion of the arm, increasing the arm joint torques would not be required necessarily when performing, i.e., more than quaruple PeDhs.

Band Pull-Apart Exercise: Effects of Movement Direction and Hand Position on Shoulder Muscle Activity.

Background/PurposeThe Elastic band pull-apart exercise is commonly used in rehabilitation. It involves pulling an elastic resistance band with both hands in horizontal abduction or diagonal arm movements. The extent of muscle activation during this exercise is unknown. The purpose of this study was to measure the electromyographic (EMG) activity of shoulder-girdle muscles during the pull-apart exercise using resistance bands and to determine the effects of arm position and movement direction on shoulder-girdle muscle activity.Materials/MethodsSurface EMG activity was measured on the infraspinatus, upper trapezius, middle trapezius, lower trapezius and posterior deltoid of the dominant shoulder. After measurement of maximal voluntary contraction (MVC) for each muscle, subjects performed the band pull-apart exercise in three hand positions (palm up, neutral, palm down) and three movement directions (diagonal up, horizontal, diagonal down). Elastic band resistance was chosen to elicit moderate exertion (5/10 on the Borg CR10 scale). The order of the exercises was randomized and three repetitions of each exercise were performed. Mean peak EMG activity in each muscle across the repetitions was calculated and expressed as a percentage of MVC. Peak normalized EMG activity in each muscle was compared in two-way (hand position x direction) repeated-measures ANOVA.ResultsData were collected from 10 healthy subjects (all males, age 36±12 years). Peak muscle activity ranged from 15.3% to 72.6% of MVC across muscles and exercise conditions. There was a significant main effect of hand position for the infraspinatus and lower trapezius, where muscle activity was highest with the palm up hand position (p < 0.001), and for the upper trapezius and posterior deltoid, where muscle activity was highest with the palm down position (p-value range < 0.001-0.004). There was a significant main effect of movement direction, where the diagonal up direction demonstrated the highest muscle activity for the infraspinatus, upper trapezius, lower trapezius, and posterior deltoid (p-value range < 0.001-0.02).ConclusionAltering hand position and movement direction during performance of an elastic band pull-apart exercise can affect magnitudes of shoulder-girdle muscle activity. Clinicians may alter a patient’s hand position and movement direction while performing the band pull-apart exercise in order to increase muscle activity in target muscles or diminish muscle activity in other muscles.Level of Evidence2b

Effects of arm and leg positions on lumbar multifidus muscle activity while on hands and knees or while standing

BackgroundThe lumbar multifidus (LMF) muscle, which is involved in the mechanical stability of the lumbar spine, reportedly undergoes atrophy in patients with low back pain. Preventing or mitigating low back pain requires strengthening the LMF muscle; however, methods for triggering selective and significant contraction of this muscle have not been fully studied. This study aims to clarify how, in the hands-and-knees or standing position, the position of the arm and leg on one side affects the activity of the lumbar erector spinae (LES) and LMF muscles.MethodsWe recruited nine adult men with no prior history of low back pain. Measurements were taken in four different postures under varying conditions (that is, one arm and one leg were lifted in either the hands-and-knees or standing position,) as follows: (1) shoulder joint flexion and hip joint extension in the hands-and-knees position; (2) 90° shoulder joint abduction and hip joint abduction in the hands-and-knees position; (3) shoulder joint flexion and hip joint extension in the standing position; and (4) 90° shoulder joint abduction and hip joint abduction in the standing position. The 90° shoulder joint abduction involved simultaneous horizontal abduction, while the hip joint abduction involved simultaneous extension. Muscle activity of the LES and LMF in each posture was measured using a surface electromyograph.ResultsMuscle activity of the LMF was significantly higher in 90° shoulder joint abduction and hip joint abduction than in shoulder joint flexion and hip joint extension in both the hands-and-knees and standing positions. The LES muscle showed no significant differences in activity between each posture.ConclusionsThe results suggest that unilateral 90° shoulder joint abduction and contralateral hip joint abduction in the hands-and-knees and standing positions may produce selective and significant contraction of the LMF muscle.

Long Arm Serial Casting Results in Decreased Spasticity and Improved Function for Woman with Multiple Sclerosis

<h3>Research Objectives</h3> To evaluate if LASC would decrease upper extremity spasticity and improve function in a 52 y.o woman with Relapsing Remitting MS. <h3>Design</h3> This study was a single-patient case study. <h3>Setting</h3> All sessions were completed at the Andrew C. Carlos Multiple Sclerosis Institute at Shepherd Center. <h3>Participants</h3> The participant was a 52 y.o female diagnosed with relapsing remitting MS in 2009. She presented with nonfunctional use, the inability to use her extremity effectively to complete activities of daily living (ADLs)/instrumental activities of daily living (IADLs), of her right upper extremity (RUE) and an intact left upper extremity (LUE). <h3>Interventions</h3> All interventions of the right upper extremity (RUE) were performed by a licensed occupational therapist. Serial casting involves a series of casts which are applied and removed with the goal of increasing range of motion (ROM) with each cast. The final LASC is then turned into a bivalve cast by cutting it in half to allow for daily application and removal. Intervention totaled 9 weeks or 9 treatment sessions after 8 sessions of conservative measures were found to be ineffective: Week 1/session 9 consultation/education for LASC, weeks 2 and 3/sessions 10-12 LASC and bivalve fabrication, and weeks 4-9/sessions 13-17 continued use of bivalve in combination with neuromuscular re-education, strengthening and functional training. <h3>Main Outcome Measures</h3> Modified Tardieu, Modified Ashworth Scale (MAS), pain, strength, skin, ROM, and function were assessed. <h3>Results</h3> Modified Tardieu and MAS improved. Increased strength occurred in shoulder flexion, elbow flexion/extension and supination. Active shoulder range of motion, not possible pre-intervention due to pain, was pain free post-intervention for abduction, horizontal abduction, horizontal adduction and external rotation. Furthermore, increased functional use including feeding, dressing, and bathing was achieved. <h3>Conclusions</h3> Long arm serial casting may be an effective intervention for individuals with MS who have debilitating upper extremity spasticity. To the writer's knowledge, there is no published research regarding LASC for individuals with MS. Additional research is warranted. <h3>Author(s) Disclosures</h3> No known disclosures at this time.

Data-Driven Classification of Human Movements in Virtual Reality-Based Serious Games: Preclinical Rehabilitation Study in Citizen Science.

BackgroundSustained engagement is essential for the success of telerehabilitation programs. However, patients’ lack of motivation and adherence could undermine these goals. To overcome this challenge, physical exercises have often been gamified. Building on the advantages of serious games, we propose a citizen science–based approach in which patients perform scientific tasks by using interactive interfaces and help advance scientific causes of their choice. This approach capitalizes on human intellect and benevolence while promoting learning. To further enhance engagement, we propose performing citizen science activities in immersive media, such as virtual reality (VR).ObjectiveThis study aims to present a novel methodology to facilitate the remote identification and classification of human movements for the automatic assessment of motor performance in telerehabilitation. The data-driven approach is presented in the context of a citizen science software dedicated to bimanual training in VR. Specifically, users interact with the interface and make contributions to an environmental citizen science project while moving both arms in concert.MethodsIn all, 9 healthy individuals interacted with the citizen science software by using a commercial VR gaming device. The software included a calibration phase to evaluate the users’ range of motion along the 3 anatomical planes of motion and to adapt the sensitivity of the software’s response to their movements. During calibration, the time series of the users’ movements were recorded by the sensors embedded in the device. We performed principal component analysis to identify salient features of movements and then applied a bagged trees ensemble classifier to classify the movements.ResultsThe classification achieved high performance, reaching 99.9% accuracy. Among the movements, elbow flexion was the most accurately classified movement (99.2%), and horizontal shoulder abduction to the right side of the body was the most misclassified movement (98.8%).ConclusionsCoordinated bimanual movements in VR can be classified with high accuracy. Our findings lay the foundation for the development of motion analysis algorithms in VR-mediated telerehabilitation.

Mapping of human arm impedance characteristics in spatial movements

In this paper, impedance characteristics are determined for discrete movement. It explores the changes in impedance characteristics of human arm during a complete task. This study considered 3D spatial movement for horizontal adduction and abduction. The human arm is considered as mass-spring-damper system and the modelling is done accordingly. The model is solved for 3 degree of freedom (3DoF) spatial movement usually used for daily work. Inertia, stiffness and damping factor are the impedance characteristics considered in the model. Using position measuring device, the position data of elbow and wrist were obtained with respect to pre-defined references. The data were used to calculate velocity, acceleration and force. Then, the impedance characteristics were determined by solving the equation of motion of the mass-spring-damper system corresponding to different position of the wrist on the trajectory. These impedance factors were then plotted to map the characteristics. The mappings were done for both total durations to complete task and for segments of the task. The impedance characteristics were observed to vary according to the movement of the arm. Significant changes of damping factor and stiffness were found to occur at the beginning and end of the arm movement.

Range of Motion Predicts Performance in National-Level New Zealand Male Powerlifters.

Spence, AJ, Helms, ER, Sousa, CA, and McGuigan, MR. Range of motion predicts performance in National-level New Zealand male powerlifters. J Strength Cond Res 37(1): 123-128, 2023-Previous research established that male powerlifters have less range of motion (ROM) in several movements about the shoulder and hip compared with sedentary male subjects. It is unclear if these differences in ROM are related to strength, training type, and years of training experience or if individuals with less ROM have a better propensity to gain strength. The purpose of this study was to compare strength and ROM in male powerlifters and recreationally strength-trained male subjects and to determine if ROM would be an effective predictor of strength in these groups. Twelve powerlifters and 12 recreationally strength-trained control subjects completed 1 repetition maximum (1RM) squat and bench press testing. In a subsequent session, active ROM was measured, and velocity data were collected during submaximal squat repetitions. There was no significant difference (p > 0.05) between the groups for age, height, body mass, training experience, and training frequency. Powerlifters had significantly greater (p ≤ 0.05) training duration and absolute squat and bench press 1RM. Powerlifters had significantly less shoulder extension and horizontal abduction, and hip flexion, extension, and adduction than recreationally strength-trained men. Significant negative relationships were found between 2-lift Wilks score (body mass relative strength) and shoulder extension and horizontal abduction, as well as hip flexion and extension. In powerlifters, significant negative relationships were found between competition Wilks score, shoulder extension, and hip flexion. Because these relationships correspond to the bottom position of the squat and bench press, it may be best to ensure that shoulder extension and hip flexion remain sufficient to achieve competition depth.

Evaluation of the Effectiveness of Outdoor Fitness Equipment Intervention in Achieving Fitness Goals for Seniors.

Despite the popularity of outdoor fitness equipment (OFE) in public spaces with the aim of increasing physical activity (PA), very little research has been conducted to investigate the effectiveness of the equipment’s use, especially for achieving the target fitness goal. This study designed an OFE training protocol incorporating four modalities of PA: endurance (air walker and ski machine), resistance (rowing machine and bonny rider), flexibility (arm stretch and shoulder wheel), and balance exercise (waist twister). Seniors who completed the protocol demonstrated that for endurance training, participants were at moderate intensity from heart rate and perceived exertion, while significantly improving cardiac endurance in the two min step test. For resistance/flexibility/balance interventions, only the handgrip strength test, the 30 s chair stand test, the right-hand shoulder flexion test, the right-hand shoulder horizontal abduction test, the single-leg stance test, and the eyes open foam surface clinical test for sensory balance were significant, using a repeated measure analysis of variance. The results demonstrated that older adults aim for the OFE target for specific fitness goals can reach moderate intensity and improve their cardiorespiratory endurance. Yet, results for resistance/flexibility/balance are inconclusive. More studies are needed to carefully assess the effectiveness of using OFE.