Maximum Range Of Motion Research Articles

Motor Coordination and Grip Strength of the Dominant and Non-Dominant Affected Upper Limb Depending on the Body Position-An Observational Study of Patients after Ischemic Stroke.

Stroke is one of the leading causes of human disability globally. Motor function deficits resulting from a stroke affect the entire body, but relatively often it is the upper limbs that remain ineffective, which is very limiting in everyday life activities. The finding in neurorehabilitation that trunk control contributes to upper limb function is relatively common but has not been confirmed in clinical trials. This observational prospective study aims to analyze the effect of the position of the trunk and the affected upper limb on the coordination and grip strength of the affected dominant and non-dominant hand and wrist in people after ischemic stroke. The research was carried out at the Department of Neurological Rehabilitation, on a group of 60 patients with acute ischemic stroke. A Hand Tutor device and a hand dynamometer were used for the main measurements of the motor coordination parameters (maximum range of motion, frequency of movement) and the grip strength of the dominant and non-dominant upper limb. The patients were examined in two positions: sitting without back support and lying on the back with stabilization of the upper limb. Higher and relevant results were observed in the non-dominant hand, in the supine position in terms of motor coordination parameters of the fingers (p = 0.019; p = 0.011) and wrist (p = 0.033), and grip strength (p = 0.017). Conclusions: The laying position and stabilization of the affected upper limb in the acute phase following ischemic stroke is more beneficial for the coordination of movements and grip strength of the non-dominant hand.

Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation

BackgroundDislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion. MethodsAll operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve. FindingsCup inclination and anteversion, stem anteversion, and combined anteversion were 37.6°, 20.1°, 26.2°, and 46.3°, respectively. Maximum range of motion in flexion, extension, internal rotation at 90° of flexion, and external rotation were 131.8°, 42.3°, 56.4°, and 64.5°, respectively. Flexion >110°, extension >30°, internal rotation >30° at 90° of flexion, and external rotation >30° were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34°–43° of cup inclination, 18°–26° of cup anteversion, 17°–29° of stem anteversion, and 35°–56° of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion. InterpretationSurgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.

Use of Intraoperative Imaging to Preserve C1-C2 Mobility in Complex Atlas-Hangman Fractures.

Combination fractures of the C1-C2 complex especially atlas and hangman are relatively uncommon and management usually compromises C1-C2 mobility. To evaluate the treatment of combined C1- hangman's fracture with and without intraoperative O- arm based navigation system, and its outcome in terms of preserving C1-C2 mobility. This was a case series of patients with combined C1 and hangman's fracture, managed at a tertiary care hospital during February 2009 to December 2016. Neurological function assessed with American Spine Injury Association (ASIA) impairment scale. Radiological fusion of the operated segment assessed with computed tomographic scan, criteria used for successful fusion included formation of callus across the fracture. Preservation of rotational motion between C1 and C2 was assessed by cervical flexion rotation (CFR) test. We included 10 patients (male/female: 9/1; mean 47.7 ± 17.5 years) in our study. Operative intervention was performed in 9 patients. We used intraoperative computed tomogram (CT) scan with navigation in 5 patients. The mean follow-up period was 28.7 months (range 6 to 70 months). Neurological recovery occurred in all 4 patients with preoperative neurological deficits. Radiological fusion occurred in all cases. Rotation at C1-2 was preserved in all 5 cases operated under O-arm guidance and in one patient with type 1 fracture who was managed conservatively. The goals in treating these complex fractures are to achieve early maximum stability and preserving maximum range of motion. These are often competing phenomena, which can be achieved by using intra operative CT scan and navigation system.

Flexibilidade de crianças e adolescentes brasileiros: uma revisão sistemática da literatura

abstract Flexibility is related to specific tissue properties of the body, which aim to determine the maximum range of motion of the joints without injury. This study aimed to identify and summarize the evidence on prevalence of adequate levels of flexibility in Brazilian children and adolescents (6 to 19 years old). We performed a systematic search of studies published from 2009 to 2019 in six databases (MEDLINE/PubMed; Scopus; SportDiscus; LILACS; Web of Science; SCIELO). Fourteen studies that compiled data from 11,666 participants in seven different Brazilian states were included. All studies conducted sit and reach tests to assess flexibility. Among all the children and adolescents in the analyzed studies, 58.9% of the total (62.0% of boys and 50.9% of girls) had adequate flexibility. We conclude that more than half of Brazilian children and adolescents have adequate flexibility for health.

Prospective Radiographic Assessment of Intraoperative Range of Motion with Total Ankle Replacement

Category:Ankle ArthritisIntroduction/Purpose:One of the proposed benefits of total ankle replacement, when compared to ankle fusion is the preservation of range of motion (ROM) of the ankle. Preservation of ankle motion may improve quality of life as evidenced by patient-reported outcome measures (PROMs). However, despite improving dorsiflexion intraoperatively during TAR, studies have not demonstrated large improvements in dorsiflexion (DF) at final followup after TAR. The objective of this study was to radiographically evaluate and quantify preoperative, intraoperative ankle dorsiflexion and plantarflexion (PF), compare it to post- operative ankle ROM, and determine the effect of Achilles lengthening (TAL) on preserving dorsiflexion motion that is gained during surgery.Methods:This prospective study compared 111 patients with an average age of 62.3 years who underwent primary total ankle replacement with one of four different implants between March and December 2019. A total of 71 patients (64%) had an associated TAL based on the surgeon's decision. Intraoperative fluoroscopy was utilized by the primary surgeon to document the maximal dorsiflexion and plantar flexion at the end of the case. This was completed after the TAL on a perfect lateral.Standardized weight bearing at maximum ROM positions lateral radiographs were obtained twelve months postoperatively. The change in range of motion was analyzed using a paired t-test with a significance level of 0.05.Results:The cohort's preoperative range was 22.0° (8.1°DF, 14°PF) and was increased to 38.5° intraoperatively (12.7°DF, 25.8°PF) as described in Table 1. Postoperative ROM is 24.9° (11.7°DF, 13.2°PF) which means that 65% of the intraoperative ROM is preserved. Preoperative and intraoperative range of motion was not different between the group that had a TAL compared to no TAL. At the year postoperatively, the dorsiflexion was similar between both groups. The group who did not have a TAL went from 12.8 intraoperatively to 12.2° postoperatively whereas the group who had a TAL went from 12.2° to 11.3° which was statistically equivalent.Conclusion:This study is the first to assess how much ankle range of motion is retained after TAR. Overall, we observed that 65% of dorsiflexion was retained after TAR. TAL as a concomitant procedure did not effect the proportion of dorsiflexion motion that was retained. Additional studies are needed to determine how to best optimize and increase ROM after TAR.

Regaining motion among patients with shoulder pathology - are all exercises equal?

Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P ≤ 0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P = 0.002) and a greater perceived level of difficulty compared with the table slide (P = 0.006). Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM.

Emerging Concept of Dupuytren’s Disease

Dupuytren’s disease is a disorder of fibroproliferative condition causing thickened and contracted of the palmar fascia. The pathophysiology behind this disease is complex and multifactorial. Some major factors are genetic predisposition, inflammatory response, trauma, comorbidities, and environmental factors. The treatment options for Dupuytren’s disease are divided into non-surgical and surgical management. Needle fasciotomy and fasciectomy are some of the most common surgical procedures chosen. Novel non-surgical treatment option as the recent advance in the treatment of the disease is the injection of collagenase Clostridium histolyticum (CCH). One of the pitfalls of Dupuytren’s management is the high possibility of the disease’s recurrence along with some other post-intervention complications. Rehabilitation following the interventions is needed to manage the maximum range of motion and curtail the inflammatory response after the cord disruption. Keywords: Dupuytren’s disease, clostridium histolyticum, fasciectomy.

Real-world experience of treating frozen shoulder using active manipulation under local anesthetic: A retrospective study.

Currently, there is limited evidence to guide treatment and no standard management guidelines exist for treating frozen shoulder (FS). A general management approach consists of initial evaluation, range of motion (ROM) exercises, intra-articular injection of glucocorticoid, home exercise program (HEP), and/or physical therapies. However, the general approach lacks detail and has limited evidence of its effectiveness. This retrospective cohort study evaluates the short-term recovery of near-full to full-ROM technique followed by an instructed HEP for strengthening and coordinating shoulder girdle muscle group for FS management. This study details our experiences following a general approach to managing FS and aims to fill this knowledge void, providing additional context of the efficacy of FS management in the real-world. Seven-two adult patients with FS (46 females, 26 males; mean age of 66; standard deviation of 15.1; range 23–87) from an orthopedic and physical medicine and sport medicine office between 2014 and 2018 were included in this study. Following general management of FS, patients received a glucocorticoid–lidocaine mixture injection administered to the respective shoulder at the glenohumeral joint space and/or subacromial separately. Immediately, patients underwent active manipulation of the affected shoulder in 3 directions: forward flexion, abduction, and extension in the sagittal plane. Lastly, patients were instructed to perform movements similar to the active manipulation protocol as a HEP. The abduction and forward flexion ROM showed significant improvements with the described protocol. Following treatment, there was a 90.20° and 77.33° increase in average shoulder abduction and forward flexion ROM, respectively (P < .05). The immediate goal of this protocol was to gain maximum ROM in different directions of shoulder mobility. Following the general management of FS, active manipulation under local anesthetic was a highly effective treatment modality for adhesive capsulitis that was time-saving and cost-effective.

Kinematics of whip spider pedipalps: a 3D comparative morpho-functional approach.

Amblypygi are tropical and subtropical ambush predators that use elongated, raptorial pedipalps for different activities. Although pedipalp use in predation and courtship has been explored in videography in vivo analyses, kinematic ex vivo examination of these appendages has not been conducted. Here, we rectify this lack of data by using micro-CT scans to 3D-kinematically model the appendage morphology and the range of motion (ROM) of the joints for Damon medius and Heterophrynus elaphus. We illustrate the successful application of this technique to terrestrial euarthropods in determining the maximum ROM values for each pedipalp joint. We also note that, in life, these values would be lower due to motion restricting structures like tendons, arthrodial membranes, and muscles. We further compare our maximum values obtained here with data from video-based motion analyses. The ROM of each joint shows the greatest flexibility in the femur-tibia joint (140-150°), the lowest in the basitarsus-claw joint (35-40°). ROM in the tibia-basitarsus joint is markedly distinct (D. medius: 44°; H. elaphus: 105°). This disparity reflects how H. elaphus uses the joint in the capture basket, while D. medius uses the femur-tibia joint to form the capture basket. We further illustrate notable vertical motion of the H. elaphus pedipalp compared to D. medius. This difference reflects the retro-ventral trochanter apophysis of H. elaphus. Our study opens the possibility to further whip spider kinematic understanding. Examination of other taxa using this approach will result in a more comprehensive understanding of the ecological significance and ethological implications of this unique arachnid group.

Effects of a Single Proprioceptive Neuromuscular Facilitation Stretching Exercise With and Without Post-stretching Activation on the Muscle Function and Mechanical Properties of the Plantar Flexor Muscles.

A single proprioceptive neuromuscular facilitation (PNF) stretching exercise can increase the range of motion (ROM) of a joint but can lead to a decrease in performance immediately after the stretching exercise. Post-stretching activation (PSA) exercises are known as a possible way to counteract such a drop in performance following a single stretching exercise. However, to date, no study has investigated the combination of PNF stretching with PSA. Thus, the aim of this study was to compare the effects of a PNF stretching exercise with and without PSA on the muscle function (e.g., ROM) and mechanical properties of the plantar flexor muscles. Eighteen physically active males volunteered in the study, which had a crossover design and a random order. The passive shear modulus of the gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) was measured in a neutral position with shear wave elastography, both pre- and post-intervention. Maximum voluntary isometric contraction (MVIC) peak torque, maximum voluntary dynamic contraction peak torque, dorsiflexion ROM, and passive resistive torque (PRT) were also measured with a dynamometer. The interventions were 4×30s of PNF stretching (5s of contraction) and two sets of three exercises with 20 or 40 fast ground contacts (PNF stretching+PSA) and PNF stretching only. ROM was found to have increased in both groups (+4%). In addition, the PNF stretching+PSA group showed a decrease in PRT at a given angle (−7%) and a decrease in GM and mean shear modulus (GM+GL; −6%). Moreover, the MVIC peak torque decreased (−4%) only in the PNF stretching group (without PSA). Therefore, we conclude that, if PNF stretching is used as a warm-up exercise, target-muscle-specific PSA should follow to keep the performance output at the same level while maintaining the benefit of a greater ROM.

Qualitative ultrasonography scale of the intensity of local twitch response during dry needling and its association with modified joint range of motion: a cross-sectional study

BackgroundThe relevance of local twitch response (LTR) during dry needling technique (DNT) is controversial, and it is questioned whether LTR is necessary for successful outcomes. Furthermore, because the LTR during the deep DNT may be evoked with different intensities, it is unknown whether the magnitude of LTR intensity is associated with optimal clinical results, especially concerning to the effects of joint maximal range of motion (ROM). This study aimed to (i) determine whether visual inspections can quantify the LTR intensity during the DNT through a qualitative ultrasonography scale of LTR intensity (US-LTR scale), and (ii) assess the differences of US-LTR scale associated with changes in the maximal joint ROM.MethodsUsing a cross-sectional design, seven asymptomatic individuals were treated with DNT in the latent myofascial trigger point in both medial gastrocnemius muscles. During DNT, three consecutive LTRs were collected. The US-LTR scale was used to classify the LTRs into strong, medium, and weak intensities. The categories of US-LTR were differentiated by the velocity of LTRs using the optical flow algorithm. ROM changes in ankle dorsiflexion and knee extension were assessed before and immediately after DNT.ResultsThe US-LTR scale showed the third LTR was significantly smaller than the first one (p < 0.05). A significant difference in velocity was observed between US-LTR categories (p < 0.001). A significant difference in the ROM was observed between the strong and weak-medium intensity (p < 0.05).ConclusionsThe present findings suggest that the LTR intensity can be assessed using a qualitative US-LTR scale, and the effects of DNT on joint maximal ROM is maximized with higher LTR intensity. This study reports a novel qualitative method for LTR analysis with potential applications in research and clinical settings. However, further research is needed to achieve a broader application.

Effects of multiple modes of UltraPulse fractional CO2 laser treatment on extensive scarring: a retrospective study

The main therapeutic options for extensive scarring (e.g., > 20% of the total body surface area, or TBSA) after burns and trauma have focused on conservative treatments, such as compression, moisturization, and topical agent application. However, these treatments may not achieve optimal effects due to the large size and complexity of the scars. UltraPulse fractional CO2 laser treatment is a novel approach that is currently a subject of intense interest; this treatment is most widely used to improve texture, pliability, and pigmentation in all types of scars. However, no studies on the independent use of UltraPulse fractional CO2 laser treatment for extensive scars have been reported. This retrospective study evaluated a total of 21 patients, whose scars covered 20 to 65% TBSA. Scar thickness was measured by ultrasonography before treatment. Personalized treatment modalities and parameters were set according to the scar type and thickness. Scar formation and treatment effects were evaluated by photography, the Patient and Observer Scar Assessment Scale (POSAS), and patients’ judgment of effectiveness. Where the scars covered joints, joint function was assessed by measuring the maximum range of motion (ROM). With laser therapy, scars became flatter and lighter; furthermore, pruritus, pain, and discomfort decreased significantly. POSAS scores significantly decreased after laser therapy, including the item scores for pain and pruritus. There were no instances of joint contracture, ROM reduction, apparent functional impairment, serious adverse events, or comorbidities. This study demonstrates the safety and efficiency of UltraPulse fractional CO2 laser treatment for extensive scarring.

Steerable Surgical Instrument for Conventional and Single-Site Minimally Invasive Surgery.

Background. This article aims to present an innovative design of a steerable surgical instrument for conventional and single-site minimally invasive surgery (MIS), which improves the dexterity and maneuverability of the surgeon while offering a solution to the limitations of current tools. Methods. The steerable MIS instrument consists of a deflection structure with a curved sliding joints design that articulates the distal tip in two additional degrees of freedom (DoFs), relative to the instrument shaft, using transmission by cables. A passive ball-joint mechanism articulates the handle relative to the instrument shaft, improves wrist posture, and prevents collision of instrument handles during single-site MIS procedures. The two additional DoFs of the articulating tip are activated by a thumb-controlled device, using a joystick design mounted on the handle. This steerable MIS instrument was developed by additive manufacturing in a 3D printer using PLA polymer. Results. Prototype testing showed a maximum tip deflection of 60° in the left and right directions, with a total deflection of 120°. With the passive ball-joint fully offset, the steerable tip achieved a deflection of 90° for the right and 40° for the left direction, with a total deflection of 130°. Furthermore, the passive ball-joint mechanism in the handle obtained a maximum range of motion of 60°. Conclusions. This steerable MIS instrument concept offers an alternative to enhance the application fields of conventional and single-site MIS, increasing manual dexterity of the surgeon and the ability to reach narrow anatomies from other directions.

The Influence of Kinematic Constraints on Model Performance During Inverse Kinematics Analysis of the Thoracolumbar Spine.

Motion analysis is increasingly applied to spine musculoskeletal models using kinematic constraints to estimate individual intervertebral joint movements, which cannot be directly measured from the skin surface markers. Traditionally, kinematic constraints have allowed a single spinal degree of freedom (DOF) in each direction, and there has been little examination of how different kinematic constraints affect evaluations of spine motion. Thus, the objective of this study was to evaluate the performance of different kinematic constraints for inverse kinematics analysis. We collected motion analysis marker data in seven healthy participants (4F, 3M, aged 27–67) during flexion–extension, lateral bending, and axial rotation tasks. Inverse kinematics analyses were performed on subject-specific models with 17 thoracolumbar joints allowing 51 rotational DOF (51DOF) and corresponding models including seven sets of kinematic constraints that limited spine motion from 3 to 9DOF. Outcomes included: (1) root mean square (RMS) error of spine markers (measured vs. model); (2) lag-one autocorrelation coefficients to assess smoothness of angular motions; (3) maximum range of motion (ROM) of intervertebral joints in three directions of motion (FE, LB, AR) to assess whether they are physiologically reasonable; and (4) segmental spine angles in static ROM trials. We found that RMS error of spine markers was higher with constraints than without (p < 0.0001) but did not notably improve kinematic constraints above 6DOF. Compared to segmental angles calculated directly from spine markers, models with kinematic constraints had moderate to good intraclass correlation coefficients (ICCs) for flexion–extension and lateral bending, though weak to moderate ICCs for axial rotation. Adding more DOF to kinematic constraints did not improve performance in matching segmental angles. Kinematic constraints with 4–6DOF produced similar levels of smoothness across all tasks and generally improved smoothness compared to 9DOF or unconstrained (51DOF) models. Our results also revealed that the maximum joint ROMs predicted using 4–6DOF constraints were largely within physiologically acceptable ranges throughout the spine and in all directions of motions. We conclude that a kinematic constraint with 5DOF can produce smooth spine motions with physiologically reasonable joint ROMs and relatively low marker error.

Warm-Up and Hamstrings Stiffness, Stress Relaxation, Flexibility, and Knee Proprioception in Young Soccer Players.

Nerves or fascia may limit motion in young soccer players, thereby contributing to frequent hamstrings injuries. Nerve-gliding exercises and self-myofascial release techniques may enhance range of motion (ROM). To compare the immediate effect of foam rolling (FR) and neurodynamic nerve gliding (NDNG) on hamstrings passive stiffness, viscoelasticity, flexibility, and proprioception during the warm-up of soccer players. Crossover study. Research laboratory. A total of 15 male soccer players (age = 18.0 ± 1.4 years, height = 183.1 ± 6.0 cm, mass = 76.9 ± 7.8 kg) on the same team. The FR and NDNG consisted of 6 sets of 45 seconds with a 15-second rest between sets. Over a 2-week period, participants performed FR and NDNG on 2 separate occasions. Stiffness (between 50% and 80%, and 85% and 95% [STFmax] of maximal knee-extension ROM), viscoelasticity (stress-relaxation test), knee-extension ROM, hamstrings passive-resistance torque (PRT), hip-flexion angle (straight-leg raise test), and active knee-joint position sense. We observed an interaction between time and intervention for STFmax (F1,17 = 5.024, P = .042), knee-extension ROM (F1,17 = 7.371, P = .02), and PRT (F1,17 = 4.876, P = .044). The NDNG technique induced increases in STFmax (t17 = 2.374, P = .03), ROM (t17 = 2.843, P = .01), and PRT (t17 = 2.982, P = .008). Both NDNG and FR led to improved performance on the straight-leg raise test (F1,17 = 87.514, P < .001). No interaction or main effect was found for the stress-relaxation test or active knee-joint position sense. Adding NDNG to the warm-up routine increased ROM more than FR and may benefit soccer players.

Assessment of the Maximal Range of Motion from Initial Sensation of Stretching to the Limits of Tolerance.

The aim of this study was to determine whether the first sensation of stretching (ROMFSS) may predict the maximum range of motion (ROMMAX) in male (N = 37) and female (N = 32) volunteer subjects, and to assess the reliability of the ROM perceived by subjects in relation to a pre-determined ROM (ROM50%). Subjects attempted three experimental sessions with 48 hours between sessions 1 and 2 and 28 days between sessions 1 and 3. Within each session, five trials were performed with isokinetic equipment to assess posterior thigh muscle flexibility. The results revealed a strong and significant correlation between ROMMAX and ROMFSS for both sexes, females (r = 0.96, p < 0.001, R2 = 0.92) and males (r = 0.91, p < 0.001; R2 = 0.82). The accuracy of the model verified by the standard error of estimate (SEE) was high in the equations proposed for both female (SEE = 4.53%) and male (SEE = 5.45%). Our results revealed that ROMFSS may predict the ROMMAX for both male and female subjects. The ROMFSS may contribute to the development of evaluation methods that do not subject the individuals to conditions that may include unnecessary risk of injury and is well suited to monitor the training process of stretching exercises with submaximal loads.

Effects of Nordic hamstring exercise combined with glider exercise on hip flexion flexibility and hamstring passive stiffness

ABSTRACT Eccentric training proved to be effective in hamstring injury prevention; however, little is known about effects of eccentric hamstring training at long muscle length on hamstring flexibility. Hence, the aim was to evaluate the effect of eccentric training at long muscle lengths on flexibility and passive properties of the hamstring muscles. 34 physically active young adults were randomized to either the control or intervention group (6 weeks of eccentric hamstring training at long muscle length; control group resumed with their usual activities). Maximal passive hip flexion range of motion (ROM), passive hamstring stiffness, shear modulus and tendon length of the biceps femoris long head (BFlh) were measured pre- and post-intervention. A significant time × group effect was observed for maximal passive hip ROM. Post-hoc testing revealed a significant increase in the intervention group (+11.2%; p < 0.001; d = 1.55). Additionally, a significant time effect was shown for shear modulus in a relaxed position (p < 0.001). No significant interaction was shown for other parameters. Results indicate that eccentric hamstring training at long muscle length elicits large gains in hamstring flexibility, which are most likely not related to changes in passive hamstring stiffness or BFlh distal tendon length.

Study on setup errors for different body carcinoma radiotherapy with image guidance in TOMO-HD

Objective The literature study the setup errors of head and neck, thoracic, abdominal and pelvic tumors by megavoltage fan-beam CT based image guidance in TOMO-HD to provide the margin enlarging from clinic target volume (CTV) to planning target volume (PTV) in treatment planning system of TOMO-HD. Methods 103 patients with head and neck (30 patients), thoracic (42 patients), abdominal and pelvic (31 patients) carcinoma were enrolled. Megavoltage fan-beam CT based image guidance in tomotherapy-HD was used to acquire CT scan before every treatment. The left-right (X), superior-inferior (Y), anterior-posterior (Z) and rotation (Fy) setup errors of patients can be obtained from the tomography image automatically restructured by the system. Calculating the systematic error and the random error in the three dimensions and check whether the setup data accord with the normal distribution or not, then acquire the data expand in the three directions. Results According to 2 593 fan-beam CT scans, the shift errors (µ ± s) in X, Y, Z and Fy (rotation) of three study group were [(−0.31 ± 2.16) mm, (1.09 ± 3.56) mm, (2.36 ± 2.27) mm, (0.29 ± 0.96)°] (head and neck tumor), [(−0.98 ± 2.95) mm, (0.45 ± 6.86) mm, (3.79 ± 2.47) mm, (0.18 ± 0.60)°] (thoracic cancer) and [(−0.86 ± 2.85) mm, (−1.59 ± 6.91) mm, (5.77 ± 2.40) mm, (0.20 ± 0.68)°] (abdominal and pelvic carcinoma). The systematic errors (Σ) and random errors (σ) in X, Y, Z dimensions of patients with head and neck, thoracic, abdominal and pelvic tumors were (1.06 mm and 1.84 mm), (1.93 mm and 3.43 mm), (2.41 mm and 2.71 mm), (1.10 mm and 2.56 mm), (3.79 mm and 5.46 mm), (1.38 mm and 1.99 mm) and (1.39 mm and 0.87 mm), (4.98 mm and 5.69 mm), (1.19 mm and 2.05 mm), respectively. Conclusion It is recommended as a reference for image guidance in TOMO-HD according to the frequency distribution of setup errors, for patients with head and neck, chest and abdominal and pelvic tumors, the maximum range of motion in three dimensions are (5.00, 5.00, 5.00) mm, (6,63, 17.25, 16.00) mm and (6.49, 16.24, 13.60) mm. 摘要： 目的 利用 TOMO-HD 螺旋加速器的 MV 级扇形束 CT 研宄头颈部、胸部、腹盆部肿瘤在放疗中的摆位误差, 为 PTV 边界的外扩提供数据支持。 方法 采用 TOMO-HD 螺旋断层系统分别对 30 例头颈部、42 例胸部和 31 例腹盆 部肿瘤患者每次放疗前行 MV 级扇形束 CT 扫描, 系统自动重建图像并与治疗计划 CT 图像进行配准, 获得患者左右 (X 轴)、头脚 (Y 轴)、腹背 (Z 轴)、沿Y轴方向的旋转 (Fy) 方向的摆位误差。计算出X、Y、Z方向的系统误差(Σ) 和随 机误差(σ)并对摆位误差进行正态性检验, 计算出 PTV 的各方向外扩边界。 结果 共行 2 593 次扫描, 头颈部、胸部、腹盆部患者在 X 轴、Y 轴、Z轴、Fy 方向 (沿 Y 轴方向的旋转) 的摆位误差 (µ ± s) 分别为 [(−0.31 ± 2.16)mm、(1.09 ± 3.56)mm、(2.36 ± 2.27)mm、(0.29 ± 0.96)°], [(−0.98 ± 2.95)mm、(−0.45 ± 6.86)mm、(3.79 ± 2.47)mm、(0.18 ± 0.60)°] 和 [(−0.86 ± 2.85)mm、(−1.59 ± 6.91)mm、(5.77 ± 2.40)mm、(0.20 ± 0.68)°]。头颈部、胸部、腹盆部患者在 X 轴、Y 轴、Z轴方向的系统误差(Σ)和随机误差(σ)分别为 (1.06 mm 和 1.84 mm)、(1.93 mm 和 3.43 mm)、(2.41 mm 和 2.71 mm)、(1.10 mm 和 2.56 mm)、(3.79 mm 和 5.46 mm)、(1.38 mm 和 1.99 mm) 和 (1.39 mm 和 0.87 mm)、(4.98 mm 和 5.69 mm)、(1.19 mm 和 2.05 mm)。 结论 根据不同部位的摆位误差频数分布, 头颈部、胸部、腹盆部不同 部位肿瘤患者的靶区在三维方向上最大运动范围参考值为 (5.00, 5.00, 5.00)mm, (6.63, 17.25, 16.00)mm 和 (6.49, 16.24,13.60)mm, 推荐以此作为图像引导参考。

Analysis of the Sagittal Motion Posture of the Acromioclavicular Joint Using Image Registration and Axial Angle Representation.

ObjectiveThis study aimed to directly and accurately measure the range of motion of the acromioclavicular joint through 3D reconstruction and image registration.MethodsThirteen healthy volunteers participated in the study. Computerized tomography (CT) was used to measure the acromioclavicular joint in four different motion poses. The images were integrated using reconstruction and registration technology, and the rotation angle range of the acromioclavicular joint was measured using 3D reconstruction. The measurements were expressed by axial angle representation. The dominant and the non-dominant sides were compared, and the difference in the axial angle of the acromioclavicular joint was compared in different postures.ResultsThe difference between the dominant and non-dominant sides in acromioclavicular motion was not significant. In the sagittal motion of the upper limb, the rotation angle of the acromioclavicular joint was greatest in a resting horizontal position, with an average of 26.1°. In this position, 34.6% of flexion and extension movements of the upper limb were completed by the acromioclavicular joint, which was the highest level of engagement. The rotation angle was lowest in the resting posteroinferior position, with an average of 8.2°. In this position, 24.9% of the flexion and extension movements of the upper limb were completed by the acromioclavicular joint.ConclusionCombining 3D reconstruction and image registration is a direct and accurate method of measuring the motion of the acromioclavicular joint. The rotational motions of the acromioclavicular joint are bilaterally symmetrical and can be used as a reference for comparative study. The maximum range of motion of the acromioclavicular joint during rotation was found in the resting horizontal position. The clinical examination and post-treatment evaluation of the acromioclavicular joint’s rotation function can therefore be targeted in this range.

Developing flexibility for combat sports athletes

The range of motion of a joint is extremely important in combat sports, especially when there is a need to execute a certain motor gesture with maximum range of movement, as in throwing techniques such as uchi-mata in judo, certain types of guards in Brazilian jiu-jitsu or the high kicks common in a variety of striking combat sports. Therefore, in this chapter, we will discuss the elements related to flexibility response during training sessions or combat sports competitions, flexibility tests commonly used for these athletes, and the monitoring and control of the evolution of flexibility in athletes. We will also present the means and methods used for the development of flexibility and longitudinal studies on the development of flexibility in combat sports athletes. Finally, this chapter supports based on the evidence the inclusion of flexibility development within training sessions is an important consideration to maximize performance and other physical capabilities that may be affected both acutely or in the long-term by flexibility.