Plane Range Of Motion Research Articles

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

Biomechanics of the lower limb in patients with mild knee osteoarthritis during the sit-to-stand task

BackgroundKnee osteoarthritis (KOA) is a prevalent and debilitating condition that markedly affects the sit-to-stand (STS) activity of patients, a prerequisite for daily activities. Biomechanical recognition of movements in patients with mild KOA is currently attracting attention. However, limited studies have been conducted solely on the observed differences in sagittal plane movement and muscle activation.AimThis study aimed to identify three-dimensional biomechanical and muscle activation characteristics of the STS activity in patients with mild KOA.MethodsA cross-sectional study was conducted to observe the differences between patients with mild KOA and a control group (CG). It was conducted to observe the differences in muscle activation, including root mean square (RMS%) and integrated electromyography (items), kinematic parameters like range of motion (ROM) and maximum angular velocity, as well as dynamic parameters such as joint moment and vertical ground reaction force (vGRF).ResultsPatients with mild KOA had a higher body mass index and longer task duration. In the sagittal plane, patients with KOA showed an increased ROM of the pelvic region, reduced ROM of the hip–knee–ankle joint, and diminished maximum angular velocity of the knee–ankle joint. Furthermore, patients with KOA displayed increased knee–ankle joint ROM in the coronal plane and decreased ankle joint ROM in the horizontal plane. Integrated vGRF was higher in both lower limbs, whereas the vGRF of the affected side was lower. Furthermore, patients showed a decreased peak adduction moment (PADM) and increased peak external rotation moment in the knee joint and smaller PADM and peak internal rotation moment in the ankle joint. The affected side exhibited decreased RMS% and iEMG values of the gluteus medius, vastus medialis, and vastus lateralis muscles, as well as a decreased RMS% of the rectus femoris muscle. Conversely, RMS% and iEMG values of the biceps femoris, lateral gastrocnemius, and medial gastrocnemius muscles were higher.ConclusionThe unbalanced activation characteristics of the anterior and posterior muscle groups, combined with changes in joint moment in the three-dimensional plane of the affected joint, may pose a potential risk of injury to the irritated articular cartilage.

Is there a role for acromioplasty and tuberoplasty in reverse shoulder arthroplasty to improve impingement-free range of motion?

Hypothesis and BackgroundLateralizing the center of rotation in reverse shoulder arthroplasty (RSA) decreases the risk of scapular notching due to inferior impingement but may limit range of motion (ROM) in abduction and forward flexion related to superior acromial impingement. Our primary hypothesis was that, using a 3-dimensional (3D) computer model, a virtual acromioplasty (with or without tuberoplasty) could improve abduction and forward flexion following RSA for cuff tear arthritis (CTA) or massive cuff tear. Our secondary hypothesis was that, based on the virtual planning, a surgical acromioplasty could be performed safely during RSA, without increasing the risk of postoperative acromial fracture. MethodsEighty seven patients with CTA scheduled for RSA were analyzed with a 3D software and impingement-free ROM was measured. After virtual prosthesis implantation, early acromio-humeral impingement (abduction ≤ 80° or forward flexion ≤ 120°) was observed in 25% of the cases (22/87). A virtual acromioplasty (with or without tuberoplasty) was then performed and glenohumeral ROM was measured again. Based on this 3D planning, a surgical acromioplasty (with or without tuberoplasty) was performed to improve ROM in the vertical plane in these 22 patients with early acromial impingement. Patients were followed with minimum 24 months of follow-up to assess final shoulder ROM and complications. ResultsAfter virtual acromioplasty alone (n = 11) or acromioplasty with tuberoplasty (n = 11), glenohumeral abduction significantly increased from 75° ± 6.9 before to 89.5° ± 23.4, and forward flexion from 119.3° ± 12 to 135.2° ± 10 (P < .001). After surgical acromioplasty/tuberoplasty, the final mean global forward flexion was 148° ± 5 and mean global abduction 150° ± 8 in these patients. At last follow-up, no acromial fracture was observed. ConclusionIn a 3D model, early acromial impingement may limit abduction (≤80°) or forward flexion (≤120°) after virtual RSA implantation for CTA or massive cuff tear. Virtual acromioplasty (with or without tuberoplasty) shows improved ROM in abduction and flexion. In patients with early impingement, a surgical acromioplasty can be performed safely during RSA, through a deltopectoral approach, without increasing the risk of postoperative acromial fracture.

Managing Postoperative Complications in a Patient with Excessive Ankle Stiffness: A Case Study Addressing Balance, Muscle Strength, and Quality of Life

Introduction: Postoperative complications decrease muscle strength and balance. Thus, managing the complications is crucial for optimizing patient outcomes and promoting speedy recovery. This case study explores the use of Instrument-Assisted Soft Tissue Mobilization (IASTM) and electrotherapy in managing postoperative complications in a patient with excessive ankle stiffness, addressing balance and muscle strength, as they are essential components of functional mobility in patients with ankle stiffness. Case Presentation: A 41-year-old female athlete with Achilles tendon contracture participated in this study. A 12-week IASTM and electrotherapy was implemented. Isokinetic muscle strength, balance, and quality of life were investigated. Results: The results showed significant improvement in the stability index, path length and area, dorsiflexion/plantarflexion peak torque, range of motion (ROM), total work, and reduced passive stiffness. The results of all domains of quality of life (SF-36), Foot and Ankle Ability Measure (FAAM), , Achilles Tendon Rupture Score (ATRS), Visual Analog Scale (VAS), and Foot and Ankle Outcome Score (FAOS) improved. The intervention was successful in improving balance, muscle strength, sagittal plane ROM, and quality of life and reduced pain during balance in the patient. Conclusions These findings suggest that the intervention may be an effective treatment option for individuals with excessive ankle stiffness and related balance and strength deficits.

Sagittal plane knee kinematics can be measured during activities of daily living following total knee arthroplasty with two IMU.

Knee function is rarely measured objectively during functional tasks following total knee arthroplasty. Inertial measurement units (IMU) can measure knee kinematics and range of motion (ROM) during dynamic activities and offer an easy-to-use system for knee function assessment post total knee arthroplasty. However, IMU must be validated against gold standard three-dimensional optical motion capture systems (OMC) across a range of tasks if they are to see widespread uptake. We computed knee rotations and ROM from commercial IMU sensor measurements during walking, squatting, sit-to-stand, stair ascent, and stair descent in 21 patients one-year post total knee arthroplasty using two methods: direct computation using segment orientations (r_IMU), and an IMU-driven iCloud-based interactive lower limb model (m_IMU). This cross-sectional study compared computed knee angles and ROM to a gold-standard OMC and inverse kinematics method using Pearson's correlation coefficient (R) and root-mean-square-differences (RMSD). The r_IMU and m_IMU methods estimated sagittal plane knee angles with excellent correlation (>0.95) compared to OMC for walking, squatting, sit-to-stand, and stair-ascent, and very good correlation (>0.90) for stair descent. For squatting, sit-to-stand, and walking, the mean RMSD for r_IMU and m_IMU compared to OMC were <4 degrees, < 5 degrees, and <6 degrees, respectively but higher for stair ascent and descent (~12 degrees). Frontal and transverse plane knee kinematics estimated using r_IMU and m_IMU showed poor to moderate correlation compared to OMC. There were no differences in ROM measurements during squatting, sit-to-stand, and walking across the two methods. Thus, IMUs can measure sagittal plane knee angles and ROM with high accuracy for a variety of tasks and may be a useful in-clinic tool for objective assessment of knee function following total knee arthroplasty.

Assessing the Impact of Sensor Orientation on Accelerometer-Derived Angles: A Systematic Analysis and Proposed Error Reduction

Accelerometers have been widely used for motion analysis. The effect of initial sensor orientation (ISO) on the derived range of motion (ROM) is currently unexplored, limiting clarity in understanding error. This two-step study systematically explored the effect of ISO on the error of accelerometer-derived range of motion (ROM) and the effect of a proposed correction algorithm. Accelerometer data were used to compute peak and through-range ROM across a range of ISO and movement angular velocities up to 148° s−1 compared to an optoelectronic gold-standard. Step 1 demonstrated that error increased linearly with increasing ISO offsets and angular velocity. Average peak ROM RMSE at an ISO of 20° tilt and twist was 5.9° for sagittal motion, and for an ISO of 50° pitch and 20° twist, it was 7.5° for frontal plane ROM. Through-range RMSE demonstrated errors of 7–8° for similar ISOs. Predictive modeling estimated a 3.2° and 3.7° increase in peak and through-range sagittal plane error for every 10° increase in tilt and twist ISO. Step 2 demonstrated error reduction utilizing mathematical correction for ISO, resulting in &lt;1° mean peak error and &lt;1.2° mean through-range ROM error regardless of ISO. Accelerometers can be used to measure cardinal plane joint angles, but initial orientation is a source of error unless corrected.

Reliability and measurement properties of upper cervical flexion-extension range of motion testing in people with cervicogenic headache and asymptomatic controls

ABSTRACT Objective The objective was to determine reliability of sagittal plane range of motion (ROM) assessment in a healthy population and in people with cervicogenic headache (CGH). Methods Upper cervical flexion/extension ROM was measured using an iPhone magnetometer sensor and retraction/protraction ROM measured by linear displacement. Two independent raters evaluated these movements in 33 subjects with CGH and 33 age and gender matched asymptomatic healthy controls on two occasions. Measurement procedures were standardized; and the order of testing randomized. Reliability, standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Results Subjects comprised 30 females and 36 males. The iPhone method demonstrated high reliability (ICC >0.82) with SEM values ranging from 0.62 to 1.0 and MDC values ranging from 1.70 to 4.81 respectively. Evaluation of linear displacement demonstrated moderate reliability (ICC >64). with SEM values ranging from 0.38 to 1.91 and MDC values ranging from 1.05 to 1.63 respectively. Compared to healthy controls, upper cervical flexion, retraction and protraction ROM was significantly less in the CGH group with mean difference of 6.50°, 1.52 cm and 2.34 cm respectively. Discussion Upper cervical spine sagittal plane ROM can be measured with moderate to high reliability and was found to be more restricted in people with CGH.

The relationship between cervical spine range of motion and postural sway in mechanical neck pain: A cross-sectional study.

Impairments in postural sway have been identified in people with mechanical neck pain. The influence of cervical spine range of motion (ROM) on postural sway is unclear in mechanical neck pain (MNP). This study investigated the relationship between cervical spine range of motion (ROM) and postural sway in MNP. The cervical ROM was measured using the Cervical Range of Motion (CROM) device. Standing postural sway characterised by mean centre of pressure (COP) measurements in the anterior posterior (AP) and medio-lateral direction with eyes closed and feet together condition was recorded on a posturography platform. Pearson product moment correlation coefficient was used to identify the relationship between cervical ROM and postural sway. Seventy-two MNP individuals (Mean age: ) of either sex (Male: ) were recruited. Overall, no statistically significant correlations were identified between cervical spine ROM in sagittal and frontal plane and postural sway (r values ranging from 0.00 to ; p-values ). However, a weak negative correlation was present between the cervical rotation and AP (r-; p-) and mediolateral (r-; p-) COP excursion. The cervical spine ROM was found to have a weak relationship with postural sway in individuals with MNP. This suggests the investigation of other mechanisms especially muscle tension which might be responsible for altered postural sway in MNP.

Quadriceps strength and psychological readiness are associated with multiplanar knee kinematics after anterior cruciate ligament reconstruction

BackgroundGait asymmetry, negative psychological factors and quadriceps strength deficits are common after anterior cruciate ligament reconstruction (ACLR). Whether quadriceps strength and psychological factors have impacts on multiplanar knee kinematics remains unclear. Research questionWhat are the relationships of multiplanar knee kinematics during the gait cycle and psychological readiness to quadriceps strength after ACLR? MethodIn total, 45 patients were enrolled in this study at 8.3 ± 1.5 months after ACLR. All patients underwent gait analysis and isokinetic testing. Interlimb differences in the range of motion (ROM) and maximum and initial contact (IC) angles in abduction-adduction, flexion-extension, and internal-external rotation were calculated. The limb symmetry index (LSI) for quadriceps strength was calculated. Psychological readiness was measured using the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale. The paired t test analyzed the differences between contralateral and affected limbs in quadriceps and hamstrings strength. Pearson or Spearman correlation was used to assess relationships between the variables of interest. ResultsSignificant differences between contralateral and affected limbs were observed in isokinetic knee quadriceps strength (P < 0.001) and hamstring strength (P = 0.009). The ACL-RSI score correlated negatively with interlimb differences in the knee flexion angle at IC (r = –0.35, P = 0.02) and ROM in the transverse plane (r = –0.41, P = 0.003). The LSI for quadriceps strength correlated negatively with the peak knee flexion angle (r = –0.37, P = 0.02) and positively with the ACL-RSI score (r = 0.3, P = 0.05). SignificanceGreater psychological readiness and quadriceps strength are associated with more symmetrical multiplanar knee kinematics. The improvement of these parameters may aid the recovery of knee kinematics after ACLR, and reduce the rate of reinjury and incidence of posttraumatic osteoarthritis.

Robotic biomechanical evaluation of six different reverse shoulder implants

BackgroundThe reverse total shoulder arthroplasty is a popular surgical treatment for a degenerative shoulder with a nonfunctional rotator cuff. Currently, more than 36 different brands with small different features are available. This creates choice stress among many surgeons, who no longer know which parameters and surgical factors are important to optimize the placement of the implant. PurposeThe first purpose of this pilot study was to compare the passive range of motion (ROM) of 6 different implant designs implanted following the manufacturer’s guidelines. The second goal was to identify the impingements after implantation which determines the maximal ROM. The last goal of the study was to link the different parameters of an implant with the ROM. MethodsSix implant systems were implanted on identical sawbones. The procedure was repeated 3 times on a different sawbone to objectify the surgical repeatability of the procedures. A Stäubli TX-90 robot was used to perform and control the humerus' kinematic movement. An optical tracking system was used to perform the system's calibrations, track the humerus and scapula in space, and compute the center of rotation. ResultsThere was a wide ROM in the scapular plane (44.8°-105.5°) while the minimal elevation (adduction) varied between −4.8° and 35.6°. The rotational movements were limited by contact of the superior humeral polyethylene inlay and the inferior scapular neck. The adduction in the coronal and scapular plane was limited by inferior scapular impingement, whereas the maximal abduction was limited either by bony contact between the humerus and acromion or by contact between the humeral polyethylene inlay and the superior glenoid cavity. A bigger radius of the glenosphere resulted in a larger passive humeroscapular ROM (P < .001). A larger Neck-Shaft-Angle results in a better abduction (P < .001) but compromised adduction (P < .001). The localization of the center of rotation has a significant impact on the ROM. The medialized designs have larger abduction and rotational angles (P < .001). ConclusionThere is a wide variation in the measured glenohumeral ROM between the 6 frequently implanted prostheses. The most important factor to optimize the impingement-free ROM in all types of prostheses is the creation of the prosthetic overhang of the glenosphere to the bone. Too much lateralization of the center of the glenosphere with or without lateralization of the humeral stem can create a subacromial and/or subcoracoidal impingement.

Effects of Contralateral Hip Flexion Angle on the Ober Test.

The Ober test is an orthopedic evaluation procedure used to assess for tightness of the tensor fascia latae (TFL) and iliotibial band (ITB). Multiple versions of this test have been described using different degrees of contralateral hip joint flexion to stabilize the pelvis. The aim of this study was to analyze the hip range of motion (ROM) in the frontal plane and perceived tension produced during the Ober test using four different angles of contralateral hip flexion prepositioning. The secondary objective was to analyze the differences in the Ober test with different contralateral hip flexion angles according to limb dominance. This cross-sectional study included healthy individuals aged 18 years or older. The Ober test was performed on the right and left leg of each participant with the contralateral hip joint stabilized at 0° flexion, 45° flexion, 90° flexion, and maximal flexion. Hip range of motion in the frontal plane (abduction or adduction) was measured using a digital inclinometer. Three measurements were performed on each limb for every angle of contralateral prepositioning, using the average of the three measurements for statistical analysis. Participants were asked to report the location of any perceived tension and the intensity of tension using a Numeric Rating Scale during the test. Twenty-eight participants (17 men and 11 women) were examined. Significant differences in the Ober test hip ROM in the frontal plane (p < 0.01) were observed when comparing different angles of contralateral hip flexion prepositioning. Significant differences between tests were also present for intensity of perceived tension (p ≤ 0.001), except for the intensity of perceived tension between 0° and 45°. No statistically significant differences were observed related to limb dominance (p > 0.05) or gender (p > 0.05), except for the Ober test at 0° (p < 0.001) which was higher in men (9.61° ± 5.01°) than in women (5.05° ± 2.87°). Greater contralateral hip flexion prepositioning during the Ober test results in decreased hip adduction ROM in the tested limb and greater perceived tension in the region of tensor fascia latae-iliotibial band.

Is there a correlation between isometric muscle strength and the kinematics of the pelvis, hip and knee during functional tasks in women with patellofemoral pain?

ObjectivesTo evaluate the correlation between isometric muscle strength of the hip abductors (HABD) and lateral rotators (HLR) with the range of motion (ROM) of the pelvis/hip in the frontal/transverse planes, respectively, and between the strength of the knee extensors (KExt) with the ROM of the knee in the sagittal plane during seven tasks. DesignCross-sectional study. SettingLaboratory. ParticipantsThirty-five women with patellofemoral pain. Main outcome measuresMaximum isometric muscle strength of the HABD, HLR, and KExt was measured using a manual dynamometer, and pelvis and lower limbs kinematics were evaluated using 3D optical system during gait, ascending and descending stairs, the forward and lateral step down tests, and the propulsion and landing phases of the single leg hop test (SLHT). ResultsA weak correlation was found between KExt strength and knee ROM in the sagittal plane (p = 0.05; r = −0.33) during SLHT landing, and a moderate correlation between HABD strength and ROM of pelvic obliquity (p < 0.01; r = 0.50) during ascending stairs. ConclusionsThe lower strength of KExt has a weak correlation with higher knee flexion during the landing phase of the SLHT, and the lower strength of HABD has a moderate correlation with lower pelvis ROM in the frontal plane when ascending stairs.

Cadaveric Gait Simulation of the Effect of Subtalar Arthrodesis on Total Ankle Replacement Kinematics.

Patients undergoing total ankle replacement (TAR) often have symptomatic adjacent joint arthritis and deformity. Subtalar arthrodesis can effectively address a degenerative and/or malaligned hindfoot, but there is concern that it places abnormal stresses on the TAR and adjacent joints of the foot, potentially leading to early TAR failure. This study hypothesized that ankle and talonavicular joint kinematics would be altered after subtalar arthrodesis in the setting of TAR. Thirteen mid-tibia cadaveric specimens with neutral alignment were tested in a robotic gait simulator. To simulate gait, each specimen was secured to a static mounting fixture about a 6-degree of freedom robotic platform, and a force plate moves relative to the stationary specimen based on standardized gait parameters. Specimens were tested sequentially in TAR and TAR with subtalar arthrodesis (TAR-STfuse). Kinematics and range of motion of the ankle and talonavicular joint were compared between TAR and TAR-STfuse. There were significant differences in kinematics and range of motion between TAR and TAR-STfuse groups. At the ankle joint, TAR-STfuse had less internal rotation in early-mid stance (P < .05), with decreased range of motion in the sagittal (-2.7 degrees, P = .008) and axial (-1.8 degrees, P = .002) planes in early stance, and increased range of motion in the coronal plane in middle (+1.2 degrees, P < .001) and late (+2.5 degrees, P = .012) stance. At the talonavicular joint, there were significant differences in axial and coronal kinematics in early and late stance (P < .05). Subtalar arthrodesis resulted in significantly decreased talonavicular range of motion in all planes in early and late stance (P < .003). In ankles implanted with the TAR design used in this study, kinematics of the ankle and talonavicular joint were found to be altered after subtalar arthrodesis. Aberrant motion may reflect altered contact mechanics at the prosthesis and increased stress at the bone-implant interface, and affect the progression of adjacent joint arthritis in the talonavicular joint. These findings may provide a correlate to clinical studies that have cited hindfoot arthrodesis as a risk factor for TAR failure.

Exploring effects of cryotherapy modalities on pain, muscle strength and joint position sense in healthy participants with induced knee pain

Keywords: Cryotherapy; Compression; Rehabilitation Purpose: In the current guidelines for acute injury management ‘optimal loading’ has been introduced to facilitate early activity to optimise recovery. Although studies have identified potential adverse effects on muscle performance and knee joint repositioning following ice, evidence supports the use of cryotherapy to provide short-term pain relief. Cryotherapy interventions which can provide short-term pain relief, yet minimise adverse effects, would allow early activity with a lower risk of injury. This study utilised a targeted compressive-cryotherapy approach on experimentally induced knee pain in healthy participants and explored the effects on muscle strength and joint position sense. Methods: 10 healthy participants (7 females, 3 males; 32.9 ± 11.6 years) were induced with experimental knee pain using capsaicin cream (0.075%). Topical capsaicin is a common experimental pain method and was applied to the participant's skin on the medial aspect of the non-dominant knee. A randomised crossover design was adopted, exploring two 20-minute cryotherapy interventions, (1) ice (wetted: 400 g cubed ice, 400 ml water) and (2) Swellaway (10 °C, 50 mmHg compression), during separate testing sessions. Four outcome measures were explored: (i) participant-reported numerical pain rating scale (NPRS), (ii) pressure pain threshold (PPT), (iii) quadriceps muscle strength and (iv) joint position sense (JPS). These outcomes were recorded at four time points: pre-capsaicin cream application (T1), post-capsaicin (T2), post-cooling intervention (T3) and 20-minutes post-cooling (T4). Repeated measures ANOVAs (3 × 2) with post-hoc pairwise comparisons were used to assess change in outcomes between time points. Results: Complete pain relief (≥93% pain reduction) was achieved immediately post-cooling in 7 participants for Swellaway and in 4 participants for ice. Participant NPRS was reduced by 100% (Swellaway) and 91% (ice) 20-minutes post-cooling. No statistically significant differences were found in short-term pain relief between interventions. Significant increases in PPT were found between post-capsaicin and post-cooling (27% increase) and between post-capsaicin and 20-minutes post-cooling (20% increase) following Swellaway. No significant differences were found in PPT between any time points following ice. Ice reduced quadriceps strength by 13% immediately post-cooling. Swellaway had a negligible effect on muscle strength immediately post-cooling (+0.3%). The strength deficit post ice was almost double the percentage reduction (6%) associated with clinically important functional deficits in people with knee osteoarthritis. Significant increases were found in range of motion (ROM) in the coronal plane following ice, which indicates increased instability (adduction/abduction). Despite not being statistically significant, a trend of increased instability (14%) in the transverse plane ROM 20-minutes post-cooling was most apparent following the ice (P = 0.053). Conclusion(s): Targeted compressive-cryotherapy has the potential to achieve short-term pain relief, as demonstrated on healthy participants with experimentally induced knee pain. The results suggest a targeted approach can also minimise the negative effects on muscle strength, dynamic stability and knee joint repositioning, which may traditionally have discouraged early optimal loading post cryotherapy. This would allow individuals to return to weight-bearing rehabilitation exercises earlier, at a lower risk of re-injury post-intervention. Impact: Clinicians could consider utilising targeted compressive-cryotherapy to provide a short-term pain relief and minimise the reported adverse effects following cryotherapy, facilitating early weight-bearing rehabilitation. Funding acknowledgements: This research was carried out as part of a Knowledge Transfer Partnership between Manchester Metropolitan University, University of Central Lancashire and Swellaway.

ATLAS2030 Pediatric Gait Exoskeleton: Changes on Range of Motion, Strength and Spasticity in Children With Cerebral Palsy. A Case Series Study.

Background: Cerebral Palsy (CP), the most common motor disability in childhood, affects individual's motor skills, movement and posture. This results in limited activity and a low social participation. The ATLAS2030 exoskeleton is a pediatric device that enables gait rehabilitation for children with neurological or neuromuscular pathologies with gait pathology.Purpose: To study changes in relation to range of motion (ROM), strength and spasticity in children with CP after using the ATLAS2030 gait exoskeleton.Methods and Participants: Three children (mean age 8.0 ± 2.0), two girls and one boy, two of them with GMFCS IV and one with GMFCS III, received robot-assisted gait training (RAGT) with ATLAS2030 for one month.Results: The average time of exoskeleton use was 54.7 ± 10.4 min in all sessions, and all participants were able to perform all exercises. The strength of all muscle groups was increased after the 10 sessions for the participants assessed and the limited ROM in the sagittal plane (hip and knee extension and ankle dorsiflexion) decreased after the use of the exoskeleton compared to the initial state. Spasticity was reduced at the end of the sessions after the use of the exoskeleton compared to their initial state.Conclusion: The ROM, spasticity and strength were improved after RAGT with ATLAS2030 exoskeleton in these children with CP. However, further studies with larger samples should be carried out to confirm our findings.

Influence of using knee sleeve and lateral wedge insole on knee loading among healthy individuals during stair negotiation

BackgroundFor individuals with knee osteoarthritis (OA), stair negotiation is a challenging task and the first task during which they report pain due to the high knee loading required. The use of lateral wedge insole (LWI) has been found to reduce loading in patients with OA but not to reduce pain, whereas the use of knee sleeve has been shown to result in good pain reduction. Understanding the effect of combining LWI and knee sleeve use on healthy individuals before testing on individuals with knee OA is an important step. Research questionThe current study aimed to evaluate the effect of combining the use of LWI and knee sleeve and compare the results with the application of each treatment separately and with the control condition. MethodsThis randomised cross-over study included 17 healthy participants who underwent 3D gait analysis. Participants performed ascending and descending stair activities with the following four treatment conditions: five-degree LWI, off-the-shelf knee sleeve, both LWI and knee sleeve and control condition. External knee adduction moment (EKAM) and knee frontal plane range of motion (ROM) were evaluated as primary outcomes. Repeated measure ANOVA or the Friedman test was selected based on meeting the assumption followed by multiple pairwise comparisons with Bonferroni correction. ResultsIn general, the use of LWI reduced the first peak EKAM significantly (p < 0.001) compared to the control condition in stir ascending (12% reduction) but not in stair descending (p > 0.05). Interestingly, knee sleeve use did not result in any reduction in the first peak EKAM compared to the control or any other condition. However, knee sleeve use led to a significant reduction in the knee frontal plane ROM during stair descending. The combined treatment was not superior to the LWI use when compared to control in the EKAM reduction. SignificanceCombined knee sleeve and LWI use was not superior to LWI use alone in reducing the knee loading, but it may be beneficial for individuals with knee OA since it helped in reduction of the knee frontal plane ROM during stair descending. Importantly, the effect of LWI use or any other treatment must be investigated for each different activity, and the results found in one activity must not be generalised across other activities.

Validity and Sensitivity of an Inertial Measurement Unit-Driven Biomechanical Model of Motor Variability for Gait.

Motor variability in gait is frequently linked to fall risk, yet field-based biomechanical joint evaluations are scarce. We evaluated the validity and sensitivity of an inertial measurement unit (IMU)-driven biomechanical model of joint angle variability for gait. Fourteen healthy young adults completed seven-minute trials of treadmill gait at several speeds and arm swing amplitudes. Trunk, pelvis, and lower-limb joint kinematics were estimated by IMU- and optoelectronic-based models using OpenSim. We calculated range of motion (ROM), magnitude of variability (meanSD), local dynamic stability (λmax), persistence of ROM fluctuations (DFAα), and regularity (SaEn) of each angle over 200 continuous strides, and evaluated model accuracy (RMSD: root mean square difference), consistency (ICC2,1: intraclass correlation), biases, limits of agreement, and sensitivity to within-participant gait responses (effects of speed and swing). RMSDs of joint angles were 1.7–9.2° (pooled mean of 4.8°), excluding ankle inversion. ICCs were mostly good to excellent in the primary plane of motion for ROM and in all planes for meanSD and λmax, but were poor to moderate for DFAα and SaEn. Modelled speed and swing responses for ROM, meanSD, and λmax were similar. Results suggest that the IMU-driven model is valid and sensitive for field-based assessments of joint angle time series, ROM in the primary plane of motion, magnitude of variability, and local dynamic stability.

Global Spine Range of Motion in Patients With Adolescent Idiopathic Scoliosis Before and After Corrective Surgery.

Given the importance of the spine in carrying out daily movements, adolescent idiopathic scoliosis (AIS) can significantly limit the range of motion (ROM). Severe forms of AIS are treated surgically, most commonly with posterior spinal fusion and instrumentation, which may also reduce spine ROM. This review is the first to describe the literature on total spine ROM in patients with AIS before and after corrective surgery. A systematic literature search was performed using PubMed and Google Scholar to identify articles reporting global spine ROM in AIS patients. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 486 articles were initially identified. Two independent reviewers (YM and JH) assessed eligibility for inclusion.A total of 11 articles fit the inclusion criteria. AIS in untreated patients seems to limit axial and coronal plane ROM based on the degree of curve severity, with more severe curves having less ROM. More research comparing total spine ROM in untreated AIS patients to that of healthy controls is needed. In those undergoing spinal fusions, the lowest instrumented vertebra and surgical approach appear to minimize further reductions in ROM; however, the findings are mixed. Vertebral body tethering (VBT) shows promising preliminary results in treating AIS while preserving motion; however, long-term outcomes have yet to be assessed for this novel procedure. The results of this systematic review suggest that further research is required before treatment strategies can be modified for surgically treating patients with AIS to take into account the effects of treatment on changes in spine mobility.

Are external and internal measures of knee joint loading closely related in knee OA subjects?

The elderly are susceptible to many disorders that alter the gait pattern and could lead to falls and reduction of mobility. One of the most applied therapeutical approaches to correct altered gait patterns is the insertion of insoles. Principal Component Analysis (PCA) is a powerful method used to reduce redundant information and it allows the comparison of the complete waveform. The purpose of this study was to verify the influence of wedges on lower limbs’ net joint moment and range of motion (ROM) during the gait of healthy elderly participants using PCA. In addition, discrete values of lower limbs’ peak net moment and ROM were also evaluated. 20 subjects walked with no wedges (control condition) and wearing six different wedges. The variables analyzed were the Principal Components from joint net moments and ROM in the sagittal plane in the ankle and knee and joint net moments in frontal plane in the knee. The discrete variables were peak joint net moments and ROM in sagittal plane in knee and ankle. The results showed the influence of the wedges to be clearer by analyzing through PCA methods than to use discrete parameters of gait curves, where the differences between conditions could be hidden.

Trunk, pelvis, and knee kinematics during running in females with and without patellofemoral pain

Females are two times more likely to develop patellofemoral pain (PFP) than males. Abnormal trunk and pelvis kinematics are thought to contribute to the pathomechanics of this condition. However, there is a scarcity of evidence investigating proximal segments kinematics in females with PFP. The purpose of this study was to investigate whether females with PFP demonstrate altered trunk, pelvis, and knee joint kinematics compared with healthy controls during running. Thirty-four females (17 PFP, 17 controls) underwent a 3-dimensional motion analysis during treadmill running at preferred and fixed speeds, each trial for 30 s. Variables of interest included magnitudes of peak angles for trunk (forward flexion, ipsilateral trunk lean), pelvis (anterior tilt, contralateral drop), knee (flexion, valgus, internal rotation), range of motion (RoM) of trunk and pelvis in sagittal and frontal planes and RoM of knee joint in the three cardinal planes of motion. Kinematic data were compared between groups using mixed model repeated measure analysis of variance with the trial as the repeated measure. The PFP group displayed significantly less pelvis frontal plane RoM, greater knee frontal plane RoM, and less knee sagittal plane RoM during running compared with controls, irrespective of running trial. No differences were found in peak kinematic variables between PFP and healthy groups. These results may suggest a rigid stabilization strategy at the pelvis, which the body has adapted to prevent further frontal plane knee malalignment. Less knee sagittal plane RoM may be indicative of another protective strategy in the PFP group to avoid patellofemoral joint reaction force. Clinical assessments and rehabilitative treatments may benefit from considering a global program with focus on pelvis kinematics in addition to the knee joint in females with PFP.