Joint Mobility Research Articles

Comparative effects of gong's mobilization and mobilization with movement in patients with adhesive capsulitis: a randomized clinical trial.

Adhesive Capsulitis results in a progressive contraction of the Glenohumeral joint capsule limiting active and passive range of motion, leading to functional disabilities. Joint mobilization plays a key role in the physical therapy treatment of Adhesive Capsulitis. A relatively new technique, Gong's Mobilization, has been introduced for the treatment of Adhesive Capsulitis. It is focused on the correction of positional faults through controlled dynamic motion of the Glenohumeral joint. The mainstay of this clinical trial is a comprehensive comparative evaluation of MWM with Gong's Mobilization as it remains insufficiently explored. The objective of this clinical trial was to compare the effects of Gong's Mobilization and Mobilization with Movement on pain, range of motion and functional disability in patients with Adhesive Capsulitis. In this triple blinded randomized clinical trial, sixty patients of Adhesive Capsulitis were enrolled within group A (Gong's Mobilization) and group B (Mobilization with Movement). The treatment protocol covered 12 treatment sessions for 4 weeks. Numeric Pain Rating Scale (NPRS), Goniometer, and Urdu version of Shoulder Pain and Disability Index (U-SPADI) were used to assess the pain, range of motion and functional status respectively. These outcome measures were assessed at baseline, after 6 treatment sessions (2 weeks) and conclusively after 12 treatment sessions (4 weeks). For data analysis, within the group differences were measured by Repeated Measure ANOVA and across the group differences were measured by independent t test. A significant difference within the mean values of baseline, week 2 and week 4 NPRS, ROM, and SPADI score was observed in both study groups (p < 0.001). Results of independent t test used to calculate across the group differences indicated that Gong's Mobilization was more effective in reducing disability (SPADI)(p < 0.001) and improving ROM(p < 0.001), meanwhile both groups were equally effective in reducing NPRS scores(p = 0.78). Moreover, a medium to large effect size was also observed for all the outcomes, pain(d = 0.5), ROM (d = 0.5-2.7), SPADI(d = 0.5). It was concluded that Gong's Mobilization is more effective than Movement with Mobilization. Following four weeks of treatment, it pronounced statistically significant and clinically relevant results in improving pain, ROM and functional status of patients with Adhesive Capsulitis. Trial Registration Trial was registered in IRCT (Trial registration number: IRCT20190717044238N4 Trial Registration Date: 01-03-2023).

Conservative treatment of knee arthrofibrosis according to acellular cytokine-based model : Aretrospective pilot evaluation.

Arthrofibrosis (AF) is arelatively frequent complication after knee surgery, leading to painful limitation of joint mobility. Currently, intense stretching is performed in many patients, without improvements in mobility. Anovel concept, established on acellular, cytokine-based model, advocates to consider the warning function of pain and to terminate forced joint mobilization to disrupt the cycle of arthrofibrosis. Based on these findings, our clinic developed acomprehensive antifibrotic treatment protocol. The aim of this analysis was to evaluate the patients treated so far. Patients treated at the Clinic Donaustadt, an academic teaching hospital of the Medical University of Vienna, Austria, according to the clinic's AF protocol, were evaluated by reviewing their records. Patellar mobility, range of motion, tightness, overheat, pain, general mobility, assistive devices, working status and the necessity of additional surgery were assessed at baseline, after 2months and after 12months (follow-up). Four patients were treated according to the AF protocol. After two months, patellar mobility and range of motion clearly increased in three out of four patients. At the follow-up examination, patella mobility further increased, extension was complete, flexion at least 120°, and symptoms such as tightness, overheating, nocturnal pain and pain after activity had disappeared in three out of four patients. None of the patients had analgesics or walking aids and three out of four patients had returned to work. Out of the four patients, three expressed high satisfaction with the AF protocol and reported no limitations in daily life, including recreational activities. Based on this pilot evaluation, the comprehensive conservative AF program seems to have high potential. Therefore, larger future studies should be conducted to validate this concept.

Fibrillin-1 G234D mutation in the hybrid1 domain causes tight skin associated with dysregulated elastogenesis and increased collagen cross-linking in mice

Fibrillin-1, an extracellular matrix (ECM) protein encoded by the FBN1 gene, serves as a microfibril scaffold crucial for elastic fiber formation and homeostasis in pliable tissue such as the skin. Aside from causing Marfan syndrome, some mutations in FBN1 result in scleroderma, marked by hardened and thicker skin which limits joint mobility. Here, we describe a tight skin phenotype in the Fbn1G234D/G234D mice carrying a corresponding variant of FBN1 in the hybrid1 domain that was identified in a patient with familial aortic dissection. Unlike scleroderma, skin thickness and collagen fiber abundance do not change in the Fbn1G234D/G234D mutant skin. Instead, increased collagen cross-links were observed. In addition, short elastic fibers were sparsely located underneath the panniculus muscle layer, and an abundance of thin, aberrant elastic fibers was increased within the subcutaneous fascia, which may have tightened skin attachment to the underlying skeletal muscle. Structurally, Fbn1G234D/G234D microfibrils have a disrupted shoulder region that shares similarities with hybrid1 deletion mutant microfibrils. We then demonstrate the consequence of fibrillin-1 G234D mutation on dermal fibroblast functions. Mutant primary fibroblasts produce fewer elastic fibers, exhibit slower migration and increased cell stiffness. Moreover, secretome from mutant fibroblasts are marked by enhanced secretion of ECM, ECM-modifying enzymes, proteoglycans and cytokines, which are pro-tissue repair/fibrogenic. The transcriptome of mutant fibroblasts displays an increased expression of myogenic developmental and immune-related genes. Our study proposes that imbalanced ECM homeostasis due to a fibrillin-1 G234Dmutation impacts fibroblast properties with potential ramifications on skin function.

Influencing factors of the outcome of patients with haemophilia after knee replacement–a retrospective study

ObjectiveTo explore the factors that affect the efficacy of knee replacement surgery in hemophiliacs.MethodsA retrospective analysis was conducted on 87 patients with hemophilia (PWH) (117knees) who underwent knee arthroplasty in our hospital from January 2012 to December 2020 (mean follow-up 70.8 ± 22 months). General information, hemophilia information, surgical information, follow-up information and psychological assessment information were collected. The knee joint efficacy was evaluated using the Hospital for Special Surgery (HSS) knee score, the American Knee Society’s Clinical (KSC) and Functional (KSF) scores, flexion contracture degree (FC), range of motion (ROM), and wound healing. The excellent and poor groups were divided based on these factors. Logistic regression analysis was used to analyze factors that may affect the knee joint efficacy of patients.ResultsSeventy-four cases of excellent knee joints and 43 cases of poor knee joints were included. Single factor analysis: The pre-ROM, SF-12MCS, HSS, KSF, and KSC of the excellent group were significantly higher than those of the poor group (P < 0.05); the Hamilton Depression Scale (HAMD), Preoperative Visual Analogue Scale(Pre-VAS), pre-FC degree of the excellent group were significantly lower than those of the poor group (P < 0.05). The proportion of patients undergoing Simultaneous bilateral knee replacement, severe hemophilia, and quadricepsplasty during surgery in the excellent group was significantly lower than that in the poor group (P < 0.05). Logistic regression: Pre-ROM and Simultaneous bilateral knee replacement are independent risk factors affecting knee joint efficacy. Pre-ROM is positively correlated with knee joint efficacy, while Simultaneous bilateral knee replacement is negatively correlated.ConclusionIn PWH, the efficacy of knee replacement surgery is related to preoperative ROM and Simultaneous bilateral knee replacement. Better preoperative knee joint mobility is associated with improved outcomes, whereas Simultaneous bilateral knee replacement negatively impacts surgical efficacy.

Analysis of kinematic and kinetic changes in scoliosis following spinal manipulation

Scoliosis is a prevalent condition among adolescents, and the spinal manipulation is one of the conservative treatment methods for scoliosis patients. Impairment in movement function stands out as a typical characteristic in cases of scoliosis. This study utilized a single-arm clinical trial design involving 35 patients aged 18 to 20 with idiopathic scoliosis (IS) and Cobb angles ranging from 10° to 30°. The treatment protocol consisted of spinal manipulation sessions three times a week, each lasting 40 min, administered over a span of six weeks. Pre- and post-intervention assessments focused on the Cobb angle and lower limb kinematics and kinetics during functional movements such as level walking, stair ascent, and descent. Patients with IS showed improvements in the Cobb angle, as well as changes in lower limb kinematics and kinetics during functional activities, such as walking and stair navigation, following six weeks of spinal manipulation intervention. The study further demonstrated that spinal manipulation reduced lower limb’s sagittal joint mobility, increased stability in individuals with IS. Patients with IS exhibited significant changes in lower limb kinematics and kinetic following spinal manipulation, which may serve as a potential mechanism underlying the alteration of the Cobb angle. Future studies, particularly RCTs, are needed to further validate the effectiveness of spinal manipulation in treating IS.

The effects of contralateral limb cross-education training on post-surgical rehabilitation outcomes in patients with anterior cruciate ligament reconstruction: a randomized controlled trial

ObjectiveThis study examines whether cross-education training of the healthy limb promotes cross-transfer through central nervous system stimulation, enhancing the function, kinematic parameters, dynamic balance, and plantar pressure of the affected knee joint in patients recovering from postoperative anterior cruciate ligament reconstruction (ACLR).MethodsForty anterior cruciate ligament reconstruction (ACLR) patients, 5–6 weeks postoperatively, were included and randomly assigned to either an experimental group (n = 20) or a control group (n = 20). The experimental group participated in six weeks of cross-education (CE) training in addition to conventional rehabilitation, while the control group received only conventional rehabilitation. Assessment outcomes included knee function (Lysholm score, joint mobility, and surface electromyographic characteristics of the rectus femoris muscle), kinematic parameters (stride length, stride speed, and stride width), dynamic balance (gait line length, single-support line length, and medial-lateral displacements), and plantar pressure (forefoot, midfoot, and hindfoot pressures). The effect of CE training on postoperative ACLR rehabilitation was comprehensively assessed by comparing the pre- and post-intervention changes within each group and the differences between the groups.ResultsBefore the intervention, no statistically significant differences were observed between the two groups across all measured parameters (P > 0.05). Following the intervention, significant improvements in knee function, kinematic parameters, balance function, and plantar pressure were observed in both groups, with the experimental group showing significantly more significant improvements (P < 0.05). The Lysholm score, range of motion (ROM), and surface electromyographic activity of the rectus femoris muscle were significantly higher in the experimental group compared to the control group (P < 0.01). Among kinematic parameters, the experimental group demonstrated a significant increase in stride length and reduced stride width, whereas differences in stride speed were not statistically significant (P > 0.05). Regarding balance function, the experimental group exhibited significantly longer gait and single-support line lengths, significantly reducing medial-lateral displacement (P < 0.05). Analysis of plantar pressure revealed significant improvements in forefoot and hindfoot pressures in the experimental group, with a particularly notable increase in hindfoot pressure (P < 0.05). However, changes in midfoot pressure were not statistically significant (P > 0.05).ConclusionCE training markedly enhanced knee function, kinematic metrics, dynamic stability, and plantar pressure in postoperative ACLR patients providing initial evidence for the prospective utilization of CE theory in rehabilitation. Nonetheless, the fundamental mechanics of its effects remain ambiguous, and variables such as individual differences and neuromuscular adaptation processes may affect training results. Future studies should examine its long-term impacts and uncover potential neuromuscular pathways to establish a solid scientific basis for improving postoperative rehabilitation procedures.

Current status and factors influencing kinesiophobia in patients with meniscus injury: a cross-sectional study

ObjectivesThis study aimed to examine the relationships between kinesiophobia and injury severity, balance ability, knee pain intensity, self-efficacy, and functional status in patients with meniscus injuries and to identify key predictors of kinesiophobia.DesignA single-center, prospective cross-sectional study.MethodsA cross-sectional study involving 123 patients diagnosed with meniscus injuries at Fujian Provincial Hospital was conducted. The knee range of motion test was used to determine limitations in knee joint mobility, whereas magnetic resonance imaging (MRI) was used to assess the severity of meniscus damage. Several validated scales were administered: the Tampa Scale of Kinesiophobia (TSK-17) to measure kinesiophobia, the visual analog scale (VAS) to assess pain intensity, the general self-efficacy scale (GSES) to evaluate self-efficacy, and the Lysholm knee score (LKS) to assess knee functional status. Additionally, balance ability was assessed using the Huber 360 Neuromuscular Control Training and Assessment System (DJO, USA). Spearman’s correlation analysis was applied to explore factors associated with kinesiophobia, whereas simple linear regression analysis was used to identify its predictors.ResultsAmong the 123 participants included in the study, 60.16% were identified as experiencing kinesiophobia. Among these participants, 69.10% had grade III meniscus injuries, and 33.3% exhibited limited joint movement. The key clinical characteristics were as follows: the median VAS score was 4 (IQR 2–6), the GSES score was 22 (IQR 20–29), and the LKS score was 45 (IQR 38–55). Kinesiophobia was significantly correlated with injury severity, limited joint movement, pain intensity, self-efficacy, and other functional parameters (P < 0.05). However, no significant correlation was detected between kinesiophobia and limits of stability. Simple linear regression analysis (R²=0.917) revealed several significant predictors of kinesiophobia, including injury severity (β = 2.08), pain intensity (β = 0.882), Romberg quotient (RQ) (β = 3.239), and limited joint movement (β = 0.868). In contrast, self-efficacy (β =-0.455) was negatively associated with kinesiophobia. Furthermore, Grade III injuries and RQ were found to be associated with markedly higher levels of kinesiophobia.ConclusionKinesiophobia is strongly associated with knee injury severity, limited joint movement, RQ, pain intensity, and self-efficacy, which are key predictors. Clinical interventions should focus on these factors to enhance rehabilitation outcomes.

Study on the impact of Kinesiophobia after Total Knee Arthroplasty on the rehabilitation of patients during hospitalization: A pilot study.

The purpose of this study is to investigate the influence of kinesiophobia following Total Knee Arthroplasty (TKA) on the rehabilitation outcomes of patients during hospitalization, includes examining the trends in resting pain levels at various time points post-surgery, the trends in active flexion of the knee at various time points post-surgery, and the effects of kinesiophobia on the timing of first postoperative ambulation, the duration of postoperative hospital stay, and the results of the two-minute walk test on the day of discharge. Postoperative kinesiophobia in patients was identified using the Tampa Scale for Kinesiophobia (TSK), with 33 patients scoring >37 points and 35 patients scoring ≤37 points. Resting Pain levels were assessed using the Numerical Rating Scale (NRS) at various time points, including upon return to the ward (T1), the first (T2), second (T3), third (T4), fifth(T5) postoperative days, and the day of discharge (T6). Furthermore, active flexion of the knee joint was measured at different time points for both groups, including the first (T1*), third (T2*), and fifth (T3*) postoperative days, and the day of discharge (T4*). The first time out of bed activities of the two groups of patients were compared, along with the results of the 2-Minute Walk Test (2-MWT) on the day of discharge. The pain scores of patients in the kinesiophobia group at different time points after surgery were worse than those in the non-kinesiophobia group (P<0.05). There were significant time effects (F = 131.297;P<0.01), inter-group effects (F = 15.016; P<0.01), and interaction effects (F = 5.116; P<0.05). The active knee flexion of patients in the kinesiophobia group at different time points after surgery were worse than those in the non-kinesiophobia group (P<0.05).There were significant time effects (F = 628.258;P<0.01), inter-group effects (F = 16.546; P<0.01), and interaction effects (F = 66.025; P<0.01). Patients in the kinesiophobia group delayed getting out of bed for the first time (35.39±9.82vs28.77±9.81hours; P<0.01), had shorter activity time (4.12±1.36vs5.80±1.96minutes; P<0.01) and distance (19.12±3.36vs30.17±5.64meters;P<0.01), and experienced higher pain scores during activity (6.30±1.10vs5.48±0.95scoresP<0.05). Additionally, patients in the kinesiophobia group walked shorter distances in the 2-MWT test on the day of discharge compared to the non-kinesiophobia group (37.60±5.76vs50.68±5.37meters;P<0.05), and had longer hospitalization time (8.11±1.31vs50.68±5.37days; P<0.05). In short, compared to patients without kinesiophobia, the presence of kinesiophobia after TKA surgery significantly impacts the efficacy of early rehabilitation exercises during hospitalization. This impact is observed in pain perception, knee joint mobility, the 2-minute walk test, etc. Early identification of patients with kinesiophobia after TKA and timely intervention are necessary and beneficial.

P-22 INSIDIOUS, RARE, AND MIMICKING BONE DISEASE: PROGRESSIVE PSEUDORHEUMATOID DYSPLASIA

Abstract Introduction Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal recessive skeletal dysplasia that primarily affects joint cartilage, leading to progressive stiffness and enlargement without inflammation. Symptoms typically manifest between ages 3 and 6. Here we report a case of PPD with a prolonged undiagnosed period, despite early symptom onset. Clinical Case A 43-year-old female office manager presented with significant joint mobility limitations and walking difficulties. Her medical history revealed that she first sought medical attention at the age of two due to leg deformities, where genu varum was detected and initially treated as rickets with vitamin D supplementation. At ages 7 and 9, the patient underwent limb lengthening and corrective surgeries for bilateral lower extremity deformities. By age 12, worsening gait required assistive devices. At age 33, a right femoral head fracture necessitated prosthesis implantation, followed by a similar procedure on the left hip at age 36. In the last five years, mobility limitations and pain in the left shoulder and knee have increased. Her medical history was otherwise unremarkable, though her parents were noted to be consanguineous. Physical exam revealed 147 cm height and significant scoliosis. Flexion contractures were observed in the proximal and distal interphalangeal joints of both hands, along with significant mobility limitations in the metacarpophalangeal joints, wrists, and elbows, especially in extension. Additionally, there was limited extension in both knees, more severe on the left, and contractures in the left ankle. No signs of arthritis were present. Laboratory results showed a 25-OH Vitamin D level of 17.53 µg/L, leading to replacement therapy initiation. Acute phase reactants were normal. Radiographic imaging (Figure 1) showed osteoporotic bones, platyspondyly, scoliosis, vertebral endplate irregularities, narrowed disc spaces, and peripheral osteophytes in the vertebral column. Furthermore, epiphyseal enlargement, uniform joint space narrowing, irregular joint surfaces, and periarticular osteopenia were observed bilaterally in the shoulders, elbows, knees, ankles, radiocarpal, midcarpal, carpometacarpal, metacarpophalangeal, and interphalangeal joints. Despite these findings, bone mineral density (BMD) of the L1-L4 vertebrae measured 1.337 g/cm² (Z-score: 1.2) via dual-energy X-ray absorptiometry (DEXA). Based on the clinical, laboratory, and imaging findings, a diagnosis of PPD was established, and the patient was referred for physical therapy and rehabilitation. Conclusion This case illustrates a patient with PPD, marked by significant involvement of the hand joints, large joints, and spine, accompanied by short stature. Patients with PPD are frequently undiagnosed or misdiagnosed. The absence of inflammatory features is crucial in distinguishing PPD from juvenile idiopathic arthritis. The lack of extraskeletal involvement further characterizes this disease.Figure 1Figure 1a shows osteoporotic bones, platyspondyly, scoliosis, vertebral endplate irregularities, narrowed disc spaces, and peripheral osteophytes in the vertebral column. Figure 1b and 1c show epiphyseal enlargement, uniform joint space narrowing, irregular joint surfaces, and periarticular osteopenia in both knees and hands.

Meta-analysis of the efficacy of plate fixation and external fixator fixation in the treatment of AO-C type distal radius fractures

Meta-analysis of the clinical efficacy of plate and external fixator fixation in the treatment of AO-C type distal radius fractures. PubMed, Embase, Cochrane Medical Library, Web of Science, CNKI, Wanfang, VIP and SinoMed databases were searched for all literature on randomized controlled clinical trials of AO-C distal radius fractures. The search time limits were from each database. The database will be established until June 30, 2023. The included studies were extracted according to the Cochrane Handbook (Version 6.3, 2022) for information extraction and literature quality evaluation. RevMan 5.4 was used to evaluate the risk of Publication bias, test heterogeneity and Perform Meta-analysis. The outcome indicators were:imaging anatomy indicators (volar inclination angle, ulnar deviation angle, radial height), wrist joint mobility (flexion, extension, rotation, ulnar deviation), complication rate, and comparison of surgical treatments (operative blood loss, operation time, hospitalization time, fracture healing time) and wrist joint function scores and related scales. (1) A total of 28 studies were included, with a total of 2 192 patients, including 1 096 cases in the plate internal fixation group and 1 096 cases in the external fixation group.(2) Meta analysis results showed:the surgical treatment situation of the external fixation group:surgical blood loss MD=-37.93, 95%CI(-48.54, -27.31), P<0.000 01;operation time MD=-31.58, 95%CI(-48.96, -14.20), P<0.000 4;hospitalization time MD=-4.58, 95%CI(-5.44, -3.71), P<0.000 01;the fracture healing time MD=-0.88, 95%CI(-1.35, -0.41), P<0.000 2, which were significantly better than that of the plate internal fixation group(P<0.05).(3) The two groups:palmar inclination angle MD=-0.17, 95%CI(-0.95, 0.61), P=0.68;ulnar declination MD=0.22, 95%CI(-0.73, 1.17), P=0.65, radial height MD=-0.24, 95%CI(-1.15, 0.67), P=0.60;flexion and extension MD=-5.63, 95%CI(-11.85, 0.58), P=0.08;rotation MD=-5.80, 95%CI(-12.77, 1.17), P=0.10, radioulnar deviation MD=-2.86, 95%CI(-10.87, 5.15), P=0.48;complication rate RR=0.96, 95%CI(0.63, 1.46), P=0.83;Gartland-Werley clinical wrist score MD=0.13, 95%CI(-0.80, 1.06), P=0.78;excellent and good rate of Gartland-Werley wrist clinical score RR=0.93, 95%CI(0.87, 1.01), P=0.08;excellent and good rate of Cooney wrist score RR=0.99, 95%CI(0.62, 1.59), P=0.98;wrist DASH score MD=-4.67, 95%CI(-14.96, 5.62), P=0.37;the differences were not significant (P>0.05). Compared with internal fixation with plate, external fixation can significantly reduce the amount of surgical bleeding, shorten the operation time, hospitalization time and fracture healing time, and its imaging anatomical indicators, wrist mobility, and complications can be significantly reduced in treating AO-C distal radius fractures. Rates and wrist function scores were equivalent.

The effect of dynamic neuromuscular stabilization technique combined with Kinesio Taping on neuromuscular function and pain self-efficacy in individuals with chronic nonspecific low back pain: A randomized trial.

This study investigates the therapeutic efficacy of dynamic neuromuscular stabilization (DNS) technology paired with Kinesio Taping in patients with persistent nonspecific low back pain, as well as the effect on neuromuscular function and pain self-efficacy. A randomized controlled clinical study was conducted to collect clinical data on DNS combined with KT for the treatment of chronic nonspecific low back pain from November 2023 to April 2024. The inclusion criteria were patients with chronic nonspecific lower back pain, aged between 18 and 30 years old, and without serious underlying medical conditions, such as cardiac disease, hypertension, and diabetes. The control group received Kinesio Tape therapy, and the experimental group received a combination of Kinesio Tape therapy and DNS technology. The treatment lasted for 6 weeks, 3 times a week. Patients were examined before and after treatment using the Visual Analog Rating Scale, Oswestry Dysfunction Score, and Pain Self-Efficacy Questionnaire. Multifidus and transversus abdominis muscle strength was tested using surface electromyography signals, and the patient's joint mobility, maximal isometric muscle strength, and muscular endurance were tested using the Davy Spine Rehabilitation System. Internal lumbar and abdominal pressures were assessed using stabilizer pressure biofeedback. A total of 32 subjects (17 males and 15 females) were enrolled, of which 16 were in the experimental group and 16 in the control group. After the treatment, the patients in both groups showed significant improvements in the visual analogue scale, Oswestry disability index, Chinese version of Pain Self-Efficacy Questionnaire (PSEQ), joint mobility, maximum isometric strength, muscle endurance, abdominal pressure, transverse abdominal muscle and multifidus muscle scales compared with the pretreatment results. (Chinese version of Pain Self-Efficacy Questionnaire) scales were significantly improved compared with the pretreatment; joint mobility, maximal isometric muscle strength, muscular endurance, intra-abdominal pressure, transversus abdominis and multifidus AEMG (average electromyography) were more significantly improved, and the differences were statistically significant (P < .05). The experimental group showed more significant improvement than the control group (P < .05). DNS technology paired with Kinesio Taping can considerably improve neuromuscular function and enhance pain self-efficacy in chronic nonspecific low back pain patients, reducing discomfort and improving dysfunction.

Design of a Novel Bio-Inspired Three Degrees of Freedom (3DOF) Spherical Robotic Manipulator and Its Application in Human–Robot Interactions

Studying the interactions between biological organisms and their environment provides engineers with valuable insights for developing complex mechanical systems and fostering the creation of novel technological innovations. In this study, we introduce a novel bio-inspired three degrees of freedom (DOF) spherical robotic manipulator (SRM), designed to emulate the biomechanical properties observed in nature. The design utilizes the transformation of spherical Complex Spatial Kinematic Pairs (CSKPs) to synthesize bio-inspired robotic manipulators. Additionally, the use of screw theory and the Levenberg–Marquardt algorithm for kinematic parameter computation supports further advancements in human–robot interactions and simplifies control processes. The platform directly transmits motion from the motors to replicate the ball-and-socket mobility of biological joints, minimizing mechanical losses, and optimizing energy efficiency for superior spatial mobility. The proposed 3DOF SRM provides advantages including an expanded workspace, enhanced dexterity, and a lightweight, compact design. Experimental validation, conducted through SolidWorks, MATLAB, Python, and Arduino, demonstrates the versatility and broad application potential of the novel bio-inspired 3DOF SRM, positioning it as a robust solution for a wide range of robotic applications.

Neuromuscular Response to High-Velocity, Low-Amplitude Spinal Manipulation—An Overview

The clinical use of spinal manipulation to treat musculoskeletal conditions has nearly tripled in the United States since 1980, and it is currently recommended by most global clinical guidelines as a conservative treatment for musculoskeletal pain, despite a lack of knowledge concerning its mechanisms of action. This overview highlights evidence of direct neuromuscular responses to high-velocity, low-amplitude spinal manipulation (HVLA-SM) as delivered by chiropractic, osteopathic, and physical therapy clinicians, with an intent to foster greater interprofessional dialogue and collaborative research to better address current gaps in mechanistic knowledge of the neuromuscular response to HVLA-SM. Three databases (PubMed, CINAHL Ultimate (EBSCO), EMBASE (Elsevier)) were searched from 2000 to December 2024 with specific search terms related to thrust HVLA-SM and the neuromuscular response. To focus strictly on neuromuscular responses related to HVLA-SM, this literature overview excluded articles using non-HVLA-SM manual therapy techniques (i.e., massage, non-thrust joint mobilization, and/or combined HVLA-SM with other forms of treatment such as exercise or non-thrust joint mobilization) and studies in which patient-centered outcomes (i.e., pain scores) were the primary outcomes of the HVLA-SM interventions. Pediatric studies, animal studies, and studies in languages other than English were also excluded. One-hundred and thirty six articles were identified and included in this overview. Neuromuscular findings related to HVLA-SM in the areas of electromyography (EMG), muscle thickness, muscle strength, reflexes, electroencephalogram (EEG), and evoked potential were often mixed; however, evidence is beginning to accumulate either in favor of or opposed to particular neuromuscular responses to HVLA-SM as larger and more scientifically rigorous studies are being performed. Recurrent limitations of many HVLA-SM-related studies are small sample sizes, leading to a lack of generalizability, and the non-standardization of HVLA-SM delivery, which has prevented researchers from arriving at definitive conclusions regarding neuromuscular responses to HVLA-SM. Discussions of future neuromuscular research needs related to HVLA-SM are included for clinicians and researchers inside and outside of the field of manual therapy, to advance this field.

Current Rehabilitation Practices of Physiotherapists in Intensive Care Units in the UAE: A National Survey

Abstract* Background Intensive care units (ICUs) are essential for patient recovery, but prolonged stays often result in complications like reduced mobility and muscle weakness. Aims This study examines current ICU rehabilitation practices in the United Arab Emirates (UAE) through a web-based cross-sectional survey involving 80 physiotherapists from both public and private sectors. Methods The questionnaire, validated by experts with a Cronbach’s alpha of 0.84, explored various rehabilitation strategies. Most participants held bachelor’s degrees and had 2-5 years of experience. Results Over 96% required physician referrals for ICU physiotherapy sessions, and 75% noted that hospitals provided development programs to enhance skills. Respiratory therapy, joint mobilization, and electrical stimulation were the most commonly used interventions, while massage, continuous passive motion machines, and taping were less frequently applied. Among neonatal ICU patients, 85.7% of physiotherapists regularly performed passive range of motion exercises, and 69% consistently involved parents in the treatment plan. The results indicate a variety of practices among ICU physiotherapists in the UAE, with no clear adherence to standardized protocols. This lack of consistency may negatively affect patient care quality. Conclusion The study underscores the importance of implementing standardized rehabilitation protocols and enhancing patient education to improve outcomes in ICU settings.

Interprosthetic Joint Motion in Bipolar Partial Hip Arthroplasty After One-Year Follow-up

Background: Partial hip arthroplasty is the treatment of choice for displaced femoral fractures in the elderly. The bipolar prosthesis was developed to lessen the acetabular erosion encountered with the unipolar prosthesis. However, bipolar prostheses lose their motion between the inner or outer articulation (interprosthetic joint motion) after three months, rendering them biomechanically like unipolar prostheses. Literature has shown that the interprosthetic joint is mobile radiographically up to one year after the surgery. Objective: This study evaluated and quantified the interprosthetic joint motion (motion between the outer and inner articulations) of bipolar prostheses one year after partial hip arthroplasty for proximal femoral fractures in a tertiary hospital. We also investigated the effect of adding the hip measurement in adduction. Methodology: This retrospective cohort study measured the motion of the outer and inner articulations of locally available bipolar prostheses and the interprosthetic joint movement using one-year postoperative radiographs of patients who underwent bipolar partial hip arthroplasty for femoral fractures in a tertiary hospital from 2019 to 2021. Immediate and one-year post-operative AP radiographs in neutral, maximum hip abduction, and maximum hip adduction were measured and compared. The interprosthetic joint motion was calculated from the difference in pelvic-head angles and pelvic-shaft angles. Results: Twelve patients were included in the study. The interprosthetic joint in bipolar prosthesis was still mobile even after one year in 75% of patients (p = 0.0001). Adding hip adduction measurements resulted in a significantly higher mean of 74.69 degrees as compared to only 34.67 degrees (p = 0.0006). Conclusion: Most patients retained a mobile interprosthetic joint at one year post-op. Hip adduction radiographs gave additional information on the total interprosthetic joint motion. At both time points studied, the inner head articulation contributed more to the interprosthetic joint motion. All five local implant systems used showed good motion after one year.

Comparative study of arthroscopic autologous cancellous bone grafting and medial malleolar osteotomy combined with autologous periosteal iliac bone grafting for the treatment of osteochondral lesions of the talus

BackgroundSurgical management methods for Hepple IV-V osteochondral lesions of the talus (OLT) are diverse. This study aimed to compare the clinical efficacy of arthroscopic autologous cancellous bone grafting and medial malleolar osteotomy combined with autologous periosteal iliac bone grafting in the treatment of medial Hepple IV-V OLT.MethodsA retrospective analysis of clinical data from patients who underwent surgical treatment for Hepple IV-V OLT (2020–2023) was conducted. A total of 37 patients were included, with 17 receiving arthroscopic autologous cancellous bone grafting (Group A) and 20 receiving medial malleolar osteotomy combined with autologous periosteal iliac bone grafting (Group B). Compared the surgical time of the two groups; the visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and ankle joint mobility were used preoperatively, and at 3 months and 1 year postoperatively to assess clinical efficacy; the magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 ankle scores were evaluated at early postoperatively and 1 year postoperatively to assess cartilage repair.ResultsThe surgical time for Group A was significantly shorter than Group B (P < 0.05). At 3 months and 1 year postoperatively, both groups showed a significant improvements in VAS scores, AOFAS scores, and ankle joint mobility compared to preoperative levels (P < 0.05). At 3 months postoperatively, Group A had significantly higher AOFAS scores and ankle joint mobility than Group B (P < 0.05), while there was no statistically significant difference in VAS scores between the two groups (P > 0.05). At 1 year postoperatively, no significant differences in any of the assessed parameters were found between the two groups (P > 0.05). The MOCART 2.0 ankle scores at 1 year postoperatively were significantly higher than early postoperatively for both groups (P < 0.05), with no significant differences between the two groups (P > 0.05).ConclusionArthroscopic autologous cancellous bone grafting showed superior early functional recovery at the 3-month follow-up compared to medial malleolar osteotomy combined with autologous periosteal iliac bone grafting, with shorter surgical time and avoiding osteotomy. Both surgical methods were able to relieve patients’ pain, restore function, and improve cartilage repair.Level of evidenceIII, retrospective comparative study.

Pneumatically Actuated Rehabilitation Equipment for the Sagittal and Frontal Plane Movements of the Neck Joint

The timely reintegration into their daily routine of patients suffering from work-related musculoskeletal disorders is a priority in medical rehabilitation. This can be accomplished by means of certain procedures and adequate medical rehabilitation equipment. Starting from these considerations this paper proposes an original constructive solution of a rehabilitation device designed for the passive mobilization of the neck joint in the sagittal and frontal plane. The constructive solution that is put forward uses a pneumatic muscle as the actuation element, ensuring the adaptability of the equipment to the particular pain tolerance of each patient. The construction and dimensioning calculations of the equipment are presented, followed by the determination of the torsional rigidity and compliance permitted by the system. Based on the results the paper concludes with recommendations for the optimum deployment of the rehabilitation equipment.

A compliant metastructure design with reconfigurability up to six degrees of freedom

Compliant mechanisms with reconfigurable degrees of freedom are gaining attention in the development of kinesthetic haptic devices, robotic systems, and mechanical metamaterials. However, available devices exhibit limited programmability and form-customizability, restricting their versatility. To address this gap, we propose a metastructure concept featuring reconfigurable motional freedom and tunable stiffness, adaptable to various form factors and applications. These devices incorporate passive flexures and actively stiffness-changing rods to modify kinematic freedom. A rational design pipeline informs the flexures’ topological arrangements, geometric parameters, and control signals based on targeted mobilities, enabling the creation of unitary joints with up to six degrees of freedom. Our demonstrative application examples include a wrist device that has an effective stiffness of 0.370 Nm/deg (unlocked state, 5% displacement) to 2.278 Nm/deg (locked state, 1% displacement) to enable dynamic joint mobility control, a haptic thimble device (2.27-52.815 Nmm−1 at 1% displacement) that mimics the sensation of touching physical materials ranging from soft gel to metal surfaces, and a wearable device composed of multiple joints tailored for the arm and hand to augment haptic experiences or facilitate muscle training. We believe the presented method can help democratize compliant metastructures development and expand their versatility for broader contexts.

An assessment of burden associated with problem joints in children and adults with moderate or severe haemophilia A: analysis of the CHESS-Paediatrics and CHESS II cross-sectional studies

BackgroundClinical research has offered many definitions and fragmented perspectives of joint morbidity in haemophilia. As joint damage, pain and mobility impairment can be present without clinical record of persistent bleeding, a person-centric joint morbidity characterisation remained a priority for the haemophilia community, giving rise to the ‘problem joint’ concept.As diagnosing and managing joint morbidity is critical, the aim of this study was to analyse the holistic burden of problem joints in people with moderate or severe haemophilia A (HA).Data from the ‘Cost of Haemophilia in Europe: a Socioeconomic Survey’ (CHESS) cross-sectional studies were used. CHESS-Paediatrics included male paediatric patients (≤ 17 years) with congenital moderate or severe haemophilia, while CHESS II included adult males (≥ 18 years) of any severity. Both studies sought to collect detailed information on the clinical, economic and humanistic burden of haemophilia.Demographics, clinical outcomes, treatment regimen, adherence, physical activity, healthcare resource use and number of problem joints were evaluated and described by HA severity and number of problem joints (none, 1, ≥ 2).ResultsIn total, 1171 people with non-inhibitor moderate or severe HA from CHESS-Paediatrics (n = 703) and CHESS II (n = 468) were included in this analysis.Presence of problem joints was more prevalent among CHESS II participants (44%) than in CHESS-Paediatrics (14%). Around two-thirds (67%) of CHESS-Paediatrics and 39% of CHESS II participants received prophylactic factor VIII replacement therapy. The presence of chronic pain was greater in severe HA with ‘ ≥ 2’ problem joints in both cohorts. Clinical symptoms and bleed-related hospitalizations were more prevalent in the presence of problem joints regardless of HA severity in both cohorts.ConclusionsThis analysis of the CHESS population studies has expanded on previous work by examining the relevance of the problem joint measure of haemophilic morbidity and its associated burden. Adverse clinical symptoms and increased bleed-related hospitalizations were observed in the presence of problem joints in both children/adolescents and adults across HA severities. Use of person-centric characterizations of joint morbidity may improve analysis of long-term outcomes and lead to improvements in future haemophilia care.

Effects of an Easily Implemented Physical Exercise Program on the Ventricular Ejection Fraction of Women with Breast Cancer Undergoing Chemotherapy.

Breast cancer (BC) is the most common cancer among women, with an incidence of 85-94 per 100,000 people annually in Europe. Despite the increasing incidence of BC, advancements in early detection and novel therapeutic approaches have improved survival rates. However, adjuvant treatments are associated with side effects, including a reduction in the left ventricular ejection fraction (LVEF), which can result in severe cardiac damage and progress to heart failure. Methods: Thirty-eight women undergoing BC treatment were included in the study. Eighteen women (47.2 ± 5.4 years old) participated in a supervised physical exercise (PE) program for 60 min/day, twice weekly, at moderate to high intensity (5 min joint mobilization, 20 min predominantly aerobic training, 30 min of strength training, and 5 min cooldown). The remaining 20 women (51.5 ± 9.5 years) were advised to remain active during treatments, but without specific supervision. In the PE group, a slight reduction in the LVEF was observed after chemotherapy (63.73 ± 3.34% vs. 61.00 ± 6.54%, p = 0.131). In contrast, the control group showed a statistically significant reduction in the LVEF (64.93 ± 4.00% vs. 60.57 ± 4.86%, p = 0.008). Although the results suggest a potential protective effect of regular physical exercise during BC treatment, the study was inconclusive regarding its role in preventing cardiac dysfunction. Further research with a larger sample size and longer follow-up is warranted.