Abduction Movements Research Articles

Assessment of Hip Abduction Motion Assistance Using a Single-Joint Hybrid Assistive Limb Robot: Feasibility and Safety Evaluation in Healthy Adults

Background/Objectives: Preoperative muscle atrophy leads to persistent gait abnormalities in patients undergoing total hip arthroplasty (THA). Efficient motor learning of the gluteus medius is crucial for their recovery. In this study, a single-joint hybrid assistive limb (HAL) was developed to assist hip abduction. We aimed to evaluate the muscle activity and safety of this device during hip abduction in healthy adults. Methods: Ten healthy adults (five males and five females; mean age, 40.7 years) with no hip disorders performed one set of 30 repetitions of side-lying hip abduction under three conditions: without HAL (pre-HAL), with HAL, and without HAL (post-HAL). Muscle activities of the gluteus medius, gluteus maximus, tensor fasciae latae, rectus femoris, and biceps femoris (expressed as percentage of maximum voluntary contraction [%MVC]); vital signs; hip visual analog scale (VAS); and hip abduction and flexion angles were assessed. The mean values were compared among the conditions. Results: The %MVC of the gluteus medius significantly increased from 52% (pre-HAL) to 75.4% (HAL) and then decreased slightly to 61.6% (post-HAL). No other muscle groups showed significant changes. Vital signs and hip VAS scores showed no significant variation. Although no significant differences were found in the hip abduction and flexion angles, a reduction in the hip flexion angle was observed in the HAL and post-HAL conditions. Conclusions: The hip abduction HAL effectively and safely enhanced gluteus medius activity. Reduction in the hip flexion angle during HAL and post-HAL suggests the possibility of appropriate abduction movements and motor learning effects.

Health-related quality of life after Dega pelvic osteotomy and varus derotation osteotomy due to spastic hip disease in children with cerebral palsy.

Our study aimed to present health-related quality of life (HRQL) after combined bone reconstruction in nonambulatory patients with cerebral palsy (CP) after at least a 2-year follow-up and to assess its impact on HRQL using the Caregiver Priorities and Child Health Index of Life with Disabilities questionnaire (CPCHILD) as the primary outcome measure. In this prospective study, we analyzed 31 nonambulatory patients with spastic or mixed CP (GMFCS levels IV-V) who underwent hip reconstructive surgery between 2015 and 2021. The surgical procedures included one-sided varus derotation osteotomy of the femur with Dega transiliac osteotomy and, on the opposite side, varus derotation osteotomy (VDRO) of the femur with shortening and, as needed, Dega pelvic osteotomy. The study demonstrated significant improvement in the hip joint motion range, as assessed by the Thomas test, in hip abduction and rotational movements of the hip, as well as reduction of spasticity. The procedures also resulted in significant radiographic improvement of the femoral head coverage. The assessment of symptoms and problems associated with the hip revealed a positive influence of the surgery on pain, contractures, toileting/perineal hygiene, dressing, seating, transferring, and position changes. The mean improvement at a follow-up visit was significant in all domains of the CPCHILD, except for communication and social interaction. Hip reconstruction with VDRO and Dega pelvic osteotomy can enhance the HRQL of children with CP. These surgical interventions can help to achieve the correct hip position and to reduce pain, which positively affects the patient QL, although proactive treatment results in less invasive procedures. IV case series.

Association of Antihypertensive and Statin Medication Usage With Postoperative Stiffness After Arthroscopic Rotator Cuff Repair: A Retrospective Cohort Study.

Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and statins may be able to modulate postoperative stiffness, a major cause of morbidity after arthroscopic rotator cuff repair (aRCR). To determine whether there is an association between ACEi, ARB, or statin usage and stiffness after aRCR. Cohort study; Level of evidence, 3. Patients who underwent primary aRCR between January 2016 and December 2019 were categorized into 4 groups depending on the usage of ACEi (n = 45), ARB (n = 27), statins (n = 53), or none of these medications (controls; n = 113). Range of motion in flexion, abduction, internal rotation (IR), and external rotation (ER) was recorded preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Functional outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Simple Shoulder Test (SST) preoperatively and at 1 and 2 years postoperatively. The groups were compared using t test or Mann-Whitney U test for continuous data and chi-square or Fisher exact test for categorical data. Preoperatively, compared with controls, the ACEi group had decreased flexion (P = .038), abduction (P = .001), ER (P = .009), and IR (P = .015); the ARB group had decreased abduction (P = .012) and IR (P = .019); and the statins group had decreased abduction (P = .015), ER (P = .008), and IR (P = .011). Postoperatively, compared with controls, the ACEi group had decreased 6-month abduction (P = .034) that resolved by 12 months and 3-month ER (P = .004) that persisted into 6 months, the ARB group had greater ER at 12 months (P = .006), and the statins group had increased 6-week abduction (P = .017) that normalized by 3 months. Patients taking ACEi had lower postoperative ASES (30 vs 58.6; P = .001) and SANE scores (28.4 vs 52.3; P = .002) at 1 year and lower SST scores at 2 years (74.7 vs 85.5; P = .002) versus controls. Patients who used ACEi showed an increased risk of stiffness 6 months postoperatively and had worse SST scores at 2 years after aRCR, while those who used ARB demonstrated improved postoperative ER and IR, with no changes in functional outcomes at longer-term follow-ups.

Surgical Treatment of Obstetric Plexus Lesions by Direct Coaptation Compared to Sural Nerve Graft Interposition.

Background To date, there are no uniform guidelines for the treatment of obstetric plexus lesions in German-speaking countries. An end-to-end direct suture after resection of trunk neuroma is recommended for surgical treatment if tension-free coaptation is possible, whereas the use of autologous nerve grafts bridging the gap between the adaptation margins is advised by consensus if tension-free coaptation is impossible. Objective The aim of the study was to investigate which reconstruction strategy may provide a better recovery of motor function for patients after obstetric brachial plexus lesion. Methods This study compared postoperative functional outcome after obstetric brachial plexus palsy from a patient collective including a total of 43 children. The surgical techniques of plexus reconstruction by end-to-end coaptation versus the use of sural nerve interposition graft have been analyzed. Therefore, the degrees of active motion of abduction and external rotation in the shoulder joint, and flexion in the elbow joint were assessed using the neutral zero method. Results For abduction in the shoulder joint, significantly better motor function was found in the group with direct sutures ( p = 0.033). For external rotation in the shoulder joint and flexion in the elbow joint, there was no statistically significant difference between the groups ( p = 0.284 and p = 0.270, respectively). Conclusions This study could not demonstrate absolute superiority of either reconstruction method. Slight evidence was found for a better functional outcome for plexus reconstruction by direct coaptation. Further arguments support a better suitability of plexus reconstruction by direct suture if its use is justifiable.

Validity Analysis of Monocular Human Pose Estimation Models Interfaced with a Mobile Application for Assessing Upper Limb Range of Motion.

Human Pose Estimation (HPE) is a computer vision application that utilizes deep learning techniques to precisely locate Key Joint Points (KJPs), enabling the accurate description of a person's pose. HPE models can be extended to facilitate Range of Motion (ROM) assessment by leveraging patient photographs. This study aims to evaluate and compare the performance of HPE models for assessing upper limbs ROM. A physiotherapist evaluated the degrees of ROM in shoulders (flexion, extension, and abduction) and elbows (flexion and extension) for fifty-two participants using both Universal Goniometer (UG) and five HPE models. Participants were instructed to repeat each movement three times to obtain measurements with the UG, then positioned while photos were captured using the NLMeasurer mobile application. The paired t-test, bias, and error measures were employed to evaluate the difference and agreement between measurement methods. Results indicated that the MoveNet Thunder INT16 model exhibited superior performance. Root Mean Square Errors obtained through this model were <10° in 8 of 10 analyzed movements. HPE models demonstrated better performance in shoulder flexion and abduction movements while exhibiting unsatisfactory performance in elbow flexion. Challenges such as image perspective distortion, environmental lighting conditions, images in monocular view, and complications in the pose may influence the models' performance. Nevertheless, HPE models show promise in identifying KJPs and facilitating ROM measurements, potentially enhancing convenience and efficiency in assessments. However, their current accuracy for this application is unsatisfactory, highlighting the need for caution when considering automated upper limb ROM measurement with them. The implementation of these models in clinical practice does not diminish the crucial role of examiners in carefully inspecting images and making adjustments to ensure measurement reliability.

Neuroadaptive Control of a Continuum Robot for Finger Rehabilitation

This study has designed an easy-to-wear parallel continuum robot-based hand rehabilitation system that supports and enhances the finger’s flexion, extension, abduction, and adduction movements. The primary novelty of the proposed system lies in its ability to focus therapeutic exercises on a single joint, a feature not commonly found in existing rehabilitation robots. A kinematic model of the system was developed, and to perform both kinematic and dynamic analyses, a multibody model was constructed in the MATLAB Simulink environment. Joint angle control was implemented using a nominal controller, and to account for individual uncertainties in joint dynamics, a neuroadaptive controller was integrated with the nominal controller. This approach aims for the neural network architecture to learn these uncertainties during control iterations and incorporate them into the control, resulting in a robust controller. Thus, a model reference control approach was proposed for active and passive rehabilitation processes. The system model was tested in a simulation environment, and then all tests were repeated in the physical system. The simulation and real system results include the real system’s open-loop responses, nominal controller responses for each joint, responses, and the results for active, passive, and assistive control modes.

Physical Performance Effects Associated with a 16-Week Therapeutic Yoga Intervention in Survivors of Cancers in the South Texas Region: A Pilot Study.

Yoga is recognized as a complementary practice that improves physical, mental, and spiritual health in survivors of cancer. The present study assessed associations between a holistic approach and physical function for 30 survivors of cancer in south Texas. Cancer survivors (86% female) of diverse backgrounds (62% underrepresented minorities) performed a battery of physical function tests, including a 6-minute walk test, to assess cardiorespiratory function, isometric shoulder and elbow-flexor strength, dominant-arm grip strength, dominant-arm shoulder range of motion via inclinometer, sit-and-reach test to assess trunk and lower-extremity flexibility, and a 30-second sit-to-stand test to assess lower-extremity endurance. Participants were reassessed 16 weeks after starting the intervention. The intervention involved a 75-minute live-streamed therapeutic yoga program, including meditation, three times a week and daily psychosocial support text messaging through a telehealth platform to increase efficacy in promoting health-enhancing behaviors. Repeated-measures analysis of variance was used to assess changes in physical performance between sessions. Statistically significant improvements were observed for the 6-minute walk test (+35.68 m; p = 0.020), elbow-flexor strength (+7.44 kg; p < 0.001), dominant-hand grip strength (+3.19 kg; p < 0.004), sit-and-reach test (+5.25 cm; p = 0.010), and dominant-arm shoulder range of motion in flexion (+11.18 degrees, p = 0.012) and abduction (+17.06 degrees, p = 0.036). A 16-week live-streamed therapeutic yoga intervention performed three times a week, coupled with daily psychosocial support messaging, was associated with improved cardiorespiratory endurance by increasing the distance walked in 6 minutes, improving upper-extremity strength and range of motion, and increasing the flexibility of back and hamstring muscles.

Effect of Structured Core Stabilization Exercise Program on Pain and Muscle Performance in Individuals with Scapular Dyskinesia

Purpose: The purpose of this research was to determine the effect of structured core stabilization exercise program on pain and muscle performance in individuals with scapular dyskinesis. Methods: The study commenced obtaining ethical clearance from an institutional committee, briefing participants about the research and intervention, and obtaining informed consent. In accordance with the inclusion and exclusion criteria, 90 participants were enrolled for the research among which 80 participants enrolled in this study and were allocated into 2 groups at random- Group A (Control group) as well as Group B (Experimental group) by using the envelope method. Treatment was provided for about 6 weeks to both groups.Pre and post test examination was done using Individual Muscle Testing (IMT), core strength testing with Pressure Biofeedback (PB), shoulder joint range of motion (ROM) with Goniometry, in addition with Visual Analogue Scale (VAS) for pain. Statistical methods were utilised to analyse the results. Findings: This research found substantial improvements in pain, individual muscle testing and shoulder range of motion for flexion and abduction in two groups (p-value &amp;lt;0.0001), whereas, for internal and external rotation, group A showed p value of 0.0193 and 0.0098, whereas, group B showed p value of &amp;lt;0.0001 and 0.2399.Group B showed more improvement in pressure biofeedback unit (p&amp;lt;0.0001) as compared to Group A (p value 0.0208). Conclusion: The present research observed that a structured core stabilization exercise program had shown a significantly enhanced improving muscle performance and reducing pain in individuals with scapular dyskinesis.

Biological total hip arthroplasty combined with impacting bone grafting for the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis

To explore the surgical technique and clinical outcomes of biological total hip arthroplasty(THA) combined with impacting bone grafting for the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis(RA). Total of 20 patients(28 hips) with RA secondary to acetabular invagination were treated with THA of bioprosthesis combined with autogenous bone grafting from January 2012 to October 2020, including 5 males(8 hips) and 15 females(20 hips) with an average age of (55.10±4.96) years old from 45 to 64 years old. The depth of acetabular invagination was 8.43 to 16.25 mm with an average of (11.91±2.59) mm. According to Sotello-Garza and Charnley classification criterion, there were 15 cases(23 hips) of type Ⅱ(protrusio acetabuli 6 to 15 mm), and 5 cases(5 hips) of type Ⅲ(protrusio acetabuli>15 mm). Autologous femoral head granular bone and(or) allograft impacting grafting were used to reconstruct the acetabum, the biological porous acetabular cup was fixed by pressure fitting. At the postoperative follow-up, the activity function of the hip joint, the length of both lower limbs, VAS and Harris score were evaluated, and the healing of bone graft, the restoration of the hip rotation center and loosening of prosthesis were assessed by X-ray. The operation time was 75 to 160 min with anverage of (103.32±18.18) min, the intraoperative blood loss was 150 to 650 ml with an average of (319.64±122.61) ml. There were no neurovascular complications during the operation. All patients were followed up from 2 to 10 years with an average of (5.45±2.50) years. The horizontal distance between the center of femoral head and the Kohler's line was increased from (11.40±1.85) mm preoperatively to (25.99±2.56) mm at the final follow-up(P<0.01), and the vertical distance between the center of femoral head and the line joining bilateral ischial tuberosities was decreased from (89.36±5.20) mm preoperatively to (71.84±3.55) mm at the final follow-up(P<0.01). The range of flexion motion of hip joint increased from (44.43±10.57)° preoperatively to (98.75±12.52)° at the final follow-up(P<0.01), the range of abduction motion of hip joint increased from (12.50 ±6.01)°preoperatively to final follow-up (32.82±5.39)°(P<0.01). The discrepancy of both lower limbs was significantly decreased from (19.39±5.93) mm preoperatively to (6.64±2.87) mm at the final follow-up(P<0.01). The VAS decreased from (5.36±0.78) preoperatively to (1.82±0.86) at the final follow-up(P<0.05), and the Harris score increased from (41.39±7.77) preoperatively to (89.00±4.67) at the final follow-up(P<0.01). All the patients could move independently without assistance. Among them, 2 patients(2 hips) had hip pain after exercise, and 1 patient(1 hip) suffered from periprosthetic fracture due to fall. Autologous femoral head granular bone grafting can reconstruct the acetabulum, and restore the rotation center of the hip joint, combined with biological porous tantalum/titanium acetabular cup can achieve good short-and medium-term outcomes in the treatment of moderate to severe acetabular invagination secondary to rheumatoid arthritis.

Simulation of hip bony range of motion (BROM) corresponds to the observed functional range of motion (FROM) for pure flexion, internal rotation in deep flexion, and external rotation in minimal flexion-extension – A cadaver study

BackgroundThe study investigated the relationship between computed bony range of motion (BROM) and actual functional range of motion (FROM) as directly measured in cadaveric hips. The hypothesis was that some hip movements are not substantially restricted by soft tissues, and therefore, computed BROM for these movements may effectively represent FROM, providing a reliable parameter for computational pre-operative planning. MethodsMaximum passive FROM was measured in nine cadaveric hips using optical tracking. Each hip was measured in at least ninety FROM positions, covering flexion, extension, abduction, flexion-internal rotation (IR), flexion-external rotation (ER), extension-IR, and extension-ER movements. The measured FROM was virtually recreated using 3D models of the femur and pelvis derived from CT scans, and the corresponding BROM was computed. The relationship between FROM and BROM was classified into three groups: close (mean difference<5°), moderate (mean difference 5–15°), and weak (mean difference>15°). ResultsThe relationship between FROM and BROM was close for pure flexion (difference = 3.1° ± 3.9°) and IR in deep (>70°) flexion (difference = 4.3° ± 4.6°). The relationship was moderate for ER in minimal flexion (difference = 10.3° ± 5.8°) and ER in minimal extension (difference = 11.7° ± 7.2°). Bony impingement was observed in some cases during these movements. Other movements showed a weak relationship: large differences were observed in extension (51.9° ± 14.4°), abduction (18.6° ± 11.3°), flexion-IR at flexion<70° (37.1° ± 9.4°), extension-IR (79.6° ± 4.8°), flexion-ER at flexion>30° (45.9° ± 11.3°), and extension-ER at extension>20° (15.8° ± 4.8°). ConclusionBROM simulations of hip flexion, IR in deep flexion, and ER in low flexion/extension may be useful in dynamic pre-operative planning of total hip arthroplasty.

The Pericoracoid Tissue Release in Children With Brachial Plexus Birth Injury

In brachial plexus birth injury (BPBI), children with upper trunk injuries have multidirectional movement deficits, including global abduction and hand-to-neck, hand-to-abdomen, and hand-to-spine movements. The aim of this study was to evaluate the results of pericoracoid tissue release and postoperative structured physiotherapy as a first-step intervention to reduce the multidirectional movement deficit in children with BPBI. Thirty-four children with BPBI underwent pericoracoid tissue release, including coracohumeral and coracoacromial ligament release, pectoralis minor release, and coracoid process osteotomy. Patients were followed up with regular physiotherapy and a home exercise program for 1 year after surgery. Before surgery and at 3 and 12 months after surgery, upper-extremity function was measured using the modified Mallet classification and Active Movement Scale, passive shoulder and elbow joint movements were measured using goniometry, and the difference in the distance between the treatment table and the acromion was measured. There was an improvement in all movement tasks evaluated with modified Mallet classification, and there was increased shoulder flexion, abduction, and external and internal rotation movements as evaluated with Active Movement Scale. Increased passive joint movements were noted in abduction, external rotation, and internal rotation movements with the arm next to the body and with the limb in 90° abduction. There was a decrease in the distance difference between the acromion and the treatment table between both sides. Pericoracoid tissue release provided multidirectional improvement in shoulder joint movements in children with BPBI. Therapeutic IV.

Coracoacromial ligament integrity influences scapular spine strain after reverse shoulder arthroplasty

BackgroundThe purpose of this biomechanical study was to examine the effect of coracoacromial (CA) ligament state (intact vs. released) and arm position on acromial and scapular spine strain following reverse total shoulder arthroplasty (rTSA). MethodsEight cadaveric shoulders were implanted with a custom rTSA system and tested using an in-vitro shoulder simulator. The specimens were cycled through static range of motion in both abduction and forward elevation; first with the CA ligament in the “intact” state followed by the “released” state. Scapular spine strain was quantified via four strain gauges placed along anatomic locations on the acromion and scapular spine. ResultsIncreases in strain were observed across all four strain gauge locations upon release of the CA ligament in both 0° of abduction and forward elevation. Increases in the mean strain were observed to be as great as 14% in abduction and 31% in forward elevation The increases in strain at 0° elevation approached but did not reach statistical significance (P≥0.072). At 90° of abduction and forward elevation, no increases in the mean strain were observed. The greatest strain was consistently observed with the arm positioned in 0° of forward elevation (P<0.001). DiscussionCA ligament release in the setting of rTSA resulted in increased scapular spine and acromial strain with the arm adducted, although these increases in strain were not statistically significant. Caution should be taken intraoperatively as the release of the CA ligament may alter scapular spine and acromion stresses from deltoid loading, which may increase the risk for postoperative scapular spine fracture.

Does minimally invasive external fixation of proximal humerus fractures provide adequate stability? A biomechanical in vitro study

IntroductionProximal humerus fractures are usually treated with rigid angle-stable plates or nails. As an alternative, semi-rigid, minimally invasive systems have been developed for supportive fixation. A new system uses this principle with 2.5 mm partially threaded pins and external fixation.AimThis study aimed to compare the fracture stability of the fixator with an angular stable plate about whether the mechanical stability is sufficient for early postoperative mobilisation.Materials and methodsHuman proximal humeri (paired, female, age ≥ 60, n = 8) were cut to a 3-part fracture and treated with an external fixator (Galaxy Shoulder, Orthofix) or an angular stable plate (Philos, DePuy Synthes). A physiological load was simulated in vitro based on a 45° abduction motion. The load level was continuously increased from 10 to 320 N within 10,000 cycles simulating the loads during rehabilitation. This was followed by another 10,000 cycles at 320 N for fatigue testing. Fracture motion was recorded with a 3D camera. Fracture stability was evaluated at a partial load of 160 N and 240 N (simulating loads during early mobilisation).ResultsThe fracture motion at the lateral aspect was significantly (p < 0.034) larger for the fixator compared to the plate both for axial and for shear movements, while at the medial aspects fracture motions were similar. Both fixation systems adequately stabilized the lateral tubercle fragment with no significant differences between fixation techniques. The migration of the fixator pins (1.1 ± 1.0 mm) and valgus rotation of the head fragment were minimal (3.1 ± 2.0°). The maximum load level of 320 N was reached by all plate constructs and 3 fixator constructs.ConclusionOur results suggest that the external fixator system allows early but gentle postoperative mobilisation. More aggressive rehabilitation measures should be postponed after the healing of the fracture.

Clinical study on the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence

To explore the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence. Ninety stroke patients during convalescence were collected and randomized into scalp point group, robot training group and combined intervention group, with 30 cases each. In the scalp point group, the cluster needling was delivered at scalp points with the needles retained. In the robot training group, the patients were trained with the upper-limb intelligent rehabilitation robot. In the combined intervention group, the patients received both the cluster needling and the training of the upper-limb intelligent rehabilitation robot. In each group, the treatment was given once daily, 5 treatments a week with 2 days rest, for consecutive 4 weeks. Separately, before and after treatment, the score of Fugl-Meyer assessment upper extremity scale (FMA-UE) and the score of activity of daily living (ADL) were evaluated. Using the in-built assessment system of the upper-limb intelligent rehabilitation robot, the range of motion (ROM) of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint were evaluated. With surface electromyogram (sEMG), the sEMG value of the deltoid muscle and the pectoralis major on the affected side were detected. Compared with the values before treatment, ADL score and FMA-UA score increased in patients of the three groups (P<0.05), and ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint was larger (P<0.05), the sEMG value of the fasciculi pectoralis major anterior of patients in the combined intervention group was reduced (P<0.05), and the sEMG of anterior deltoid tract was elevated in the three groups (P<0.05). When compared with the scalp point group and the robot group, in the combined intervention group, after treatment, ADL score and FMA-UA score were higher (P<0.05), ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint elevated (P<0.05) and sEMG value of the fasciculi pectoralis major anterior reduced (P<0.05), while which of the anterior deltoid tract was elevated (P<0.05). The cluster needling at scalp points with needle retaining, combined with the training of the upper-limb intelligent rehabilitation robot, improves the upper limb motor function and the range of motion of the shoulder joint in stroke patients during convalescence.

Home-based guidance training system with interactive visual feedback using kinect on stroke survivors with moderate to severe motor impairment

The home-based training approach benefits stroke survivors by providing them with an increased amount of training time and greater feasibility in terms of their training schedule, particularly for those with severe motor impairment. Computer-guided training systems provide visual feedback with correct movement patterns during home-based training. This study aimed to investigate the improvement in motor performance among stroke survivors with moderate to severe motor impairment after 800 min of training using a home-based guidance training system with interactive visual feedback. Twelve patients with moderate to severe stroke underwent home-based training, totaling 800 min (20–40 min per session, with a frequency of 3 sessions per week). The home-based guidance training system uses Kinect to reconstruct the 3D human body skeletal model and provides real-time motor feedback during training. The training exercises consisted of six core exercises and eleven optional exercises, including joint exercises, balance control, and coordination. Pre-training and post-training assessments were conducted using the Fugl-Meyer Assessment-Upper Limb (FMA-UE), Fugl-Meyer Assessment-Lower Limb (FMA-LE), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Barthel Index (BI), Modified Ashworth Scale (MAS), as well as kinematic data of joint angles and center of mass (COM). The results indicated that motor training led to the attainment of the upper limit of functional range of motion (FROM) in hip abduction, shoulder flexion, and shoulder abduction. However, there was no improvement in the active range of motion (AROM) in the upper extremity (U/E) and lower extremity (L/E) joints, reaching the level of the older healthy population. Significant improvements were observed in both left/right and superior/inferior displacements, as well as body sway in the mediolateral axis of the COM, after 800 min of training. In conclusion, the home-based guidance system using Kinect aids in improving joint kinematics performance at the level of FROM and balance control, accompanied by increased mediolateral body sway of the COM for stroke survivors with moderate to severe stroke. Additionally, spasticity was reduced in both the upper and lower extremities after 800 min of home-based training.

Posture Estimation Model Combined With Machine Learning Estimates the Radial Abduction Angle of the Thumb With High Accuracy.

The thumb function is complex, and accurate evaluation through images or videos is difficult. Pose estimation, a technology that uses artificial intelligence (AI) to estimate skeletal detection of the body, is gaining popularity.In this study, we combined the pose estimation library MediaPipe-Hands and five machine learning (ML) models to predict the radial abduction angle of the thumb.Radial abduction movements of 20 hands from 10 healthy volunteers were captured on video and processed into 5,000 images. Angle measurements by goniometer were used as true values to evaluate the angle reliability of the MediaPipe-Hands and the angle reliability of the MediaPipe-Hands combined with ML. The correlation coefficient (CC) between the angle measured by goniometry and the angle calculated by MediaPipe-Hands was 0.84. In contrast, applying ML to MediaPipe-Hands resulted in models with improved accuracy, and all models showed high CCs (0.94-099) with angle measurements taken by goniometry. The ML model also predicted the abduction angles when the camera was taken from three different angles. In visualizing the features that the AI deemed important, the ML model predicted the abduction angle by focusing on the tip distance between the thumb and index finger along with the angle of the metacarpophalangeal joint between the thumb and middle finger. These results enable angle estimation even without frontal imaging with a camera, and expansion of this system may lead to real-time functional assessment in telemedicine and rehabilitation without the need for physical contact.

SPORTS CUPPING FOR SUPRASPINATUS TENDINOSIS: A CASE STUDY

Supraspinatus tendinosis is a common source of shoulder pain. This tendinopathy is in most cases caused by an impingement of the supraspinatus tendon on the acromion as it passes between the acromion and the humeral head. Pain, and a decrease in range of motion, strength and functionality are the main complaints that accompany this injury. Being one of the well-established techniques, Sports wet cupping therapy (WCT) was used to treat a case of Supraspinatus tendinosis in this study. This paper aims to report the improved case of supraspinatus tendinosis using the treatment with sports cupping. We used sports cupping therapy for treatment of this patient. This case is measured and assessed by visual analogue scale (VAS), shoulder range of motion (ROM) and shoulder physical examination. Results show the VAS decreased from 10 to 1 and the patient showed nearly full shoulder range of motion in forward flexion, abduction, extension, internal rotation and external rotation. In addition, the physical examination of shoulder and MRI was improved. Sports cupping treatment with wet cupping therapy is found to be helpful to relieve pain and recover function of shoulder joint.

Magnetic stimulation of the abducens nerve reduces sixth nerve palsy after brain hemorrhage: case series

Magnetic stimulation has been explored for various neurological disorders, yet its application for abducens nerve paralysis, which often results from brain hemorrhage and severely impairs ocular mobility and quality of life, remains unclear. The report included three cases of eye abduction disorders secondary to brain hemorrhage: two brainstem and one temporal lobe hemorrhage. All cases were treated with 1 -Hz magnetic stimulation applied to the abducens nerve for 4–10 days, according to their medical history and clinical manifestations. All cases showed immediate significant improvements in ocular abduction movements following treatment. Walking function, hand-eye coordination, and daily living activities were also significantly enhanced, with a notable increase in self-reported life satisfaction. These cases suggest that magnetic stimulation might offer a promising avenue for treating abducens nerve paralysis, especially where traditional approaches prove ineffective. The observed outcomes highlight the versatility of magnetic stimulation as a treatment modality and its potential applicability to other cranial nerve dysfunctions. This case series underscores the potential efficacy of magnetic stimulation in treating abducens nerve paralysis, warranting more extensive studies to establish its safety, optimal parameters, and long-term benefits.

Isolated humeral distalization in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study

BackgroundHumeral distalization is inherent to reverse total shoulder arthroplasty (rTSA) and is often produced with concomitant humeral lateralization via the level of the humeral head cut, implant positioning, implant neck shaft angle, and polymer insert thickness. Biomechanical data on the isolated effects of humeral distalization remain limited but could be important to consider when optimizing postoperative rTSA shoulder function. This study investigated the effects of isolated humeral distalization on shoulder biomechanics using a biorobotic shoulder simulator. MethodsEight fresh-frozen cadaveric shoulders were tested using custom polymer inserts that translated the bearing surface 0, +5, +10, and +15 mm along the humeral stem axis, producing isolated distalization without lateralization. Specimens underwent passive elevation in the scapular plane with a static scapula to assess glenohumeral range of motion. Scapular plane abduction motion trajectories were then performed, driven by previously collected scapulothoracic and glenohumeral kinematics from rTSA patients. The effect of isolated distalization on passive elevation was tested using mixed-effects linear regression and the effect on muscle force, joint reaction force, and muscle excursion during active scapular-plane abduction was tested using statistical parametric mapping random effects analysis. ResultsMaximum passive scapular plane elevation increased with humeral distalization (4° per 5 mm distalization). During active elevation, deltoid and rotator cuff muscle forces, and joint reaction forces, increased up to 37% per 5 mm of distalization. Simulated deltoid muscle excursion was altered with increasing distalization but amounted to no more than 0.8 mm change from baseline per 5 mm of distalization. Rotator cuff muscles were consistently lengthened throughout abduction, up to 1.6 mm per 5 mm of distalization. These trends were observed across various patient motions. ConclusionsIsolated humeral distalization caused dramatic increases in the muscle forces required to perform scapular-plane abduction. Joint reaction forces increased correspondingly. These results suggest that implant and surgical strategies to generate deltoid muscle tension without humeral distalization may promote better active range of motion and more durable long-term outcomes over approaches that rely on distalization.

Treatment of acromioclavicular joint dislocation with looped steel plate and clavicular hook steel plate: recent therapeutic observation.

To compare the clinical efficacy of Endobutton-looped steel plate and clavicular hook steel plate in the treatment of acromioclavicular joint dislocation. The retrospective case-control study was conducted at the Baoding Forensic Hospital, Hebei University, China and comprised data from January 2022 to June 2023 of adult inpatients of either gender with acromioclavicular joint dislocation. The data was divided into intervention group A and control group B. Group A patients had been treated with Endobutton-looped steel plate, while those in group B had been treated using clavicular hook steel plate. Clinical efficacy, clinical indicators, Karlsson score for shoulder joint function, range of motion of the shoulder, and complications during 6-month follow-up were compared between the groups. Data was analysed using SPSS 26. Of the 50 patients, there were 25(50%) in group A; 15(60%) males and 10(40%) females with mean age 37.75±6.24 years (range: 19-58 years) and mean dislocation-to-visit time 2.52±0.61 days (range: 0-7 days). There were 25(50%) patients in group B; 16(64%) males and 9(36%) females with mean age 38.24±6.30 years (range: 18- 59 years) and mean dislocation-to-visit time 2.47±0.58 days (range: 0-6 days). The groups showed no significant differences (p>0.05). Clinical efficacy of group A was higher than that of group B (p<0.05). Group A showed shorter surgical duration and incisional length, and lower average treatment cost compared to group B(p<0.05). The shoulder joint function in group A was significantly better than group B (p<0.05). Post-treatment, the range of motion of abduction, external rotation and internal rotation in group A were superior to group B (p<0.05). Complications in the two groups showed no significant difference (p>0.05). Compared to clavicular hook steel plate, Endobutton-looped steel plate presented higher clinical efficacy, shorter surgical duration, smaller incision and lower treatment cost, which promoted the recovery of shoulder joint function and contributed to high therapeutic safety.