Trunk Dysfunction Research Articles

Vision-Based Robot Arm Control Interface for Retrieving Objects from the Floor

Approximately half of the patients with spinal cord injuries in Japan have a cervical spinal cord injury. Owing to the trunk dysfunction, patients with high-level spinal cord injuries have particular difficulty when searching for or picking up objects from the floor. Recently, welfare robot arms have been developed to help such individuals increase self-reliance. In this study, we propose an operating system that includes an eye-in-hand system with a touchscreen interface for grasping objects from the floor and delivering them to the individual. In the proposed method, the visual information of the target object is shown on a touchscreen interface. The patient specifies the target position for the robot arm by drawing a line on the target object on the interface. We conducted an experiment to compare the proposed interface with an on-screen joystick to demonstrate the proposed system’s efficiency and its ability to reduce physical burden. The results show that the proposed method is both quicker to use and effectively reduces the physical burden on the user compared to the conventional method.

Effects of trunk stabilization exercises using laser pointer visual feedback in patients with chronic stroke: A randomized controlled study.

Many previous studies have cited the importance of trunk stabilization exercises in patients with stroke. However, the evidence for optimal trunk stabilization exercises for patients with stroke is still lacking. To investigate the effects of laser pointer visual feedback in trunk stabilization exercises that are important for improving trunk dysfunction in patients with stroke. In total, 30 patients with chronic stroke were randomly assigned to experimental and control groups. The experimental group underwent a traditional stroke rehabilitation program and trunk stabilization exercises using laser pointer visual feedback. The control group underwent a traditional stroke rehabilitation program and trunk stabilization exercises without visual feedback. Pre- and postintervention results after 6weeks were evaluated using the Berg Balance Scale, static and dynamic plantar pressure, 10-m walk test, and the Korean version of the Fall Efficacy Scale. The results were analyzed using a general linear repeated measurement model. Both groups showed significant improvements in BBS scores, static plantar pressure, dynamic plantar pressure, 10 MWT, and K-FES scores after 6weeks of intervention (P< 0.05). Compared to the control group, significant improvements were observed in the experimental group in the Berg Balance Scale scores, dynamic paretic posterior plantar pressure, 10-m walk test, and Korean version of the Fall Efficacy Scale scores (P< 0.025). Our results demonstrated the effectiveness of visual feedback during trunk stabilization exercises for resolving trunk dysfunction in patients with stroke. Trunk stabilization exercises using laser pointer visual feedback have been found to be more effective in balance, walking, and fall efficacy in patients with stroke.

Effects of "Taking the Waist as the Axis" Therapy on trunk postural control disorder after stroke: A randomized controlled trial.

Sufficient attention to trunk rehabilitation after stroke is still lacking. Loss of trunk selective activity is considered to be the leading cause of trunk postural control disorder after stroke. "Taking the Waist as the Axis" Therapy (WAT) was developed as a combination of the concept of "Taking the Waist as the Axis" from Tai Chi and the rehabilitation of trunk dysfunction after stroke. The present clinical trial examined and assessed the effects of WAT on stroke patients. A total of 43 stroke hemiplegic patients with trunk postural control disorder, whose Trunk Impairment Scale (TIS) scoring between 8 and 18, participated in the present study and were allocated randomly to the experimental (n = 23) or control groups (n = 20). The experimental group received WAT plus conventional therapy, and the control group received "Trunk Selective Activity" Therapy (TSAT) plus conventional therapy. Both groups received treatment once daily and 5 times per week for 3 weeks. The Trunk Impairment Scale (TIS), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), change of Intra-abdominal Pressure (IAP), static balance ability assessment, rapid ventilation lung function test and the Modified Barthel Index (MBI) were evaluated before and after intervention for both groups. The experimental group was superior to the control group in TIS [4 (2, 5) vs. 3 (1.25, 4), p = 0.030], change of IAP [-3 (-8, -1.33) vs. -0.02 (-3.08, 6), p = 0.011], FMA-upper extremity [10 (6, 18) vs. 1 (0, 3), p = 0.002], FMA-lower extremity [2 (1, 4) vs. 1 (0, 2), p = 0.009] and FMA [14 (7, 21) vs. 2 (0.25, 3.75), p = 0.001]. Within experimental group, forced vital capacity (FVC) [81.35 (63.30, 94.88) vs. 91.75 (79.40, 97.90), p = 0.02] was significantly improved. WAT was an effective trunk treatment after stroke, which significantly improved the patients' trunk posture control ability, motor function and forced vital capacity. However, the results still need to be interpreted with caution for the intervention only lasted for 3 weeks.

Approaches to reduce trunk dysfunction in central nervous system diseases

Approaches to reduce trunk dysfunction in central nervous system diseases

Examination of Rehabilitation Intensity According to Severity of Acute Stroke: A Retrospective Study

ObjectivesTo investigate the intensity and effectiveness of rehabilitation in acute stroke patients according to the severity of functional impairments in them. Materials and methodsThis retrospective cohort study included 294 patients with acute hemispheric stroke admitted to three acute-care hospitals who subsequently underwent an inpatient rehabilitation program. Stroke severity was classified according to neurological deficits and trunk dysfunction. The following data were obtained from medical records: age, sex, stroke type, lesion side, hospitalization duration, initial functional status determined using the National Institutes of Health Stroke Scale, rehabilitation start date, first day out of bed after admission, total treatment duration, total number of treatment sessions, rehabilitation implementation rate between start of rehabilitation and discharge, trunk control test and Barthel Index score on the first day out of bed after admission and discharge, and post-discharge outcomes. Hierarchical cluster analysis was performed with clusters categorized using the National Institutes of Health Stroke Scale and trunk control test scores. Variables were compared using the Kruskal–Wallis test, and Dunn's nonparametric comparison test was performed for post-hoc analysis to determine differences between clusters. ResultsThe National Institutes of Health Stroke Scale and trunk control test showed a significant correlation (r = −0.816, p < 0.01) using which cluster analysis identified three clusters. Rehabilitation showed a ceiling effect in patients with mild stroke and a floor effect in patients with severe stroke. ConclusionThese results may guide the determination of rehabilitation intensity with reference to the severity of neurological deficits and trunk dysfunction.

Human Evaluation of Wheelchair Robot for Active Postural Support (WRAPS)

SummaryPeople with severe neuromuscular trunk impairment cannot maintain or control upright posture of the upper body in sitting while reaching. Passive orthoses are clinically available to provide support and promote the use of upper extremities in this population. However, these orthoses only position the torso passively without any degree of trunk movement.We introduce for the first time a novel active-assistive torso brace called Wheelchair Robot for Active Postural Support (WRAPS). It consists of two rings over the hips and chest connected by a 2RPS-2UPS parallel robotic device. WRAPS can modulate the displacement of the upper ring and/or the forces applied on the torso through the ring in four degrees-of-freedom (DOF), including rotations and translation in the sagittal and frontal planes.In the present study, we evaluate the design of WRAPS and its functions. Moreover, we discuss the potential effectiveness of WRAPS as a therapeutic robotic tool in people with severe trunk control deficits. The performance of WRAPS was evaluated in seated healthy subjects. Kinematics and surface electromyography (sEMG) were collected when the participants performed selective trunk movements. First, the torso range of motion (tROM) was calculated with WRAPS in transparent mode—zero-force control mode—which was compared with free-guided tROM (no WRAPS) with motion capture system. Second, a position control mode was configured to mobilize the torso along the trajectories obtained with the transparent mode.Our results show that the design of WRAPS suited well the subject’s anthropometrics while supporting the weight of the torso. Importantly, WRAPS can be programmed to replicate the subject’s tROM, without the full activation of torso muscles. This can be critical in individuals with no trunk control. Altogether, these preliminary results indicate the potential applicability of WRAPS to promote active-assistive trunk mobility in people who cannot sit independently because of trunk dysfunction.

Effect of Segmental Trunk Support on Posture and Reaching in Children With Cerebral Palsy.

To test the effects of segmental trunk support on seated postural and reaching control in children with cerebral palsy. Seventeen children (age range 2-15 y, Gross Motor Function Classification System levels III-V) were classified with the Segmental Assessment of Trunk Control into mild (complete trunk control/lower lumbar deficits), moderate (thoracic/upper lumbar deficits), and severe (cervical/upper thoracic deficits). Postural and arm kinematics were measured while reaching with trunk support at axillae, mid-ribs, or pelvis. Children in the mild group did not display changes in posture or reaching across conditions. The moderately involved group showed decrements in postural and reaching performance with pelvic compared with higher supports (P < .01). Children in the severe group were unable to maintain posture with pelvic support and showed postural deficiencies with mid-ribs compared with axillae support (P < .01). Children with cerebral palsy and trunk dysfunction demonstrate improved motor performance when the external assistance matches their intrinsic level of trunk control.

A test of the hydraulic vulnerability segmentation hypothesis in angiosperm and conifer tree species

Water transport from soils to the atmosphere is critical for plant growth and survival. However, we have a limited understanding about many portions of the whole-tree hydraulic pathway, because the vast majority of published information is on terminal branches. Our understanding of mature tree trunk hydraulic physiology, in particular, is limited. The hydraulic vulnerability segmentation hypothesis (HVSH) stipulates that distal portions of the plant (leaves, branches and roots) should be more vulnerable to embolism than trunks, which are nonredundant organs that require a massive carbon investment. In the current study, we compared vulnerability to loss of hydraulic function, leaf and xylem water potentials and the resulting hydraulic safety margins (in relation to the water potential causing 50% loss of hydraulic conductivity) in leaves, branches, trunks and roots of four angiosperms and four conifer tree species. Across all species, our results supported strongly the HVSH as leaves and roots were less resistant to embolism than branches or trunks. However, branches were consistently more resistant to embolism than any other portion of the plant, including trunks. Also, calculated whole-tree vulnerability to hydraulic dysfunction was much greater than vulnerability in branches. This was due to hydraulic dysfunction in roots and leaves at less negative water potentials than those causing branch or trunk dysfunction. Leaves and roots had narrow or negative hydraulic safety margins, but trunks and branches maintained positive safety margins. By using branch-based hydraulic information as a proxy for entire plants, much research has potentially overestimated embolism resistance, and possibly drought tolerance, for many species. This study highlights the necessity to reconsider past conclusions made about plant resistance to drought based on branch xylem only. This study also highlights the necessity for more research of whole-plant hydraulic physiology to better understand strategies of plant drought tolerance and the critical control points within the hydraulic pathway.

Pruning Acer rubrum at Planting Impacts Structure and Growth After Three Growing Seasons

Branches present in the tree crown at planting can become obstructions in urban landscapes, requiring large pruning cuts later and possibly creating weak structure by growing upright to comprise a large section of the crown. Pruning at planting, currently a discouraged practice, could shorten or remove selected branches and thus improve the structure of a newly planted tree. Acer rubrum L. trees planted into soil from 170 L containers were pruned at planting to subordinate the largest primary branches, or not. Pruning induced a 26% reduction in total cross-sectional area in the five largest primary branches. This sizable reduction in growth on pruned branches resulted in a significant reduction in aspect ratio of the largest (11%) and three largest (10%) branches. The negligible pruning wound from raising the crown on pruned trees would result in little trunk dysfunction when branches are later removed for clearance, and the debris would be minimal. Tree height growth after three growing seasons was unaffected by pruning; the 8% slower trunk diameter growth might be difficult to recognize in a landscape. Bending stress required to tilt trunks three growing seasons after planting was equivalent with or without pruning.

Percutaneous pulmonary valve implantation: an update

The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous pulmonary valve implantation (PPVI) represents the first in-human application of these techniques and is a nonsurgical option for treating right ventricular outflow tract/pulmonary trunk dysfunction. With the growing numbers of patients with right ventricle to pulmonary artery conduit dysfunction after repair of congenital heart disease, the importance of a technique with lower morbidity and mortality, good patient acceptance and efficacy, that is comparable to surgery, cannot be underestimated. Over the last 9 years, PPVI has become a feasible, safe and effective treatment for both conduit stenosis and regurgitation. Median follow-up data show good freedom from reoperation and recatheterization and demonstrate that PPVI can postpone open-heart surgery, thereby potentially reducing the number of operations that patients have to undergo within their lifetime. Complications seen after PPVI, in particular stent fractures, can require reintervention in some cases (second stent-in-stent PPVI); however, valve competency remains good, with significant regurgitation during follow-up only seen in the context of occasional endocarditis. Attempts are now being made to prolong the lifespan of the device by reducing the incidence of stent fractures. Further, meticulous patient selection must be maintained to ensure that hemodynamic results are optimized and the safety of the procedure remains high. Finally, new devices have to be developed that will allow for PPVI in dilated, distensible outflow tracts, to offer this nonsurgical treatment option to a larger patient population with congenital heart disease.

Segmental Radiculopathic Model and Chronic Musculoskeletal Pain

The term peripheral neuropathic pain has recently been suggested to embrace the combination of positive and negative symptoms in patients whose pain is due to pathological changes or dysfunction in peripheral nerves or nerve roots (including nerve trunk). Nerve root pain characteristically shows the tenderness following the course of the involved innervation area, whereas dysesthesia on locus is the pain felt in its peripheral sensory distribution. However, when pain of nerve origin is severe, it can be felt in regions outside the sensory distribution of the particular nerve. Careful examination of chronic musculoskeletal pain often reveals them to be the effects of nerve trunk dysfunction appearing in the musculoskeletal system. The underlying problem is malfunction of the peripheral nervous system due to chronic nerve root irritative injury, and pain is one possible result of downstream product of the neuropathy which is not inevitable. Some findings of neuropathic changes, which is not usually detected through conventional radiologic and laboratory methods, are present primarily in soft tissue (ie., tenderness over muscle motor point, tendon and ligament; palpable soft tissue contracture bands and restricted joint range). Therefore, careful evaluation must be performed and those soft tissue changes should be described. Neuropathy degrades the quality of collagen, causing it to have fewer cross-links; it is, therefore, become frailer than normal collagen. Careful palpation and physical examination is the important tool can detect all of these phenomena.

The effect of task asymmetry, age and gender on dynamic trunk motion characteristics during repetitive trunk flexion and extension in a large normal population

Management of low back pain (LBP) has remained a major challenge to both clinical and engineering communities. With present technology, the lack of anatomical finding in a majority of LBD patients has increased the interest in objective quantification of trunk performance from all areas of rehabilitation: diagnosis, treatment, disability evaluation, return to work determination, ergonomic intervention and prevention. Different dimensions of trunk performance have been quantified with a diverse set of technologies. It is essential that a normative database be established to facilitate the use of these quantitative measures in both the ergonomics and rehabilitation fields. The present study provides a new technique to measure dynamic trunk performance characteristics during repetitive flexion and extension of the trunk at the preferred speed in a large, healthy population (N=351). The effects of task asymmetry, gender and age on these dynamic parameters were investigated. Significant results were found due to task asymmetry, age and gender on dynamic parameters of trunk performance. The higher derivative motion parameters such as velocity and acceleration were more sensitive to the main effects than the range of motion. In general, increased asymmetry and age caused diminished dynamic trunk capability. These results were compared to an industrial surveillance study that identified the injurious levels of high trunk velocity and acceleration. Clinically, these results have provided the basis for quantifying the extent of trunk dysfunction of patients with different low back disorder diagnoses.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>

Trunk Testing Using a Prototype Cybex II Isokinetic Dynamometer Stabilization System

This pilot study represents Cybex II isokinetic dynamometer trunk testing on 160 subjects (98 males, 62 females). A prototype apparatus which provides stabilization in the standing (functional) position was used in the testing. The testing protocols were performed first for trunk flexion and then trunk extension. The protocols consisted of two isometric tests for 5 seconds at 0 degrees trunk angle and 45 degrees trunk angle followed by three repetitions each at the isokinetic speeds of 30, 60, 90, and 120 degrees per second. Peak torque values were measured for the isometric tests. lsokinetic data interpretation consisted of: peak torque, time rate of tension development, range of motion where peak torque occurred, and total work performed. The ratios of trunk flexors to extensors at each test were also calculated. The conclusion from this pilot study is that the use of an isokinetic testing of trunk musculature and establishing normative data provide clinically useful guidelines for sports screening, industrial medicine screening, and objective parameters for discharging patients with trunk dysfunction. J Orthop Sports Phys Ther 1982;3(4):164-170.