Manual Examination Techniques Research Articles

Assessment of robotic patient simulators for training in manual physical therapy examination techniques.

Robots that simulate patients suffering from joint resistance caused by biomechanical and neural impairments are used to aid the training of physical therapists in manual examination techniques. However, there are few methods for assessing such robots. This article proposes two types of assessment measures based on typical judgments of clinicians. One of the measures involves the evaluation of how well the simulator presents different severities of a specified disease. Experienced clinicians were requested to rate the simulated symptoms in terms of severity, and the consistency of their ratings was used as a performance measure. The other measure involves the evaluation of how well the simulator presents different types of symptoms. In this case, the clinicians were requested to classify the simulated resistances in terms of symptom type, and the average ratios of their answers were used as performance measures. For both types of assessment measures, a higher index implied higher agreement among the experienced clinicians that subjectively assessed the symptoms based on typical symptom features. We applied these two assessment methods to a patient knee robot and achieved positive appraisals. The assessment measures have potential for use in comparing several patient simulators for training physical therapists, rather than as absolute indices for developing a standard.

Simulated crepitus and its reality-based specification using wearable patient dummy

Physical therapists are trained in manual examination techniques to test the impaired motor functions of patients. In this study, we have introduced a wearable robotic dummy joint to simulate disordered joint resistances or behaviors to support physical therapists in learning such techniques. We developed a discontinuous joint friction model based on a stick-slip phenomenon to simulate knee joint resistances caused by crepitus, a typical symptom accompanied by osteoarthritis. Practicing therapists participated in a reality-based evaluation test and specified acceptable parameter sets to adjust the simulated crepitus for the exoskeletal patient robot. The simulated crepitus and wearable dummy joint are expected to support the training of physical therapists.

Manual examination in the diagnosis of cervicogenic headache: a systematic literature review

Study Design:Systematic literature review.Objective:To evaluate the diagnostic validity of manual examination techniques used to diagnose cervicogenic headache (CGH).Background:Cervicogenic headache is a specific type of headache that originates from the cervical spine and is typically chronic in nature. Diagnostic criteria for CGH have been established by the International Headache Society (IHS) and are cited extensively in the literature. Diagnosis of CGH through manual examination is a more recent practice. To our knowledge, no systematic review of manual diagnosis of CGH has been performed.Methods:Searches of electronic databases (CINAHL, Cochrane Library, Medline, PEDro, Scopus, and SPORTDiscus) were conducted for research studies from July 2003 to February 2014. The GRADE approach was used to determine the quality of each paper.Results:Twelve papers that fulfilled the inclusion and exclusion criteria were identified (12 observational studies). The level of evidence ranged from very low to low, and recommendations for use of specific manual techniques ranged from weak to strong.Conclusions:Despite low levels of evidence, manual examination of the cervical spine appears to aid the diagnostic process related to CGH and can be implemented by both experienced and inexperienced examiners.

2A1-B08 運動機能障害を模擬する装着型ダミージョイント: 脳卒中や膝関節疾患にみられる症状の模擬(福祉ロボティクス・メカトロニクス(1))

Physical therapists master manual examination techniques for testing impaired motor functions. We developed a wearable robotic dummy joint to simulate disordered joint resistances for supporting physical therapists to learn such techniques. We implemented 5 symptoms seen in knee joint diseases and strokes. The implemented models were validated based on the introspection of physical therapists, and some simulated resistances well matched with their experiences. The symptom models and dummy joint have been continuously undergoing improvement cycles.

Recovery of Muscle Strength after Microdiscectomy for Lumbar Disk Herniation: A Prospective Cohort Study with 1-Year Follow-Up

Introduction It has not been shown that surgery is better than nonsurgical management for treating limb paresis caused by lumbar disk herniation.1–3 However in clinical practice, limb paresis is a frequent additional symptom to pain4–6, and for the patients, a major concern remains: “What are the chances that my muscle strength will recover after surgery?”. The aim of this study is to give an answer to this question. We also wanted to investigate if persisting paresis is associated with worse outcome measured by changes in physical function, health related quality of life (HRQL), pain, and working capability. Materials and Methods In this prospective cohort study, we evaluated 403 consecutive patients operated with microdiscectomy for lumbar disk herniation. Of these patients, 91 (23%) had limb paresis and were included. All patients were operated at the Department of Neurosurgery, University Hospital of North Norway. Data were collected in a comprehensive clinical spine surgery registry for quality control and research between 1st of January 2004 and 30th of September 2006. Follow-up time from date of operation (baseline) was 1 year. The primary outcome measure was muscle strength of the affected limb. We used Daniels and Worthingham's techniques of manual muscle testing,7 which was graded to range from 0 to 5. Based on this scale we categorized the patients into three groups: severe paresis (grade 0–3), mild paresis (grade 4), and normal muscle strength (grade 5). Changes in motor function were classified as recovery (normal muscle strength) or nonrecovery (incompletely improved, unchanged or worse). Secondary outcome measures were HRQL (EQ-5D), Oswestry disability index (ODI), visual analogue scale (VAS) for leg pain and back pain, EQ-5D for general health state, and employment status. Results At 12 months 68 patients (75%) were fully recovered. Out of 23 patients (25%) who were not fully recovered, 9 (10%) were improved and 14 (15%) were unchanged. None got worse. Out of 29, 16 (55%) patients with severe paresis fully recovered whereas 52 (84%) out of 62 patients with mild paresis fully recovered ( p = 0.003). A severe paresis at baseline was the only independent risk factor we could find for not having full recovery of muscle function, odds ratio: 4.2 (95% CI, 1.6–11.4). Duration of the paresis was not associated with recovery. The mean (SD) duration of paresis was 30 (57) days. For the whole study population, there was a statistically significant improvement of pain, functional status, HRQL, and general health ( p < 0.001). Patients who recovered had a significant better outcome than patients with persistent paresis, except for leg pain. Amongst those who did not recover, three times as many received workers compensation at 12 months follow up (57% vs. 20%, p = 0.001). Conclusion In general, patients have a 75% chance of recovery from a limb paresis after surgical treatment for lumbar disk herniation. Patients with mild paresis can have a good chance to recover (84%). Patients with severe paresis have less good chance to recover (55%). Persisting paresis seems to have a significant negative impact on the physical function and HRQL. There was no association between the preoperative duration of the muscle weakness and recovery. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared Cribb GL, Jaffray DC, Cassar-Pullicino VN (2007) Observations on the natural history of massive lumbar disc herniation. Journal of Bone and Joint Surgery British Volume2007;89(6):782–784 Dubourg G, Rozenberg S, Fautrel B et al. A pilot study on the recovery from paresis after lumbar disc herniation. Spine 2007;27(13):1426–1431 Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 1983;8(2):131–140 Eysel P, Rompe JD, Hopf C. Prognostic criteria of discogenic paresis. European Spine Journal 1994;3(4):214–218 Mariconda M, Galasso O, Secondulfo V, Cozzolino A, Milano C. The functional relevance of neurological recovery after lumbar discectomy: a follow-up of more than 20 years. Journal of Bone and Joint Surgery British Volume 2008;90(5):622–628 Postacchini F, Giannicola G, Cinotti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation. Journal of Bone and Joint Surgery British Volume 2002;84(7):1040–1045 Hislop H, Montgomery J, H. Connolly B, Daniels L. Daniels and Worthingham's muscle testing: techniques of manual examination, 2007;Elsevier, 8th edn. 437

Recovery of Muscle Strength after Microdiscectomy for Lumbar Disk Herniation: A Prospective Cohort Study with 1-Year Follow-Up

IntroductionIt has not been shown that surgery is better than nonsurgical management for treating limb paresis caused by lumbar disk herniation.1–3 However in clinical practice, limb paresis is a frequent additional symptom to pain4–6, and for the patients, a major concern remains: “What are the chances that my muscle strength will recover after surgery?”. The aim of this study is to give an answer to this question. We also wanted to investigate if persisting paresis is associated with worse outcome measured by changes in physical function, health related quality of life (HRQL), pain, and working capability.Materials and MethodsIn this prospective cohort study, we evaluated 403 consecutive patients operated with microdiscectomy for lumbar disk herniation. Of these patients, 91 (23%) had limb paresis and were included. All patients were operated at the Department of Neurosurgery, University Hospital of North Norway. Data were collected in a comprehensive clinical spine surgery registry for quality control and research between 1st of January 2004 and 30th of September 2006. Follow-up time from date of operation (baseline) was 1 year.The primary outcome measure was muscle strength of the affected limb. We used Daniels and Worthingham's techniques of manual muscle testing,7 which was graded to range from 0 to 5. Based on this scale we categorized the patients into three groups: severe paresis (grade 0–3), mild paresis (grade 4), and normal muscle strength (grade 5). Changes in motor function were classified as recovery (normal muscle strength) or nonrecovery (incompletely improved, unchanged or worse).Secondary outcome measures were HRQL (EQ-5D), Oswestry disability index (ODI), visual analogue scale (VAS) for leg pain and back pain, EQ-5D for general health state, and employment status.ResultsAt 12 months 68 patients (75%) were fully recovered. Out of 23 patients (25%) who were not fully recovered, 9 (10%) were improved and 14 (15%) were unchanged. None got worse. Out of 29, 16 (55%) patients with severe paresis fully recovered whereas 52 (84%) out of 62 patients with mild paresis fully recovered (p = 0.003). A severe paresis at baseline was the only independent risk factor we could find for not having full recovery of muscle function, odds ratio: 4.2 (95% CI, 1.6–11.4). Duration of the paresis was not associated with recovery. The mean (SD) duration of paresis was 30 (57) days.For the whole study population, there was a statistically significant improvement of pain, functional status, HRQL, and general health (p < 0.001). Patients who recovered had a significant better outcome than patients with persistent paresis, except for leg pain. Amongst those who did not recover, three times as many received workers compensation at 12 months follow up (57% vs. 20%, p = 0.001).ConclusionIn general, patients have a 75% chance of recovery from a limb paresis after surgical treatment for lumbar disk herniation. Patients with mild paresis can have a good chance to recover (84%). Patients with severe paresis have less good chance to recover (55%). Persisting paresis seems to have a significant negative impact on the physical function and HRQL. There was no association between the preoperative duration of the muscle weakness and recovery.I confirm having declared any potential conflict of interest for all authors listed on this abstractNoDisclosure of InterestNone declaredCribb GL, Jaffray DC, Cassar-Pullicino VN (2007) Observations on the natural history of massive lumbar disc herniation. Journal of Bone and Joint Surgery British Volume2007;89(6):782–784Dubourg G, Rozenberg S, Fautrel B et al. A pilot study on the recovery from paresis after lumbar disc herniation. Spine 2007;27(13):1426–1431Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 1983;8(2):131–140Eysel P, Rompe JD, Hopf C. Prognostic criteria of discogenic paresis. European Spine Journal 1994;3(4):214–218Mariconda M, Galasso O, Secondulfo V, Cozzolino A, Milano C. The functional relevance of neurological recovery after lumbar discectomy: a follow-up of more than 20 years. Journal of Bone and Joint Surgery British Volume 2008;90(5):622–628Postacchini F, Giannicola G, Cinotti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation. Journal of Bone and Joint Surgery British Volume 2002;84(7):1040–1045Hislop H, Montgomery J, H. Connolly B, Daniels L. Daniels and Worthingham's muscle testing: techniques of manual examination, 2007;Elsevier, 8th edn. 437

The Occurrence of Strain Symptoms in the Lumbosacral Region and Pelvis During Pregnancy and After Childbirth

Objective The etiology and pathology of pain in the lumbosacral region and pelvis of pregnant women during and after pregnancy have not been fully determined. This study evaluated if lower back pain during pregnancy and after childbirth is connected with static alterations in the alignment of the pelvis, dysfunction of sacroiliac joints, and irritation of the pelvic ligaments and spine in the lumbosacral region. Methods This study was carried out on a group of 30 women in their eighth month of pregnancy and through 3 months after childbirth. Techniques of manual examination were used to determine the strain. Static alteration of the pelvis was evaluated in both the sitting and standing positions on the basis of alignment of the posterior superior iliac spines. Irritation of the iliolumbar ligaments, sacrotuberous, sacroiliac, and interspinous ligaments was evaluated by means of pressure palpation. Disorders of sacroiliac joint function were evaluated with the Patrick FABERE test, the standing Gillet test, and the standing and sitting flexion tests. Results The most frequently irritated ligaments in the lumbar region are interspinous (60%), iliolumbar (40%), and sacroiliac (36%). Conclusions In women, in their eighth month of pregnancy and after childbirth, disorders of static alterations in pelvis alignment and sacroiliac joint dysfunction may occur. The state of pregnancy may result in strain symptoms in the lumbosacral region and pelvis with variable pain intensifying in various static positions.

March 2003 Book Reviews

JOSPT offers invited reviews of current titles. The March 2003 column includes 6 reviews of the following books: Twenty Common Problems in Sports Medicine; Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination, Seventh Edition; Neuroscience: Fundamentals for Rehabilitation, Second Edition; Orthotics: A Comprehensive Clinical Approach; Tachdjian's Pediatric Orthopaedics, Third Edition, Volumes 1–3; and Therapeutic Modalities for Physical Therapists, Second Edition. J Orthop Sports Phys Ther 2003;33(3):156–158. doi: 10.2519/jospt.2003.33.3.156

Semi-automated analysis of NMDA-mediated toxicity in digitised colour images from rat hippocampus

The evaluation of neuronal cell survival after, for example, mechanical, hypoxic or drug-mediated injury requires the analysis of a high number of histological specimens. Since this is a time-consuming occupation, we have developed a semi-automated analysis routine for the determination of the distribution of live and dead cells. After digitalization of the histological preparations, 8-bit colour bitmaps were assessed using a compiled image-analysis programme of the software package Khoros. In the current study a detailed example of the application of this image-processing approach is described for the investigation of the cell survival after intraventricular application of N-methyl- d-aspartate (NMDA). The samples were prepared as fuchsin acid/toluidine blue stained hippocampal thin slices. The calculated areas of the live and dead cells were highly correlated with manual counts of live and dead cells in the 100 samples examined in this study. Twenty-four hours following NMDA-treatment animals ( n=5) were found to have significantly fewer live and more dead hippocampal cells than the saline-treated animals ( n=5), using either automated or manual examination techniques. The automated technique also revealed that NMDA treatment resulted in a reduction in the density of live cell distribution.

A comparison of manual diagnosis with a diagnosis established by a uni-level lumbar spinal block procedure

SUMMARY. The study was designed to test if a manipulative therapist (MT) using manual examination techniques alone or when accompanied by a verbal response from the subject as to the pain produced, could diagnose the lumbar segmental level responsible for a subjects low back pain and referred pain. The study consisted of prospective and retrospective parts where the MTs manual diagnosis of the symptomatic lumbar segmental level was compared to a segmental level diagnosis attained by subsequent or previous spinal anaesthetic blocks. In the prospective part of the study the MT's manual diagnosis was 94.12% and 52.9% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the retrospective part of the study the MTs manual diagnosis was found to be 60.86% and 47.82% sensitive in detecting the symptomatic lumbar segmental level with verbal and non-verbal subject responses, respectively. In the prospective study the MT's manual diagnosis showed 100% and 80% specificity in detecting subjects with no history of low back pain with verbal and non-verbal subject responses, respectively, and 100% and 75% specificity in the retrospective study with verbal and non-verbal subject responses, respectively. Inter-therapist reliability analysis for the recording of passive physiological intervertebral movements (PPIVMs), passive accessory intervertebral movements (PAIVMs) and ‘tissue response’ showed percentage agreement rates ranging from 55% to 99%; 74% to 100% and 43% to 100%, respectively, with weighted kappa values ranging from −0.11 to 0.32; −0.15 to 0.24 and kappa values ranging from -0.16 to 0.28, respectively. This study demonstrates that a MT's manual examination when accompanied by a verbal subject response, is highly accurate in detecting the lumbar segmental level responsible for a subjects complaint.

Muscle Testing: Techniques of Manual Examination

Muscle Testing: Techniques of Manual Examination

Muscle Testing: Techniques of Manual Examination

Medical Journal of AustraliaVolume 2, Issue 8 p. 404-404 Book Reviews Muscle Testing: Techniques of Manual Examination First published: 01 August 1973 https://doi.org/10.5694/j.1326-5377.1973.tb115143.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue8August 1973Pages 404-404 RelatedInformation

Book ReviewMuscle Testing: Techniques of manual examination.

Book ReviewMuscle Testing: Techniques of manual examination.

Muscle Testing: Techniques of Manual Examination

Muscle Testing: Techniques of Manual Examination

Muscle Testing: Techniques of Manual Examination

Muscle Testing: Techniques of Manual Examination