Limb Range Of Motion Research Articles

Assessment of Clinical and Functional Outcomes of the Proximal Humerus Internal Locking Compression Plate in Different Neer’s Types of Proximal Humeral Fracture: A Prospective Observational Study

Abstract Background: Over the years, various fixation methods have been developed for managing unstable proximal humerus fractures (PHFs), including conservative and surgical approaches like tension band wiring, suture fixation, intramedullary nailing, hemiarthroplasty, fixed-angled locking plates, and proximal humerus internal locking system (PHILOS) plating. Each method claims superior effectiveness as a fixation device. Aims: The study evaluated the functional outcome of the PHILOS in different parts of the PHF using the Constant–Murley score (CMS), which measures post-operative pain, daily activity ability, limb range of motion (ROM), and strength. Materials and Methods: A prospective observational study of 50 participants aged 16 years and above at Rajasthan Hospitals in Ahmedabad, conducted from July 2020 to July 2022, examined the use of the PHILOS for PHF treatment. Results: The results revealed that two-part fractures had a significantly higher mean CMS (72.4 ± 10.8) compared with three-part (60.8 ± 8.1) and four-part (59.3 ± 5.3) fractures. The P value of 0.0003 indicated that the difference in CMS score between two and three or four parts of PHF after fixing them with PHILOS was statistically significant. Conclusion: The study concludes that using a locking plate for PHFs consistently leads to positive clinical and functional outcomes, including improved CMS, daily living activities, and ROM.

Mind the gap: treating post-surgical scar tissue in post-mastectomy patients – a randomized clinical trial

IntroductionPost-mastectomy physiotherapy typically includes massage, exercise, and stretching, but often fails to treat post-surgical scar tissue, a significant contributor to long-term disability. This study aimed to compare conventional therapy with myofascial manual therapy for treating post-surgical scar tissue in post-mastectomy patients and to determine the effectiveness of these treatments.MethodsThe study was an experimental controlled study with pre- and post-testing of two parallel groups. Forty-eight women experiencing shoulder and/or upper torso impairment following mastectomy were randomly allocated to either a control group (<i>n</i> = 21) or a myofascial therapy group (<i>n</i> = 27). Conventional physiotherapy involving exercise and massage or myofascial therapy was used. Pre- and post-therapy measurements included muscle length, pain intensity, range of motion (ROM), and scar mobility.ResultsMyofascial therapy was superior to conventional physiotherapy in reducing the percentage of patients with below-normal muscle lengths at several sites. Significant decreases from baseline were observed in the treatment group for the pars clavicularis, descending trapezius, pars sternocostalis, latissimus dorsi, and levator scapulae muscles. Myofascial therapy also improved mobility in the scar area, with increases of 3 mm relative to the xiphoid process and 4 mm relative to the coracoid.ConclusionsOur study indicates that myofascial interventions improve upper limb ROM and muscle elasticity in the upper limb girdle of post-mastectomy patients. These findings provide empirical evidence supporting the benefits of myofascial intervention over conventional physiotherapy in the treatment of post-surgical scar tissue in this patient group.

Effects of a Virtual Reality Cycling Platform on Lower Limb Rehabilitation in Patients With Ataxia and Hemiparesis: Pilot Randomized Controlled Trial.

New interventions based on motor learning principles and neural plasticity have been tested among patients with ataxia and hemiparesis. Therapies of pedaling exercises have also shown their potential to induce improvements in muscle activity, strength, and balance. Virtual reality (VR) has been demonstrated as an effective tool for improving the adherence to physical therapy, but it is still undetermined if it promotes greater improvements than conventional therapy. Our objective was to compare the effect on lower limb range of motion (ROM) when using VR technology for cycling exercise versus not using VR technology. A randomized controlled trial with 20 patients with ataxia and hemiparesis was carried out. The participants were divided into 2 groups: the experimental group (n=10, 50%) performed pedaling exercises using the VR system and the control group (n=10, 50%) performed pedaling exercises without using VR. Measurements of the active and passive ROM of the hip and knee joint were taken before and after a cycling intervention, which consisted of 3 sessions of the same duration but with progressively increasing speeds (4, 5, and 6 km/h). Repeated measures ANOVAs were conducted to compare the preintervention (Ti) and postintervention (Te) assessments within each group. Additionally, the improvement effect of using the VR system was analyzed by comparing the variation coefficient (Δ = 1 - [Te / Ti]) between the preintervention and postintervention assessments for each group. Group comparisons were made using independent 1-tailed t tests. Significant improvements were shown in active left hip flexion (P=.03) over time, but there was no group-time interaction effect (P=.67). Passive left hip flexion (P=.93) did not show significant improvements, and similar results were observed for active and passive right hip flexion (P=.39 and P=.83, respectively). Neither assessments of knee flexion (active left: P=.06; passive left: P=.76; active right: P=.34; passive right: P=.06) nor knee extension showed significant changes (active left: P=.66; passive left: P=.92; active right: P=.12; passive right: P=.38). However, passive right knee extension (P=.04) showed a significant improvement over time. Overall, although active and passive ROM of the knee and hip joints showed a general improvement, no statistically significant differences were found between the groups. In this study, participants who underwent the cycling intervention using the VR system showed similar improvement in lower limb ROM to the participants who underwent conventional training. Ultimately, the VR system can be used to engage participants in physical activity.

Effect of Combined Intervention of Yoga and Physiotherapy as Compared to Only Physiotherapy on Lower Limb Muscle Strength, Balance and Range of Motion among Elders with Compromised Stair Climbing in Puducherry - A Parallel Arm Non-Randomized Control Trial.

The activity of daily living (ADL) related to stair climbing is one of the most compromised ADLs among the elders. It requires good muscle strength, balance, and range of motion (ROM) in the lower limb. We aimed to investigate the effects of Yoga complemented with physiotherapy (Intervention group) compared to only physiotherapy (control group) on lower limb muscle strength, balance, and ROMs among elders with ADL limitation in stair climbing. Sixty-five community-dwelling elders with compromised stair climbing were enrolled. Elders who consented to yoga along with physiotherapy were enrolled in the intervention arm. Data were collected and analyzed following 12 weeks of intervention. Endline assessment showed that the intervention group had more improvement in all test scores and ROMs as compared to the control group, although there were improvements in both arms as compared to baseline. Considering the beneficial effects of both interventions, yoga can be added to gain additional advantages.Trial Registration:Indian Clinical Trials Registry number CTRI/2021/08/035825.

Detecting fatigue of sport horses with biomechanical gait features using inertial sensors.

Detection of fatigue helps prevent injuries and optimize the performance of horses. Previous studies tried to determine fatigue using physiological parameters. However, measuring the physiological parameters, e.g., plasma lactate, is invasive and can be affected by different factors. In addition, the measurement cannot be done automatically and requires a veterinarian for sample collection. This study investigated the possibility of detecting fatigue non-invasively using a minimum number of body-mounted inertial sensors. Using the inertial sensors, sixty sport horses were measured during walk and trot before and after high and low-intensity exercises. Then, biomechanical features were extracted from the output signals. A number of features were assigned as important fatigue indicators using neighborhood component analysis. Based on the fatigue indicators, machine learning models were developed for classifying strides to non-fatigue and fatigue. As an outcome, this study confirmed that biomechanical features can indicate fatigue in horses, such as stance duration, swing duration, and limb range of motion. The fatigue classification model resulted in high accuracy during both walk and trot. In conclusion, fatigue can be detected during exercise by using the output of body-mounted inertial sensors.

Multidisciplinary rehabilitation intervention on mobility and hemodynamics of joint contracture animal model

BackgroundJoint contracture causes a decrease in range of motion (ROM), which severely affects activities of daily living of patients. We have investigated the effectiveness of a multidisciplinary rehabilitation on joint contracture by rat model.MethodsWe used 60 Wistar rats in this study. The rats were divided into five groups as follows: group 1 was the normal control group; except the group 1, we created left hind limb knee joint contracture using Nagai method for other four groups. The joint contracture modeling group 2 was the model control group for monitoring the spontaneous recovery, and other three groups were given different rehabilitation treatments; for example, group 3 was treadmill running group; group 4 was medication group; group 5 was treadmill running plus medication group. The left hind limbs knee joint ROM and the femoral blood flow indicators (FBFI) including PS, ED, RI, and PI were measured right before and after the 4 weeks of rehabilitation.ResultAfter 4 weeks of rehabilitation treatments, the measured values of ROM and FBFI are compared with the corresponding values of group 2. Firstly, we did not see clear difference in the values of ROM and FBFI for group 2 before and after 4 weeks spontaneous recovery. The improvement of left lower limb ROM for group 4 and group 5 as compared to the group 2 was statistically significant (p < 0.05), whereas a less recovery for group 3 was observed. However as compared to the group 1, we did not observe full recovery in ROM of group 4 and group 5 after 4 weeks of rehabilitation. The PS and ED level for rehabilitation treatment groups was significantly higher than those modeling ones (Tables 2, 3, Figs. 4, 5), while the RI and PI values show the contrary trends (Tables 4, 5, Figs. 6, 7).ConclusionOur results indicate that multidisciplinary rehabilitation treatments had a curative effect on both contracture of joints and the abnormal femoral circulations.

Abstract P4-07-43: Effect of acupuncture and exercise therapy in rehabilitation of physical disfunctions in breast cancer survivors: randomized clinical trial

Abstract Introduction: The treatment of breast cancer can trigger physical dysfunctions and psychological difficulties such as pain, depression, limitation of upper limb function and shoulder range of motion (ROM) deficits. Exercise therapy is a treatment well established in the literature for these disorders and another form of treatment is acupuncture. However, most studies using acupuncture only assess pain. Objective: To compare three distinct rehabilitation treatments (exercise therapy, acupuncture and Stiper®) in women undergoing breast cancer surgery, assessing pain, depression, upper limb function and range of motion parameters (ROM). Methods: Seventy-nine women with pain above 3 on the visual analogue pain scale (VAS) and with more than 90 days of surgery were included. They were divided into three groups that received weekly treatment for 10 weeks: group I (G1) treated with standard, pre-defined exercise therapy, based on stretching of the cervical muscles, shoulder girdle and shoulder ROM exercises with a duration of 30 minutes, group II (G2) treated with 30 minutes of acupuncture using predefined points and group III (G3) treated with the same acupuncture points as group II, however, using the Stiper ® (silicon oxide micronized quartz pellet) in place of needles. Results: Sixty-seven patients completed the treatment, being 26 from G1, 23 from G2 and 18 from G3. There was an improvement of pain over time in all groups (first session compared with the fifth (p &amp;lt; 0.001) and with the tenth (p &amp;lt; 0.001), but not between groups. There was a statistically significant difference in depressive symptoms using the Beck questionnaire over time in the three groups (between the first and tenth sessions (p = 0.001), between the first and fifth sessions (p = 0.052), but not between groups. Regarding the DASH questionnaire for shoulder function, there were significant differences overtime at all evaluated moments (p&amp;lt; 0.001), but not between groups. There was a statistically significant difference in ROM over time in the three groups, but not between groups. Conclusion: The rehabilitation of physical dysfunctions in women who survived breast cancer through exercise therapy, acupuncture and Stiper® in pain, depression, upper limb function and ROM, proved to be effective, without statistically difference between the groups, which in leads to the conclusion that acupuncture don’t showed the superiority of results when compared with exercise therapy, thus being an effective approach in the rehabilitation of these women. Citation Format: Patricia Santolia, Gil Facina, Cinira Haddad, Afonso Nazário, Samantha K. Lopes de Almeida Rizzi, Simone Elias. Effect of acupuncture and exercise therapy in rehabilitation of physical disfunctions in breast cancer survivors: randomized clinical trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-43.

Upper limb training using visual feedback for children with cerebral palsy

Purpose: This study aimed to investigate that if upper limb visual feedback training added to the usual therapy was effective on upper limb functions in children with cerebral palsy. Methods: Thirty-eight children with cerebral palsy (4-18 years) participated in the study. The participants were randomly assigned into two groups. Study group (n=19, mean age 8.50±3.40, 53% female) received visual feedback training plus usual therapy twice a week for 8 weeks, 16 sessions in total, while control group (n=19, mean age 10.60±3.80, 42% female) received only usual therapy. The participants’ Gross Motor Function Classification System levels were between I-III and spasticity levels were between ‘0’ to ‘1+’ according to Modified Ashworth Scale. Upper limb range of motion (ROM), grip and pinch strength, hand skills (Minnesota Manual Dexterity Test (MMDT)), and functional abilities (Childhood Health Assessment Questionnaire (CHAQ)) were assessed before and after treatment. Results: The change amount in shoulder flexion (p=0.004) and abduction (p=0.01), supination (p=0.019) and wrist flexion (p=0.004) and extension (p=0.00) ROM values; bilateral MMDT scores (p=0.003) were statistically significantly improved in study group compared to control group. Conclusion: Adding visual feedback training to the usual therapy program of children with cerebral palsy was found to be effective in some outcome measurements such as upper limb ROM and hand skills. In the long-term rehabilitation process, this new training method may be an alternative additive option for children, families, and physiotherapists.

Correlations between Crawl Kinematics and Speed with Morphologic, Functional, and Anaerobic Parameters in Competitive Swimmers.

The purpose of this study was to examine the relationship between a unique complex of predictors and 100 m front crawl race kinematics and swimming speed. In 28 male competitive swimmers (age: 19.6 ± 2.59 years), the following groups of predictors were assessed: (a) the morphologic, (b) the functional upper limb range of motion, and (c) the anaerobic indices of arm-cranking and a series of countermovement jumps. The Pearson product-moment correlation coefficient was calculated to distinguish the predictors and the swimming results. The main finding was that the indices of the power (arm-cranking) and the work (countermovement jump) generated in the anaerobic tests showed a significant and higher correlation with stroke length and stroke index than total body length, upper limb range of motion, or hand and forearm surface area. These results were obtained in accordance with the high swimming economy index relation to clear surface swimming speed. This study reveals that the strength generated by the limbs may represent a predictor of swimming kinematics in a 100 m front crawl performance.

A bio-inspired robotic climbing robot to understand kinematic and morphological determinants for an optimal climbing gait

Robotic systems for complex tasks, such as search and rescue or exploration, are limited for wheeled designs, thus the study of legged locomotion for robotic applications has become increasingly important. To successfully navigate in regions with rough terrain, a robot must not only be able to negotiate obstacles, but also climb steep inclines. Following the principles of biomimetics, we developed a modular bio-inspired climbing robot, named X4, which mimics the lizard’s bauplan including an actuated spine, shoulders, and feet which interlock with the surface via claws. We included the ability to modify gait and hardware parameters and simultaneously collect data with the robot’s sensors on climbed distance, slip occurrence and efficiency. We first explored the speed-stability trade-off and its interaction with limb swing phase dynamics, finding a sigmoidal pattern of limb movement resulted in the greatest distance travelled. By modifying foot orientation, we found two optima for both speed and stability, suggesting multiple stable configurations. We varied spine and limb range of motion, again showing two possible optimum configurations, and finally varied the centre of pro- and retraction on climbing performance, showing an advantage for protracted limbs during the stride. We then stacked optimal regions of performance and show that combining optimal dynamic patterns with either foot angles or ROM configurations have the greatest performance, but further optima stacking resulted in a decrease in performance, suggesting complex interactions between kinematic parameters. The search of optimal parameter configurations might not only be beneficial to improve robotic in-field operations but may also further the study of the locomotive evolution of climbing of animals, like lizards or insects.

Real-Time Limb Motion Tracking with a Single IMU Sensor for Physical Therapy Exercises.

Limb exercises are common in physical therapy to improve range of motion (RoM), strength, and flexibility of the arm/leg. To improve therapy outcomes and reduce cost, motion tracking systems have been used to monitor the user's movements when performing the exercises and provide guidance. Traditional motion tracking systems are based on either cameras or inertial measurement unit (IMU) sensors. Camera-based systems face problems caused by occlusion and lighting. Traditional IMU-based systems require at least two IMU sensors to track the motion of the entire limb, which is not convenient for use. In this paper, we propose a novel limb motion tracking system that uses a single 9-axis IMU sensor that is worn on the distal end joint of the limb (i.e., wrist for the arm or ankle for the leg). Limb motion tracking using a single IMU sensor is a challenging problem because 1) the noisy IMU data will cause drift problem when estimating position from the acceleration data, 2) the single IMU sensor measures the motion of only one joint but the limb motion consists of motion from multiple joints. To solve these problems, we propose a recurrent neural network (RNN) model to estimate the 3D positions of the distal end joint as well as the other joints of the limb (e.g., elbow or knee) from the noisy IMU data in real time. Our proposed approach achieves high accuracy with a median error of 7.2/7.1 cm for the wrist/elbow joint in leave-one-subject-out cross validation when tracking the arm motion, outperforming the state-of-the-art approach by more than 10%. In addition, the proposed model is lightweight, enabling real-time applications on mobile devices.Clinical relevance- This work has great potential to improve limb exercises monitoring and RoM measurement in home-based physical therapy. It is also cost effective and can be made available widely for immediate application.

A national survey in United Arab Emirates on practice of passive range of motion by physiotherapists in intensive care unit.

Patients admitted to intensive care units (ICU) are at an increased risk of developing immobility related complications. Physiotherapists are challenged to employ preventive and rehabilitative strategies to combat these effects. Passive limb range of motion (PROM) exercises- a part of early mobilization-aid in maintaining joint range of motion and functional muscle strength and forms a part of treatment for patients in ICU. However, there is a lack of evidence on practice of PROM exercises on patients admitted to ICU in the United Arab Emirates (UAE). This study aimed at exploring practices regarding the same in UAE. This survey, conducted from January 2021 to February 2021 in College of Physiotherapy, Sharjah University studied practice of physiotherapists in the intensive care units. Physiotherapists currently working in ICU completed an online questionnaire composed of forty-two questions about physiotherapy service provision, assessment and intervention in the intensive care units. 33 physiotherapists completed the survey. 66.6% of respondents routinely assessed PROM for all the patients in ICU referred for physiotherapy. 84.8% of them assessed all the joints. More than half of the respondents (57.8%) reported that they administered PROM regularly to all the patients. According to 63.6% respondents, maintaining joint range of motion was the main reason for performing PROM. Responses pertaining to sets and repetitions of PROM were variable ranging from 1-6 sets and from 3 to 30 repetitions. Personal experience, resources/financial consideration and research findings were found to have influence on the practice. PROM was found to be one of the frequently used mobilization techniques administered by physiotherapists in the intensive care units and was mostly performed after assessment. Maintaining joint range of motion was the main aim for performing PROM. Variability was found in the sets and repetitions of PROM administered. Various factors influenced the practice of PROM.

A pilot study evaluating the effect of early physical therapy on pain and disabilities after breast cancer surgery: Prospective randomized control trail

BackgroundMorbidity of the shoulders after breast cancer (BC) surgery is a common side effect that includes; persistent pain, function limitation, and decreased range of motion (ROM). This study examines the effect of early physical therapy (PT) and patient's education on these morbidities. MethodsA prospective, randomized clinical trial was conducted at a single medical center from October 2018 until April 2019. Women scheduled for breast cancer surgery were divided into intervention or control as standard care. The intervention included a PT treatment that included exercise instructions from the first postoperative day. Pain levels, upper limb function, ROM, and complications were measured. ResultsThe study includes 157 women (mean age, 52.2 ± 12.9). Early PT reduced pain levels at the first month (NPRS 1.5 ± 1.2) and six months (NPRS 0.5 ± 0.8), compared with control (NPRS 2.1 ± 1.4, 1.0 ± 1.2), p = 0.019 and p = 0.011, respectively. Subdivision of the sample into small and extensive surgeries revealed additional positive effect for the intervention six months postoperatively on functional disabilities, p = 0.004 and p = 0.032 respectively. No complications attributable to the intervention were recorded. ConclusionsEarly PT and patient education reduces pain levels, and may improve function disabilities, without causing postoperative complications, although a larger study is needed to achieve unequivocal results.

A reliability and validity study on upper limb range of motion measurement using mobile sensor compared with goniometers

Introduction: The use of tele-rehabilitation devices to aid physiotherapy has gained popularity in recent years. In particular, measuring limb range of motion with a wearable mobile sensor can facilitate rehabilitation therapies by providing more efficient progress monitoring and reducing clinicians’ workload. This study aimed to examine the test-retest reliability and validity of using a wearable mobile sensor to measure upper limb range of motion (ROM). Materials and methods: Participants were recruited by convenient sampling. They were instructed to perform four kinds of upper limb movements including shoulder flexion, abduction, external rotation and elbow flexion, from which the ROM was measured by Mobile sensors REBEE (XCLR8 Technologies) and a standard goniometer (Model 12-1000) in each movement. Each kind of movements and the two ROM measurements were performed twice for the evaluation of test-retest reliability using Intraclass Correlation Coefficients (ICC). Pearson's correlations were computed between the ROM measured by the mobile sensors and the goniometer in each movement to assess construct validities of the mobile sensors. The agreement (95% mean difference) between the two sets of measurement was illustrated by Bland-Altman plots. Results: Thirty-four asymptomatic young Asian adults (15 males) participated in this study (Mage ± SD, 24.2 ± 3.82 years). The ICC for the ROM measured by the sensors were between 0.94 and 0.99, p &lt;0.01 and for the goniometer measurements were between 0.95 and 0.98, p &lt;0.01 in the four movements, indicating excellent reliability in both measurement methods. The Pearson's correlation between the sensor’s and goniometric ROM measurements in four kinds of movements ranged from r =0.96 to 0.99, p &lt;0.01, indicating a very strong construct validity for using the mobile sensors to measure upper limb ROM. The mean difference between the two measurements ranged from 0.13 degrees to 7.6 degrees. Conclusions: The results demonstrated that measuring upper limb ROM using the mobile sensors by non-healthcare trained students were as reliable and valid as using the standard universal goniometers by healthcare trained students. The findings implied that the wearable mobile sensors possibly allow non-healthcare trained carers to measure clinically useful, reliable and valid upper limb ROM from patients, which may facilitate symptom monitoring and improve the efficiency of the rehabilitation process.

The Biomechanical Characteristics of the Strongman Yoke Walk.

The yoke walk is a popular strongman exercise where athletes carry a heavily loaded frame balanced across the back of their shoulders over a set distance as quickly as possible. The aim of this study was to use ecologically realistic training loads and carry distances to (1) establish the preliminary biomechanical characteristics of the yoke walk; (2) identify any biomechanical differences between male and female athletes performing the yoke walk; and (3) determine spatiotemporal and kinematic differences between stages (intervals) of the yoke walk. Kinematic and spatiotemporal measures of hip and knee joint angle, and mean velocity, stride length, stride rate and stance duration of each 5 m interval were taken whilst 19 strongman athletes performed three sets of a 20 m yoke walk at 85% of their pre-determined 20 m yoke walk one repetition maximum. The yoke walk was characterised by flexion of the hip and slight to neutral flexion of the knee at heel strike, slight to neutral extension of the hip and flexion of the knee at toe-off and moderate hip and knee range of motion (ROM), with high stride rate and stance duration, and short stride length. Between-interval comparisons revealed increased stride length, stride rate and lower limb ROM, and decreased stance duration at greater velocity. Although no main between-sex differences were observed, two-way interactions revealed female athletes exhibited greater knee extension at toe-off and reduced hip ROM during the initial (0–5 m) when compared with the final three intervals (5–20 m), and covered a greater distance before reaching maximal normalised stride length than males. The findings from this study may better inform strongman coaches, athletes and strength and conditioning coaches with the biomechanical knowledge to: provide athletes with recommendation on how to perform the yoke walk based on the technique used by experienced strongman athletes; better prescribe exercises to target training adaptations required for improved yoke walk performance; and better coach the yoke walk as a training tool for non-strongman athletes.

Using a biologically mimicking climbing robot to explore the performance landscape of climbing in lizards.

Locomotion is a key aspect associated with ecologically relevant tasks for many organisms, therefore, survival often depends on their ability to perform well at these tasks. Despite this significance, we have little idea how different performance tasks are weighted when increased performance in one task comes at the cost of decreased performance in another. Additionally, the ability for natural systems to become optimized to perform a specific task can be limited by structural, historic or functional constraints. Climbing lizards provide a good example of these constraints as climbing ability likely requires the optimization of tasks which may conflict with one another such as increasing speed, avoiding falls and reducing the cost of transport (COT). Understanding how modifications to the lizard bauplan can influence these tasks may allow us to understand the relative weighting of different performance objectives among species. Here, we reconstruct multiple performance landscapes of climbing locomotion using a 10 d.f. robot based upon the lizard bauplan, including an actuated spine, shoulders and feet, the latter which interlock with the surface via claws. This design allows us to independently vary speed, foot angles and range of motion (ROM), while simultaneously collecting data on climbed distance, stability and efficiency. We first demonstrate a trade-off between speed and stability, with high speeds resulting in decreased stability and low speeds an increased COT. By varying foot orientation of fore- and hindfeet independently, we found geckos converge on a narrow optimum of foot angles (fore 20°, hind 100°) for both speed and stability, but avoid a secondary wider optimum (fore -20°, hind -50°) highlighting a possible constraint. Modifying the spine and limb ROM revealed a gradient in performance. Evolutionary modifications in movement among extant species over time appear to follow this gradient towards areas which promote speed and efficiency.

Usability study of wearable inertial sensors for exergames (WISE) for movement assessment and exercise.

Accurate assessment of movement limitations and compliance monitoring of exercises to restore movement are necessary to tailor treatments for individuals with motor deficits. Although several commercial-grade technologies are available to clinicians for evaluating movement limitations, they require one-on-one time-consuming assessments with limited reproducibility across care settings. To address these limitations, a wearable inertial sensors for exergames (WISE) system has been designed with: (I) an animated virtual coach to deliver instruction and (II) a subject-model whose movements are animated by real-time sensor measurements from the WISE system worn by a subject. This paper examines the WISE system's accuracy and usability for the assessment of upper limb range of motion (ROM). Seventeen neurologically intact subjects were recruited to participate in a usability study of the WISE system. The subjects performed five shoulder and elbow exercises for each arm instructed by the animated virtual coach. The accuracy of ROM measurements obtained with the WISE system versus those obtained with the Kinect™ were compared using the root mean square error (RMSE) of the computed joint angles. The subjects additionally completed a system usability scale (SUS) to evaluate the usability of the virtual coach for tutoring ROM exercises. The absolute agreement between the WISE and Kinect devices was moderate to very good and it was limited because the Kinect sensor suffers from occlusion. The Bland-Altman limits of agreement for the exercises in the coronal and transverse planes were within the acceptable limits of ±10°. The SUS response data produced relatively high third and first quartile scores of 97.5 and 82.5, respectively, with the interquartile range of 15 and the minimum score of 65, suggesting that the subjects were interested in using the animated virtual coach for tutoring ROM exercises. An animated virtual coach-based WISE system for mHealth is presented, tested, and validated for guided upper limb ROM exercises. Future studies with patient populations will facilitate the use of these devices in clinical and telerehabilitation settings.

Dual-task walking reduces lower limb range of motion in individuals with Parkinson's disease and freezing of gait: But does it happen during what events through the gait cycle?

It is unclear how dual-task gait influences the lower limb range of motion (RoM) in people with Parkinson's disease (PD) and freezing of gait (FOG). The lower limb kinematics during dual-task gait might differ from regular gait, but during what events in the gait cycle? This is an observational within-subjects study. Thirty-two individuals with PD and FOG underwent a gait analysis. Single and dual-task gait was assessed by a 3D motion analysis system and the RoM data of the lower limb were extracted from hips, knees and ankles in the sagittal plane. Dual-task assignment was performed using word-color interference test. To compare both gait conditions, we used two different analyses: (1) common discrete analysis to provide lower limb RoM and (2) Statistical Parametric Mapping analysis (SPM) to provide lower limb joint kinematics. A correlation between lower limb RoM and spatiotemporal gait parameters was also performed for each gait condition. Common discrete analysis evidenced reductions in RoM of hips, knees and ankles during the dual task gait when compared to single gait. SPM analysis showed reductions in flexion-extension of hip, knees and ankles joints when dual task was compared to single task gait. These reductions were observed in specific gait events as toe off (for knees and ankles) and heel strike (for all joints). The reduction in lower limb RoM was positively correlated with the reduction in step length and gait speed. Lower limb joints kinematics were reduced during toe off and heel strike in dual task gait when compared to single gait. These findings might help physiotherapists to understand the influence of dual and single walking in lower limb RoM throughout the gait cycle in people with PD and FOG.

Kinematic effects of the circle with and without rider in walking horses.

BackgroundBiomechanical studies of walk, especially walk on the circle, are scarce, while circles or curved tracks are frequently used during equestrian activities. To study horse–rider–circle interactions on the circle, the first steps would be to investigate how the unridden, freely walking horse is influenced by circular movement, and then add a rider. The aim was to study horse vertical trunk movements, and sagittal cannon angles (protraction–retraction) during walk in straight-line and on the circle without rider, and on the circle with a rider using minimal influence.MethodsTen horses were ridden by five riders, summing to 14 trials. Each trial included straight walk unridden (on concrete), and walk on 10 m diameter circles (left and right on soft surface) first lunged (unridden) and then ridden with minimal rider influence. Inertial measurement units (100 Hz) were positioned on the withers, third sacral vertebra (S3) and laterally on metacarpal and metatarsal bones (using self-adhesive bandage). Selected data were split in steps (withers and S3 vertical translations) or strides (cannon protraction–retraction) at maximum hind limb protraction, and range of motion (ROM), minima and maxima, and their timing, were extracted. Data were analyzed using mixed models with inner/outer/straight nested within unridden/ridden as fixed effect, and controlling for stride duration. Differences between: inner vs outer steps/limbs; the same step/limb unridden vs ridden; and the same step/limb straight vs inner/outer unridden; were examined for statistical significance at p < 0.05.ResultsInner limbs had smaller cannon ROM than outer limbs, for example, forelimbs when ridden (inner vs outer 62° vs 63°) and hind limbs when unridden (53° vs 56°). Forelimb cannon ROM was the largest for straight (65°). Hind limb ROM for straight walk (55°) was in-between inner (52–53°) and outer hind limbs (56–57°). Vertical ROM of S3 was larger during the inner (unridden/ridden 0.050/0.052 m) vs the outer step (unridden/ridden 0.049/0.051 m). Inner (0.050 m) and outer steps (0.049 m) unridden had smaller S3 ROM compared to straight steps (unridden, 0.054 m). Compared to when unridden, withers ROM was smaller when ridden: inner hind steps unridden/ridden 0.020 vs 0.015 m and outer hind steps 0.020 vs 0.013 m. When ridden, withers ROM was larger during the inner hind step vs the outer.ConclusionThe outer hind limb had greater cannon pro-retraction ROM, compared to the inner limb. Larger croup ROM during the inner step appears to be coupled to increased retraction of the outer hind limb. Knowledge of magnitudes and timing of the horse’s movements on the circle in unridden and ridden walk may stimulate riders to educate eye and feel in analyzing the execution of circles, and stimulate further studies of the walk, for example, on interactions with rider influence, natural horse asymmetries, or lameness.

Effect of myofascial release on lower limb range of motion, sit and reach and horizontal jump distance in male university students

ObjectiveEvaluate the effects of Myofascial release (MR) on lower limb ROM, sit and reach and horizontal jump distance in male university students. Study designQuasi-experimental study. BackgroundMR is a technique that aims to stretch fascia to increase range of motion (ROM), relieve pressure points and improve performance. However, there is limited evidence of its actual effects on flexibility and physical performance. MethodsTwenty-one uninjured, male university students received MR (11 on the first session and the other 10 on the second session 24 h later), completed lower limb ROM assessments, the sit and reach and the horizontal jump tests in a randomized order. MR was performed before the tests with a myofascial stick in the anterior and posterior aspects of the right and left thigh and calf muscles. Each muscle group was massaged for 90 s, totaling 9 min of MR. The testing conditions with MR and without MR were compared using Student t-tests and the effect sizes (ES) were calculated. ResultsThere were no significant differences between the testing conditions on horizontal jump distance. However, the sit and reach distance (28 ± 9 vs. 32 ± 9 cm, p = 0.001; ES = 0.44), left hip extension (10 ± 2 vs. 8 ± 2°, p = 0.006; ES = 1.00) and left plantar flexion (36 ± 7 vs. 39 ± 7°, p = 0.044; ES = 0.43) were higher with MR. ConclusionsMR increased sit and reach distance, left hip extension and plantar flexion, but it did not affect horizontal jump distance in uninjured, male university students.