Arthur Quanbury

Elbow joint restriction: Effect on functional upper limb motion during performance of three feeding activities

This study was conducted to quantify and compare changes in upper limb joint motion during different feeding tasks when the elbow joint was restricted. Ten male and nine female volunteer subjects age 18 to 50 years participated; all were healthy, right dominant, with no upper limb pathology. A splint was used to restrict elbow joint motion. Three feeding tasks under both unrestricted and restricted conditions were randomly assigned; motion was recorded by a video-based three-dimensional motion analysis system. Elbow restriction resulted in significantly (p < .05) larger arcs of motion in shoulder flexion and internal rotation. Differences between feeding types were similar during both unrestricted and restricted conditions. Increased shoulder joint motion resulting from elbow joint restriction may require greater activity of shoulder girdle muscles increasing the risk of soft tissue problems and degenerative joint disease. Decisions regarding elbow immobilization should take into consideration potential effects upon total upper limb motion.

Antagonist cocontraction of knee flexors during constant velocity muscle shortening and lengthening.

Electromyography (EMG) was used to study the role of antagonist cocontration of the hamstring muscles of 24 normal subjects during constant velocity muscle performance tests on a KIN COM (™) dynamometer. The hypothesis tests whether antagonist cocontraction varies dependent on joint angle, limb velocity, and type of contraction. Seated subjects performed two dynamic tests of resisted quadriceps muscle shortening and lengthening through a 65° range of knee motion under two constant velocity conditions in a single session. Each test consisted of four repetitions of maximum effort constant velocity muscle shortening and lengthening of the knee extensors; one test performed at 30° s(-1), the other at 90° s(-1). The sequence of velocity testing was randomized. Normalized values of peak amplitude EMG of knee flexors were measured every 5° in the constant velocity phase of each test and compared in a paired manner between each angle, contraction type, and velocity, by split-plot 2-way ANOVA. Antagonist hamstrings cocontraction was found to be contraction type, and velocity dependent. Cocontraction was greater at larger angles of knee flexion and at higher velocity. These results do not support the hypothesis that such activity is a function of muscle moment-arm, but are consistent with the idea that antagonist muscle function is controlled by muscle spindles and perhaps Golgi tendon organs. Because antagonist cocontraction ranged up to a mean of 32% of maximum agonist activity in normal individuals, it should be taken into consideration when interpreting clinical muscle performance tests.

Participation in community-based activities of daily living: Comparison of a pushrim-activated, power-assisted wheelchair and a power wheelchair

Purpose. The purpose of this study was to evaluate pushrim-activated, power-assisted wheelchair (PPW) performance among dual-users in their natural environment to determine whether the PPW would serve as a satisfactory alternative to a power wheelchair for community-based activities. Methods. A concurrent mixed methods research design using a cross-over trial was used. The outcome measures used were number of hours reported using the different wheelchairs, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Functioning Everyday with a Wheelchair (FEW), Psychosocial Impact of Assistive Devices Scale (PIADS) and Canadian Occupational Performance Measure (COPM). Results. The number of hours spent participating in self-identified activities was not significantly different. Only the Self-Esteem subscale of the PIADS identified a statistically significant difference between the PPW and power wheelchair conditions (p = 0.016). A clinically important difference for Performance and Satisfaction was suggested by the COPM, in favour of the power wheelchair. Conclusions. Additional knowledge was gained about the benefits of PPW technology. Participants were able to continue participating independently in their self-identified community activities using the PPW, and identified comparable ratings of satisfaction and performance with the PPW and the power wheelchair. For some individuals requiring power mobility, the PPW may provide an alternative to the power wheelchair.

Burn Therapists' Opinion on the Application and Essential Characteristics of a Burn Scar Outcome Measure

Comprehensive burn rehabilitation requires the use of an appropriate burn scar outcome measure (BSOM). The literature reports many BSOMs; however, an objective, practical, inexpensive, valid, reliable, and responsive instrument eludes us. A problem in the development of such a measure is disagreement in which scar properties to include. The objective of this study was to determine the burn scar variables that therapists believe should be included in a BSOM. An Internet survey was administered to burn occupational and physical therapists. The response rate was 38.6% (105 surveys). Of the respondents, 38.1% use a BSOM; of those, 75% use the Vancouver Scar Scale. Reasons why respondents do not use a BSOM (61.9%) are because they are not familiar with available measures, have not found one that is clinically practical, or need more training. The majority (95%) believes that using a BSOM is important, and the following BSOM characteristics were reported as important: reliable, valid, quick, easy, and noninvasive. Respondents indicated that the following properties should be included in a BSOM: pliability (96.2%), vascularity (92.4%), height (87.6%), appearance (75.2%), skin breakdown (74.3%), itch (73.3%), surface texture (70.5%), pigmentation (68.6%), and pain (67.6%). This study suggests that using a BSOM is important despite its inconsistent use, and BSOM education may be valuable. The top three agreed-upon properties for inclusion are already incorporated into the most commonly used BSOM—the Vancouver Scar Scale—suggesting that modifications may be reasonable.

Musculoskeletal Injuries among Ultrasound Sonographers in Rural Manitoba A Study of Workplace Ergonomics

The purpose of this study was to compare the epidemiology of musculoskeletal injuries and workplace ergonomics among rural-based sonographers compared to urban-based sonographers. The authors also tested the use of a biomechanical software program to assess load on the spine and upper extremity joints. A mail-in survey was sent to all practicing sonographers in rural Manitoba, and on-site video-taped ergonomic and biomechanical evaluations were completed for four sites. Rural-based sonographers appear to have greater work stress related to waiting lists, use of outdated and non-adjustable equipment, and high client load. They also do not advocate for better working conditions because they are few in number and geographically distant from one another. Use of the biomechanical software proved minimally useful. Information related to industry standards and greater collaboration is needed to promote workplace health for sonographers.

The Effect of Alternate Style Keyboards on Severity of Symptoms and Functional Status of Individuals with Work Related Upper Extremity Disorders

There is evidence that performing job tasks involving repetition, vibration, sustained posture or forceful movement may contribute to symptoms of work related upper extremity disorders. Typing is one such activity; symptoms that develop as a result of this activity can affect performance of work, self-care and leisure occupations. Studies investigating the impact of ergonomic keyboards on symptom reduction are limited, and little research exists regarding the reduction of key activation force as an intervention. Methods: This randomized, prospective study used a sample of 68 symptomatic workers employed by a single company. One group received a commercially available ergonomic keyboard, a second group used a modified version of the same keyboard designed to reduce activation force, vibration and key travel. We measured symptoms and clinical signs, functional status, and device satisfaction in both groups over a six-month study period. Results: Between-groups analyses indicated that the groups performed similarly on the outcomes of interest. Repeated-measure analysis identified a reduction of symptoms, an improvement in functional status, preference for and increased satisfaction with the intervention keyboards, and maintenance of typing speed and accuracy for both groups. Conclusions:

Experiences with using a pushrim-activated power-assisted wheelchair for community-based occupations: : A qualitative exploration

Background. Occupational therapists strive to engage individuals in occupation and enhance community access through wheelchair prescription. Previous research with pushrim-activated, power-assisted wheelchairs identifies a reduction in the physical demands of manual wheelchair propulsion but limited evidence exists regarding user evaluation in context. Purpose. This study explored the experience of using a power-assisted wheelchair in the community. Methods. Eight individuals who used both a power and manual device participated in focus groups after trialing a power-assist wheelchair for three weeks. Data were analyzed using a qualitative description approach. Findings. Three themes emerged from our analysis: relative advantages and disadvantages; environmental factors that affect accessibility; and evaluation of mobility device. Implications. Participants perceived the power-assist as improving performance and accessibility compared with the manual wheelchair, increasing the potential scope of occupations and environments, but not replacing their power mobility device. Sufficient time for adjustment of both user and device was important.

A variable axis electrogoniometer for the measurement of single plane movement.

Abstract An accurate single plane electrogoniometer weighing 181 grams is described. This instrument permits all knee movements in 3 planes of motion measuring the functionally applicable flexion and extension for use in objective clinical assessment and as a research tool. The main features of the design are a flexible junction bar connecting the two main electrogoniometer arms and the application of a trigonometric relationship for the determination of the actual joint angle. Evaluation, both dynamic during walking and static including a radiographic technique, has shown overall accuracy of the attached instrument to be ±2°. The instrument has been used to measure knee flexion and extension during stair climbing and has demonstrated its ease of attachment and lack of restriction of any motion in this application.

Effectiveness of an ergonomic keyboard for typists with work related upper extremity disorders: a follow-up study.

OBJECTIVE To investigate whether long-term use of an ergonomic keyboard was effective in reducing symptom severity and improving functional status for individuals who experience symptoms of work related upper extremity disorders (WRUED). PARTICIPANTS Twenty-nine symptomatic workers employed by a single company. METHODS Participants were assessed after using an ergonomic keyboard for an average of 34 months. Symptom severity, clinical signs, functional status, and typing speed were measured and compared with baseline and six-month study data. RESULTS Repeated-measure analysis identified that participants maintained the improvement realized at the six-month study mark for symptom severity and functional status, and maintained their typing speed and accuracy. CONCLUSIONS The results of the study suggest that continuous ergonomic keyboard use was effective in maintaining improvements obtained after six months of use. The potential for ergonomic keyboard use in preventing injury in keyboard operators warrants further investigation.

Trunk Kinematics and Trunk Muscle EMG Activity during Five Functional Locomotor Types

The incidence of back injury is a significant problem in heavy industry, but little is known about the demands placed on the spinal mechanism during functional types of locomotion such as might be used in the workplace. In this study electromyography was used to analyze the activity of erector spinae and rectus abdominis muscles in 18 normal male subjects during level walking, stair climbing, stair descent, ramp climbing and ramp descent. Body segment position in the sagittal plane was recorded on high speed cinefilm. Comparison between the five different locomotion types showed significant differences in segment positions, range of motion and myoelectric activity. The results of this study could be used by occupational therapists to design assessment instruments, work hardening programs and modifications to the workplace for back injured clients and to recommend prevention programs for persons at risk for low-back injury.