Range Of Motion Testing Research Articles

Association between age, sex and cervical and upper cervical rotation tests. Descriptive and correlational study in healthy volunteers.

Active cervical spine rotation (ACROM Rot) shows cervical rotation and flexion rotation test (FRT); side-bending rotation test (SBRT) and upper cervical axial rotation test (C0-C2ART) are described to measure upper cervical rotation. The objectives of this study are (1) to describe the normal range of motion (ROM) of ACROM Rot, and the ROM in FRT, SBRT and C0-C2ART tests; (2) to explore the correlation among the four tests and (3) to investigate the influence of age and sex in their ROM. A cross-sectional study was carried out with healthy volunteers from 18 to 75 years of age. Tests were measured using a CROM device and a bubble inclinometer. Descriptive analysis was performed to establish normative data for the ROM tests. Correlation analysis was conducted to understand the relation between upper and global cervical rotation ROM and among the three upper cervical rotation tests. Linear regression models were developed to understand the influence of age and sex in the ROM of all tests. Normative values were obtained from 122 healthy volunteers (50% male), by sex and age strata. The degree of correlation ranged between 0.582 (p < 0.01) for FRT and ACROM Rot left and 0.217 (p < 0.05) for SBRT and C0-C2ART left. Linear regression models showed the influence of sex for ACROM Rot right (men -4.64° less than women), SBRT (men -4.1° less than women) left and C0-C2ART right and left (men -2.24° and -1.78° less than women). The age influenced rotation ROM with a decrease for every 10 years of -2.11° and -1.96° for ACROM Rot right and left, of -1.72° and -1.26° for FRT right and left and -0.58° and -0.41° for C0-C2ART right and left in the linear regression models. No association was found between age and SBRT (p = 0.63 for right SBRT and p = 0.49 for left SBRT). Weak-to-moderate correlation was found between the upper cervical spine rotation tests and with the ACROM. Women had a larger ROM in ACROM Rot right, SBRT left and C0-C2ART. Decreases in ROM related with age were observed for ACROM Rot, FRT and C0-C2ART but not for SBRT.

PILOT STUDY ON THE USE OF YUMEIHO THERAPY IN THE TREATMENT OF LOW BACK PAIN

Introduction. Low back pain causes great socio-economic costs. It is found among the adult population but also among children and teenagers. Yumeiho therapy is increasingly appreciated as being effective in relieving myo-articular pains by applying manual methods, which cause relaxation of tense muscles, effective drainage and an improvement in the trophicity of the tissues. Aim. This study aims to test the effectiveness of Yumeiho manual therapy and how it can bring benefits in joint mobility and decreased low back pain in adults. Material and Method. A group of 8 participants, 4 men and 4 women, aged between 22 and 60 years participated in the study. The joint range of motion (ROM), the Schöber test, Fingertips to floor (FTF) test and the VAS scale were used for evaluation. The therapeutic protocol was applied during 6 months, one session per week. The comparative analysis was performed in three distinct temporal sequences (I - initial, II - after 10 sessions, III – after 20 sessions). Results. The results revealed a significant increase in the flexibility of the lumbar spine accompanied by a reduction in the intensity of pain. Conclusions. This study confirms the hypothesis that the Yumeiho therapy brings significant improvements to patients who complain of low back pain estimated to be greater than or equal to 4 on the VAS Scale. The joint ROM and specific tests also showed considerable improvements after 6 months of treatment. In the future, a study should be conducted on numerous subjects.

Early Joint Use Following Elbow Dislocation Limits Range-of-Motion Loss and Tissue Pathology in Posttraumatic Joint Contracture.

Simple elbow dislocation occurs at an incidence of 2.9 to 5.21 dislocations per 100,000 person-years, with as many as 62% of these patients experiencing long-term elbow joint contracture, stiffness, and/or pain. Poor outcomes and the need for secondary surgical intervention can often be prevented nonoperatively with early or immediate active mobilization and physical therapy. However, immobilization or limited mobilization may be necessary following trauma, and it is unknown how different periods of immobilization affect pathological changes in elbow joint tissue and how these changes relate to range of motion (ROM). The purpose of this study was to investigate the effects of varying the initiation of free mobilization on elbow ROM and histological features in an animal model of elbow posttraumatic joint contracture. Traumatic elbow dislocation was surgically induced unilaterally in rats. Injured forelimbs were immobilized in bandages for 3, 7, 14, or 21 days; free mobilization was then allowed until 42 days after injury. Post-mortem joint ROM testing and histological analysis were performed. One-way analysis of variance was used to compare ROM data between control and injured groups, and Pearson correlations were performed between ROM parameters and histological outcomes. Longer immobilization periods resulted in greater ROM reductions. The anterior and posterior capsule showed increases in cellularity, fibroblasts, adhesions, fibrosis, and thickness, whereas the measured outcomes in cartilage were mostly unaffected. All measured histological characteristics of the capsule were negatively correlated with ROM, indicating that higher degrees of pathology corresponded with less ROM. Longer immobilization periods resulted in greater ROM reductions, which correlated with worse histological outcomes in the capsule in an animal model of posttraumatic elbow contracture. The subtle differences in the timing of ROM and capsule tissue changes revealed in the present study provide new insight into the distinct timelines of biomechanical changes as well as regional tissue pathology. This study showed that beginning active mobilization 3 days after injury minimized posttraumatic joint contracture, thereby supporting an immediate-motion clinical treatment strategy (when possible). Furthermore, uninjured but pathologically altered periarticular tissues near the injury location may contribute to more severe contracture during longer immobilization periods as the disease state progresses.

The Intra- and Inter-Rater Reliability of a Variety of Testing Methods to Measure Shoulder Range of Motion, Hand-behind-Back and External Rotation Strength in Healthy Participants.

This study determined the intra- and inter-rater reliability of various shoulder testing methods to measure flexion range of motion (ROM), hand-behind-back (HBB), and external rotation (ER) strength. Twenty-four healthy adults (mean age of 31.2 and standard deviation (SD) of 10.9 years) without shoulder or neck pathology were assessed by two examiners using standardised testing protocols to measure shoulder flexion with still photography, HBB with tape measure, and isometric ER strength in two abduction positions with a hand-held dynamometer (HHD) and novel stabilisation device. Intraclass correlation coefficient (ICC) established relative reliability. Standard error of measurement (SEM) and minimum detectable change (MDC) established absolute reliability. Differences between raters were visualised with Bland-Altman plots. A paired t-test assessed for differences between dominant and non-dominant sides. Still photography demonstrated good intra- and inter-rater reliability (ICCs 0.75-0.86). HBB with tape measure demonstrated excellent inter- and intra-rater reliability (ICCs 0.94-0.98). Isometric ER strength with HHD and a stabilisation device demonstrated excellent intra-rater and inter-rater reliability in 30° and 45° abduction (ICCs 0.96-0.98). HBB and isometric ER at 45° abduction differed significantly between dominant and non-dominant sides. Standardised shoulder ROM and strength tests provide good to excellent reliability. HBB with tape measure and isometric strength testing with HHD stabilisation are clinically acceptable.

Efficacy of Cryo-compression on Shin Splints in Female Amateur Marathon Runners

Background: Medial tibial stress syndrome (MTSS) or Shin splints is exercise-induced lower leg pain along the distal posterior-medial aspect of tibia caused by repetitive loading stress during running and jumping. It is one of the most common lower leg sports injury. Cryotherapy is the most commonly used treatment during immediate care of athletic injuries and acute soft tissue injuries and is also included as part of RICE (rest, ice, compression and elevation). Cryotherapy is helpful in reducing swelling as well as it exerts analgesic effect. The external compression is also used during immediate care phase and it helps in decrease tissue temperature and prevent oedema formation. Cryotherapy in combination with intermittent pneumatic compression hypothetically help in reducing the physiologic effects of traumatic tissue damage which is based on the models of cryotherapy and static compression therapy. This study aims to establish the efficacy of cryo-compression on shin splints in female amateur marathon runners. Methods: A total 30 subjects diagnosed with shin splints were selected for study. Subjects received cryo-compression for reducing pain and swelling and exercises to strengthen the muscles. Each session was conducted for 45 minutes duration, 5 days per week for 4 weeks. Outcome measure used was Numerical Pain Rating Scale (NPRS), Goniometry for ROM and Manual muscle testing (MMT). Results: According to statistical analysis, the results of the study demonstrate that there was a significant effect of the use of cryo-compression on numerical pain rating scale (p&lt;0.0001), range of motion (ankle plantarflexion, dorsiflexion, eversion and inversion) (p&lt;0.0001), manual muscle testing – ankle plantarflexors (p=0.0028) and ankle dorsiflexors (p&lt;0.0001) during the pre and post intervention assessment. Conclusion: The conducted study shows that efficacy of cryo-compression on shin splints in female amateur marathon runners is very effective in reducing pain, increasing range of motion (ROM) and strength of muscles along with other treatment program. KEYWORDS: Cryo-compression, shin splints, numerical pain rating scale (NPRS), range of motion, ankle plantarflexion, ankle dorsiflexion, ankle eversion, ankle inversion, manual muscle testing, ankle plantarflexors, ankle dorsiflexors.

Musculoskeletal Differences Between Healthy Postpartum Runners And Nulliparous Controls

PURPOSE: Running has become a popular form of exercise for women during and after pregnancy. A host of changes occur during pregnancy and childbirth that can affect running mechanics. Currently due to a lack of research in this area, peer reviewed clinical recommendations on how to safely return to running are non-existent. This could be the reason up to 84% of postpartum runners report pain when running. Due to the lack of research on pregnancy and childbirth related changes on the musculoskeletal system, the purpose of this study was to examine strength and range of motion differences between healthy postpartum female runners and nulliparous controls. METHODS: Participants were grouped into either a postpartum runner (PPR) or a control group. Manual muscle testing was performed at the hip, knee, and ankle using handhold dynamometry for both participant groups. Lower extremity flexibility and range of motion testing and hypermobility screens were performed. Data was averaged over three trials and then normalized to bodyweight (NBW). Independent sample t-tests were conducted using α = 0.05. RESULTS: 33 PPR’s (BMI 24.31 ± 4.33; < 36 months postpartum) and 30 BMI matched nulliparous women (BMI 23.10 N ± 3.80) participated. PPR’s had 10.9% greater strength on left ankle inversion than controls (PPR 0.10 N ± 0.04; control 0.08 N ± 0.03; p 0.04). PPR’s had less right hip internal rotation strength than their controls (PPR 0.11 N ± 3.80; control 0.08 N ± 0.04; p 0.03). CONCLUSION: These findings suggest there might be potential differences in muscular strength between PPR and their control. PPR should be evaluated individually for specific impairments in muscular strength, flexibility, and range of motion to adequately return to running. Future studies should combine musculoskeletal measures with data on kinematics and kinetics to further understand running after childbirth.

Efficacy and safety of focused low-intensity pulsed ultrasound versus pulsed shortwave diathermy on knee osteoarthritis: a randomized comparative trial

The aim of this study was to compare the efficacy and safety of focused low-intensity pulsed ultrasound (FLIPUS) with pulsed shortwave diathermy (PSWD) in subjects with painful knee osteoarthritis (OA). In a prospective randomized trial, 114 knee OA patients were randomly allocated to receive FLIPUS or PSWD therapy. The primary outcome was the change from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores. Secondary outcomes included the numerical rating scale (NRS) for pain assessment, time up and go (TUG) test, active joint range of motion (ROM) test, and Global Rating of Change (GRC) scale. Data were collected at baseline, 12 days, 12 weeks and 24 weeks. Patients receiving FLIPUS therapy experienced significantly greater improvements in the WOMAC total scores than patients receiving PSWD therapy at 12 days (mean difference, − 10.50; 95% CI − 13.54 to − 7.45; P = 0.000). The results of the NRS, TUG test, ROM test and GRC scale showed that participants treated with FLIPUS reported less pain and better physical function and health status than those treated with PSWD at 12 days (P = 0.011, P = 0.005, P = 0.025, P = 0.011, respectively). Furthermore, patients in the FLIPUS group showed significant improvements in the WOMAC total scores and NRS scores at 12 weeks (mean difference, − 7.57; 95% CI − 10.87 to − 4.26; P = 0.000 and − 1.79; 95% CI − 2.11 to − 1.47, respectively) and 24 weeks (mean difference, − 6.96; 95% CI − 10.22 to − 3.71; P = 0.000 and − 1.37; 95% CI − 1.64 to − 0.96; P = 0.000, respectively) of follow-up. There were no adverse events during or after the interventions in either group. This study concluded that both FLIPUS and pulsed SWD are safe modalities, and FLIPUS was more effective than PSWD in alleviating pain and in improving dysfunction and health status among subjects with knee OA in the short term.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032735. Registered 08/05/2020, http://www.chictr.org.cn/showproj.aspx?proj=53413.

Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents

ObjectiveTo (1) determine the level of agreement between symptom provocation and performance-based tests of vestibulo-ocular reflex (VOR) function after pediatric mild traumatic brain injury (mTBI) and (2) describe the level of symptom provocation induced by a VOR task in individuals with and without cervical findings. DesignCross-sectional. SettingThis study was conducted at a tertiary care pediatric hospital. ParticipantsA total of 101 participants (N=101) aged 6-18 years within 3 weeks of mTBI diagnosis were included (54.5% female; mean age, 13.92±2.63 years; mean time since injury at assessment, 18.26±6.16 days). InterventionsNone. Main Outcome MeasuresSymptom provocation (Vestibular/Ocular Motor Screening tool), performance (clinician-observed VOR performance, head thrust test [HTT], computerized dynamic visual acuity test, video head impulse test), and cervical impairment (cervical flexion-rotation test, range of motion test, self-reported neck pain). Agreement was evaluated using Cohen's κ statistic. ResultsNo outcomes demonstrated agreement with symptom provocation (κ=−0.15 to 0.14). Fair agreement demonstrated between clinician-observed VOR performance and HTT (κ=0.32), with little to no agreement demonstrated between other measures. Proportions reporting test-induced dizziness and headache were greater among individuals with cervical findings (29.1%-41.8%) than without (2.3%-6.8%). ConclusionsFindings support that symptom provocation and performance-based tests measure different constructs and thus have distinct roles when assessing VOR function. Findings suggest results from measures of symptom provocation may be influenced by coexisting cervical impairments, underlining the value of assessing for cervical injury after pediatric mTBI.

Relationships Between Active Myofascial Trigger Points and Depressive Symptoms and Physical and Clinical Characteristics of Individuals With Shoulder Pain: A Cross-sectional Study

ObjectiveThe purpose of this study was to evaluate relationships between the presence and number of active myofascial trigger points (MTPs) in shoulder muscles and physical and demographic characteristics, depressive symptoms, pain and function, range of motion (ROM), and strength in individuals with shoulder pain. MethodsFifty-eight individuals were assessed for physical and demographic characteristics, depressive symptoms, shoulder pain and function, MTPs (upper and lower trapezius, infraspinatus, and supraspinatus), shoulder ROM and strength test, and pain during ROM and strength test. Relationships were verified using point-biserial (rpb), Spearman correlation test, and multiple linear regression analysis. ResultsWe found weak to moderate (P < .05) correlations between presence and number of MTPs and depressive symptoms (rpb, 0.28-0.32), pain during ROM (rpb, 0.36-0.40), pain during strength test (rpb, 0.29-0.38), and shoulder function (rpb, –0.29 to 0.33) and strength (rpb, 0.26-0.34). MTPs in the infraspinatus contributed 10% (R² = 0.10; P < .05) to depressive symptoms; in the upper and lower trapezius contributed 27% (R² = 0.27; P < .05) to pain during internal rotation ROM; in the upper trapezius contributed 15% (R² = 0.15; P < .01) to pain during internal rotation strength test and 14% to pain during internal rotation ROM (R² = 0.14; P < .01); and in the supraspinatus contributed 17% (R² = 0.17; P < .01) to pain during external rotation ROM. ConclusionThis study found that MTPs in individuals with shoulder pain contributed to depressive symptoms and pain during internal and external rotation ROM and internal rotation strength test.

Exploring the appropriate test methods to examine the effects of firefighter personal protective equipment on mobility

This study aimed to ascertain the appropriate test methods for the investigation of the effect of personal protective equipment on mobility of firefighters. Nine male volunteers performed a physical performance test (crawl, obstacle course, side-to-side jumps, heavy-object drag, and step-ups), functional balance test (functional reach, timed up and go, and wooden plank time), range of motion test, and subjective evaluation under four clothing conditions with different weights and combinations of personal protective equipment. The results showed that physical performance, functional balance ability, and joint angles significantly declined with increased weight of personal protective equipment. On subjective evaluation, wearing heavy personal protective equipment increased perceived exertion and discomfort on movement. Our results proved that some of our test methods, including the obstacle course, side-to-side jumps, functional reach, timed up and go, range of motion test, and subjective evaluation, can be used to examine the mobility of personal protective equipment wearers. The findings of this study provide an effective guide for researchers and firefighters regarding the evaluation of mobility with personal protective equipment, as well as for manufacturers in the development of enhanced, comfortable personal protective equipment.

Immediate effect of trunk flexion and extension isometric exercise using an external compression device on electromyography of the hip extensor and trunk range of motion of healthy subjects

BackgroundSacroiliac joints (SIJs) transmitted trunk load to lower extremities through the lumbopelvis. External compression devices across the SIJs could provide stability to the SIJs. A previous study established that using a device known as Active Therapeutic Movement version 2 (ATM®2) has been developed to improve pain and joint range of motion (ROM) in patients with LBP. However, no study has examined the physiological change in the muscle through ATM®2-based exercise thus far. This study aimed to determine the immediate effects of ATM®2 exercise on the contraction timing, back extension endurance, muscle fatigue, and trunk ROM of lumbar and lower limb muscles in healthy subjects.MethodsThirty-six healthy subjects (mean age = 23.16 ± 2.3) volunteered to participate in this study. Subjects were instructed to perform ROM test using sit and reach test, back extensor endurance test using Biering-Sorensen test, erector spinae (ES), lumbar multifidus (LM) fatigue and onset time of Gluteus maximus (GM) in prone hip extension using electromyography before and after trunk flexion and extension isometric exercises.ResultsThe ROM in trunk flexion showed a significant increase of 7.9% after exercise compared to that before exercise (p < 0.05). Relative GM contraction onset timing significantly decreased after exercise (p < 0.05). The result of the Sorensen test after exercise showed a trend of increase in duration time. Muscle fatigue in the LM, however, showed a significant increase (p < 0.05), whereas muscle fatigue in the ES was reduced without statistical significance.ConclusionsThe results base on this study showed that exercise-based on ATM®2 is an effective exercise protocol with an effect on the biomechanics of healthy subjects.Clinical trial registration numbers KCT0006728. Clinical trial registration date: 09/11/2021.

Ability of functional performance assessments to discriminate athletes with and without chronic ankle instability : a case-control study.

BackgroundThe decline in motor function associated with chronic ankle instability (CAI) can be assessed using Functional Performance tests. Ankle muscular strength, endurance and range of motion (ROM) has been assessed in previous studies but functional activities such as sprinting and change of direction are less well studied in athletes with CAI. Hence the aim of this study was to determine how sprint, change of direction, ankle isometric strength, endurance and ROM measures may be associated with discriminate athletes with and without CAI.MethodsOne hundred and six participants (CAI: n = 53 or no CAI: n = 53) provided informed consent to participate in this study. Participants performed three functional performance tests, (30-m sprint test, Modified Illinois change of direction test (MICODT)) and change of direction test. Range of motion for dorsiflexion was measured using weight bearing lunge test and inversion, eversion and plantarflexion using Saunders® digital inclinometer. Strength was assessed using Baseline® hand-held dynamometer for plantarflexors, dorsiflexors, invertors and evertors. Muscular endurance was assessed by single heel raise test and Modified single heel raise test. Between-group comparisons utilised Student’s t-test and Mann-Whitney U-tests, with a number of unique variable and multivariable binomial logistic regression performed to determine which performance measures may discriminate participants with CAI.ResultsThe CAI participants performed significantly worse in the three functional performance tests as well as multiple measures of ankle ROM, isometric strength and muscular endurance (p < 0.008). While several measures of ROM (plantarflexion and dorsiflexion), strength (inversion and eversion) and both muscular endurance tests were significantly associated with CAI in the univariable analysis, the strongest association was the functional performance tests, especially MICDOT time (odds ratio (95% CI): 0.06 [0.02–0.17], sensitivity 94.3%, specificity 88.7%). Multivariable regression analyses indicated that performance across the functional performance tests were more strongly associated with CAI than any ankle ROM, muscular strength or endurance test. Further, the inclusion of the best ankle range of motion, strength or muscular endurance tests did not significantly improve upon the association of the MICDOT with CAI.ConclusionsChronic ankle instability in athletic populations appears to be highly associated with declines in functional performance and to a somewhat lesser extent, ankle range of motion, strength and muscle endurance measures. This may suggest that optimal rehabilitation for athletes with CAI may require a greater focus on improving sprinting speed and change of direction ability in the mid to latter stages of rehabilitation, with regular assessments of these functional performance tests necessary to guide the progression and overload of this training.

Adjacent Joint Restriction Differentially Influences Intra- and Inter-rater Reliability and Agreement of Goniometric Measurements.

BackgroundReliability and agreement of goniometric measurements can be altered by variations in measurement technique such as restricting adjacent joints to influence bi-articular muscles. It is unknown if the influence of adjacent joint restriction is consistent across different range of motion (ROM) tests, as this has yet to be assessed within a single study. Additionally, between-study comparisons are challenged by differences between methodology, participants and raters, obscuring the development of a conceptual understanding of the extent to which adjacent joint restriction can influence goniometric ROM measurements.PurposeTo quantify intra- and inter-rater reliability and levels of agreement of goniometric measurements across five ROM tests, with and without adjacent joint restriction.Study DesignDescriptive reliability studyMethodsThree trained and experienced raters made two measurements of bilateral ankle dorsiflexion, first metatarsophalangeal dorsiflexion, hip extension, hip flexion, and shoulder flexion, with and without adjacent joint restriction. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), along with participant, measurement/rater and random error variance were estimated.ResultsEleven females (age 21.4 ±2.3 years) and 19 males (age 22.1 ±2.8 years) participated. Adjacent joint restriction did not influence the reliability and agreement in a consistent way across the five ROM tests. Changes in the inter-rater reliability and agreement were more pronounced compared to the intra-rater reliability and agreement. Assessing variance components (participant, measurement/rater and random error variance) that are used to calculate the ICC and SEM, improved interpretation of ICC and SEM scores.ConclusionThe effects of adjacent joint restriction on reliability and agreement of goniometric measurements depend on the ROM test and should be considered when comparing measurements between multiple raters. Reporting variance components that are used to calculate the ICC and SEM can improve interpretation and may improve between-study comparisons, towards developing a conceptual framework to guide goniometric measurement technique.Level of Evidence3b

Evaluating stability of the craniovertebral junction after unilateral C1 lateral mass resection: implications for the direct lateral approach.

The direct lateral approach is an alternative to the transoral or endonasal approaches to ventral epidural lesions at the lower craniocervical junction. In this study, the authors performed, to their knowledge, the first in vitro biomechanical evaluation of the craniovertebral junction after sequential unilateral C1 lateral mass resection. The authors hypothesized that partial resection of the lateral mass would not result in a significant increase in range of motion (ROM) and may not require internal stabilization. The authors performed multidirectional in vitro ROM testing using a robotic spine testing system on 8 fresh cadaveric specimens. We evaluated ROM in 3 primary movements (axial rotation [AR], flexion/extension [FE], and lateral bending [LB]) and 4 coupled movements (AR+E, AR+F, LB + left AR, and LB + right AR). Testing was performed in the intact state, after C1 hemilaminectomy, and after sequential 25%, 50%, 75%, and 100% C1 lateral mass resection. There were no significant increases in occipital bone (Oc)-C1, C1-2, or Oc-C2 ROM after C1 hemilaminectomy and 25% lateral mass resection. After 50% resection, Oc-C1 AR ROM increased by 54.4% (p = 0.002), Oc LB ROM increased by 47.8% (p = 0.010), and Oc-C1 AR+E ROM increased by 65.8% (p < 0.001). Oc-C2 FE ROM increased by 7.2% (p = 0.016) after 50% resection; 75% and 100% lateral mass resection resulted in further increases in ROM. In this cadaveric biomechanical study, the authors found that unilateral C1 hemilaminectomy and 25% resection of the C1 lateral mass did not result in significant biomechanical instability at the occipitocervical junction, and 50% resection led to significant increases in Oc-C2 ROM. This is the first biomechanical study of lateral mass resection, and future studies can serve to validate these findings.

Design of an Affordable, Modular Implant Device for Soft Tissue Tension Assessment and Range of Motion Tracking During Total Hip Arthroplasty.

Background: In hip arthroplasties, surgeons rely on their experience to assess the stability and balance of hip tissues when fitting the implant to their patients. During the operation, surgeons use a modular, temporary set of implants to feel the tension in the surrounding soft tissues and adjust the implant configuration. This process is naturally subjective and therefore depends on the operator. Inexperienced surgeons undertaking hip arthroplasties are twice as likely to experience errors than their experienced colleagues, leading to dislocations, pain and discomfort for the patients. Methods: To address this issue, a new, 3DOF force measurement system was developed and integrated into the modular, trial implants that can quantify forces and movements intraoperatively in 3D. The prototypes were evaluated in three post-mortem human specimens (PMHSs), to provide surgeons with objective data to help determine the optimal implant fit and configuration. The devices comprise a deformable polymer material providing strain-based displacements measured with electromagnetic-based sensors and an inertial measurement unit (IMU) for motion data. Results: Device results show a relative accuracy of approx. 2% and a sensitivity of approx. 1%. PMHS results indicated that soft tissue forces on the hip joint peak in the order of ~100 N and trend with positions of the leg during range of motion (ROM) tests, although force patterns differ between each PMHS. Conclusion: By monitoring forces and force patterns of hip soft tissues, in combination with standardised ROM tests, the force patterns could shed a light on potential anomalies that can be addressed during surgery. Clinical and Translational Impact Statement: The development of an instrumented hip implant device for use during surgery knowledge will eventually allow us to develop a predictive model for soft tissue balancing, that can be used for pre- and intra-operative planning for each patient on a tailored and personalised basis. Ultimately, we hope that with this device, patients will benefit from a faster recovery, from a more-precisely fitted hip, and an improved quality of life.

Correlations between Functional Movement Screening (FMS) Results and the Range of Motion of Lower Limb Joints Young Middle Distance Runners

Background: The relationship between range of motion (ROM) in lower limb joints and Functional movement screen still not clear. The aim of this study was therefore to investigate the correlation between Functional Movement Screening (FMS) results and ROM in lower limb joints. Methods: Forty-eight young middle distance runners (26 men and 22 women) performed an FMS test and a ROM test of the lower limb joints. Nonparametric testing was used to compare the ROM of left and right lower extremities, an independent-sample T-test was used to compare FMS test scores between left and right sides, and Spearman correlation was used to analyze relationships between FMS test results and ROM of lower limb joints. Results: A negative correlation was observed between left hurdle step and ROM of right knee flexion (r = –0.435, p &lt; 0.05), while a positive correlation was observed between right hurdle step and ROM of right ankle flexion (r = 0.392, p &lt; 0.05). A negative correlation was observed between left in-line lunge and ROM of left knee flexion (r = –0.508, p &lt; 0.05), while a positive correlation was observed between right in-line lunge and ROM of right hip extension (r = 0.445, p &lt; 0.05). A positive correlation was observed between left active straight-leg-raise and ROM of left hip flexion (r = 0.464, p &lt; 0.05), and a positive correlation between right rotary stability and ROM of right ankle extension (r = 0.393, p &lt; 0.05). The trunk-stability push-up and ROM of left ankle flexion was negatively correlated (r = –0.446, p &lt; 0.01). Conclusions: FMS test results were significantly correlated with ROM of hip, knee and ankle joints on the sagittal plane, with differences observed between the left and right sides. The ROM of flexion, extension of hip and extension of ankle were positively correlated with the FMS test results, while larger knee flexion and ankle flexion ROM were negatively correlated with FMS test results. We propose that excessive ROM of the knee and ankle could affect the development of stability. The results of this study should help to further our understanding of FMS.

Comparison of Plantar Sensitivity, Dynamic Balance, and Lower Extremity Joint Range of Motion Between Experienced Female Ballet Dancers and Female Non-Dancing Athletes: A Cross-Sectional Study.

Ballet dancers may increasingly use plantar sensory feedback to control foot position and movement during dance activities. Balance and joint range of motion (ROM) are important factors in ballet and may be related to plantar sensation in ballet dancers. Data on related functions of female ballet dancers compared to female non-dancing athletes are sparse. The aims of the study were twofold: 1. the relationships between plantar sensitivity and dynamic balance as well as between joint ROM and dynamic balance were determined in experienced female ballet dancers and female non-dancing athletes; and 2. the differences of plantar sensation, joint ROM of the lower limb, and dynamic balance between experienced female ballet dancers and female non-dancing athletes were investigated. In this cross-sectional study, 21 subjects (11 experienced female ballet dancers and 10 female non-dancing athletes; median age: 23, range: 11 years; median body height: 1.7 m, range: 0.2 m; median body mass: 59 kg, range: 36 kg) were included. Plantar sensitivity was determined by Semmes-Weinstein monofilaments, active ranges of motion of the hip, knee, and ankle joints were measured using a goniometer and dynamic balance was assessed by the Y-Balance test. Correlations between outcome measures were determined in both groups. Outcome measures were compared between ballet dancers and non-dancing athletes using parametric or non-parametric statistical tests (α = 0.05). For the fifth metatarsal head and the heel, higher correlations between plantar sensitivity and Y-Balance test scores in non-dancing athletes compared to ballet dancers were found. Higher correlations between joint ROM and Y-Balance test scores were determined for certain movements in non-dancing athletes compared to ballet dancers. A significantly lower cutaneous threshold was only found for the fifth metatarsal head in ballet dancers compared to non-ballet dancers (p < 0.05). Range of motion was significantly higher in ballet dancers for almost all movements (p < 0.05). Ballet dancers showed significantly higher normalized scores of the Y-Balance test (p ≤ .001). Results of correlation analyses may indicate that non-dancing athletes increasingly must rely on plantar sensation of the fifth metatarsal head and the heel while maintaining dynamic balance compared to ballet dancers, especially in posterolateral direction of the Y-Balance test. Active joint range of motion of the lower extremity and dynamic balance differ between female ballet dancers and non-dancing athletes. Plantar sensitivity is not different for most of the assessed localizations.

Effect of Stretching of Spastic Elbow Under Intelligent Control in Chronic Stroke Survivors-A Pilot Study.

Objective: To assess the short-term effects of strenuous dynamic stretching of the elbow joint using an intelligent stretching device in chronic spastic stroke survivors.Methods: The intelligent stretching device was utilized to provide a single session of intensive stretching to the spastic elbow joint in the sagittal plane (i.e., elbow flexion and extension). The stretching was provided to the extreme range, safely, with control of the stretching velocity and torque to increase the joint range of motion (ROM) and reduce spasticity and joint stiffness. Eight chronic stroke survivors (age: 52.6 ± 8.2 years, post-stroke duration: 9.5 ± 3.6 years) completed a single 40-min stretching intervention session. Elbow passive and active ROM, strength, passive stiffness (quantifying the non-reflex component of spasticity), and instrumented tendon reflex test of the biceps tendon (quantifying the reflex component of the spasticity) were measured before and after stretching.Results: After stretching, there was a significant increase in passive ROM of elbow flexion (p = 0.021, r = 0.59) and extension (p = 0.026, r = 0.59). Also, elbow active ROM and the spastic elbow flexors showed a trend of increase in their strength.Conclusion: The intelligent stretching had a short-term positive influence on the passive movement ROM. Hence, intelligent stretching can potentially be used to repeatedly and regularly stretch spastic elbow joints, which subsequently helps to reduce upper limb impairments post-stroke.

Lower Extremity Flexibility Profile in Basketball Players: Gender Differences and Injury Risk Identification.

Analysis of the flexibility profile of basketball players (BPs) can reveal differences in range of motion (ROM) by gender and also identify those players who are at higher risk for sports injuries. A descriptive observational study was conducted to determine the lower extremity flexibility profile of sixty-four basketball players and gender differences to identify players at higher risk of injury due to limited and asymmetric ROM in one or more movements. Participants: Sixty-four (33 male and 31 female) competitive athletes from the national leagues of the Spanish basketball league system participated in the present study (power of sample size ≥0.99). The eight passive ROM tests of the hip, knee and ankle were assessed using the ROM-SPORT battery. Each player completed a questionnaire on age, basic anthropometric data, dominant extremities, and training and sport-related variables. The lower extremity flexibility profile was established at 15° and 10° hip extension (HE), 39° and 38° ankle dorsiflexion with knee extended (ADF-KE), 40° and 39° ankle dorsiflexion with knee flexed (ADF-KF), 43° and 43° hip abduction (HAB), 75° and 61° hip abduction with the hip flexed (HAB-HF), 78° and 83° hip flexion with the knee extended (HF-KE), 134° and 120° knee flexion (KF), and 145° and 144° hip flexion (HF) by male and female basketball players, respectively. Sex differences in HE, HAB-HF, and KF were observed in BPs (p ≤ 0.01; Hedges’ g ≥ 1.04). Players reported limited ROM in ADF-KF, HE, HAB-HF, HF-KE, and KF; and asymmetric ROM mainly in HE, ADF-KE, KF, ADF-KF, and HF-KE. In conclusion, this study provides gender-specific lower extremity flexibility profile scores in BPs that can help athletic trainers and athletic and conditioning trainers to identify those players who are at higher risk of injury due to abnormal ROM scores.

A novel wrist rehabilitation exoskeleton using 3D-printed multi-segment mechanism.

Wrist rehabilitation exoskeleton can effectively assist wrist recovery from stroke. However, current wrist rehabilitation devices have shortcomings such as heavy weight, uncertain motion trajectory, etc. This paper proposes a wrist rehabilitation robot driven by 3D-printed multi-segment mechanism to realize wrist rehabilitation in three degrees of freedom. We conducted three tests including bearing force, rehabilitation trajectory, range of motion tests. The results prove this exoskeleton can provide enough force and torque, and it can achieve larger range of motion within the same motor displacement, that makes it more compact and lighter in hardware and less expensive in cost. Moreover, its motion trajectory can be controlled and stable, that makes it more applicable for real application in human rehabilitation.Clinical Relevance- Stroke is the leading cause of hemiplegia, and this symptom usually degrades patients' living standard and flexibility. This device can offer patients stable wrist rehabilitation training in three degrees of freedom with compact and lightweight characteristics.