Passive Range Of Motion Research Articles

Comparison of Static Stretching on Whole Body Vibration and Strength Training for Improving and Maintaining Hamstring Range of Motion

Background: Hamstring strains are prevalent among individuals engaged in sports and recreational activities. Addressing this, static stretching, whole-body vibrations (WBV), and strength training are recognized for enhancing range of motion (ROM) and reducing muscle injury risks. However, the comparative effectiveness of these modalities on hamstring flexibility and ROM requires further exploration. Objective: The primary objective of this study was to investigate the effects of static stretching combined with whole-body vibrations and strength training on improving and maintaining hamstring range of motion. Methods: This crossover randomized control trial in Karachi involved 44 participants aged 18-25 years, actively participating in various recreational activities. Participants were randomly divided into two groups: one underwent static stretching on whole-body vibration, and the other received strength training. The interventions lasted four weeks, with pre- and post-intervention assessments of active and passive range of motion (AROM and PROM). Data analysis was conducted using SPSS version 23.0. Results: The static stretching with whole-body vibration group showed an increase in AROM from a pre-intervention mean of 131.05° to a post-intervention mean of 136.55°, and in PROM from 131.67° to 137.41°. The strength training group exhibited an increase in AROM from a pre-intervention mean of 135.21° to 142.42°, and in PROM from 135.98° to 144.81°. Both interventions demonstrated statistically significant improvements in hamstring ROM. Conclusion: The study demonstrates that both static stretching on whole-body vibration and strength training are effective in enhancing the flexibility and range of motion of hamstrings. These findings suggest their beneficial incorporation in rehabilitation and athletic training programs.

Efficacy of Combination Therapy (Hydrodilatation and Subdeltoid Bursa Injection With Corticosteroid, Mobilization, and Physical Therapy) vs Physical Therapy Alone for Treating Frozen Shoulder: A Randomized Single-Blind Controlled Trial, Phase I

ObjectiveTo compare the efficacy of combination therapy (hydrodilatation and subdeltoid bursa injection with corticosteroid, mobilization, and physical therapy [PT]) with that of PT alone for treating frozen shoulder. DesignA prospective, 2-arm parallel, single-blinded, randomized controlled trial. SettingRehabilitation clinic of a private academic hospital. ParticipantsPatients (n=70) with frozen shoulder (freezing stage). InterventionsParticipants (n=35) in the combination group underwent hydrodilatation and subdeltoid bursa injection with corticosteroid twice, mobilization, and usual-care PT for 8 weeks; participants (n=35) in the PT group received only the usual-care PT for 8 weeks. Main Outcome MeasuresThe Shoulder Pain and Disability Index (SPADI) was the primary outcome measure. The secondary outcome measures were pain scores on a visual analog scale, range of motion (ROM), the Shoulder Disability Questionnaire (SDQ), quality of life (evaluated using the 36-item Short-Form Health Survey [SF-36]), and self-assessment of the treatment effect. ResultsCompared with the PT group, the combination group had significantly better pain (during activity), SPADI, SDQ, active and passive ROM, and self-assessment scores (all P<.001) as well as scores on some parts of the SF-36 (physical function and bodily pain, P<.05). Between-group differences were significant at the 1-, 2-, 4-, and 6-month follow-ups. ConclusionsA combination of hydrodilatation (with corticosteroid), bursal corticosteroid injection, and joint mobilization with PT was superior to PT alone for treating frozen shoulder, and the effects persisted for at least 6 months.

Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large sized tear): a meta-analysis of randomized controlled trials

BackgroundThe timing to start passive or active range of motion (ROM) after arthroscopic rotator cuff repair remains unclear. This systematic review and meta-analysis evaluated early versus delayed passive and active ROM protocols following arthroscopic rotator cuff repair. The aim of this study is to systematically review the literature on the outcomes of early active/passive versus delayed active/passive postoperative arthroscopic rotator cuff repair rehabilitation protocols.MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) published up to April 2022 comparing early motion (EM) versus delayed motion (DM) rehabilitation protocols after arthroscopic rotator cuff repair for partial and full-thickness tear was conducted. The primary outcome was range of motion (anterior flexion, external rotation, internal rotation, abduction) and the secondary outcomes were Constant-Murley score (CMS), Simple Shoulder Test Score (SST score) and Visual Analogue Scale (VAS).ResultsThirteen RCTs with 1,082 patients were included in this study (7 RCTs for early passive motion (EPM) vs. delayed passive motion (DPM) and 7 RCTs for early active motion (EAM) vs. delayed active motion (DAM). Anterior flexion (1.40, 95% confidence interval (CI), 0.55–2.25) and abduction (2.73, 95%CI, 0.74–4.71) were higher in the EPM group compared to DPM. Similarly, EAM showed superiority in anterior flexion (1.57, 95%CI, 0.62–2.52) and external rotation (1.59, 95%CI, 0.36–2.82), compared to DAM. There was no difference between EPM and DPM for external rotation, retear rate, CMS and SST scores. There was no difference between EAM and DAM for retear rate, abduction, CMS and VAS.ConclusionEAM and EPM were both associated with superior ROM compared to the DAM and DPM protocols. EAM and EPM were both safe and beneficial to improve ROM after arthroscopic surgery for the patients with small to large sized tears.

Spatial mapping of posture-dependent resistance to passive displacement of the hypertonic arm post-stroke

BackgroundMuscles in the post-stroke arm commonly demonstrate abnormal reflexes that result in increased position- and velocity-dependent resistance to movement. We sought to develop a reliable way to quantify mechanical consequences of abnormal neuromuscular mechanisms throughout the reachable workspace in the hemiparetic arm post-stroke.MethodsSurvivors of hemiparetic stroke (HS) and neurologically intact (NI) control subjects were instructed to relax as a robotic device repositioned the hand of their hemiparetic arm between several testing locations that sampled the arm's passive range of motion. During transitions, the robot induced motions at either the shoulder or elbow joint at three speeds: very slow (6°/s), medium (30°/s), and fast (90°/s). The robot held the hand at the testing location for at least 20 s after each transition. We recorded and analyzed hand force and electromyographic activations from selected muscles spanning the shoulder and elbow joints during and after transitions.ResultsHand forces and electromyographic activations were invariantly small at all speeds and all sample times in NI control subjects but varied systematically by transport speed during and shortly after movement in the HS subjects. Velocity-dependent resistance to stretch diminished within 2 s after movement ceased in the hemiparetic arms. Hand forces and EMGs changed very little from 2 s after the movement ended onward, exhibiting dependence on limb posture but no systematic dependence on movement speed or direction. Although each HS subject displayed a unique field of hand forces and EMG responses across the workspace after movement ceased, the magnitude of steady-state hand forces was generally greater near the outer boundaries of the workspace than in the center of the workspace for the HS group but not the NI group.ConclusionsIn the HS group, electromyographic activations exhibited abnormalities consistent with stroke-related decreases in the stretch reflex thresholds. These observations were consistent across repeated testing days. We expect that the approach described here will enable future studies to elucidate stroke's impact on the interaction between the neural mechanisms mediating control of upper extremity posture and movement during goal-directed actions such as reaching and pointing with the arm and hand.

Inlay vs. onlay humeral components in reverse total shoulder arthroplasty: a biorobotic shoulder simulator study

BackgroundBoth inlay and onlay humeral implants are available for reverse total shoulder arthroplasty (rTSA), but biomechanical data comparing these components remains limited. This study investigated the effects of inlay and onlay rTSA humeral components on shoulder biomechanics using a biorobotic shoulder simulator. MethodsTwenty fresh-frozen cadaver shoulders were tested before and after rTSA with either an inlay or onlay humeral implant. Comparisons were performed between the most commonly implanted configurations for each implant (baseline), and a modification to provide equivalent neck shaft angle (NSA) for the inlay and onlay configurations. Specimens underwent passive range of motion (ROM) assessment with the scapula held static, and performed scapular plane abduction driven by previously collected human-subject scapulothoracic and glenohumeral kinematics. Passive ROM glenohumeral joint angles were compared using t-tests while muscle force and excursion data during scapular plane elevation were evaluated with statistical parametric mapping and t-tests. ResultsMaximum passive elevation was reduced for the inlay versus onlay humeral component, while both implants caused reduced passive elevation versus the native joint. Inlay rTSA also demonstrated reduced passive internal rotation at rest and increased external rotation at 90° humerothoracic elevation versus the native joint. All preoperative plan ROM estimates differed from experiments. Rotator cuff forces were elevated with an onlay versus inlay humeral implant, but simulated muscle excursions did not differ between systems. Compared to the native joint, rotator cuff forces were increased for both inlay and onlay implants and deltoid forces were reduced for inlay. The rTSA dramatically altered muscle excursions versus the native joint. Comparisons of inlay and onlay humeral implants with equivalent NSA were consistent with the baseline comparisons. ConclusionsRotator cuff forces required to perform scapular plane abduction increase following rTSA using both inlay and onlay implants. Rotator cuff forces are lower with inlay implants compared to onlay, although inlay implants also result in reduced passive elevation ROM. Deltoid forces are lower with inlay implants in comparison to native, but not with onlay implants. The differences between inlay and onlay components are largely unaffected by NSA, indicating that these differences are inherent to the inlay and onlay designs. In those patients with an intact rotator cuff, decreased rotator cuff forces to perform abduction with an inlay humeral implant compared to an onlay implant may promote improved long-term outcomes due to reduced deltoid muscle fatigue when using an inlay implant.

Passive Range of Motion for Conservative Management of Brachial Plexus Birth Injury: A Survey of Expert Therapists

Brachial plexus birth injury (BPBI) occurs in almost 1/1000 live births potentially resulting in lifelong upper extremity weakness and joint contracture. Early referral and initiation of passive range of motion (PROM) are recommended but there is no standard of care to guide treatment. A descriptive survey study design was used to target occupational and physical therapists who work in brachial plexus clinics to identify current practices for early therapeutic intervention. With 26 respondents, therapists recommend initiating PROM by 4 wks of life performed at every diaper change. Seventy-four percent of therapists report differences in outcomes for children whose caregivers are more adherent, however, there was no significant relationship between frequency of PROM and outcomes. More outcome research is needed to identify an optimal frequency and duration, examine the efficacy of methods for parent education, and identify training methods to facilitate adherence.

Clinical Utility of Robot-Assisted Gait Training in Patients with Spinal Cord Injury Caused by Electrical Burns: A Case Report

Robot-assisted gait training (RAGT) has been proven effective in improving gait function in not only patients with central nervous system damage, but also in patients who have undergone musculoskeletal surgery. Nevertheless, evidence supporting the efficacy of such training in burn patients remains insufficient. This report aimed to evaluate the effect of RAGT in burn patients with spinal cord injuries (SCI) caused by electrical trauma. We reported a case of two patients. The total duration of each session was about 1 h 30 min. This included 10 min to put on the exoskeleton, 30 min of robot-assisted training using SUBAR®, 10 min to remove the exoskeleton, 10 min to observe whether complications such as skin abrasion, ulcer, or pain occur in the scar area after RAGT, and 30 min of conventional physiotherapy, at a rate of 5 days a week for 12 weeks. All measurements were assessed before training (0 week) and after training (12 weeks). The American Spinal Cord Injury Association (ASIA) lower extremity motor score (LEMS), passive range of motions (ROMs) of different joints (hip, knee, and ankle), ambulatory motor index (AMI), functional ambulation categories (FAC), and 6 min walking (6 MWT) distances were evaluated to measure the degree of gait function through training. In both patients, manual muscle test measurement and joint ROM in the lower extremities improved after 12 weeks training. The first patient scored 0 in the FAC before training. After 12 weeks of training, he could walk independently indoors, improving to an FAC score of 4. He also reached 92.16 m in the 6 MWT. LEMS improved from 22 before training to 30 after training, and AMI score improved from 12 before training to 16 after training. In the second patient, an independent walking function was not acquired. LEMS improved from 10 before training to 26 after training. AMI scores were the same at 10 points before and after training. The results suggested the possibility of achieving clinical effects in terms of improving lower extremity muscle strength, joint ROMs, and gait performance in patients with SCI caused by electrical trauma.

Clinical Evaluation Findings in Patients Diagnosed With Deltoid Ligament Ankle Sprains: A Report From the Athletic Training Practice-Based Research Network

Objective: To describe clinical presentation and initial management of patients with deltoid ligament ankle sprains. Design: Retrospective. Setting: Practice-based research network. Participants: Athletic trainers (n = 133) from 52 clinics in 19 states. Independent Variable: Deltoid sprains (October 2009–April 2020). Main Outcome Measurements: Clinical findings (e.g., sport, mechanism of injury, severity, range of motion, tests) and initial management. Results: Deltoid sprains (n = 105) were diagnosed within 3.2 ± 4.1 days of injury, mostly in male secondary school athletes (n = 62/105, 59.0%). Common sports were football (n = 29/94, 30.9%) and basketball (n = 28/94, 29.8%). Common mechanism of injuries were twisting (n = 35/94, 37.2%) and contact (n = 28/94, 29.8%). Sprains were mostly mild (n = 59/94, 62.7%) with mild or no edema (n = 85/96, 85.5%) and effusion (n = 90/96, 93.4%). Active (n = 49/96, 51.0%) and passive range of motion (n = 54/96, 56.3%) were mostly normal, and a median of four (interquartile range = 2–5) tests were used, mostly anterior drawer (n = 74/105, 70.5%) and talar tilt-eversion (n = 74/105, 70.5%). Management involved removal from participation (n = 48/94, 51.1%), treatment by athletic trainers (n = 22/40, 55.0%), and referral to physicians (n = 16/40, 40.0%). Conclusions: Deltoid sprains mostly occurred in males playing football or basketball and were caused by twisting with minimal effusion, edema, and range of motion loss. Given the infrequency of deltoid sprains and difficulty diagnosing them, thorough clinical evaluation is necessary for treatment decisions.

Changes in serum levels of pain mediators in hemiplegic shoulder pain.

To provide a new insight into the diagnosis and treatment of hemiplegic shoulder pain (HSP) by investigating changes in serum pain mediators. Cross-sectional study. Shoulder pain group (n=34) and control group (n=21). Pain-free shoulder mobility, anxiety status, depression status, and shoulder pain were measured by passive range of motion (PROM), self-rating anxiety scale, self-rating depression scale (SDS), and visual analog scale, respectively. The enzyme-linked immunosorbent assay was used to test the serum pain mediators, including interleukin (IL)-1β, IL-2, IL-6, IL-10, nerve growth factor (NGF), tumor necrosis factor-α (TNF-α), substance P (SP), calcitonin gene-related peptide (CGRP), bradykinin (BK), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2), and lysophosphatidic acid (LPA). Shoulder pain group pain-free PROM significantly lower than control (p<.01), and SDS index score of shoulder pain group was significantly higher than control (p<.05). The rate of spasticity in the flexor elbow muscles is higher in shoulder pain group (p<.01). CGRP, IL-10, and IL-2 were significantly upregulated in shoulder pain group compared with control (p<.01), whereas NGF, TNF-α, IL-6, 5-HT, PGE2, SP, LPA, BK, and IL-1β were significantly decreased (p<.01). Patients with HSP have a higher risk of joint mobility disorders and depression; spasticity may be an important factor in the development of shoulder pain; CGRP is thought to be the major pain mediator in HSP, and HSP may not be inflammatory.

Comparison between Intra-Articular Corticosteroid Injection with Physiotherapy and Corticosteroid Injection Alone in Management of Early Stage Frozen Shoulders: A Randomized Clinical Trial

Introduction: Frozen shoulder (FS) is the most prevalent cause of shoulder pain and impairment, affecting 2-4% of all adults. As an appropriate strategy of treatment for FS, supportive physiotherapy treatment (PT) and exercises within the limits of pain has been recommended. Objective: To compare between intra-articular corticosteroid injection with physiotherapy and corticosteroid injection alone in the management of early-stage frozen shoulder. Methods: This prospective randomized clinical trial study was done among 23 patients with symptoms of early-stage (stage I or II) FS in the Department of Orthopedics, Monno Medical College Hospital from July to December 2022. Two groups were formed out of all the patients. While the other group (non-PT) did not receive any additional physiotherapy treatment, one group did. A follow-up was planned for weeks 6, 12, and 26. Results: Patients who had symptoms for ≥6 months was significantly higher in PT group (81.8%) in comparison to non-PT group (p&lt;0.05). Patients who took physiotherapy treatment was significantly higher in PT group (72.7%) in comparison to non-PT group (p&lt;0.05). The median total SPADI scores in the PT group at baseline, which were 82 (IQR: 35-86) and in the non-PT group, which were 80 (IQR: 65-87), showed the significant pain and limitations of frozen shoulder (FS) in its early stages. Both therapy groups significantly improved at the primary endpoint of 6 weeks for SPADI scores (p&lt;0.05). At 6 weeks compared to baseline, passive ROM increased significantly (p&lt;0.05). Each of the three ROM orientations showed significant changes in favor of the PT group after 12 weeks (p&lt;0.05). At 6 weeks after baseline, both pain scores and Rand-36 physical component scale scores significantly increased (p&lt;0.05). Conclusion: In the first 12 weeks of the early stage of frozen shoulder, physiotherapy in addition to corticosteroid injection improves range of motion (ROM) and functional mobility limitations compared ............

Continuous suprascapular nerve blockade to potentiate intensive rehabilitation for refractory adhesive shoulder capsulitis: a cohort study.

Evaluating the short- and long-term efficacy of a continuous tenday suprascapular nerve block combined with daily multidisciplinary rehabilitation on shoulder range of motion (ROM), pain, and function in patients with refractory adhesive capsulitis (AC). In this retrospective cohort study, patients admitted to a specialized pain clinic for refractory AC for more than 6 months underwent continuous suprascapular nerve blockade for ten days and received 2 hours of physiotherapy and occupational therapy daily. Standardized assessments were performed at baseline, at days three, six, ten, 30, 90, and 180, and included active and passive ROM measurements, the visual analog scale (VAS) for pain and the disabilities of the arm, shoulder and hand (DASH) questionnaire to assess pain, disability, and quality of life. Improvements over time were assessed using ANOVAs. Thirty-two patients were followed (age: 52 ± 8 years, 25 females, mean symptoms duration of two years). There was a significant improvement in ROM for all amplitudes at day ten (short-term; range: 20-35°, p < 0.001) and at day 180 (long-term; range: 18-47°, p < 0.001). The pain and disability scores significantly reduced by day 180 (mean VAS reduction: 2.6 units, p < 0.001; mean DASH reduction: 9.5 points, p < 0.001). Continuous SSNB combined with intensive multidisciplinary rehabilitation represents an efficient therapeutic option for patients with chronic AC who did not respond to conventional treatments.

Profiling migraine patients according to clinical and psychophysical characteristics: clinical validity of distinct migraine clusters

AimsInvestigate if different clinical and psychophysical bedside tools can differentiate between district migraine phenotypes in ictal/perictal (cohort 1) and interictal (cohort 2) phases.MethodThis observational study included two independent samples in which patients were subgrouped into distinct clusters using standardized bedside assessment tools (headache frequency, disability, cervical active range of motion, pressure pain threshold in different areas): (A) cohort 1—ictal/perictal migraine patients were subgrouped, based on previous studies, into two clusters, i.e., Cluster-1.1 No Psychophysical Impairments (NPI) and Cluster-1.2 Increased Pain Sensitivity and Cervical Musculoskeletal Dysfunction (IPS-CMD); (B) cohort 2—interictal migraine patients were subgrouped into three clusters, i.e., Cluster-2.1 NPI, Cluster-2.2 IPS, and Cluster-2.3 IPS-CMD. Clinical characteristics (multiple questionnaires), somatosensory function (comprehensive quantitative sensory testing (QST)), and cervical musculoskeletal impairments (cervical musculoskeletal assessment) were assessed and compared across headache clusters and a group of 56 healthy controls matched for sex and age.ResultsCohort 1: A total of 156 subjects were included. Cluster-1.2 (IPS-CMD) had higher headache intensity (p = 0.048), worse headache-related (p = 0.003) and neck-related disability (p = 0.005), worse quality of life (p = 0.003), and higher symptoms related to sensitization (p = 0.001) and psychological burden (p = 0.005) vs. Cluster-1.1(NPI). Furthermore, Cluster-1.2 (IPS-CMD) had (1) reduced cervical active and passive range of motion (p < 0.023), reduced functionality of deep cervical flexors (p < 0.001), and reduced values in all QST(p < 0.001) vs. controls, and (2) reduced active mobility in flexion, left/right lateral flexion (p < 0.045), and reduced values in QST (p < 0.001) vs. Cluster-1.1 (NPI). Cohort 2: A total of 154 subjects were included. Cluster-2.3 (IPS-CMD) had (1) longer disease duration (p = 0.006), higher headache frequency (p = 0.006), disability (p < 0.001), and psychological burden (p = 0.027) vs. Cluster-2.2 (IPS) and (2) higher headache-related disability (p = 0.010), neck-related disability (p = 0.009), and higher symptoms of sensitization (p = 0.018) vs. Cluster-2.1 (NPI). Cluster-2.3(IPS-CMD) had reduced cervical active and passive range of motion (p < 0.034), and reduced functionality of deep cervical flexors (p < 0.001), vs. controls, Custer-2.1 (NPI), and Cluster-2.2 (IPS). Cluster-2.2 (IPS) and 2.3 (IPS-CMD) had reduced QST values vs. controls (p < 0.001) and Cluster-2.1 (p < 0.039).ConclusionA battery of patient-related outcome measures (PROMs) and quantitative bedside tools can separate migraine clusters with different clinical characteristics, somatosensory functions, and cervical musculoskeletal impairments. This confirms the existence of distinct migraine phenotypes and emphasizes the importance of migraine phases of which the characteristics are assessed. This may have implications for responders and non-responders to anti-migraine medications.

Efficacy of ultrasound-guided subacromial bursa steroid injection for treating shoulder pain in post-stroke hemiparetic patients

Purpose: To assess the efficacy of ultrasound-guided subacromial bursa (SAB) steroid injection for treating hemiplegic shoulder pain (HSP) after stroke (CS), as well as its impact on joint mobility, and inflammatory mediators.Methods: Seventy-two (72) patients with CS-related HSP were divided into two groups: study and control groups. The study group received ultrasound-guided SAB injection of triamcinolone acetonide in addition to conventional treatment, while control group received only conventional rehabilitation. Both groups received 4 weeks of treatment and were assessed using pain visual analogue scale (VAS) and passive range of motion (PROM) indices before treatment and at 1, 4, and 12 weeks after treatment. Additionally, the Fugl-Meyer motor function (FMA-U) scale score, activities of daily living (ADL) score, modified Barthel index (MBI), serum IL-1β, IL-6, nitric oxide (NO) levels, and incidence of adverse reactions were assessed before and after 4 weeks of treatment.Results: The study group had a significantly higher total efficacy/effectiveness (86.11 %) compared to control group (53.89 %). Both groups showed initial decreases and subsequent increases in VAS and PROM from week 1 to week 12 after treatment. However, the study group had significantly lower VAS scores, angle of forward flexion, abduction, and external rotation at all time points compared to control group (p &lt; 0.05). At week 4, the study group had significantly higher FMA-U, ADL, and MBI scores, as well as significantly lower IL-1β, IL-6, and NO levels when compared to control group (p &lt; 0.05).Conclusion: Ultrasound-guided SAB steroid injection improves the efficacy of HSP after CS, improves joint mobility, and reduces serum levels of IL-1β, IL-6, and NO. Further large-sample studies with increased sample sizes and longer investigation periods are needed to validate these findings.

Preoperative Planning Software Does Not Accurately Predict Range of Motion in Reverse Total Shoulder Arthroplasty.

The purpose of this study was to determine whether preoperative planning software (PPS) accurately predicts clinical range of motion (ROM) in patients with reverse total shoulder arthroplasty 1 year postoperatively with preoperative and postoperative computed tomography (CT) scans. This was a retrospective study of 16 reverse total shoulder arthroplasty patients with preoperative and postoperative (CT) scans obtained at least 1 year postoperatively. Clinical ROM was measured in abduction, external rotation at resting abduction, extension, and flexion at a minimum of 1 year postoperatively. All clinical measurements were obtained before generation of PPS ROM values. Using postoperative CT scans, the achieved implant component positions were quantified and then replicated in PPS on the preoperative CT scans. The preoperative predicted ROM was then recorded, both with and without osteophyte removal. Bland-Altman plots were generated within each motion comparing the differences between clinically measured motion and software-predicted motion. The variation in clinically measured ROM in abduction, external rotation at resting abduction, extension, and flexion were 118 ± 27 (65° to 180°), 33 ± 16 (10° to 75°), 56 ± 8 (50° to 65°), and 137 ± 25 (80° to 160°), respectively. Clinically measured motion differed greatly from PPS-predicted ROM, with mean differences of 33 ± 29 (-32 to 93) for abduction, 44 ± 25 (-38 to 57) for external rotation, 44 ± 25 (-35 to 65) for extension, and 54 ± 50 (-51 to 147) for flexion with no significant correlations between clinically measured and PPS-predicted ROM ( P > 0.05). With humeral or humeral and glenoid osteophyte resection, correlations for only flexion became significant ( P = 0.002 for both). The passive glenohumeral impingement-free ROM generated from PPS incompletely predicts clinically measured active humerothoracic ROM, possibly because of the unmeasured factors of soft-tissue tension, muscular strength, humeral torsion, resting scapular posture, and, most importantly, scapulothoracic motion. IV.

Feasibility and outcomes of supplemental gait training by robotic and conventional means in acute stroke rehabilitation

IntroductionPracticality of implementation and dosing of supplemental gait training in an acute stroke inpatient rehabilitation setting are not well studied but can have positive impact on outcomes.ObjectivesTo determine the feasibility of early, intense supplemental gait training in inpatient stroke rehabilitation, compare functional outcomes and the specific mode of delivery.Design and settingAssessor blinded, randomized controlled trial in a tertiary Inpatient Rehabilitation Facility.ParticipantsThirty acute post-stroke patients with unilateral hemiparesis (≥ 18 years of age with a lower limb MAS ≤ 3).InterventionLokomat® or conventional gait training (CGT) in addition to standard mandated therapy time.Main outcome measuresNumber of therapy sessions; adverse events; functional independence measure (FIM motor); functional ambulation category (FAC); passive range of motion (PROM); modified Ashworth scale (MAS); 5 times sit-to-stand (5x-STS); 10-m walk test (10MWT); 2-min walk test (2MWT) were assessed before (pre) and after training (post).ResultsThe desired supplemental therapy was implemented during normal care delivery hours and the patients generally tolerated the sessions well. Both groups improved markedly on several measures; the CGT group obtained nearly 45% more supplemental sessions (12.8) than the Lokomat® group (8.9). Both groups showed greater FIM improvement scores (discharge – admission) than those from a reference group receiving no supplemental therapy. An overarching statistical comparison between methods was skewed towards a differential benefit (but not significant) in the Lokomat® group with medium effect sizes. By observation, the robotic group completed a greater number of steps, on average. These results provide some evidence for Lokomat® being a more efficient tool for gait retraining by providing a more optimal therapy “dose”.ConclusionsWith careful planning, supplemental therapy was possible with minimal intrusion to schedules and was well tolerated. Participants showed meaningful functional improvement with relatively little supplemental therapy over a relatively short time in study.

Analysis of patients with adhesive capsulitis after COVID-19 vaccination: An observational study.

This study aimed to increase the awareness of clinicians about shoulder injury related to vaccine administration (SIRVA) by analyzing 21 patients with adhesive capsulitis that developed after COVID-19 (coronavirus disease 2019) vaccination. In this observational study, 21 patients (11 males, 10 females; mean age: 60.7±7.3 years; range, 45 to 70 years) with incipient shoulder pain and limitation diagnosed with adhesive capsulitis due to SIRVA were evaluated between June 2021 and December 2022. Demographic and clinical data of the patients were recorded. Pain was evaluated with the Visual Analog Scale (VAS). The passive range of motion (ROM) of the affected shoulder was measured by a goniometer. The applied treatment methods (medical treatment, physical therapy, intraarticular steroid injection, hydrodilatation, and suprascapular nerve block) were recorded. The patients were called in for control two months later. Visual Analog Scale scores and passive shoulder ROMs were reevaluated. Symptoms started after the second dose in nine (42.9%) patients. The mean time between vaccination and onset of complaints was 8.0±6.4 days. Sinovac vaccine was administered to eight patients, BioNTech vaccine was administered to five patients, and Sinovac+BioNTech vaccine was administered to eight patients. Baseline to control ROM angle changes were 128.8±30.4º to 155.0±20.6° for flexion, 117.1±37.8° to 147.1±26.4° for abduction, 45.9±17.8° to 61.9±12.6° for internal rotation, and 43.4±21.9° to 56.3±18.3° for external rotation, respectively. The mean VAS scores were 7.0±1.2 (5-9) at baseline and 2.7±1.0 (1-5) at the control. There was a statistically significant difference between the baseline and control (two months after treatment) in terms of VAS scores and ROM angles (p<0.001). Clinicians should be aware of adhesive capsulitis following vaccine administration since a significant improvement can be obtained by proper treatment for SIRVA.

Comparison of the physiotherapy with and without focus on the scapulothoracic joint on pain, range of motion, functional disability, quality of life, and treatment effectiveness of patients after arthroscopic shoulder rotator cuff tendon repair: A randomized controlled trial with short-term follow-up

BackgroundRotator cuff tears are prevalent shoulder injuries, significantly affecting shoulder stabilization and patient quality of life. Despite rehabilitation efforts post-arthroscopic surgery, the efficacy of scapular-focused exercises remains uncertain with limited supportive evidence. PurposeThis study aimed to compare the immediate and short-term effects of emphasizing scapulothoracic joint rehabilitation in addition to conventional physiotherapy on pain, range of motion (ROM), function, quality of life, and treatment effectiveness in patients after shoulder arthroscopic rotator cuff tendon repair (ARCR). Study DesignTwo arms, parallel-group, randomized controlled trial, with concealed allocation MethodsThis parallel-group randomized controlled trial, with concealed allocation, was conducted in a clinic setting on 28 participants aged 30-75 years, exhibiting progressive degenerative full-thickness tears of rotator cuff muscles and undergoing ARCR, provided the tear size was small or medium. Participants were randomly allocated to receive 21 sessions of conventional rehabilitation (n = 14) or comprehensive rehabilitation (with a focus on scapula training; n = 14) in 12 weeks (reporting of intervention complied with Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) Guideline). Pain (as primary outcome), ROM, functional disability, quality of life, and treatment effectiveness were assessed both pre- and post-intervention, along with a 3-month follow-up. Participants, assessors, and statistician were blinded to group assignment. For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used. ResultsTrial was completed with 28 participants and no dropouts. The analysis of variance revealed statistically significant group-by-time interaction (p < 0.05) for all outcome measures except for active ROMs (p > 0.05). Multiple comparison analysis showed statistically significant between-group differences (p < 0.05) at 3-month follow-up with large effect size (>0.8 Hedges’ g) for all outcomes (mean differences: visual analog scale: 1.3, American Shoulder and Elbow Surgeons: −17.3, Shoulder Pain and Disability Index: 17.6, Western Ontario Rotator Cuff: −19.5, QuickDASH: 17.8), except for extension ROM (passive ROM: confidence interval = −25.4 to 0.56; active ROM: confidence interval = −20.0 to 6.0). The differences in American Shoulder and Elbow Surgeons and Western Ontario Rotator Cuff were also clinically significant based on their minimally clinical important difference cutoff points. For the Global Rating of Change scale, more participants stated “much improved” in the comprehensive group than in the conventional. No adverse effects were reported. ConclusionsComprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR.

Factors Associated with Medial Elbow Torque Measured Using a Wearable Sensor in Junior High School Baseball Pitchers

There are no reports investigating the relationship between shoulder range of motion (ROM) and pitching elbow torque in junior high school pitchers. Therefore, we aimed to evaluate the factors associated with medial elbow torque in this population. Sixty-three junior high school baseball pitchers were recruited for this study. The participants completed a questionnaire and passive ROM measurements of shoulder abduction and horizontal adduction. All pitchers pitched three fastballs at maximum effort while wearing a wireless sensor recording pitching mechanics and elbow valgus torque for each pitch. Age (r = 0.65, p &lt; 0.001), height (r = 0.83, p &lt; 0.001), body weight (r = 0.82, p &lt; 0.001), BMI (r = 0.60, p &lt; 0.001), and ball velocity (r = 0.80, p &lt; 0.001) were significantly positively correlated with elbow valgus torque. Participants were divided into two groups based on elbow valgus torque, &gt;30 (high torque [HT]) and &lt;30 N·m (low torque [LT]). Age, height, body weight, BMI, and ball velocity were significantly higher in the HT group than in the LT group. The difference between dominant and non-dominant shoulder horizontal adduction ROM was 5.3 ± 9.3° and 1.0 ± 6.4° in the HT and LT groups, respectively, which was also significantly different. Ball velocity, age, larger physique, and increased restriction of the dominant shoulder’s horizontal adduction ROM were associated with higher medial elbow torque in junior high school pitchers. This suggests that improving the dominant shoulder’s horizontal adduction ROM contributes to preventing elbow injuries.

The Use of Physical Rehabilitation to Improve Outcome Following Traumatic Brain Injury in Dog- A Case Report

Traumatic brain injury (TBI) in the canine patient is a common sequela to head trauma accidents such as vehicular trauma or high-rise falls. A 3-year-old, intact female mixed breed dog presented to Purdue University College of Veterinary Medicine following a suspected hawk attack. At presentation, this non-ambulatory, tetraparetic, mentally inappropriate, and stuporous patient was diagnosed with suspected TBI secondary to trauma. Physical rehabilitation was initiated and continued during the hospitalization period and afterwards on an outpatient basis. Rehabilitation focused on a combination of mental stimulation, proprioceptive and balance work, and sensory stimulation. Therapies and exercises used consisted of massage, stretching, passive range of motion (PROM), assisted standing, weight shifting, underwater treadmill (UWTM), and the use of textured surfaces, music, and positive encouragement. The patient’s coordination, balance, and mentation greatly improved. At a follow-up visit 4 months post-injury, she could ambulate with no assistance and had minimal neurological deficits. Physical rehabilitation after TBI in humans is considered to be standard of care. In this veterinary patient, rehabilitation contributed to healing, return of function, and good quality of life.

Evaluating the feasibility of implementing the Sup-ER protocol for infants with brachial plexus birth injury

BackgroundThe Sup-ER protocol involves a repositioning program for infants with brachial plexus birth injury to position the shoulder in external rotation (ER) to address progressive loss in passive range of motion (PROM). The British Columbia Children’s Hospital (BCCH) eligibility criteria for this protocol are infants aged 4-8 weeks with decreased shoulder ER PROM and/or Active Movement Scale (AMS) shoulder ER and/or supination scores ≤2. The resources needed to implement this protocol in large clinics have not been studied. PurposeThis study aims to evaluate the BCCH criteria that are used to identify appropriate candidates for the Sup-ER protocol. Study DesignA retrospective cohort study was conducted to identify the percentage of infants who would have been recommended the Sup-ER protocol based on their PROM and AMS scores between 4 and 8 weeks of age. MethodsA sensitivity and specificity evaluation was used to describe the BCCH criteria's ability to identify infants in this historical cohort who went on to have incomplete shoulder function (ie, true positive) vs infants who had functional shoulder outcome at 9 months of age (ie, false positive). ResultsAt a mean of 5.8 weeks (95% confidence interval [CI] 5.3, 6.3), 46 of the 87 (53%) infants satisfied the BCCH Sup-ER protocol criteria. Forty-four (51%) were female, half (n = 45) were left side affected, and 88% had upper plexus injury. The BCCH Sup-ER protocol criteria had sensitivity of 100% and specificity of 71% to identify infants with incomplete shoulder function. Removing the AMS supination ≤2 score criterion from the criteria improves the specificity to 84%, while sensitivity remains high (97%). ConclusionsModifying the BCCH criteria to all infants aged 4-8 weeks with AMS shoulder ER ≤2 and/or decreased shoulder ER PROM improves the precision of identifying infants who would benefit from the Sup-ER protocol.