Manual Manipulation Research Articles

Absence of Neuroplastic Changes in the Bilateral H-Reflex Amplitude following Spinal Manipulation with Activator IV.

Background and Objectives: Chiropractic spinal manipulation is an alternative medical procedure for treating various spinal dysfunctions. Great interest exists in investigating its neuroplastic effects on the central nervous system. Previous studies have found contradictory results in relation to the neuroplastic changes in the H-reflex amplitude as a response to manual spinal manipulation. The discrepancies could be partly due to differences in the unilateral nature of these recordings and/or the variable force exerted in manual techniques applied by distinct chiropractors. Concerning the latter point, the variability in the performance of manual interventions may bias the determination of the significance of changes in H-reflex responses derived from spinal manipulation. To investigate such responses, a chiropractic device can be used to provide more precise and reproducible results. The current contribution aimed to examine whether spinal manipulation with an Activator IV instrument generates neuroplastic effects on the bilateral H-reflex amplitude in dancers and non-dancers. Materials and Methods: A radiograph verified spinal dysfunction in both groups of participants. Since there were significant differences between groups in the mean Hmax values of the H-reflex amplitude before spinal intervention, an assessment was made of the possible dependence of the effects of spinal manipulation with Activator IV on the basal conditions. Results: Ten sessions of spinal manipulation with Activator IV did not cause statistically significant changes in the bilateral H-reflex amplitude (measured as the Hmax/Mmax ratio) in either group. Furthermore, no significant difference was detected in the effects of spinal manipulation between groups, despite their distinct basal H-reflex amplitude. Conclusions: Regarding the therapeutic benefits of a chiropractic adjustment, herein carried out with Activator IV, the present findings suggest that the mechanism of action is not on the monosynaptic H-reflex pathway. Further research is needed to understand the mechanisms involved.

Management of atypical occlusal discrepancy after condylar resection: A clinical report

This clinical report describes the prosthetic management of occlusion for a patient who had received condylar resection as part of cancer treatment. Previous reports have identified that patients with unrepaired segmental resection of the mandible experienced a frontal plane rotation of the mandible toward the nonsurgical side. In contrast, because of preservation of temporomandibular muscles and their attachments, the mandible rotated toward the surgical side, and occlusal contacts were limited to a pair of molars on that side. Manual manipulation and instructions for muscular stretching and massages were provided to reduce muscular tension. A mandibular guidance prosthesis was fabricated and gradually adjusted to guide the mandible progressively toward a normal position. These treatments helped improve general comfort, mastication, occlusion, and the gradual rotation of the mandible toward a normal position.

TEMPOROMANDIBULAR JOINT DISLOCATION DUE TO NEAR SELF-EXTUBATION

TEMPOROMANDIBULAR JOINT DISLOCATION DUE TO NEAR SELF-EXTUBATION

Novel External Fixation Device for the Treatment of Hallux Distal Phalanx Fractures

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The great toe plays a large role in activity, including maintenance of balance and substantial weight bearing capabilities. Fractures of the hallux distal phalanx, especially when displaced or unstable, can lead to significant dysfunction of the interphalangeal joint (IP) and pain and may need operative intervention. Surgical options include wire pinning, screw fixation, external fixation, arthrodesis, or amputation. For patients with significant comminution and shortening who would like to attempt toe salvage without fusion, external fixation can lead to great outcomes. Unfortunately, the use of these devices is hindered by cost, size, and availability. We recommend the use of a novel low cost external fixation device that can be made intraoperatively using common materials found in the operative room. Methods: A 27-year-old female, with a severely comminuted right distal phalanx fracture with interphalangeal (IP) joint dislocation, presented 4 days after a skiing accident. We discussed treatment may require IP joint arthrodesis or partial amputation, however, salvage fixation could be attempted initially. First, a transverse percutaneous wire was placed through the distal phalanx tip since the fragment was still mostly intact. The wire exited the skin medially. Two Kocher clamps to each side of the wire were applied for distraction of the fracture site while simultaneous manual manipulation of the more proximal fragments was performed. Once reduced, three more proximal transverse wires were placed through a 3cc syringe, which acted as a rail to hold the fracture length stable. The distal transverse wire was then impaled through the rail so that all four wires were within the rail providing two points of fixation in the distal phalanx and proximal phalanx. Results: The patient's weight-bearing status was non-weight bearing to the right lower extremity for 6 weeks. This was actually being dictated by the more proximal tibial plateau fracture for which she was non-weight bearing. With regard specifically to the hallux fracture, she could have been heel weight beared immediately. At her most recent post-operative visit at 6 weeks, she was doing well with minimal pain. The external fixation device was removed in clinic and she was transitioned to a post-op shoe and allowed to weight bear as tolerated. She was motor and sensate intact with the ability to actively range her IP joint. Radiographs at the most recent visit revealed excellent alignment of the toe with minimal articular step off. Conclusion: With severely unstable hallux distal phalanx fractures, operative intervention should be considered. For those with a significant degree of comminution who still would like to undergo salvage fixation, external fixation is an excellent option. Unfortunately, the use of these devices is hindered by cost, size, and availability. Hand surgeons solved this problem by introducing small, low cost external fixators composed of common materials such as needle sheaths, IV cannulas, and syringes. We adapted their model to the toes and were able to obtain great clinical outcomes with low cost, all the while maintaining the patient's expectations for cosmesis.

A validation and acceptability study of cognitive testing using switch and eye-gaze control technologies for children with motor and speech impairments: A protocol paper.

Despite the importance of knowing the cognitive capabilities of children with neurodevelopmental conditions, less than one-third of children with cerebral palsy participate in standardized assessments. Globally, approximately 50% of people with cerebral palsy have an intellectual disability and there is significant risk for domain-specific cognitive impairments for the majority of people with cerebral palsy. However, standardized cognitive assessment tools are not accessible to many children with cerebral palsy, as they require manual manipulation of objects, verbal response and/or speeded response. As such, standardised assessment may result in an underestimation of abilities for children with significant motor and/or speech impairment. The overall aim of the project is to examine and compare the psychometric properties of standardised cognitive assessment tools that have been accommodated for use with either a switch device or eye-gaze control technologies, with the specific aims to: (1) Examine the psychometric properties (measurement agreement and validity) of accommodated assessment tools by comparing the performance of typically developing children on six cognitive assessment tools administered via standardised versus accommodated (switch or eye-gaze control) administration; (2) Describe and compare the performance and user experience of children with cerebral palsy on six accommodated cognitive assessments administered via switch or eye-gaze control technologies. Secondary aims are to: (1) Describe the completion rates and time to complete assessments of participants in each group; (2) Within the group with cerebral palsy, examine the effects of condition-specific characteristics (type of cerebral palsy, functional levels, and pain) and demographics (age, socio-demographic) on participation. This protocol paper describes a two-phase validation and acceptability study that utilizes a mixed-model design. This study will collect concurrent data from 80 typically developing children and 40 children with cerebral palsy, who use switch or eye-gaze control technology as alternate access communication methods. The set of instruments will measure receptive vocabulary, fluid reasoning, sustained attention, vision perception, visuospatial working memory and executive functions. Data analyses will be conducted using SPSS v. 25 and R v 4.1.0. SPSS Sample Power 3 was used for power computation and allows for a 10% drop out rate. Quantitative descriptive statistics, measurement agreement data plotting, bivariate and multiple regressions analysis will be conducted using appropriate methods.

Development of an Open Microfluidic Platform for Oocyte One-Stop Vitrification with Cryotop Method.

Oocyte vitrification technology is widely used for assisted reproduction and fertility preservation, which requires precise washing sequences and timings of cryoprotectant agents (CPAs) treatment to relieve the osmotic shock to cells. The gold standard Cryotop method is extensively used in oocyte vitrification and is currently the most commonly used method in reproductive centers. However, the Cryotop method requires precise and complex manual manipulation by an embryologist, whose proficiency directly determines the effect of vitrification. Therefore, in this study, an automatic microfluidic system consisting of a novel open microfluidic chip and a set of automatic devices was established as a standardized operating protocol to facilitate the conventional manual Cryotop method and minimize the osmotic shock applied to the oocyte. The proposed open microfluidic system could smoothly change the CPA concentration around the oocyte during vitrification pretreatment, and transferred the treated oocyte to the Cryotop with a tiny droplet. The system better conformed to the operating habits of embryologists, whereas the integration of commercialized Cryotop facilitates the subsequent freezing and thawing processes. With standardized operating procedures, our system provides consistent treatment effects for each operation, leading to comparable survival rate, mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) level of oocytes to the manual Cryotop operations. The vitrification platform is the first reported microfluidic system integrating the function of cells transfer from the processing chip, which avoids the risk of cell loss or damage in a manual operation and ensures the sufficient cooling rate during liquid nitrogen () freezing. Our study demonstrates significant potential of the automatic microfluidic approach to serve as a facile and universal solution for the vitrification of various precious cells.

A model scaling approach for fracture and size effect simulations in solids: Cohesive zone, smeared crack band and phase-field models

Despite many noteworthy contributions, the computational modeling of arbitrary fracture configurations and in particular, the quantification of size effect in quasi-brittle solids, still remains a challenging issue. In this work we proposed a model scaling approach for fracture and size effect simulations in solids. It employs only the geometric transformation relations and thus applies to any material model for fracture. Those popular models, i.e., the cohesive zone model, the smeared crack model and the phase-field cohesive zone model, are considered. With the geometric scaling factor intrinsically incorporated in the formulation, the resulting scaled models are able to predict the energetic size effect of a series of geometrically similar structures by parametric numerical simulations of the reference one. The 1-D analytical results of all the three scaled models are coincident with those from the underlying unscaled counterparts, validating the proposed model scaling approach. As it is independent of the mesh discretization and insensitive to the length scale, the scaled phase-field cohesive zone model (PF-CZM) is adopted for application to several representative benchmark tests of concrete and ice with mode-I and mixed I+II failure modes. The numerical results demonstrate that, owing to the strength-based crack nucleation criterion, the energy-based crack propagation criterion and the variational principle based path chooser, as well as the geometric scaling factor, are all incorporated into a standalone framework, the scaled PF-CZM is able to predict both the type II size effect law of pre-cracked quasi-brittle structures and the type I size effect law of intact ones. Moreover, those laborious manual manipulations in the numerical modeling of a large size range of geometrically similar structures, e.g., spatial discretization, enforcement of loading and boundary conditions, postprocessing of output data, etc., need to be done only once on the reference structure. These advantages make the scaled PF-CZM rather promising in the quantification of size effect in quasi-brittle structures.

Neural Correlates of Oral Stereognosis—An fMRI Study

Oral stereognosis is the ability to recognize, discriminate and localize a bolus in the oral cavity. Clinical observation indicates deficits in oral stereognosis in patients with vascular or neurodegenerative diseases particularly affecting the parietal lobes. However, the precise neural representation of oral stereognosis remains unclear whereas the neural network of manual stereognosis has already been identified. We hypothesize that oral and manual stereognosis share common neuronal substrates whilst also showing somatotopic distribution. Functional magnetic resonance images (fMRI; Siemens Prisma 3 T) from 20 healthy right-handed participants (11 female; mean age 25.7 years) using a cross-modal task of oral and manual spatial object manipulation were acquired. Data were analyzed using FSL software using a block design and standard analytical and statistical procedures. A conjunction analysis targeted the common neuronal substrate for stereognosis. Activations associated with manual and oral stereognosis were found in partially overlapping fronto-parietal networks in a somatotopic fashion, where oral stereognosis is located caudally from manual stereognosis. A significant overlap was seen in the left anterior intraparietal sulcus. Additionally, cerebellar activations were shown particularly for the oral condition. Spatial arrangement of shaped boli in the oral cavity is associated with neuronal activity in fronto-parietal networks and the cerebellum. These findings have significant implications for clinical diagnostics and management of patients with lesions or atrophy in parietal lobule (e.g. Alzheimer’s disease, stroke). More studies are required to investigate the clinical effect of damage to these areas, such as loss of oral stereognosis or an impaired oral phase.

MiniKers

Automating operations of objects has made life easier and more convenient for billions of people, especially those with limited motor capabilities. On the other hand, even able-bodied users might not always be able to perform manual operations (e.g., both hands are occupied), and manual operations might be undesirable for hygiene purposes (e.g., contactless devices). As a result, automation systems like motion-triggered doors, remote-control window shades, contactless toilet lids have become increasingly popular in private and public environments. Yet, these systems are hampered by complex building wiring or short battery lifetimes, negating their positive benefits for accessibility, energy saving, healthcare, and other domains. In this paper we explore how these types of objects can be powered in perpetuity by the energy generated from a unique energy source - user interactions, specifically, the manual manipulations of objects by users who can afford them when they can afford them. Our assumption is that users' capabilities for object operations are heterogeneous, there are desires for both manual and automatic operations in most environments, and that automatic operations are often not needed as frequently - for example, an automatic door in a public space is often manually opened many times before a need for automatic operation shows up. The energy harvested by those manual operations would be sufficient to power that one automatic operation. We instantiate this idea by upcycling common everyday objects with devices which have various mechanical designs powered by a general-purpose backbone embedded system. We call these devices, MiniKers. We built a custom driver circuit that can enable motor mechanisms to toggle between generating powers (i.e., manual operation) and actuating objects (i.e., automatic operation). We designed a wide variety of mechanical mechanisms to retrofit existing objects and evaluated our system with a 48-hour deployment study, which proves the efficacy of MiniKers as well as shedding light into this people-as-power approach as a feasible solution to address energy needed for smart environment automation.

Digitalization of an experimental electrochemical reactor via the smart manufacturing innovation platform

The exponential increase in data produced over the last two decades has revolutionized the way we collect, store, process, analyze, model, and interpret information to improve profitability. Manufacturing is no exception. However, Smart Manufacturing, the digital practice, organization, workforce, and infrastructure transformation for collection and deployment of data and models at scale and at all levels of manufacturing, is a complex, costly, and labor-intensive journey that is still seeing slow adoption. The Clean Energy Smart Manufacturing Innovation Institute (CESMII), a national Manufacturing USA public-private partnership sponsored by the Department of Energy, is addressing this scaled use of data and modeling in manufacturing. CESMII has focused on how to collect and use operating data for numerous applications that improve productivity, precision, and performance of manufacturing operations from factory floor to supply chain using process simulation, predictive analytics, monitoring and control, and real-time optimization. Because contextualized data are key, CESMII has developed the Smart Manufacturing Innovation Platform (SMIP) to lower the barriers to the data that are needed to accelerate data-based model building, improve data visualization, and more quickly gain insights. Reusable, standards-based ways of doing data collection, ingestion, and contextualization are particularly important for scaling access and use of data. The SMIP uses a standards-based definition and construct for reusable information models called an SM Profile. When an SM Profile is used in conjunction with the SMIP, the SMIP ensures the availability of contextualized, operational data for model building. The present work demonstrates Smart Manufacturing and the application of the SMIP for building several data-centered models for the operation and control of an experimental electrochemical reactor that reduces carbon dioxide (CO2) gas to valuable liquid and gas chemicals, such as alcohols, olefins, and syngas. We describe how the SMIP plays a central role in more effective model building and we demonstrate how the electochemical reactor can be controlled and optimized for the desired products. Use of the SMIP involves the transmission of real-time sensor measurements to a cloud resource so that the operating data are available to all model building experts. The data collection and transmission process is fully automated to greatly reduce the need for manual manipulation of the data. Data-driven machine learning models are used for advanced real-time state estimation, real-time optimization, and model-based feedback control for the reactor. The application models are implemented as a system to monitor the data flow and control the electrochemical reactor with a single visualization interface. SM Profiles are used to demonstrate reusability of the information models for the reactor and the instrumentation. The application packages, algorithms, and user interfaces developed are cast as Docker images in a library to facilitate reusability of the application models.

Quantification of manipulation forces needed for robot-assisted reduction of the ankle syndesmosis: an initial cadaveric study.

Manual surgical manipulation of the tibia and fibula is necessary to properly align and reduce the space in ankle fractures involving sprain of the distal tibiofibular syndesmosis. However, manual reduction is highly variable and can result in malreduction in about half of the cases. Therefore, we are developing an image-guided robotic assistant to improve reduction accuracy. The purpose of this study is to quantify the forces associated with reduction of the ankle syndesmosis to define the requirements for our robot design. Using a cadaveric specimen, we designed a fixture jig to fix the tibia securely on the operating table. We also designed a custom fibula grasping plate to which a force-torque measuring device is attached. The surgeon manually reduced the fibula utilizing this construct while translational and rotational forces along with displacement were being measured. This was first performed on an intact ankle without ligament injury and after the syndesmosis ligaments were cut. Six manipulation techniques were performed on the three principal directions of reduction at the cadaveric ankle. The results demonstrated the maximum force applied to the lateral direction to be 96.0N with maximum displacement of 8.5mm, applied to the anterior-posterior direction to be 71.6N with maximum displacement of 10.7mm, and the maximum torque applied to external-internal rotation to be 2.5 Nm with maximum rotation of 24.6°. The specific forces needed to perform the distal tibiofibular syndesmosis manipulation are not well understood. This study quantified these manipulation forces needed along with their displacement for accurate reduction of ankle syndesmosis. This is a necessary first step to help us define the design requirements of our robotic assistance from the aspects of forces and displacements.

Bundling gentle body massage along with regular position change under phototherapy among full-term neonates with hyperbilirubinemia: Is it effective?

PurposeNeonatal nurses are challenged by applying evidence-based interventions that maximize the photochemical effect whilst reducing the duration of exposing neonates to phototherapy and its iatrogenic adverse effects. This study aimed to investigate the effect of bundling gentle body massage along with regular position change on bilirubin level and clinical outcomes among full-term neonates with hyperbilirubinemia under phototherapy. Design and methodsA quasi-experimental study was carried out in the NICU of University Specialized Hospital in Smouha, Alexandria. Sixty full-term neonates were randomly assigned to two equal groups. The intervention group received gentle body massage twice a day and position change from supine to lateral every 2 h under the phototherapy for three consecutive days in addition to routine NICU care. ResultsThe mean difference in bilirubin level between the third and first day of receiving phototherapy among the intervention group was −4.99 ± 2.34 mg/dL compared to −2.28 ± 1.68 mg/dL for the control group (P < 0.001). Neonates who received the intervention bundle had a more frequent passage of stool at the three days (3.23 ± 1.38,4.13 ± 1.38 and 4.57 ± 1.59 times/day) compared to the control group (2.67 ± 1.21,3.03 ± 1.03 and 3.07 ± 1.01 times/day). The mean length of hospital stay for the two groups was 4.87 ± 1.46 and 6.07 ± 1.91 days, respectively (P = 0.014). ConclusionChanging position increased body surface area exposed to phototherapy light, and the manual manipulation of neonates' bodies stimulated their circulation and lymphatic blood flow, promoted bilirubin dynamic migration, and reduced its reabsorption through enterohepatic circulation. Hence, the intervention bundle effectively reduced the serum bilirubin level, increased the frequency of stool passage, percentage of consumed milk, weight gain, and shortened phototherapy duration.

The Immediate Effects of the Manual Therapy Traction Manipulations on Parameters of Cardiorespiratory System Functioning

The aim of this study was to determine the changes in the cardiorespiratory system activity under the influence of traction manipulations in the thoracic spine. The study involved 26 adults, including 18 women aged 39.6 ± 12.1 years and 8 men aged 36.3 ± 8.3 years. The mean age of patients was 38.6 ± 11.2 years. The work used an integral method of studying the cardiorespiratory system - spiroarteriocardiorhythmography (SAKR). SACR registration was performed before and after traction manipulations in the thoracic spine directly in the procedure of manual therapy. The study of the immediate effect of traction manipulations of SMT in the thoracic spine on the cardiorespiratory system allowed establishing the main significant effects: decrease in HR (min^-1) from 85.1 (77.1; 94.2) to 79.5 (69.8; 87.6), p=0.000, decrease in duration of QTC (s) from 0.419 (0.404; 0.434) to 0.413 (0.401; 0.427), p=0.012, decrease in CO (dm³) from 5.2 (4.6; 5.8) to 4.9 (4.4; 5.6), p=0.000, SI (dm³/m²) from 3.05 (2.75; 3.30) to 2.90 (2.62; 3.20), p=0.000, increase in Vexp (L/s) from 0.28 (0.22; 0.34) to 0.31 (0.25; 0.39), p=0.030. The obtained data suggest that the main effects of traction manipulations on the thoracic spine are associated more with the changes in hemodynamic parameters of blood circulation due to activation of expiratory muscles and chest mobility, when the suction mechanisms of the chest and cardiovascular function of diaphragm are activated.

MVFStain: Multiple virtual functional stain histopathology images generation based on specific domain mapping.

To the best of our knowledge, artificial intelligence stain generation is an urgent requirement for histopathology images. Pathological examinations usually only utilize hematoxylin and eosin (H&E) regular staining to show histomorphological characteristics, but to accurately diagnose the disease, functional staining (such as oil red O and Ki67) are also required to provide important auxiliary information. However, the same tissue sectionis usually stained with one stain, and additional functional staining is not only time-consuming but also causes inevitable morphological misalignment due to manual manipulation. This brings difficulties to the development of artificial intelligence pathological image analysis tools. In this work, we propose a histopathology staining transfer framework to generate virtual functional staining images from H&E regular staining images. Compared with the framework that emphasizes generation diversity in the natural image field, we use KL loss and histo loss to align and separate style feature spaces in different domains to obtain domain-variant style features. The proposed multiple virtual functional stain (MVFStain) abstracts staining conversion to domain mapping and comprehensively utilizes multiple staining information. We evaluated the proposed method on four datasets (lung lesion, lung lobes, breast, and atherosclerotic lesion). The experiment involves the translation of H&E to nine other functional stains: CC10, Ki67, proSPC, HER2, PR, ER, oil red O, α-SMA, and macrophages. The major quantitative results are divided into image quality and positive signal prediction. MVFStain is close to or even surpasses one-to-one image translation on psnr and HTI image quality metrics. The best psnr reaches 26.1919, and HIT reaches 0.9430. We used mIOD to evaluate the optical density of positive signals, and CNR and gCNR to evaluate the lesion detectability. The results show that the mIOD of positive signals of virtual staining was slightly lower than the ground truth and close the lesion detectability of artificial staining. These results prove that the potential exists to develop a successful clinical alternative to artificial functional stains.

Semiautomated Algorithm for the Diagnosis of Multiple System Atrophy With Predominant Parkinsonism.

ObjectivePutaminal iron deposition is an important feature that helps differentiate multiple system atrophy with predominant parkinsonism (MSA-p) from Parkinson’s disease (PD). Most previous studies used visual inspection or quantitative methods with manual manipulation to perform this differentiation. We investigated the value of a new semiautomated diagnostic algorithm using 3T-MR susceptibility-weighted imaging for MSA-p.MethodsThis study included 26 MSA-p, 68 PD, and 41 normal control (NC) subjects. The algorithm was developed in 2 steps: 1) determine the image containing the remarkable putaminal margin and 2) calculate the phase-shift values, which reflect the iron concentration. The next step was to identify the best differentiating conditions among several combinations. The highest phase-shift value of each subject was used to assess the most effective diagnostic set.ResultsThe raw phase-shift values were present along the lateral margin of the putamen in each group. It demonstrates an anterior-to-posterior gradient that was identified most frequently in MSA-p. The average of anterior 5 phase shift values were used for normalization. The highest area under the receiver operating characteristic curve (0.874, 80.8% sensitivity, and 86.7% specificity) of MSA-p versus PD was obtained under the combination of 3 or 4 vertical pixels and one dominant side when the normalization methods were applied. In the subanalysis for the MSA-p patients with a longer disease duration, the performance of the algorithm improved.ConclusionThis algorithm detected the putaminal lateral margin well, provided insight into the iron distribution of the putaminal rim of MSA-p, and demonstrated good performance in differentiating MSA-p from PD.

Effects of Manual Versus Instrumental Spinal Manipulation on Blood Flow of the Vertebral and Internal Carotid Arteries in Participants With Chronic Nonspecific Neck Pain: A Single-Blind, Randomized Study

ObjectiveThe aim of this study was to compare the hemodynamic effects of manual spinal manipulation (MSM) and instrumental spinal manipulation (ISM) on the vertebral artery (VA) and internal carotid artery (ICA) in participants with chronic nonspecific neck pain (NNP). MethodsThirty volunteers aged 20 to 40 years old with NNP over 3 months duration were included. Participants were randomly divided into the following 2 groups: (1) MSM group (n = 15) and (2) ISM group (n = 15). Ipsilateral (intervention side) and contralateral (opposite side of intervention) VAs and ICAs were evaluated using spectral color Doppler ultrasound before and immediately after manipulation. Measurements were recorded by visualizing the ICA carotid sinus (C4 level) and the VA at the V3 segment (C1-C2 level). The blood flow parameters of peak systolic velocity (PSV), end-diastolic velocity, resistive index, and volume flow (only for VA) were evaluated. The spinal segment, in which biomechanical aberrant movement was detected by palpation in the upper cervical spine, was manually manipulated in the MSM group. The same methodology was performed for the ISM group using an Activator V instrument (Activator Methods). ResultsIntragroup analysis exhibited no statistically significant difference between the MSM and ISM groups in terms of PSV, end-diastolic velocity, resistive index of ipsilateral and contralateral ICA and VA, in addition to volume flow of both VAs preintervention and postintervention (P > .05). Within the intergroup analysis, there was a significant difference in ipsilateral ICA PSV (P = .031) (preintervention vs postintervention difference was –7.9 ± 17.2 cm/s [95% confidence interval, –17.4 to 1.6] in the ISM group and 8.7 ± 22.5 cm/s [95% confidence interval, –3.6 to 21.2]) in the MSM group (P < .05). Other parameters did not show any significant difference (P > .05). ConclusionManual and instrumental spinal manipulations applied to the upper cervical spine in participants with chronic NNP did not appear to alter blood flow parameters of the VAs and ICAs.

Механо-резонансное манипулирование в лечении заболеваний опорно-двигательного аппарата

The article describes a method of manual manipulation where the necessary movement of the element of the musculoskeletal system, which was selected for exposure, is performed in accordance with the principles of achieving vibrational and translational mechanical resonance. This method of mechanical and resonance manipulation proved to be more effective and less traumatic in clinical practice when compared with the traditional manipulation method, and the intended effect, which consisted in increasing mobility and more physiologically correct arrangement of the exposed elements of the musculoskeletal system, was more pronounced, namely, greater mobility was achieved with a more uniform increase in the mobility of all the exposed elements of the musculoskeletal system. At the same time, fewer manual therapy sessions by 30% were required for achieving the planned therapeutic effect, and, due to less trauma to biological tissues during mechanical and resonance manipulation, the sessions were less painful.

Effect of chemically accelerated vibratory finishing on the corrosion behavior of Laser Powder Bed Fusion 316L stainless steel

As-built surface morphology and texture of Additively Manufactured (AM) metal parts reduce their mechanical and corrosion properties. One chemically accelerated vibratory finishing (CAVF) technique employs a chemically-based stepwise process to gradually remove surface roughness without the need for significant manual manipulation. While this procedure is effective at producing smooth surfaces, the corrosion response of the resulting surface is unknown. This study evaluates the effect of this surface finishing technique on the corrosion response and mechanisms of 316L stainless steel fabricated using Laser Powder Bed Fusion (L-PBF) AM techniques. The results show that the CAVF process does not obviously change the microstructure but imparts residual compressive stresses on the surface which improve the breakdown potential compared to other specimens evaluated. Further, the process removed surface Cr3C2 precipitates formed during heat treatment. CAVF improves surface finish and mechanical properties with an added benefit of enhancing the corrosion response of processed parts.

Is Cervical Stabilization Exercise Immediately Effective in Patients with Chronic Neck Pain and Upper Cervical Spine Dysfunction? Randomized Controlled Trial.

Purpose: To compare the effectiveness of a single exercise session with manual therapy techniques in the segments of the upper cervical spine (C0–1, C1–2 and C2–3), against a single exercise session in patients with chronic neck pain and mobility deficits in the upper cervical spine. Methods: A single-blind randomized controlled trial was performed. Fifty-eight patients were recruited (29 for the manual therapy and exercise group and 29 for the exercise group) who presented chronic neck pain and upper cervical spine dysfunction. The exercise focused on the deep muscles. The manual therapy combined manipulations and mobilizations with these exercises. Cervical range of motion, flexion-rotation test, pressure pain threshold and pain intensity were measured by a blind evaluator before and after the intervention. Results: Compared to pre-intervention, after intervention, the exercise group was significantly lower in terms of the range of motion, flexion-rotation test, and pressure pain threshold (p < 0.05). The manual therapy and exercise group improved in upper cervical flexion, the flexion-rotation test and intensity of pain (p < 0.05). Conclusions: It may be necessary to normalize the mobility of the upper cervical spine before cervical stabilization training, in patients with chronic neck pain and mobility deficits in the upper cervical spine.

Pre-manipulative cervical spine testing and sustained rotation do not influence intracranial hemodynamics: an observational study with transcranial Doppler ultrasound

ABSTRACT Introduction Manual joint mobilization and manipulation are recommended therapeutic interventions for people with neck pain. High-velocity thrust and sustained techniques have an uncertain association with serious arterial trauma. The validity of pre-manipulative tests of the cervical spine is often questioned, and the understanding of the effect of head/neck position on blood flow is still incomplete. Most of the evidence concerning hemodynamics in this area relates to extracranial flow (vertebral and carotid artery). Less is understood about the effects on intracranial flow while performing pre-manipulative tests and sustained positions like end of range cervical rotation mobilization. The aim of the study was to assess the influence of commonly used evaluation and treatment positions on intracranial hemodynamic parameters. Method A randomized, cross-over observational study using ultrasonography on healthy subjects (n = 19) was conducted to measure hemodynamic parameters (peak systolic velocity and end diastolic maximum) of intracranial arterial systems. Two test positions (sustained pre-manipulative thrust C0-1 and sustained cervical end of range rotation) were compared with a sham position for each test position. Results :Neither the sequence of tests performed nor an independent variable (the two positions) had a significant effect (p < 0.05) on peak systolic velocity (PSV) or end diastolic maximum (EDM). Discussion No effects from commonly used assessment and treatment of neck positions on hemodynamic parameters were found. This is consistent with previous studies. Further study is indicated on people with symptoms and known pathologies.