Passive Movement Research Articles

Investigation of knee joint stability in surgically repaired canine cruciate ligament ruptures by cyclic passive joint motions

Abstract The cranial cruciate ligament (CCL) rupture is a prevalent injury in dogs. A consequence of a cruciate ligament rupture is instability in the affected knee joint. A veterinary, mostly surgical treatment of the cruciate ligament rupture is usually unavoidable. The suitability of an arthroscopic surgical method with ligament replacement material was investigated. The stability of the knee joint was determined several times during 1,200 passive robotic motion cycles with movement radius between 90° flexion and 140° extension. The stability condition was measured by triggering the drawer test. After 300 motion cycles, the drawer test could be triggered (positive drawer test). In the following movement cycles up to 1,200 cycles, the drawer test could also be triggered. However, no significant differences occurred between these triggered drawer tests. The ligament replacement material showed no damage and no loosening after the tests. The first results showed that the developed arthroscopic surgical method could be a promising approach for the surgical treatment of cruciate ligament ruptures in canines.

Case Study: The Application of Extracorporeal Shockwave Therapy (ESWT) and Active Finger Blocking Exercise on Movement and Function of Fingers Disorders Caused by Trigger the 4th Finger Dextra

Background: Trigger finger also referred to as stenosing tenosynovitis. It is a traumatic condition that involves the formation of nodules in the tendons of flexor digitorium muscle due to a combination of repetitive finger movements or local trauma and impaired healing, as a result of which the affected finger is locked in either a flexed or extended position thereby impeding movement. Objective: This case study was aimed to determine the effect of extracorporeal shockwave therapy, and active finger blocking exercise in one women patient, aged 47 years old with diagnosed of trigger the 4th finger dextra. Methods: This case studies have been carried out 6 times for 2 weeks in one women patient, by evaluating the degree of pain by using the Visual Analogue Scale (VAS), Joint Range of Motion (RoM) by using a goniometer and functional activity ability hands with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Results: There was a decrease in the motion pain degree from VAS 7 to VAS 4, and the degree of tenderness pain from VAS 5 to VAS 2. There was an increase active flexion-extension movement of the 4th finger dextra from (S)=25°-0°-50° to (S)=40°-0°-75°, while passive movement from (S)=30°-0 °-60° to (S)=40°-0°-75°. There was a decrease in the value of hand disabilities based on the results of the DASH questionnaire from 24% to 21%. Conclusion: The application of extracorporeal shockwave therapy and active finger blocking exercise can reduce the pain, increase the range of motion and functional abilities patient diagnosed Trigger the 4th Finger condition.

Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound.

The purpose of this prospective ultrasound study was to document dorso-palmar (vertical) displacement of the median nerve in relation to the superficial flexor tendons at the level of the carpal tunnel. Furthermore, the gliding patterns of the median nerve were characterized. The presence of vertical gliding was intended to serve as an additional bio-kinematic parameter of median nerve movement, and will be referred to as a 'level change'. In this study, a total of 32 healthy young individuals underwent dynamic high-resolution ultrasound examinations of both wrists. The neutral position, and maximum flexion and extension of the wrist had to be reached in active and passive movement. The gliding patterns were determined in relation to the superficial flexor tendons. When no vertical nerve gliding was observed, it was characterized as 'no level change'. The presence of a level change prevailed in the healthy young cohort and was observed in 84% (27/32) of individuals during wrist flexion. The following gliding pattern was distinctively the most common: gliding of the entire nerve in between the flexor tendons in active but not in passive movement of the right and left wrists (13/27; 48%). The extent of vertical displacement was found to be associated with the gliding pattern (Kruskal-Wallis test). Movement in the carpal tunnel allows the median nerve to adapt to biomechanical stress. Dynamic ultrasound can demonstrate median nerve level changes in response to wrist movements. Furthermore, a typical gliding pattern was characterized. The presence of level change and gliding patterns were proposed as additional movement parameters during wrist flexion in healthy individuals.

Synaptic network structure shapes cortically evoked spatio-temporal responses of STN and GPe neurons in a computational model.

The basal ganglia (BG) are involved in motor control and play an essential role in movement disorders such as hemiballismus, dystonia, and Parkinson's disease. Neurons in the motor part of the BG respond to passive movement or stimulation of different body parts and to stimulation of corresponding cortical regions. Experimental evidence suggests that the BG are organized somatotopically, i.e., specific areas of the body are associated with specific regions in the BG nuclei. Signals related to the same body part that propagate along different pathways converge onto the same BG neurons, leading to characteristic shapes of cortically evoked responses. This suggests the existence of functional channels that allow for the processing of different motor commands or information related to different body parts in parallel. Neurological disorders such as Parkinson's disease are associated with pathological activity in the BG and impaired synaptic connectivity, together with reorganization of somatotopic maps. One hypothesis is that motor symptoms are, at least partly, caused by an impairment of network structure perturbing the organization of functional channels. We developed a computational model of the STN-GPe circuit, a central part of the BG. By removing individual synaptic connections, we analyzed the contribution of signals propagating along different pathways to cortically evoked responses. We studied how evoked responses are affected by systematic changes in the network structure. To quantify the BG's organization in the form of functional channels, we suggested a two-site stimulation protocol. Our model reproduced the cortically evoked responses of STN and GPe neurons and the contributions of different pathways suggested by experimental studies. Cortical stimulation evokes spatio-temporal response patterns that are linked to the underlying synaptic network structure. Our two-site stimulation protocol yielded an approximate functional channel width. The presented results provide insight into the organization of BG synaptic connectivity, which is important for the development of computational models. The synaptic network structure strongly affects the processing of cortical signals and may impact the generation of pathological rhythms. Our work may motivate further experiments to analyze the network structure of BG nuclei and their organization in functional channels.

A computational model of motion sickness dynamics during passive self-motion in the dark.

Predicting the time course of motion sickness symptoms enables the evaluation of provocative stimuli and the development of countermeasures for reducing symptom severity. In pursuit of this goal, we present an observer-driven model of motion sickness for passive motions in the dark. Constructed in two stages, this model predicts motion sickness symptoms by bridging sensory conflict (i.e., differences between actual and expected sensory signals) arising from the observer model of spatial orientation perception (stage 1) to Oman's model of motion sickness symptom dynamics (stage 2; presented in 1982 and 1990) through a proposed "Normalized innovation squared" statistic. The model outputs the expected temporal development of human motion sickness symptom magnitudes (mapped to the Misery Scale) at a population level, due to arbitrary, 6-degree-of-freedom, self-motion stimuli. We trained model parameters using individual subject responses collected during fore-aft translations and off-vertical axis of rotation motions. Improving on prior efforts, we only used datasets with experimental conditions congruent with the perceptual stage (i.e., adequately provided passive motions without visual cues) to inform the model. We assessed model performance by predicting an unseen validation dataset, producing aQ2 value of 0.86. Demonstrating this model's broad applicability, we formulate predictions for a host of stimuli, including translations, earth-vertical rotations, and altered gravity, and we provide our implementation for other users. Finally, to guide future research efforts, we suggest how to rigorously advance this model (e.g., incorporating visual cues, active motion, responses to motion of different frequency, etc.).

OPTIMIZING KNEE JOINT REHABILITATION USING ROBOTIC ASSISTIVE TECHNOLOGY IN AN INTELLIGENT WEARABLE KNEE BRACE

AbstractIntroductionKnee braces are limited to providing passive support. There is currently no brace available providing both continuous monitoring and active robot-assisted movements of the knee joint. This project aimed to develop a wearable intelligent motorised robotic knee brace to support and monitor rehabilitation for a range of knee conditions including post-surgical rehabilitation. This brace can be used at home providing ambulatory continuous passive movement obviating the need for hospital admissions.MethodologyA wearable sensing system monitoring knee range of motion was developed to provide remote feedback to clinicians and real-time guidance for patients. A prototype of an exoskeleton providing dynamic motion assistance was developed to help patients complete their exercise goals and strengthen their muscles. The accuracy and reliability of those functions were validated in human participants during exercises including knee flexion/extension (FE) in bed and in chair, sit-to-stand and stand-to-sit.ResultsThe knee FE measurement from the sensing system showed high accuracy (correlation coefficient of 0.99°) in human participants. The real-time FE data during exercises showed that the desired exoskeleton rotation fitted well with the participant's knee rotation. This indicated the exoskeleton could coordinate with the participant's knee motion by providing consistent motion assistance. The development of user interfaces to provide feedback is currently underway.ConclusionA wearable robotic knee brace to monitor and support knee rehabilitation exercises was successfully developed. Further development of this device with the use of artificial intelligence has the potential to aid patient rehabilitation in a variety of knee conditions.

The transcription regulator Lmo3 is required for the development of medial ganglionic eminence derived neurons in the external globus pallidus

The external globus pallidus (GPe) is an essential component of the basal ganglia, a group of subcortical nuclei that are involved in control of action. Changes in the firing of GPe neurons are associated with both passive and active body movements. Aberrant activity of GPe neurons has been linked to motor symptoms of a variety of movement disorders, such as Parkinson's Disease, Huntington's disease and dystonia. Recent studies have helped delineate functionally distinct subtypes of GABAergic GPe projection neurons. However, not much is known about specific molecular mechanisms underlying the development of GPe neuronal subtypes. We show that the transcriptional regulator Lmo3 is required for the development of medial ganglionic eminence derived Nkx2.1+ and PV+ GPe neurons, but not lateral ganglionic eminence derived FoxP2+ neurons. As a consequence of the reduction in PV+ neurons, Lmo3-null mice have a reduced GPe input to the subthalamic nucleus.

Brain network characteristics between subacute and chronic stroke survivors in active, imagery, passive movement task: a pilot study.

The activation patterns and functional network characteristics between stroke survivors and healthy individuals based on resting-or task-state neuroimaging and neurophysiological techniques have been extensively explored. However, the discrepancy between stroke patients at different recovery stages remains unclear. To investigate the changes in brain connectivity and network topology between subacute and chronic patients, and hope to provide a basis for rehabilitation strategies at different stages after stroke. Fifteen stroke survivors were assigned to the subacute group (SG, N = 9) and chronic group (CG, N = 6). They were asked to perform hand grasping under active, passive, and MI conditions when recording EEG. The Fugl-Meyer Assessment Upper Extremity subscale (FMA_UE), modified Ashworth Scale (MAS), Manual Muscle Test (MMT), grip and pinch strength, modified Barthel Index (MBI), and Berg Balance Scale (BBS) were measured. Functional connectivity analyses showed significant interactions on frontal, parietal and occipital lobes connections in each frequency band, particularly in the delta band. The coupling strength of premotor cortex, M1, S1 and several connections linked to frontal, parietal, and occipital lobes in subacute subjects were lower than in chronic subjects in low alpha, high alpha, low beta, and high beta bands. Nodal clustering coefficient (CC) analyses revealed that the CC in chronic subjects was higher than in subacute subjects in the ipsilesional S1 and occipital area, contralesional dorsolateral prefrontal cortex and parietal area. Characteristic path length (CPL) analyses showed that CPL in subacute subjects was lower than in chronic subjects in low beta, high beta, and gamma bands. There were no significant differences between subacute and chronic subjects for small-world property. Subacute stroke survivors were characterized by higher transfer efficiency of the entire brain network and weak local nodal effects. Transfer efficiency was reduced, the local nodal role was strengthened, and more neural resources needed to be mobilized to perform motor tasks for chronic survivors. Overall, these results may help to understand the remodeling pattern of the brain network for different post-stroke stages on task conditions and the mechanism of spontaneous recovery.

Enhancing the Hybrid Microgrid Performance with Jellyfish Optimization for Efficient MPPT and THD Estimation by the Unscented Kalman Filter

Power management in advanced grid systems requires the seamless integration of diverse renewable energy sources. This study investigates the optimization of a grid-connected system comprising a photovoltaic (PV) solar panel, energy storage system, fuel cell (FC), and diesel generator (DG) using the bioinspired metaheuristic technique called jellyfish optimization (JF). The objective is to maximize power generation from the PV system under normal and partial shading conditions. The performance of JF is compared against particle swarm optimization (PSO) using various parameters. As India heavily relies on solar PV, the results highlight JF’s exceptional effectiveness in extracting maximum power during partial shading scenarios. Inspired by the active and passive motions of jellyfish in the ocean, the JF algorithm is utilized. To further optimize the power output, the system is integrated with an efficient battery management system, PEM fuel cell stacking, and diesel generators. The system’s performance is analyzed using fast Fourier transform (FFT) to evaluate harmonic distortions, which consistently meet the limits specified in IEEE STD 1547-2018. Furthermore, unscented Kalman filter-based analysis is employed to assess total harmonic distortion (THD) and power rating for the grid system across various renewable energy scenarios. The contribution of the jellyfish optimization (JF) algorithm lies in its ability to efficiently and effectively maximize power generation from the PV system, regardless of normal or partial shading conditions. JF, a bioinspired metaheuristic optimization technique, successfully emulates the collective behavior of jellyfish in the ocean to identify optimal solutions. In this study, JF outperforms particle swarm optimization (PSO) in terms of power generation under partial shading conditions. Notably, JF exhibits remarkable capability in exploring the search space and discovering the global optimum, even when the system operates under challenging conditions. Overall, this study demonstrates the tremendous potential of JF in maximizing power generation in grid-connected systems with renewable energy sources while also highlighting the benefits of integrating additional components to further enhance the system performance.

Spatial patterns of intrinsic brain activity in rats with capsular stroke.

To explore the neural changes of brain activity in rats with circumscribed capsular infarcts to find a new therapeutic target for promoting the functional recovery. A total of 18 capsular infarct rats and 18 normal rats were conducted in this study. All animal use procedures were strictly in accordance with the guide for the care and use of laboratory animals. After establishing the photothrombotic capsular infarct model, the functional magnetic resonance imaging (fMRI) data were collected and analyzed. The fMRI results indicated that the passive movement would induce strong activation in caudate, putamen, frontal association somatosensory cortex, thalamus dorsolateral, and thalamus midline dorsal in control group, and the passive movement would only induce limited activation mostly in somatosensory cortex, thalamus dorsolateral, and thalamus midline dorsal in capsular infarct models. Capsular infarct makes the cortical activity weaken in sensory-related cortex and subcortical nuclei, including capsular area and thalamus. Such findings imply that the posterior limb of internal capsule (PLIC) is connected to these structures in function, interacts together with them, and, accordingly, the lesion of PLIC manifests the related symptoms.

Interstitial-fluid shear stresses induced by vertically oscillating head motion lower blood pressure in hypertensive rats and humans

The mechanisms by which physical exercise benefits brain functions are not fully understood. Here, we show that vertically oscillating head motions mimicking mechanical accelerations experienced during fast walking, light jogging or treadmill running at a moderate velocity reduce the blood pressure of rats and human adults with hypertension. In hypertensive rats, shear stresses of less than 1 Pa resulting from interstitial-fluid flow induced by such passive head motions reduced the expression of the angiotensin II type-1 receptor in astrocytes in the rostral ventrolateral medulla, and the resulting antihypertensive effects were abrogated by hydrogel introduction that inhibited interstitial-fluid movement in the medulla. Our findings suggest that oscillatory mechanical interventions could be used to elicit antihypertensive effects.

Elongating achilloplasty and the original tenorraphy technique for cerebral palsy

BACKGROUND:In cerebral palsy, shortening of the triceps muscle of the lower leg leads to impaired coordination and gait and orthopedic consequences that disrupt the quality of life and complicate rehabilitation. Many surgical techniques are aimed at eliminating contractures and restoring ankle joint movements. However, treatment results are not always satisfactory, and the number of complications remains high, such as recurrence of deformation and failure of the tendon suture after tenotomy.
 AIM:To analyze the results of calcaneal tendon lengthening plastic surgery with the original tendon suture technique in patients with cerebral palsy complications and consider the features of surgical technique onaclinical example.
 MATERIALS AND METHODS:This study describes the lengthening plastic surgery of the calcaneal tendon with the original tendon suture technique performed in four patients with complications of cerebral palsy. The clinical observations of the surgical treatment ofa30-year-old patient with spastic paresis of the triceps muscle of the left tibia were presented. The treatment results were followed from 1 to 12 months postoperatively. The amplitude of active and passive movements in the joints, muscle tone, presence and nature of postoperative complications, and functional outcome were evaluated.
 RESULTS:The results 1 year after the operation were evaluated as good in two initially more severe cases and excellent in two cases. In all patients, decreased pain level, restoration of movements, decreased hypertension, and hypotrophy of the triceps muscle of the lower leg were observed, and no complications were noted.
 CONCLUSIONS:The results revealed data on the pathogenetic validity of calcaneal tendon elongation in patients with spastic paralysis of the triceps muscle of the lower leg. The proposed original method of surgical treatment ensures the correct anatomical comparison and density of the contact of the tendon ends, reduces the tone of the calf-flounder complex, preserves joint physiological mobility, begins early rehabilitation, and reduces the likelihood of relapse.

Spasticity evaluation with the Amadeo Tyromotion device in patients with hemispheric stroke.

The objective of this study is to verify the reliability and the concurrent and discriminant validity of the measurements of spasticity offered by the robotic device, quantifying the (1) test-retest reliability, (2) correlation with the clinical evaluation using the Modified Ashworth Scale (MAS), (3) inter-rater reliability between the two physiotherapists, and (4) ability to discriminate between healthy and stroke patients. A total of 20 stroke patients and 20 healthy volunteers participated in the study. Two physical therapists (PT1 and PT2) independently evaluated the hand spasticity of stroke subjects using the MAS. Spasticity was assessed, both in healthy and stroke patients, with the Amadeo device at three increasing velocities of passive movement for three consecutive repeated assessments, while raw data of force and position were collected through an external program. The intraclass correlation coefficient (ICC) and the weighted kappa were computed to estimate the reliability of the Amadeo device measurements, the inter-rater reliability of MAS, and the correlation between the MAS and Amadeo device measurements. The discriminant ability of the Amadeo device was assessed by comparing the stroke and healthy subjects' spasticity measurements with the percentage of agreements with 0 in MAS for healthy subjects. The test-retest reliability of the Amadeo device was high with ICC at all three velocities (ICC = 0.908, 0.958, and 0.964, respectively) but lower if analyzed with weighted kappa correlation (0.584, 0.748, and 0.749, respectively) as mean values for each velocity. The correlation between Amadeo and the clinical scale for stroke patients with weighted kappa correlation was poor (0.280 ± 0.212 for PT1 and 0.290 ± 0.155 for PT2). The inter-rater reliability of the clinical MAS was high (ICC = 0.911). Both MAS and Amadeo spasticity scores showed good reliability. The Amadeo scores did not show a strong clinical correlation with the MAS in stroke patients. Hitherto, Amadeo evaluation shows trends that are consistent with the characteristics of spasticity, such as an increase in spasticity as the speed of muscle stretching increases. The ability of the device to discriminate between stroke patients and healthy controls is low. Future studies adopting an instrumental gold standard for spasticity may provide further insight into the validity of these measurements.

ACTIVE ASSISTED MOVEMENT DALAM MENJAGA KEMAMPUAN FUNGSIONAL PADA KONDISI DUCHENNE MUSCULAR DYSTROPHY

Background: Duchenne muscular dystrophy which is a recessive x-linked disorder that often affects males. Duchenne muscular dystrophy is caused by mutations in the dystrophin gene at the Xp21 locus so that dystrophin protein is not produced or dystrophin deficiency and structural abnormalities occur. Dystrophinopathies are X-linked recessive disorders affecting 1 in 5,000 to 1 in 6,000 live male births. The prevalence of DMD is less than 10 cases per 100,000 males. Objective: Physiotherapy management in this case aims to determine the benefits of providing physiotherapy interventions in the form of active assisted and passive movement and stretching in patients with Duchenne muscular dystrophy. Methods: This case report was conducted at PLDPI Surakarta by taking patients with Duchenne muscular dystrophy cases by providing physiotherapy modalities in the form of active assisted and passive movement and stretching for 3 physiotherapy sessions. Furthermore, measurements were taken with the GMFM and XOTR Scale in the first to third physiotherapy. Results: From the physiotherapy management given, it was found that functional ability and muscle strength remained unchanged and did not develop. Conclusion: Physiotherapy management in this case report is proven to be able to maintain functional ability and muscle strength in patients with Duchenne muscular dystrophy.

Dual-Task Interference Slows Down Proprioception.

It is well-known that multitasking impairs the performance of one or both of the concomitant ongoing tasks. Previous studies have mainly focused on how a secondary task can compromise visual or auditory information processing. However, despite dual tasking being critical to motor performance, the effects of dual-task performance on proprioceptive information processing have not been studied yet. The purpose of the present study was, therefore, to investigate whether sensorimotor task performance would be affected by the dual task and if so, in which phase of the sensorimotor task performance would this negative effect occur. The kinematic variables of passive and active knee movements elicited by the leg drop test were analyzed. Thirteen young adults participated in the study. The dual task consisted of performing serial subtractions. The results showed that the dual task increased both the reaction time to counteract passive knee-joint movements in the leg drop test and the threshold to detect those movements. The dual task did not affect the speed and time during the active knee movement and the absolute angle error between the final and the target knee angles. Furthermore, the results showed that the time to complete the sensorimotor task was prolonged in dual tasking. Our findings suggest that dual tasking reduces motor performance due to slowing down proprioceptive information processing without affecting movement execution.

Method of Objective Assessment of Proprioceptive Perception of Leg and Foot Movements in Humans

Previously, we developed a method for objective assessment of the state of proprioceptive perception of movements of the upper limb. In order to test this method for assessing the proprioceptive perception of lower limb movements, we studied the accuracy of copying with open and closed eyes a series of passive single-joint movements of the tested leg directly during their execution with the help of active movements of the other leg. Flexion-extension copying in the knee and ankle joints was studied in 30 healthy subjects for both legs and in 40 patients with unilateral stroke for the paretic leg. The accuracy of copying movements was assessed by recording the angles in the tested joint and the joint of the same name of the opposite limb using qualitative and quantitative objective indicators. It was shown that healthy subjects, both under visual control and without it, copy the passive movements of the right and left legs with high accuracy and almost simultaneously. Based on the study of the values of qualitative and quantitative indicators of copying accuracy, an objective conditional criterion for the preservation of proprioceptive perception of movements in the knee and ankle joints was formulated. In contrast to healthy subjects, in the group of patients, the results of copying with open and closed eyes were significantly different. In tests with open eyes, the copying of movements was qualitatively correct, which indicates that they understood the motor task of the test and were able to perform it with a conditionally healthy leg. In the absence of visual control, most of them either made gross errors in the transmission of the direction and number of the tested movements, or reproduced movements with a significant deterioration in accuracy (increased delays, shape distortion, etc.). It was shown that the proprioceptive perception of movements in the ankle joint was disturbed more often and more strongly than movements in the knee joint. In accordance with the developed conditional criterion of the norm, in 69% of patients there was a violation of the proprioceptive perception of movements in the knee and/or ankle joints.

Biotic vs abiotic origin of unusual features from Mesoproterozoic of Vindhyan Supergroup, India

Biogenic signatures in Precambrian rocks are often difficult to confirm and debatable. We present some unusual features associated with microbial-mat related structures (MRS) from the freshly-exposed rippled bed surface of 1.6 Ga old Chorhat Sandstone, Vindhyan Supergroup, India. The features discussed here, are present within intertidal to supratidal environments often affected by storms. One of the features includes ridge-groove couplets that run across the ripple crests. Locally, the ridge-groove couplet forms a braid-like pattern. Along the ripple troughs, the ridges are considerably long and maintain a uniform width on the mm scale. Another feature shows meandering grooves bordered by ridges. The grooves swerve, form loops, cut across older grooves, and branch up. None of them have comparable equivalents in the Precambrian record described thus far. The invariably uniform width of the ridges for both the two features cannot be compared with undersurface gas bubble migration, and the swerving and reversing nature of the grooves denies passive movement of any inorganic/organic masses under the influence of an external force. They seem to have been created by movement through a microbiota-rich surficial sediment. Such unusual features raise questions about the biosphere and biotic structures during the Boring Billion (1.8–0.8 Ga).

The effect of joint orientation on passive movement of the dog's stifle.

The cranial cruciate ligament (CCL) is one of numerous structures which determine the path of the tibia relative to the femur when passively flexing/extending the stifle of the dog. The effect of cutting the CCL on passive motion with the hind limb in different orientations, is unknown. The aim of this study was to describe passive movement of the tibia relative to the femur in dogs, with the hind limb in three different orientations, and with CCL intact and cut. Ten cadaveric hind limbs were obtained from dogs weighing between 20 kg and 25 kg and prepared for testing in a custom-built joint testing machine. Each hind limb was tested in three different orientations with data collected, using an electromagnetic tracking system, during 2 cycles of flexion/extension with the CCL intact and cut. Each cycle was initiated with the stifle in full extension (0°) and data was collected at 0°, 20°, 30°, 40°, 45°, and 55° of stifle flexion/extension. Flexion of the stifle resulted in caudal translation and internal rotation of the tibia relative to the femur, with cranial translation and external rotation occurring during extension along the identical path. Cutting the cranial cruciate ligament did not result in significant differences in translation or rotation when the stifle was orientated to approximated the standing position of a dog. Isometric points at the origin and insertion of the CCL can potentially be identified in CCL deficient stifles using a technique based on passive motion of an intact stifle.

Comparative efficacy of ultrasound-guided combined suprascapular and axillary nerve block with suprascapular nerve block alone in patients with frozen shoulder: A prospective, double-blinded randomized, single-centre trial

BackgroundFrozen shoulder is a troublesome disease of the shoulder joint. It leads to marked disability because of pain with restriction of active and passive movement of the joint. We aimed to determine and compare the efficacy of combined suprascapular and axillary nerve blocks with suprascapular nerve block alone for the treatment of frozen shoulder pain. MethodologyA total of 61 patients with frozen shoulder included in the study underwent ultrasound-guided combined suprascapular and axillary nerve block (n ​= ​31) and suprascapular nerve block (n ​= ​30). All the patients were assessed for visual analogue scale (VAS) pain (0-10), simple pain score (0-5), total pain score (0-9), range of motion (abduction, external rotation, and internal rotation) of the affected shoulder joint at baseline and post-procedure at 7 days, 1 month, 3 months, 6 months, and 12 months. ResultThere was a significant improvement in VAS pain score, simple pain scores, total pain scores and range of motion of the affected shoulder joint in both groups at all time points as compared to the baseline. However, in the combined nerve block group the VAS scores, simple and total pain scores, abduction, and internal rotation were significantly better at 6 months, 3 months, 6 months, and 12 months, respectively. ConclusionThe combined block provided faster and superior pain relief and improvement in function.

Implementation of Family Nursing Care for Clients with Rheumatoid Arthritis to Physical Mobility Disorders with Active and Passive Movement Exercises

Background: Rheumatoid Arthritis (RA) is a disease characterized by a chronic autoimmune inflammatory disorder or autoimmune response that causes weakening of the joints and synovial lining, especially in the hands, feet, and knees. Patients with RA often experience impaired physical mobility, a condition where a person cannot move freely due to conditions that hinder movement (activity). One of the interventions that can be given to RA patients is Range of motion (ROM) exercises, which are exercises performed to maintain or improve the perfection of the ability to move joints normally and completely to increase muscle mass and muscle tone. research to assess the effectiveness of implementing family nursing care with active and passive movement exercises against impaired physical mobility in Rheumatoid Arthritis sufferers in the work area of Taba Health Center, Lubuklinggau City, in 2022. Methods: This study uses a qualitative design with a case study approach to describe information descriptively. In-depth and explores nursing problems for families with rheumatoid arthritis with impaired physical mobility due to joint stiffness. Results: After implementation by giving active and passive motion exercises to both subjects (Mr. S and Mrs. E) for five consecutive days with a time of 10-15 minutes, both subjects said that stiffness in the extremities was reduced and the value of muscle strength increased to 5 and 4. Conclusion: Implementing nursing care with active and passive motion exercises can increase joint strength in clients with rheumatoid arthritis.