Trunk Movements Research Articles

A Spine Assistive Robot With a Routed Twisted String Actuator and a Flat-Back Alleviation Mechanism for Lumbar-Degenerative Flat Back

A lumbar-degenerative flat back is a condition caused by a decline in back muscle strength with aging. The symptoms of this condition include severe lower back pain and spinal disorders, which restrict people from performing activities of daily living (ADL). Recently, various wearable robots have been developed to assist the weakened muscles. However, despite their effectiveness, the wearables require either bulky and rigid structures (active wearables) or tend to constrain users’ motion (passive wearables). In addition, the complex biomechanics of the human spine have not been sufficiently investigated during the design process. To address these issues, we propose a human-inspired spine assistive robot with a routed twisted string actuator (RTSA, active element) and a flat-back alleviation mechanism (FAM, passive element). This innovative RTSA conforms to the complex human spine curvature while minimizing friction and assists the ADL with its unique prioritizing characteristics. The human spine-inspired FAM, on the other hand, was designed to prevent spinal disorder injury while performing ADL. The experimental results showed that the proposed system successfully reduced the electromyography signals while performing ADL. Furthermore, the spinal disorder injury during trunk motion could be prevented by reducing the lumbopelvic ratio of the users.

Body asymmetries as risk factors for musculoskeletal injuries in dancesport, hip-hop and ballet dancers?

The study aimed to determine the incidence and expression of body asymmetries in dancers of three different dance styles: dancesport (n = 14), hip-hop (n = 21) and ballet (n = 20) and to examine how body asymmetries (muscle strength and power, stability and range of motion) are associated with musculoskeletal injuries occurring over the past 12 months. Cross-sectional and retrospective study. Maximal isometric voluntary contraction was measured for trunk, hip, knee and ankle movements. Participants performed a single leg stance, unilateral landing, weight bearing symmetry, squat and countermovement jump on force platforms. Passive range of motion was measured for hip, knee and ankle with two-arm goniometer or digital inclinometer (hip flexion, extension and rotations). A retrospective questionnaire was used to collect data on musculoskeletal injuries occurring in the last 12 months. Different dance styles were associated with different body asymmetries, including strength asymmetries (hip flexion and external rotation), agonist/antagonist asymmetries (trunk flexion/extension, hip abduction/adduction, ankle dorsi/plantar flexion) and hip adduction and internal rotation range of motion asymmetries. Moreover, strength asymmetries of hip flexion, adduction and abduction/adduction as well as stability asymmetries were associated with the total number of musculoskeletal injuries. The incidence of body asymmetries (> 10%) in dancesport, hip-hop and ballet dancers was confirmed, as well as the association of some asymmetries with self-reported injuries occurring over the last 12 months. The cause-effect relationship should be clarified by further studies.

Coordination of trunk motion during bipedal walking in the frontal plane: A comparison between Homo sapiens, Macaca fuscata, and an exploratory study on a gibbon

AbstractObjectivesIn human walking, the pelvis lists toward the swing side during the support phase while the thorax lists toward the stance side. In contrast, during bipedal walking in chimpanzees, both the pelvis and thorax list toward the stance side during the support phase, making their body mass oscillation larger than that in humans. However, aside from a few reports on chimpanzees and macaques, studies on the relationship between trunk movements and step width during bipedal walking in nonhuman primates are limited.Materials and MethodsWe collected three‐dimensional trunk kinematic data during bipedal walking in five humans and five Macaca fuscata. While walking, the positions of cluster markers, which defined trunk segments, were recorded by multiple video cameras. Segmental xyz coordinates were digitized, and frontal rotations and translations were calculated using motion analysis software.ResultsThe kinematic approximation of the safety ratio, which is the center of mass motion relative to the step width, was similar in all species. Nevertheless, the relationship between intratrunk movements and step width varied among the species.DiscussionOur results support the hypothesis that trunk movement in the frontal plane in humans is unique among anthropoid primates. Because the safety ratio is within a similar range, regardless of habitual or facultative bipeds, this further supports the use of fossil footprints to estimate the center of mass motion.

Smart Shirt for Measuring Trunk Orientation

Improper cycling posture is linked to a variety of spinal musculoskeletal diseases, including structural malformation of the spine and back discomfort. This paper presents a novel smart shirt integrated tri-axial gyroscope and accelerometer that can detect postural variation in terms of spinal curvature changes. To provide accurate feedback to the wearer and improve the wearer's correct movement, the garment is able to recognize trunk body posture. The gyroscope/accelerometer was placed around the upper and mid trunk of the user to record tri-axial angular velocity data. The device can also be used to help determine the trunk bending angle and monitor body postures in order to improve optimal orientation and position. The garment enables continuous measurement in the field at high sample rates (50 Hz), and the sensor has a large measurement range (16 g, 2000°/s). As electronic components are non-washable, instead of encapsulating them, a detachable module was created. In this, magnets are embedded in the jersey, and allow the positioning and removal of the sensor. The test results show that the average trunk-bending angle was 21.5°, and 99 percent of the observed angle fell within the standard (ranging from 8° to 35°). The findings demonstrate the feasibility of employing the smart shirt sensor to estimate trunk motions in the field on a regular basis.

Acute effects of game-based biofeedback training on trunk motion in chronic low back pain: a randomized cross-over pilot trial

BackgroundImproving movement control might be a promising treatment goal during chronic non-specific low back pain (CLBP) rehabilitation. The objective of the study is to evaluate the effect of a single bout of game-based real-time feedback intervention on trunk movement in patients with CLBP.MethodsThirteen CLBP patients (8female;41 ± 16 years;173 ± 10 cm;78 ± 22 kg) were included in this randomized cross-over pilot trial. During one laboratory session (2 h), participants performed three identical measurements on trunk movement all including: first, maximum angle of lateral flexion was assessed. Secondly, a target trunk lateral flexion (angle: 20°) was performed. Main outcome was maximum angle ([°]; MA). Secondary outcomes were deviation [°] from the target angle (angle reproduction; AR) and MA of the secondary movement planes (rotation; extension/flexion) during lateral flexion. The outcomes were assessed by an optical 3D-motion-capture-system (2-segment-trunk-model). The measurements were separated by 12-min of intervention and/or resting (randomly). The intervention involved a sensor-based trunk exergame (guiding an avatar through virtual worlds). After carryover effect-analysis, pre-to-post intervention data were pooled between the two sequences followed by analyses of variances (paired t-test).ResultsNo significant change from pre to post intervention for MA or AR for any segment occurred for the main movement plane, lateral flexion (p > .05). The upper trunk segment showed a significant decrease of the MA for trunk extension/flexion from pre to post intervention ((4.4° ± 4.4° (95% CI 7.06–1.75)/3.5° ± 1.29° (95% CI 6.22–0.80); p = 0.02, d = 0.20).ConclusionsA single bout of game-based real-time feedback intervention lead to changes in the secondary movement planes indicating reduced evasive motion during trunk movement.Trial registration No. DRKS00029765 (date of registration 27.07.2022). Retrospectively registered in the German Clinical Trial Register.

Comparisons of Trunk Motions and Low Back Injury Risk between Alternative Hotel Room Cleaning Methods.

Hotel room cleaners frequently report job-related pain, with high rates of work-related musculoskeletal disorder injuries established for this group of workers. Surprisingly, there is limited published research documenting the impact of interventions to reduce ergonomic-related injury risks specific to hotel room cleaners' job tasks. In this study focused on hotel bathroom-cleaning and furniture-dusting tasks, twelve experienced hotel room cleaners used their standard method and a risk-reduction method-a tool with a handle that could extend, to perform these tasks. The female study participants' average age was 45.3 (SD 8.7) years with an average of 10 years of work experience as cleaners (range: 0.8-26.0 years). Trunk kinematics and a low back injury risk assessment were measured using the Lumbar Motion Monitor. All study metrics were significantly reduced when cleaning tasks involved use of adjustable, long-handled tools (p < 0.05). This study demonstrated that commonly available cleaning and dusting tools with extendable handles can significantly reduce low back injury risk among hotel room cleaners and potentially reduce injury risk to other body parts known to be the site of musculoskeletal disorders in this workforce. The study findings suggest that cleaning or housekeeping jobs in other industries where these same tasks are performed could benefit from use of extended-handle tools like those investigated here.

Effects of visual-motor illusions with different visual stimuli on the sit-to-stand of people with hemiplegia following stroke: A randomized crossover controlled trial

BackgroundThe objective of this study was to determine the effects of different visual stimuli during visual-motor illusion on sit-to-stand in people with hemiplegia following stroke. MethodsThis was a randomized crossover controlled trial. Twenty people with hemiplegia following stroke were randomly divided into groups. The video images used for visual-motor illusion were ankle dorsiflexion without resistance (standard visual-motor illusion [standard illusion]) and maximum effort dorsiflexion with resistance (power visual-motor illusion [power illusion]). People with hemiplegia following stroke underwent both illusion interventions with a 1-week washout period in between; group A started with the standard illusion intervention and group B started with the power illusion intervention. Outcomes included the sit-to-stand duration, maximum weight-bearing value, trunk movement during sit-to-stand, ankle joint movement during sit-to-stand, and active ankle dorsiflexion movement on the paralyzed side. ResultsThe angular velocity of the trunk and ankle joints increased significantly during sit-to-stand, and sit-to-stand duration decreased significantly in response only to power illusion. In addition, the change in angular velocity of active ankle dorsiflexion was significantly greater in response to power illusion than was the change in response to standard illusion. ConclusionPower illusion induces a greater improvement in paralyzed ankle dorsiflexion function than standard illusion, resulting in shorter sit-to-stand duration.

Effects of vestibular stimulation on gait stability when walking at different step widths.

Vestibular information modulates muscle activity during gait, presumably to contribute to stability. If this is the case, stronger effects of perturbing vestibular information on local dynamic stability of gait, a measure of the locomotor system's response to small, naturally occurring perturbations, can be expected for narrow-base walking (which needs more control) than for normal walking and smaller effects for wide-base walking (which needs less control). An important mechanism to stabilize gait is to coordinate foot placement to center of mass (CoM) state. Vestibular information most likely contributes to sensing this CoM state. We, therefore, expected that stochastic electrical vestibular stimulation (EVS) would decrease the correlation between foot placement and CoM state during the preceding swing phase. In 14 healthy participants, we measured the kinematics of the trunk (as a proxy of the CoM), and feet, while they walked on a treadmill in six conditions: control (usual step width), narrow-base, and wide-base, each with and without stochastic EVS (peak amplitude of 5mA; RMS of ~ 1.2mA; frequency band from 0 to 25Hz). Stochastic EVS decreased local dynamic stability irrespective of step width. Foot placement correlated stronger with trunk motion during walking with EVS than without in the control condition. However, residual variance in foot placement was increased when walking with EVS, indicating less precise foot placement. Thus, a vestibular error signal leads to a decrease in gait stability and precision of foot placement, but these effects are not consistently modulated by step width.

Recovery from an unexpected standing-slip in professional ballet dancers

Although interventional studies have suggested that dance-based training may reduce fall risk for older adults based on unperturbed assessments, it remains unknown whether dance (particularly ballet) enhances recovery from an external perturbation. This preliminary study sought to test if and how ballet dancers respond differently to a novel standing-slip perturbation relative to non-dancers. Ten young professional ballet dancers and 10 age/sex-matched non-dancers were exposed to an unannounced slip while standing on the treadmill. Their reactions to the slip, characterized by dynamic gait stability (primary outcome), and the recovery stepping and trunk movements (secondary outcomes), were compared between groups. No significant group difference in dynamic gait stability was found at slip onset and recovery step liftoff, but dancers were more stable than non-dancers at touchdown (p = 0.046). Compared to non-dancers, dancers took a longer (p = 0.049) and faster (p = 0.007) backward recovery step and exhibited a less backward leaned trunk at all instants (p ≤ 0.026). Our study suggests that professional ballet dancers are more stable after a novel standing-slip than non-dancers. This better slip-related fall resistance among dancers could result from their more effective recovery stepping strategy and better trunk movement control after the slip. Both reactions may be attributed to ballet training, which requires frequent backward stepping and an upright trunk. Our findings could potentially provide preliminary evidence for applying ballet training to reduce balance losses and falls in people at a high fall risk. More studies are needed to examine ballet training’s effects among other populations with elevated fall risk in real-life situations.

Pilot Validation Study of Inertial Measurement Units and Markerless Methods for 3D Neck and Trunk Kinematics during a Simulated Surgery Task.

Surgeons are at high risk for developing musculoskeletal symptoms (MSS), like neck and back pain. Quantitative analysis of 3D neck and trunk movements during surgery can help to develop preventive devices such as exoskeletons. Inertial Measurement Units (IMU) and markerless motion capture methods are allowed in the operating room (OR) and are a good alternative for bulky optoelectronic systems. We aim to validate IMU and markerless methods against an optoelectronic system during a simulated surgery task. Intraclass correlation coefficient (ICC (2,1)), root mean square error (RMSE), range of motion (ROM) difference and Bland-Altman plots were used for evaluating both methods. The IMU-based motion analysis showed good-to-excellent (ICC 0.80-0.97) agreement with the gold standard within 2.3 to 3.9 degrees RMSE accuracy during simulated surgery tasks. The markerless method shows 5.5 to 8.7 degrees RMSE accuracy (ICC 0.31-0.70). Therefore, the IMU method is recommended over the markerless motion capture.

Analysis of Kinematic Characteristics of Saanen Goat Spine under Multi-Slope.

In order to improve the slope movement stability and flexibility of quadruped robot, a theoretical design method of a flexible spine of a robot that was based on bionics was proposed. The kinematic characteristics of the spine were analyzed under different slopes with a Saanen goat as the research object. A Qualisys track manager (QTM) gait analysis system was used to obtain the trunk movement of goats under multiple slopes, and linear time normalization (LTN) was used to calibrate and match typical gait cycles to characterize the goat locomotion gait under slopes. Firstly, the spatial angle changes of cervical thoracic vertebrae, thoracolumbar vertebrae, and lumbar vertebrae were compared and analyzed under 0°, 5°, 10°, and 15° slopes, and it was found that the rigid and flexible coupling structure between the thoraco-lumbar vertebrae played an obvious role when moving on the slope. Moreover, with the increase in slope, the movement of the spine changed to the coupling movement of thoraco-lumbar coordination movement and a flexible swing of lumbar vertebrae. Then, the Gaussian mixture model (GMM) clustering algorithm was used to analyze the changes of the thoraco-lumbar vertebrae and lumbar vertebrae in different directions. Combined with anatomical knowledge, it was found that the motion of the thoraco-lumbar vertebrae and lumbar vertebrae in the goat was mainly manifested as a left-right swing in the coronal plane. Finally, on the basis of the analysis of the maximin and variation range of the thoraco-lumbar vertebrae and lumbar vertebrae in the coronal plane, it was found that the coupling motion of the thoraco-lumbar cooperative motion and flexible swing of the lumbar vertebrae at the slope of 10° had the most significant effect on the motion stability. SSE, R2, adjusted-R2, and RMSE were used as evaluation indexes, and the general equations of the spatial fitting curve of the goat spine were obtained by curve fitting of Matlab software. Finally, Origin software was used to obtain the optimal fitting spatial equations under eight movements of the goat spine with SSE and adjusted-R2 as indexes. The research will provide an idea for the bionic spine design with variable stiffness and multi-direction flexible bending, as well as a theoretical reference for the torso design of a bionic quadruped robot.

Lung and chest wall volume during vital capacity manoeuvre in Osteogenesis Imperfecta

BackgroundAlthough Osteogenesis Imperfecta (OI) affects the connective tissue, pulmonary function might be compromised because of thoracic deformities. OI is known to be a restrictive lung disease, but spirometry provides global measurement without localizing the site of the restriction. Opto-electronic plethysmography (OEP), is a non-invasive method able to underline altered respiratory function as well as ventilatory thoraco-abdominal paradoxes during spontaneous breathing. We aimed to reconstruct the thoraco-abdominal surface, to perform local analyses of trunk motion and to make quantitative comparison of trunk shape and respiratory kinematics according to OI severity, particularly during maximal inspiratory and expiratory expansions. This is a cross-sectional study where we have studied the thoraco-abdominal compartmental analysis in 26 adult OI patients (14 Type III) at rest and during vital capacity manoeuvre using OEP. We have also applied a new method that created realistic and accurate 3D models to perform local analyses of trunk motion and to make quantitative comparison of trunk shape and respiratory kinematics.ResultsType III patients were characterized by lower spirometric lung volume, by lower sleep quality, by a more compressed thoracic configuration aggravated by severe scoliosis, by reduced global expansion at rest and during maximal maneuvers because of the reduced expansion of the pulmonary ribcage at rest (12% vs. 65% in healthy subjects), during maximal inspiration (37% vs. 69%) and expiration (16% vs. 68%) with local paradoxical movement occurring on the side of the ribcage region.ConclusionThe kinematics of the trunk changed to compensate for the severe structural deformities by shifting the expansion in the abdomen both at rest and during maximal manoeuvre because of a restricted thorax. For the first time, we have quantified and localized the site of the restriction in OI patients in the lateral part of the thorax. The 3D analysis proposed seemed a promising graphical immediate new method for pathophysiology study of chest wall restriction.

Neuromuscular adaptations to experimentally induced pain in the lumbar region: systematic review and meta-analysis.

Experimental pain models are frequently used to understand the influence of pain on the control of human movement. In this systematic review, we assessed the effects of experimentally induced pain in the lumbar region of healthy individuals on trunk muscle activity and spine kinematics. Databases were searched from inception up to January 31, 2022. In total, 26 studies using either hypertonic saline injection (n = 19), heat thermal stimulation (n = 3), nociceptive electrical stimulation (n = 3), or capsaicin (n = 1) were included. The identified adaptations were task dependent, and their heterogeneity was partially explained by the experimental pain model adopted. Meta-analyses revealed an increase of erector spinae activity (standardized mean difference = 0.71, 95% confidence interval [CI] = 0.22-1.19) during full trunk flexion and delayed onset of transversus abdominis to postural perturbation tasks (mean difference = 25.2 ms, 95% CI = 4.09-46.30) in the presence of pain. Low quality of evidence supported an increase in the activity of the superficial lumbar muscles during locomotion and during voluntary trunk movements during painful conditions. By contrast, activity of erector spinae, deep multifidus, and transversus abdominis was reduced during postural perturbation tasks. Reduced range of motion of the lumbar spine in the presence of pain was supported by low quality of evidence. Given the agreement between our findings and the adaptations observed in clinical populations, the use of experimental pain models may help to better understand the mechanisms underlying motor adaptations to low back pain.

Validity and reliability of sensor system to measure trunk range of motion during Streamlined Wolf Motor Function Test in chronic stroke and aged-matched healthy participants

ABSTRACT Objective To investigate the validity and reliability of using the Valedo® system to measure trunk Range of Motion (ROM) during performance of the streamlined Wolf Motor Function Test (SWMFT). Methods Twenty chronic strokes and 20 age-matched healthy participants performed SWMFT while wearing Valedo® sensors on their trunks to capture trunk movements. A paired sample T-test was used to examine the validity of the system in distinguishing between the healthy and stroke group, and between the affected and unaffected sides in the stroke group. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between-days) with 95% CI. Results The Valedo® system was able to distinguish between stroke and healthy participants; stroke participants employed greater trunk range of movements than the healthy controls in all tasks (p < .01). Furthermore, the Valedo® system enabled differentiation between affected and unaffected hands of people within the stroke group. The reliability for the stroke group was good to excellent with intrarater reliability (ICC = 0.71–0.92) and interrater reliability (ICC = 0.63–0.95). Conclusions The Valedo system demonstrates an acceptable level of validity and reliability for measuring trunk ROM during the Streamlined Wolf Motor Function Test (SWMFT). Future studies with a larger sample size, different levels of upper limb impairment are warranted.

Movement Variability and Loading Characteristics in Athletes With Athletic Groin Pain: Changes After Successful Return to Play and Compared With Uninjured Athletes.

Athletic groin pain (AGP) can lead to altered movement patterns during rapid deceleration and acceleration. However, the effect of AGP on movement variability and loading patterns during such actions remains less clear. To investigate, using a continuous lateral hurdle hop task, how movement variability and magnitude measures of 3-dimensional (3D) kinematic, kinetic, and vertical ground-reaction force (vGRF) variables are (1) affected by AGP (AGP vs uninjured controls [CON]) and (2) changed after successful rehabilitation (AGP prerehabilitation vs AGP postrehabilitation vs CON). Controlled laboratory study. A total of 36 athletes diagnosed with AGP and 36 uninjured CON athletes matched on age (18-35 years), level (subelite), and type of sports played (multidirectional field sport) performed a continuous lateral hurdle hop test that involved 10 side-to-side hops over a 15-cm hurdle. The 3D joint kinematic, kinetic, and vGRF variables (total, eccentric, and concentric; ground contact time, peak force, and impulse; and eccentric rate of force development) were examined. The AGP and CON groups were tested at baseline, and the AGP group was retested after participants successfully completed a standardized, exercise-based rehabilitation program targeting intersegmental control. There were no differences in baseline characteristics between the AGP (mean ± SD: age, 27.5 ± 4.8 years; height, 179.8 ± 6.3 cm; mass, 80.3 ± 7.1 kg) and CON (mean ± SD: age, 24.1 ± 4.5 years; height, 181.0 ± 5.8 cm; mass, 80.4 ± 8.2 kg) groups. At baseline, athletes with AGP demonstrated altered loading patterns in the vGRF (longer ground contact times, reduced peak force, and reduced rate of force development) compared with CON athletes, while no significant difference in any movement variability variables was evident. After rehabilitation, the athletes with AGP demonstrated significant changes in transverse and coronal plane hip and trunk kinematics, with no significant differences in vGRF variables compared with the CON group. The differences in baseline vGRF measures between the AGP and CON groups were no longer evident after athletes with AGP underwent rehabilitation. No differences in movement variability were evident between the AGP and CON groups, either before or after rehabilitation. Rehabilitation programs should consider targeting intersegmental hip and trunk movement patterns to positively influence loading patterns in athletes with AGP.

Assessment of trunk control and core stability in spinal cord injured subjects

Objective measures for evaluating active trunk movements and postural control in sitting are important for the assessment of people with Spinal Cord Injury (SCI) and for tailoring rehabilitative interventions. However, studies addressing this issue are limited [1]. This work fills this gap by proposing a modular protocol for the kinematic and muscular quantitative assessment of trunk control, specifically designed for SCI subjects. We used hunova® (Movendo Technology), a medical robotic device for the sensory-motor assessment and training of postural control in standing and sitting [2]. consisted of two different tests: a reaching (R) and an adaptive exercise (A), both performed while sitting on hunova®. The test R aims to assess the volitional component of trunk control: six reaching exercises, where subjects need to actively tilt the seat platform to move a cursor on the screen and reach targets, are alternating with two different platform inclinations: 3.5 and 5° (1° corresponds to 1 cm of cursor motion on the screen). The test A aims to assess how subjects adapt to predictable perturbations imposed by the seat platform [3]: six repetitions of an adaptive task, where subjects need to stabilize themselves while the seat platform moves following a given infinite-shape trajectory, is repeated once with eyes open (EO) and eyes close (EC), with different inclinations of the seat platform: 3, 5 and 7°. After testing the device and protocol on 18 healthy subjects, 10 SCI subjects (with different lesion level) participated in the study. Both the reaching block and the adaptive block (Fig. 1) started with the easiest testing condition and gradually increases the difficulty of the exercises. This allowed all SCI subjects, with different lesion level, to participate in the assessment. Electromyography (EMG) was recorded bilaterally from the following muscles: obliquus externus abdominis, trapezius descendens, trapezius transversalis, trapezius ascendens, erector spinae longissimus, erector spinae iliocostalis, multifidus, latissimus dorsi, soleus, tibialis anterior, vastus medialis, semitendinosus, gluteus medium. The leg muscles were recorded only for SCI subjects with an incomplete lesion of the spinal cord. For each subject, we characterized postural responses in terms of kinematics and muscular activity, estimating the correspondent spatiotemporal organization of the motoneuronal activity in the spinal cord [4]. All subjects with an incomplete SCI could finish the whole protocol. This was not the case for subjects with a complete lesion. Only one subject (lesion level D12) completed both blocks and had movement performance like SCI subjects with an incomplete lesion. The other subjects (two with lesion level D6 and one D3) performed few repetitions of R as they found difficult to control the seat platform, and the tasks with 3 and 5° of inclination for A. Concerning the performance, for R all subjects, independently on their type of lesion, reached a greater number of targets across repetitions. During A, all subjects had a bigger trunk sway for higher inclinations of the seat platform, with higher values in the repetitions with EC. Each SCI subject used his/her own muscular strategy for reaching the different targets and also for adapting to the seat motion, despite it was continuous and predictable. This assessment highlighted the differences in the muscular control among subjects, also due to the different lesions. This modular protocol evaluated in a quantitative, objective, repeatable, and comprehensive manner the kinematic and muscular strategies adopted by SCI subjects when performing dynamic tasks while sitting. The device hunova® allowed us to evaluate different aspects related to trunk control, the volitional and the feedforward control of balance while adapting to predictable and continuous perturbations. The results of this assessment will be used to tailor specific rehabilitative interventions.

Clinical parameters predict the effect of bilateral subthalamic stimulation on dynamic balance parameters during gait in Parkinson's disease.

We investigated the effect of deep brain stimulation on dynamic balance during gait in Parkinson's disease with motion sensor measurements and predicted their values from disease-related factors. We recruited twenty patients with Parkinson's disease treated with bilateral subthalamic stimulation for at least 12 months and 24 healthy controls. Six monitors with three-dimensional gyroscopes and accelerometers were placed on the chest, the lumbar region, the two wrists, and the shins. Patients performed the instrumented Timed Up and Go test in stimulation OFF, stimulation ON, and right- and left-sided stimulation ON conditions. Gait parameters and dynamic balance parameters such as double support, peak turn velocity, and the trunk's range of motion and velocity in three dimensions were analyzed. Age, disease duration, the time elapsed after implantation, the Hoehn-Yahr stage before and after the operation, the levodopa, and stimulation responsiveness were reported. We individually calculated the distance values of stimulation locations from the subthalamic motor center in three dimensions. Sway values of static balance were collected. We compared the gait parameters in the OFF and stimulation ON states and controls. With cluster analysis and a machine-learning-based multiple regression method, we explored the predictive clinical factors for each dynamic balance parameter (with age as a confounder). The arm movements improved the most among gait parameters due to stimulation and the horizontal and sagittal trunk movements. Double support did not change after switching on the stimulation on the group level and did not differ from control values. Individual changes in double support and horizontal range of trunk motion due to stimulation could be predicted from the most disease-related factors and the severity of the disease; the latter also from the stimulation-related changes in the static balance parameters. Physiotherapy should focus on double support and horizontal trunk movements when treating patients with subthalamic deep brain stimulation.

A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study.

BackgroundNeck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck’s state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user’s home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before.Materials & MethodsA total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject’s back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale.ResultsThe mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score.ConclusionThe reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.

Biomechanical analysis of lifting on stable versus unstable surfaces—a laboratory-based proof-of-concept study

BackgroundMany workers performing manual handling tasks suffer from musculoskeletal disorders (MSD). Previous research has identified several loading aspects associated with manual handling, but it is still unknown if lifting on an unstable surface is associated with increased biomechanical loading of different body parts.AimThis proof-of-concept study aims to study what kinematic and kinetic movement parameters, such as movement time, joint angles, torque, and muscle activity are feasible and of importance when studying the effect of lifting on surfaces with varying degrees of stability in an experimental set-up.MethodsMeasurements were taken during three different surface conditions: stable, slightly unstable, and unstable. The participants were instructed to lift a box from the floor and place it on a table in front of them. The weight of the box varied from 0.5 to 15.5 kg. By using a motion capture system (VICON) with 28 reflective markers placed on the participants and one on the box, one Kistler force plate for measuring force levels and center of pressure movements (CoP), and four electromyographic transmitters (EMG), we analyzed the downward and upward phases of the lifting movement, using the Friedman’s test for repeated measures.ResultsStatistically significant results with less joint movements in the lower and upper back were seen with increased instability during both the downward and upward phases. The decrease in trunk movements with increased instability resulted in a somewhat more flexed knee position during the movement, a lower torque in the lower back, and a decrease in CoP movements, but no differences in movement time or muscle activity in back and knee muscles.ConclusionLifting while standing on unstable surfaces resulted in an alteration of both kinematics and kinetics parameters; however, further studies regarding whether this is an additional risk factor for developing lower back pain are needed. Muscle activity levels were not altered due to instability and due to the complexity of the measurement, and we suggest not including EMG measures in future experiments of this type.

Cross-spectral analysis quantifies the segmental coordination in unstable sitting

Abstract Introduction: Low back pain(LBP) affects many individuals and is known to be associated with impaired trunk control. While LBP can be associated by treating underlying trunk impairments, a better understandinf of the mechanistic origin of the disorder is required. Trunk control has been commonly studied via an unstable sitting paradigm. Knowledge on how the base of support and body segments work together to complete the unstable sitting task, and how this is modified in individuals with LBP, could be utilized when designing interventions for this population. Our obiective was to characterize the segmental coordination in non-impaired unstable sitting as elicited via a wobble board(WB) paradigm. Methods: WB, pelvis, and trunk motion were recorded in fifteen non-disabled participants sitting on a wobble board. We used cross-spectral analysis to quantify the coordination of the anterior-posterior angular kinematics of the wobble board, pelvis, and trunk. Results: During unstable sitting, the motion of the pelvis was followed by that of the trunk(one-eighth-cycle delay) and wobble board(half-cyclw delay) at frequenties between 1 and 2 Hz. Conclusion: Future work should utilize the knowledge gained in this study when creating rehabilitation interventions for individuals with LBP.