Musculoskeletal Structures Research Articles

Anabolic Steroid Use and Aortic Dissection in Athletes: A Case Series

The use of anabolic steroids in supraphysiologic doses has grown in the last decade as doping drugs in athletes. The high dose of anabolic-androgenic steroids (AAS) causes cardiomyopathy, hypertension, thrombosis, myocardial infarction (MI), weakness of connective tissue, and its sequelae such as tendon injury and aortic dissection. Dissection of the ascending aorta is an uncommon injury that has been recognized with increasing frequency in bodybuilders in recent years. It has been proposed that such cases commonly accompany the weakening of connective tissue and must be actively evaluated in the presence of anabolic steroid usage. We present a case series of isolated ascending aorta dissection in athletes who were bodybuilders. All cases were evaluated by transthoracic echocardiography (TTE) and laboratory exams. These cases also served as a reminder of the risks of ascending aorta dissection with AAS, especially in strength athletes who place high demands on their musculoskeletal structures. The results of the current study suggested that anabolic steroid abuse may be associated with detrimental effects on the myocardium represented as cardiomyopathy or atherosclerotic changes in the coronary artery as MI. These findings also strongly suggest that anabolic steroid treatment predisposes the individual to aortic dissection, especially when the patients are exercised.

Thoracic imaging finding of rheumatic diseases.

In the era of Precision Medicine, diagnostic imaging plays a key role in initial diagnosis and treatment response assessment in thoracic manifestation of various rheumatic disorders; resulting in increased dependency on imaging for treatment planning. Chest radiographs serve as a good initial screening tool for assessment of emergent and urgent thoracic conditions, e.g., pneumothorax, pulmonary edema, consolidation and pleural effusions. Cross-sectional imaging techniques, e.g., computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) are most commonly utilized to evaluate more detailed pulmonary and mediastinal manifestations of rheumatic conditions. Magnetic resonance imaging (MRI) and ultrasound are most commonly used in cardiovascular, neural and musculoskeletal structures. This review article aims to highly key common thoracic imaging findings of rheumatic disorders, highlighting imaging test of choice for the particular disorder.

663P Sarcopenia assessment in men with metastatic castration-resistant prostate cancer (mCRPC) undergoing radium 223 (Ra223) therapy

Osteosarcopenia is (i) an age-related, progressive loss of musculoskeletal structure and functionality, contributing to falls, fractures, and premature death, and (ii) amongst the detrimental consequences of having cancer and undergoing cancer therapy. While the complex interactions between bone and muscle health are being explored, efforts to diagnose and prevent osteosarcopenia in prostate cancer patients (pts) focus almost exclusively on bone health management. Ra223 is known to contribute to osteopenia, but there is a lack of studies on the impact of Ra223 on sarcopenia. We identified 52 men with mCRPC that had received ≥2 cycles of Ra223 between Feb 2015 and Dec 2019 at Odette Cancer Centre (Toronto, ON, Canada), and who had at least a baseline abdominopelvic CT scan (ie at the beginning of Ra223 therapy) and ≥1 follow-up CT scan. Using the contour tool of the eUnity imaging platform (Client Outlook Inc, Waterloo, ON, Canada), two independent assessors obtained the total contour area (TCA) and averaged Hounsfield units (HU) of the left and right psoas muscles at the level of the inferior endplate L3. We also calculated the Psoas Muscle Index (PMI) by dividing the TCA by the square of pts’ height in meters. Mixed-effects analysis was performed regarding the TCA, HU, and PMI measurements and according intra-patient changes across the following CT time points: ≤2 years before Ra223, baseline, and 6 and/or 12 months following start of Ra223. The TCA values measured by each assessor were highly correlated (r between 0.8991 and 0.9125 across the various time points). While there was a gradual psoas TCA and PMI decline over the entire study period analyzed (p=0.0020 for TCA, p=0.0028 for PMI), Ra223 therapy did not accelerate sarcopenia development. Similarly, Ra223 did not aggravate the gradual decline of psoas density (p<0.0001 for HU) seen over time. Ra223 does not appear to accelerate sarcopenia. Thus, the worsening of sarcopenia in men undergoing Ra223 is rather attributable to concurrent androgen deprivation therapy, amongst others.

Yoga and Physiotherapy

Yoga, as adjunctive remedy and a way of helping and maintaining wellness, offers a brilliant example of the mind-body connection. It has been proposed that yoga has various clinical and non-clinical applications in the physiotherapeutic method. This is mainly attributed to the degree of complication and multidimensionality of impacts that is apparent in both yoga workouts and physiotherapy as continuous progressions. Yoga exercises collective with physiotherapeutic progressions, both in clinical and nonclinical situations, can affect several body structures and systems such as the musculoskeletal, nervous, visceral, endocrine and immune structure. The aim of this study is to extant yoga's potential role in terms of the total physiotherapeutic process. The imaginary cross-fertilization of their mutual expectations would lead to various benefits in relationships of the patient mind-body relationship and general wellness. Consequently, this would indicate the possible incorporation of yoga with the physiotherapeutic process at the conceptual level. The probable integration of yoga's essence, such as beneficial effect on overall health.

Avoiding high-risk rotator cuff loading: Muscle force during three pull-up techniques.

Heavily loaded overhead training tasks, such as pull-ups are an effective strength training and rehabilitation exercise requiring high muscle forces maintained over a large range of motion. This study used experiments and computational modeling to examine loading patterns during three different pull-up variants and highlighted risks to vulnerable musculoskeletal structures. Optical motion tracking and a force platform captured kinematics and kinetics of 11 male subjects with no history of shoulder pathology, during performance of three pull-up variants-pronated front grip, pronated wide grip, and supinated reverse grip. UK National Shoulder model (UKNSM) simulated biomechanics of the shoulder girdle. Muscle forces and activation patterns were analyzed by repeated measures ANOVA with post-hoc comparisons. Motor group recruitment was similar across all pull-up techniques, with upper limb depression occurring secondary to torso elevation. Stress-time profiles show significant differences in individual muscle patterns among the three pull-up variants, with the most marked differences between wide grip and reverse grip. Comparing across techniques, latissimus dorsi was relatively more active in wide pull-ups (P<.01); front pull-ups favored activation of biceps brachii and brachialis (P<.02); reverse pull-ups displayed higher proportional rotator cuff activation (P<.01). Pull-ups promote stability of the shoulder girdle and activation of scapula stabilizers and performing pull-ups over their full range of motion is important as different techniques and phases emphasize different muscles. Shoulder rehabilitation and strength & conditioning programs should encourage incorporation of all three pull-up variants with systematic progression to provide greater global strengthening of the torso and upper limb musculature.

Relevant functioning aspects and environmental factors for adults and seniors undergoing hemodialysis: A qualitative study.

To identify which functioning, personal and environmental factors are more relevant to adults in hemodialysis treatment. Data was collected by semi-structured interview, recorded, transcribed in full, verified and produced by Bardin Thematic content analysis. Two independent researchers identified the relevant themes and named the thematic categories found according to the coding of the International Classification of Functioning, Disability and Health (ICF). Six men and three women aged between 32-65 years were interviewed, with per capita family income between 1-2.9 minimum salaries and hemodialysis treatment time between 5 to 26 years. Fifty-seven ICF categories were listed: 17 Body Functions, 9 Body Structures, 21 Activities and Participation, and 10 Environmental Factors. Health, transportation and general social support services, systems and policies; doing housework; recreation and leisure; emotional functions, temperament and personality functions; energy and drive functions; sensation of pain; and structures of the cardiovascular system, lower extremity and musculoskeletal structures related to movement were the most reported aspects by the participants. Patients' need for physical/emotional support from their partners, friends and health professionals, including emotional and social support, with health policies, transportation and job maintenance, in order to increase their survival and quality of life.

What’s in a warm-up? A preliminary investigation of how European dressage riders and show jumpers warm-up their horses for training and at competition

Equestrian sports such as dressage and show jumping cause physical and physiological stress on the horses’ musculoskeletal structures, which can lead to decreased performance and injury. Warming-up prior to intense exercise can increase utilisation of the aerobic pathway, increase performance and decrease injury risk. Whilst duration of equestrian warm-up regimes has been reported, details of which gaits and skills related tasks, such as jumping and lateral movements, riders elect to use have not been evaluated to date. The purpose of this study was to understand dressage and show jumping riders’ decision-making when warming up at home and prior to a competition. Surveys (dressage: 39 questions; show jumping: 41 questions) were distributed online via social media. Mann Whitney U tests identified significant differences in warming up practice between dressage and show jumping riders. Most riders reported that a warm-up was beneficial for getting the horse ready for work, increasing responsiveness to aids, enhancing suppleness and relaxation, and decreasing injury risk. Both dressage and show jumping riders typically warm-up between 10-20 min. While dressage riders use the walk as their main warm-up gait, show jumpers preferred the trot. Both dressage riders and show jumpers incorporate technical skills in their warm-up such as lateral work, and quick transitions (when riders change gait for only few strides before changing again). Show jumpers include 4-10 jumping efforts, using different fence types. During a competition most dressage and show jumping riders agreed that factors such as perceived stress level of both the horse and rider, crowdedness of the arena, arena footing and size, as well as time allocated by the venue, were important factors that could impact the duration and content of their warm-up routines. Both groups of riders considered horses were sufficiently ‘warmed up’ when they were responsive to the aids and felt supple and relaxed.

INFLAMMATORY BOWEL DISEASE: CLINICAL FEATURES AND MANIFESTATIONS BEYOND THE BOWEL

Inflammatory bowel disease (IBD) encompasses a spectrum of diseases, with Crohn's disease (CD) and ulcerative colitis (UC) representing the two broadest subtypes of IBD. Multiple extraintestinal manifestations (EIMs) are more frequent in (IBD); 5% –50% of the patients might be affected. The most often implicated sites of manifestations are musculoskeletal and dermatological structures. However, while some symptoms like peripheral arthritis and erythema nodosum correlate with IBD progression, others have their own course of disease like axial arthropathy, gangrenosis of the pioderma and primary sclerosic cholangitis. This review would provide a summary of the most frequent EIMs and their prevalence.&#x0D; Peer Review History: &#x0D; Received 31 May 2020; Revised 7 June; Accepted 4 July, Available online 15 July 2020&#x0D; UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.&#x0D; Received file &#x0D; &#x0D; Average Peer review marks at initial stage: 5.5/10&#x0D; Average Peer review marks at publication stage: 7.0/10&#x0D; Reviewer(s) detail:&#x0D; Name: Dr. Md. Parwez Ahmad&#x0D; Affiliation: National Medical College, Birgunj, Nepal&#x0D; E-mail: parwezmedicine@gmail.com&#x0D; &#x0D; Name: Dr. George Zhu &#x0D; Affiliation: Tehran University of Medical Sciences, Tehran, Iran&#x0D; E-mail: sansan4240732@163.com&#x0D; &#x0D; Comments of reviewer(s): &#x0D; &#x0D;

Sotrastaurin, a PKC inhibitor, attenuates RANKL-induced bone resorption and attenuates osteochondral pathologies associated with the development of OA.

Osteoarthritis (OA) is a common degenerative disease that affects the musculoskeletal structure of the whole joint, which is characterized by progressive destruction of both articular cartilage and subchondral bone. Treatment of the bone pathologies, particularly osteoclast‐mediated subchondral bone loss in the early stages of OA, could prevent subsequent cartilage degeneration and progression of OA. In the present study, the PKC inhibitor, Sotrastaurin, was found to inhibit RANKL‐induced osteoclast formation in vitro in a dose‐ and time‐dependent manner. In particular, SO exerted its anti‐osteoclastic effect predominantly at the early stages of RANKL stimulation, suggesting inhibitory effects on precursor cell fusion. Using mature osteoclasts cultured on bovine bone discs, we showed that SO also exerts anti‐resorptive effects on mature osteoclasts bone resorptive function. Mechanistically, SO attenuates the early activation of the p38, ERK and JNK signalling pathways, leeding to impaired induction of crucial osteoclast transcription factors c‐Jun, c‐Fos and NFATc1. We also showed that SO treatment significantly inhibited the phosphorylation of PKCδ and MARCKS, an upstream regulator of cathepsin K secretion. Finally, in animal studies, SO significantly alleviates the osteochondral pathologies of subchondral bone destruction as well as articular cartilage degeneration following DMM‐induced OA, markedly improving OARSI scores. The reduced subchondral bone loss was associated with marked reductions in TRAP(+) osteoclasts in the subchondral bone tissue. Collectively, our data provide evidence for the protective effects of SO against OA by preventing aberrant subchondral bone and articular cartilage changes. Thus, SO demonstrates potential for further development as an alternative therapeutic option against OA.

Closed-Incision Negative Pressure Therapy in Place of Surgical Drain Placement in Plantar Fibroma Excision Surgery: A Case Series

Plantar fibromas are benign masses of fibrous tissue that develop in the arch of the foot arising from the plantar fascia. Symptomatology varies and is often related to weight bearing anatomic correlations or impingement of neurological or musculoskeletal structures. Several treatment options are available and include palliative measures, non-operative interventions and surgery, all with varying degrees of success and complication risk. The aim of this case study series was to assess surgical wound healing retrospectively in three patients who underwent wide en bloc plantar fibroma excision surgery for symptomatic lesions. Their incision was managed with a disposable closed-incision negative pressure therapy device (Prevena™; 3M + KCI, St. Paul, MN) in lieu of surgical drains. All three patients demonstrated favorable outcomes without complications.

Biomechanics And Energetics Of Curved Treadmills

PURPOSE: This study aims to examine the biomechanical and energetic differences between the non-motorized curved treadmill and the motorized flat (i.e., traditional) treadmill (TM). We hypothesize that, when compared to TM, CT will result in significantly higher EE, percentage of VO2 max and trunk flexion under all testing conditions. METHODS: Data collection included two sessions. In session one, participants filled out an informed consent, health questionnaire, and anthropometric data was collected. After, the participants underwent a 20-minute resting energy expenditure test to gather baseline metabolic data and the session concluded with a Bruce VO2 max test. In session two, participants were connected to a metabolic cart to measure metabolic costs and outfitted with reflective markers to capture 3D kinematic data.). RESULTS: There was not a significant increase in the amount of trunk flexion under any of the conditions between treadmills. There was a significant increase in the amount of EE from the TM to the CT across all six speeds. At 15% above their self-selected jogging (SSJ) speed, EE was 10.00 ± 1.32 kcal/min and 8.74 ± 1.34 kcal/min for the CT and TM, respectively (p=.002). At 15% slower than SSJ speed, participants’ EE was 8.44 ± 1.16 kcal/min and 7.36 ± 1.05 kcal/min (p=.005) for the CT and TM, respectively. At SSJ speeds, participants EE was 8.94 ± 1.17 kcal/min and 7.47 ± 1.13 kcal/min for the CT and TM, respectively (p<0.001). At 15% above participants’ self-selected walking (SSW) speed, EE was 5.35 ± 1.18 kcal/min and 3.38 ± 0.68 kcal/min on the CT and TM, respectively (p<0.001). At 15% slower than SSW, participants EE was 4.34 ± 0.92 kcal/min and 2.93 ± .47 kcal/min on the CT and TM, respectively (p<0.001). At SSW speeds, participants EE was 4.66 ± 1.00 kcal/min and 3.18 ± 0.62 kcal/min on the CT and TM, respectively (p<0.001). CONCLUSIONS: Our findings suggest that female athletes may benefit from using CTs over TMs because of the increased EE utilization but further research needs to be conducted to assess the viability of CTs as a safe option with respect to musculoskeletal structures.

Comparative Analyses of the Dominant and Non-Dominant Upper Limbs during the Abduction and Adduction Motions

Asymmetry in repeated motion may lead to dyskinesia through imbalance in the involved musculoskeletal structures. The dominance sides are also involved greater movement involvement over the non-dominant sides. The upper limbs with multiple joints and largest range of motion are prone for unsynchronized coordination. Natural movement analysis is required for application to everyday activities. Thirty participants were first recruited from Inha University, Incheon, Korea in 2019. Twenty subjects were assessed for comparisons of asymmetrical motion between the dominant and non-dominant arms during the abduction and adduction lateral raises after excluding ten subjects for shoulder pain and left-handedness. The abduction and adduction motions of the bilateral arms were compared for the angular locations, velocity, and acceleration for every 10 degrees. The angular locations of the dominant side occurred significant earlier in the initial (10°, 20°, 30°) phase and later in the last (10°, 20°) phase of abduction and adduction in comparison to the non-dominant side (P<.05). The angular accelerations of the dominant side were also significantly greater during the initial phase (0°, 10°, 30°) and last phase (0°, 10°, 30°) (P <.05). The angular velocities were significantly greater during the later phase (40, 50, 60°) of abduction (P <.04). Comparative dominant side indicated more controlled movements through the range of motion with greater stability in angular acceleration and deceleration especially during the initial and last phase of abduction and adduction, respectively. Training for control of the specific angular points should be considered during abduction and adduction motions to prevent asymmetry of the bilateral arms.

May The Force Be With You: Acceleration-based Estimates Of Vertical Ground Reaction Forces During Running

Running-related injury (RRI) may be caused by combinations of load magnitudes and numbers exceeding musculoskeletal structure capacity. Few methods exist, however, to quantify external loads (vertical ground reaction forces; vGRFs) during running in ecologically valid settings. PURPOSE: Develop models to accurately estimate vGRF second (“active”) peaks during running from iliac crest and sacrum accelerations. METHODS: Anthropometric and sex data were collected from 40 runners. Runners wore inertial measurement units (IMUs) (±100g, ±2000deg/s, 1000Hz) secured to their iliac crests and sacra while they ran a 25m track with embedded force plate (1000Hz). Speed, IMU accelerations, and force plate data were synchronously recorded for ten stances per foot at “slow”, “typical”, and “fast” self-selected speeds. Accelerations were transformed to a segment coordinate system. Force and acceleration signals were 50Hz low-pass filtered and divided into 0-8Hz low frequency (LoF) and ≥10Hz high frequency (HiF) signals. Acceleration and vGRF peaks were extracted from the original, LoF, and HiF signals. Two multiple linear regressions were created to estimate log-transformed vGRF second peak: One used sacrum accelerations to predict bilateral forces, the other used iliac crest accelerations to predict ipsilateral forces. Each model included sex and limb lengths as fixed effects and was validated using an eight-fold cross-over. RESULTS: Both models predicted observed vGRF second peaks well (r2=0.78, mean absolute error <7%). Addition of participant as a random effect (r2≥0.93, mean absolute error <4%) or speed as a fixed effect (r2≥0.83, mean absolute error <6%) further improved results. CONCLUSIONS: The models developed here demonstrate a single IMU secured over the iliac crest or sacrum can estimate ipsilateral or bilateral vGRF second peak, respectively, with high accuracy. This approach could greatly impact our understanding of RRI by facilitating quantification of the step-by-step external forces experienced by runners over long time periods in ecologically valid settings. Supported by an ACSM Doctoral Student Research Grant, a Sigma Xi Grant-in-Aid of Research, the Maury Hull Endowed Fellowship for Musculoskeletal Biomechanics Research, and an NSERC Post-Graduate Scholarship.

Development of the amniote ventrolateral body wall.

In vertebrates, the trunk consists of the musculoskeletal structures of the back and the ventrolateral body wall, which together enclose the internal organs of the circulatory, digestive, respiratory and urogenital systems. This review gives an overview on the development of the thoracic and abdominal wall during amniote embryogenesis. Specifically, I briefly summarize relevant historical concepts and the present knowledge on the early embryonic development of ribs, sternum, intercostal muscles and abdominal muscles with respect to anatomical bauplan, origin and specification of precursor cells, initial steps of pattern formation, and cellular and molecular regulation of morphogenesis.

An evaluation of factors affecting show jumping warm-up on subsequent show jumping performance in 1.30 m class

Show jumping causes physical and physiological stress on horses’ musculoskeletal structures, which can lead to decreased performance and injury. Appropriate warm-ups can enhance performance, decrease injury risk, as well as increase oxygen kinetics for better efficiency. Despite this, little is known for how warm-up routines affect show jumping performance. Forty-five warm-up routines of show jumpers preparing to enter the show ring were recorded and analysed. Kruskal Wallis analyses with post-hoc Mann Whitney U tests identified if the number of classes combinations completed, types of jumps attempted, warm-up duration, and time spent in each gait during the warm-up varied with rider and horse sex and age, and faults. Spearman correlations assessed if relationships occurred between warm-up duration and content, and the number of faults in the show ring, and horse age. Warm-up ranged from 3:51 to 62:46 min (median 15:09 min) and included at least two jumps (range 2-15). Walk was the most common gait, while upright fences were jumped the most. Knocking down or refusing a fence when warming up did not affect performance. Male riders jumped uprights twice as much as female riders (P&lt;0.03) but this did not impact their performances. Jumping a class prior to the 1.30 affected warm-up, competitors spent longer on the flat before jumping in they had competed earlier in the day (P&lt;0.05) and had fewer jump attempts if they had competed in the class just prior to the 1.30 m (P&lt;0.007). Even though no significant differences were detected, combinations which accumulated &gt;8 faults spent less time warming up. These results suggest warm-up tactics, riders and horses’ age and sex did not influence significantly fault accumulation in the show ring, however warm up routines were influenced by rider decision making and horse age.

Design and Implementation of a Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents: Pilot Data on Improvement of Palpation Accuracy in Physical Examination.

Studies have shown that physical medicine and rehabilitation residents have poor surface anatomy palpation accuracy, suggesting that new methods of teaching musculoskeletal (MSK) examination need to be found. This study describes the design of a novel MSK ultrasound course that integrated ultrasonography skills with palpation skills. Ultrasound was used to teach, validate, and refine physical medicine and rehabilitation residents' palpation of MSK structures. Surface anatomy palpation is intimately related to ultrasonography as clinicians should use palpation to guide their ultrasound examination rather than purely follow an algorithm. This study assessed whether the ultrasound course improved physical medicine and rehabilitation resident palpation accuracy at 12 upper limb structures. Palpation accuracy was tested at the beginning of their residency training and retested several weeks after completion of the ultrasound course's upper limb component, to assess retention of skill. There was significant improvement (P < 0.05) in 9 of 12 sites from pretesting to posttesting. Mean postcourse palpation accuracy was within 1 cm for 8 of 12 structures. This study demonstrates that an integrated MSK ultrasound and palpation curriculum improves palpation accuracy at multiple MSK structures and this improvement is retained. Physical medicine and rehabilitation residencies should consider integrating palpation skills into their ultrasound curriculum to improve the caliber of their trainees.

RESISTANCE TRANING PROTOCOLS PROMOTE STRENGTH INCREASE WITHOUT MORPHOLOGICAL CHANGES

ABSTRACT Introduction Resistance training (RT) has been related to increased protein synthesis, and in the myocardium it triggers morphological adaptations that result in improved cardiac contractility. In skeletal muscle, RT promotes an improvement in functional capacity and in sarcopenia caused by aging. However, the efficacy of this training method in the cardiac and skeletal systems has not yet been clarified. Objective To investigate the effect of different vertical ladder RT protocols on cardiac and skeletal structure and morphology. Materials and Methods: Wistar rats (n = 28) were randomized into four groups: sedentary (C); RT protocol with 4 to 9 climbs, 3 sessions/week, 120 second interval and intensity of 50% to 100% of the maximum load (ML) with progressive addition of 30 g (RT1); RT protocol with 4 to 5 climbs, 3 sessions/week, 60 second interval and intensity of 50% to 100% of the ML, where a 30 g overload was added in the 5th climb (RT2); RT protocol with 4 to 5 climbs, 5 sessions/week, 60 second interval and intensity of 50% to 100% of the ML; the animals that completed the 4th climb underwent the 5th climb with 100% ML plus 30 g (RT3). RT protocols were performed for 9 weeks with a duration of 30 to 45 minutes/day. The nutritional profile and cardiac/skeletal muscle morphology were evaluated along with the cross sectional area and collagen fraction. Results RT did not promote adaptations in cardiac and musculoskeletal structure and morphology, nor was it able to reduce body weight and body fat deposits. However, RT brought about an increase in absolute and relative strength. Conclusion Vertical ladder RT protocols, regardless of weekly frequency, lead to increased muscle strength without cardiac and skeletal structural adaptations. Level of evidence I, Therapeutic studies - Investigating treatment results.

Correction: Correlation between musculoskeletal structure of the hand and primate locomotion: Morphometric and mechanical analysis in prehension using the cross- and triple-ratios.

[This corrects the article DOI: 10.1371/journal.pone.0232397.].

Development of a Biomechatronic Device for Motion Analysis Through a RGB-D Camera

This work investigates the validity and reliability of a novel biomechatronic device providing an interactive environment in Augmented Reality (AR) for neuromotor rehabilitation. A RGB-depth camera and telemonitoring/remote signaling module are the main components of the device, together with a PC-based interface. The interactive environment, which implements some optimized algorithms of body motion capture and novel methodologies for human body motion analysis, enables neuromotor rehabilitation treatments that are adaptable to the performance and individual characteristics of the patient. The RGB-Depth camera module is implemented through a Microsoft Kinect, ORBBEC ZED2K devices; the telemonitoring module for teleassistance and therapy supervision is implemented as a cloud service.&#x0D; Within the module of body motion tracking, the abduction and adduction movements of the limbs of the full-body structure are tracked and the joints angles are measured in real-time; the most distinctive feature of the tracking module is the control of the trunk and shoulder posture during the exercises performed by the patient. Indeed, the device recognizes an incorrect position of the patient's body that could affect the objective of the exercise to be performed. The recognition of an incorrect exercise is associated to the generation of an alert both to the patient and the physician, in order to maximize the effectiveness of the treatment based on the user's potential and to increase the chances of a better biofeedback.&#x0D; The experimental tests, which have been carried out by reproducing several neuromotor exercises on the interactive environment, show that the feature recognition and extraction of the joints and segments of the musculo-skeletal structure of the patient's, and of wrong posture during exercises, can achieve good performance in the different experimental conditions. &#x0D; The developed device is a valid tool for patients affected by chronic disability, but it could be extended to neurodegenerative diseases in the early stages of the disease. Thanks to the enhanced interactivity in augmented reality, the patient can overcome some difficulties in interaction with the most common IT tools and technologies; at the meanwhile she/he can perform rehabilitation at home. The physician can also check in real time the results and customize the care pathway.&#x0D; The enhanced interactivity provided by the device during rehabilitation session increases both the motivation by the patient and the continuity of the care, as well as it supports low-cost remote assistance and telemedicine by optimizing therapy costs.&#x0D; The key points are:&#x0D; &#x0D; i) making rehabilitation motivating for the patient, becoming a "player";&#x0D; ii) optimize effectiveness and costs;&#x0D; &#x0D; iii) possibility of low-cost remote assistance and telemedicine.

A model identification approach to quantify impact of whole-body vertical vibrations on limb compliant dynamics and walking stability

Extensive research is ongoing in the field of orthoses/exoskeleton design for efficient lower limbs assistance. However, despite wearable devices reported to improve lower limb mobility, their structural impacts on whole-body vertical dynamics have not been investigated. This study introduced a model identification approach and frequency domain analysis to quantify the impacts of orthosis-generated vibrations on limb stability and contractile dynamics. Experiments were recorded in the motion capture lab using 11 unimpaired subjects by wearing an adjustable ankle–foot orthosis (AFO). The lower limb musculoskeletal structure was identified as spring-mass (SM) and spring-mass-damper (SMD) based compliant models using the whole-body centre-of-mass acceleration data. Furthermore, Nyquist and Bode methods were implemented to quantify stabilities resulting from vertical impacts. Our results illustrated a significant decrease (p < 0.05) in lower limb contractile properties by wearing AFO compared with a normal walk. Also, stability margins quantified by wearing AFO illustrated a significant variance in terms of gain-margins (p < 0.05) for both loading and unloading phases whereas phase-margins decreased (p < 0.05) only for the respective unloading phases. The methods introduced here provide evidence that wearable orthoses significantly affect lower limb vertical dynamics and should be considered when evaluating orthosis/prosthesis/exoskeleton effectiveness.