Barry C. Stillman

Abnormal knee joint position sense in individuals with patellofemoral pain syndrome

The purpose of this cross‐sectional study was to compare knee joint position sense (JPS) in 20 individuals with and 20 without patellofemoral pain syndrome (PFPS). Five active tests with ipsilateral limb matching responses were performed at 20° and 60° flexion under non‐weightbearing conditions, and at 40° flexion under uni‐ and bi‐lateral weightbearing conditions. The response errors were calculated as the difference between each target and response position (accuracy) and the standard deviation of these differences (reliability).

Computer-aided video analysis of vertebrofemoral motion during toe touching in healthy subjects

OBJECTIVE Despite widespread use of the toe touch test, the relative contribution from vertebral and hip movements has not been clearly established, largely because of unsatisfactory measurement techniques. This study aimed to reinvestigate the kinematics of toe touching by combining computerized videotape analysis with a new model of reference marker placement. METHOD Twenty-two subjects were videotaped during active toe touching from upright standing. Computer software was then used to derive the sagittal thoracic, lumbar, and hip angles at .02-sec intervals throughout the movement. RESULTS Hip flexion was directly proportional to toe touch distance (TTD) (r2 = .71) but not lumbar flexion (r2 = .17) or thoracic (r2 = .20) excursion. On average there was .8 degree of thoracolumbar flexion for every 1 degree of hip flexion; however, there were wide variations between subjects. In 19 of 22 subjects the thoracic spine flexed and extended relatively equal amounts during the test resulting in a small total thoracic excursion of 4.8 degrees flexion in unsuccessful toe touchers and 4.0 degrees extension in successful toe touchers. CONCLUSION The separate contributions of hip, lumbar, and thoracic mobility to toe touching or any other vertebrofemoral motion can only be accurately determined by a measurement strategy that uses the plane of the pelvis to separate vertebral from hip motion and uses tangents at the limits of the thoracic and lumbar regions to separate lumbar from thoracic motion. Using this model the authors found that TTD is not a reliable indicator of either vertebral or hip mobility.

Functional outcome following Botulinum toxin A injection to reduce spastic equinus in adults with traumatic brain injury

Primary objective: The aim of this study was to assess the effect of Botulinum toxin A in the management of spastic equinus resulting from traumatic brain injury. Research design: A before–after intervention design was used without controls. Methods and procedures: Subjects were seven patients suffering from traumatic brain injury of average duration 14 (4–38) months as a result of motor vehicle trauma, who had spastic equinus interfering with gait. Experimental intervention: The patients were treated with injections of Botulinum toxin A into the spastic calf muscles: gastrocnemius, soleus and tibialis posterior. Assessments were made pre-injection and at 2 weeks and 3 months post-injection. Main outcome and results: At the end of the 3-month period, all patients showed a significant improvement in gait velocity, cadence and stride length. Conclusions: The findings suggest that Botulinum toxin A may be useful in the management of spastic equinus following traumatic brain injury.

A video-based version of the pendulum test: Technique and normal response

The pendulum test, where the leg is dropped and the knee allowed to swing passively in the manner of a pendulum, has been recognized as a reliable and potentially valuable measure of hypertonia. In this study the traditional form of the test, where a goniometer is attached to the leg, has been replaced by a procedure involving computerized video motion analysis. Using 77 control subjects, a battery of 10 amplitude and time-based measures were obtained for purposes of investigating reliable and valid indicators of the damped, unsustained, oscillatory motion that characterizes this test. The results from the control subjects were congruous with those obtained by other workers using the goniometric version of the test. The measures of the response considered in this study showed evidence of increasing resistance to pendular passive joint motion with advancing age. Retest reliability of pendulum test responses in 14 subjects examined on average 26.8 days apart, produced Intraclass Correlation (2,1) values for the entire pendulum test response of an average of 0.84. It is concluded that the video-based pendulum test is a simple reliable source of measures with considerable potential for the clinical and physiological investigation of neurological and nonneurological features of normal and abnormal passive joint motion, and as a standard against which the effects of therapeutic intervention, such as medication, may be evaluated.

The role of weightbearing in the clinical assessment of knee joint position sense

Knee joint position sense was assessed by active tests with active limb matching responses in supine lying and in unilateral weightbearing (WB) stance using (re)positioning of the whole limb whilst focusing on the knee, and in supine lying using (re)positioning confined to the knee. Following five tests at approximately 45 degrees knee flexion in all three test conditions, position sense was found to be significantly more accurate and reliable following the WB procedure. Possible explanations are, first, that during WB the subjects were more able to assist identification of the test positions using cues obtained during movement of the knee to and from these positions. Second, a larger volume of proprioceptive afferent information may have been derived from sources outside the examined knee, and even outside the examined limb. Whilst WB joint position sense assessments are more functional, the obtained results may not characterise the capacity of the proprioceptors in and around the examined (knee) joint. Since the WB and NWB results were not correlated, one procedure cannot be used to predict results from the others. Also, predominantly unilateral WB stance is often impractical for subjects with limited balance or WB pain.

Connective tissue disorder—a new subgroup of boys with slow transit constipation?

PURPOSE Slow transit constipation (STC) is a form of chronic constipation, with delayed colonic passage of stool. Possible etiologies include reduced neurotransmitter levels, reduced interstitial cells of Cajal density, or a disorder of connective tissue (CT) synthesis. A common CT disorder is generalized joint hypermobility (GJH). This study aimed to investigate whether there was a greater prevalence of GJH among patients with STC than controls. METHODS Children (aged 7-17) diagnosed with STC by radio/nuclear transit study were recruited from outpatient clinics. Controls (no history of constipation) were recruited from outpatient clinics and a scout jamboree. Hypermobility was assessed using the Beighton score (4 or more = hypermobile). This project received ethical approval by the human research ethics committee. RESULTS Thirty-nine STC subjects and 41 controls were measured. Of 39 STC subjects, 15 (38%) were hypermobile, compared to 8 (20%) of 41 controls (P = .06). Analyzed by gender, 10 (38%) of 26 STC males and 1 (4%) of 23 control males were hypermobile (P < .01). CONCLUSIONS These results show that GJH is higher in STC children, particularly males, suggesting that a disorder of CT synthesis plays a role in the etiology of STC. Further research is required to ascertain the nature of any relationship and how this knowledge may aid our understanding and treatment of STC.

Aftereffects of resisted muscle contractions on the accuracy of joint position sense in elite male athletes

OBJECTIVE To examine the effects of quadriceps and hamstring muscle strength testing on the results of subsequent knee joint position sense tests. DESIGN A case-control study of 40 elite male athletes divided equally into two groups, experimental and control. METHODS Both groups underwent position sense tests of both knees, with eyes closed, with isometric maintenance of the knee in each test position, return of the limb to the starting position, then active replication of the perceived test position using the same limb. In the experimental group, joint sense testing commenced 5 to 25 min after strength testing of quadriceps and hamstring muscle strength in both legs using maximum isokinetic contractions at plateau speeds of 60 degrees/sec and 120 degrees/sec. The control group did not undergo pretest muscle strength testing. RESULTS The difference in the mean absolute (signless) and relative (signed) position sense errors between the experimental and control groups was 0.8 degrees and 1.4 degrees, respectively. The difference between the standard deviation of the relative errors was 1.2 degrees. These results were not statistically significant (analysis of variance p = .24, .12, and .13, respectively). CONCLUSION In elite male athletes knee joint position sense is unaffected by nonfatiguing strength tests conducted 5 to 25 min before position sense testing.

Perceptions of the clinical efficacy of laser therapy

Adoption of therapeutic lasers has been widespread throughout Australia in recent years. A questionnaire survey was conducted amongst therapists in Victoria who were believed to have purchased this apparatus. The study sought to determine the extent of laser use in Victoria; the indications, techniques, dosage, expectations and outcomes; and the background knowledge about lasers possessed by the respondents. The elbow and shoulder were the most commonly treated regions; tendonitis and ligamentous lesions the most frequently treated disorders; pain relief and wound healing the most commonly expected effects; and 30mm the average expected penetration. Although 57.9 per cent of respondents attended one or more seminars prior to purchasing lasers, journals and other reading were given as the most valuable source of knowledge.

Use of a video time display in determining general gait measures

By superimposing a video time display (VTD) onto videotapes of patients walking, and using pause-motion replay, precise measures of walking speed, cadence and stride length may be obtained. Five groups of 10 subjects were used to investigate VTD-based gait analysis under different test conditions. An additional 20 healthy subjects were retested on two occasions on average 10.2 weeks apart. These subjects demonstrated moderate reliability for cadence and poor reliability for speed and stride length. It is recommended that progress be assessed by serial testing with regular time intervals. The results from healthy subjects were comparable with results from studies using other instruments. VTD-based gait analysis is a simple, accurate and inexpensive test procedure under a variety of clinical conditions.

Trunk strength and mobility changes in children with slow transit constipation

Background and Aim:  It appears that there are no published reports on childhood slow transit constipation (STC) that have considered the state of the musculoskeletal components of the trunk in these children. The present study aimed to determine whether children with STC have different trunk musculoskeletal characteristics that might be related to their defecation difficulties, compared to controls.