Marcel Rooze

Normal global motion of the cervical spine: An electrogoniometric study

OBJECTIVE Establishment of a normal database and clinical reference of active global cervical spine motion ranges and patterns using a commercial electrogoniometer. DESIGN Three-dimensional cervical motion ranges and patterns were analyzed in 250 asymptomatic volunteers. BACKGROUND In vivo out-of-plane motion patterns of the cervical spine have not yet been reported in large populations, but could be of clinical interest. METHODS In 250 subjects (aged 14-70 yr), motion range and patterns between the first thoracic vertebra and the head were analyzed for flexion-extension, lateral bending, rotation in neutral sagittal plane position and in full flexion using the CA 6000 Spine Motion Analyzer. RESULTS AND CONCLUSIONS Average motion range in the sagittal plane was 122 degrees (SD: 18 degrees ). Flexion was slightly more important than extension. Out-of-plane components were negligible. Global bending range averaged 88 degrees (SD: 16 degrees ), left and right bending being comparable. Homolateral rotation was associated to lateral bending. Its extent was approximately 40% of the bending range. Global rotation range in neutral sagittal plane position was 144 degrees (SD: 20 degrees ), without significant difference between right and left rotations. Associated motion components were small. During rotation in flexed head position, global range (134 degrees, SD: 24 degrees ) was comparable to the one in neutral flexion. But heterolateral bending, averaging 60% of the primary motion, was associated to flexed rotation. Significant reduction of all primary (but not conjunct) motions with age were obtained. Sex had no influence on cervical motion range. RELEVANCE Our results agreed with previous observations, validating the methodology used. They thus constitute reference data of cervical out-of-plane motion for clinical applications.

Validity and reliability of the Kinect within functional assessment activities: comparison with standard stereophotogrammetry.

The recent availability of the Kinect™ sensor, a cost-effective markerless motion capture system (MLS), offers interesting possibilities in clinical functional analysis and rehabilitation. However, neither validity nor reproducibility of this device is known yet. These two parameters were evaluated in this study. Forty-eight volunteers performed shoulder abduction, elbow flexion, hip abduction and knee flexion motions; the same protocol was repeated one week later to evaluate reproducibility. Movements were simultaneously recorded by the Kinect (with Microsoft Kinect SDK v.1.5) MLS and a traditional marker-based stereophotogrammetry system (MBS). Considering the MBS as reference, discrepancies between MLS and MBS were evaluated by comparing the range of motion (ROM) between both systems. MLS reproducibility was found to be statistically similar to MBS results for the four exercises. Measured ROMs however were found different between the systems.

Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: An In vitro study

The tendon excursion method was applied to estimate the moment arm length of triceps surae, flexor hallucis longus, tibialis posterior, tibialis anterior, peroneus brevis and peroneus longus at talocrural and subtalar joints of 10 anatomical preparations. Orthogonal polynomials were fitted to the tendon excursion data and by derivation with respect to the joint angle, the instantaneous moment arm length for any joint position was evaluated. Both joints were investigated separately. Individual data, the mean moment arm together with the significant moment arm coefficients of the polynomials are presented. Considering their moment arm, the most important plantar flexor were triceps surae, flexor hallucis longus and to a much lesser extent peroneus longus, peroneus brevis and tibialis posterior. Results suggest a partially new insight into the muscle action at the subtalar joint. Although displaying a mean inversion moment arm of about -5.3 mm over the whole range of motion, triceps surae had an inversion moment arm in eversion and an eversion one in inversion. Tibialis posterior exhibited the most important inversion moment arm (-19.1 mm), whereas tibialis anterior had a very low one (-3.8 mm). For some specimens this muscle was found to have an eversion moment arm. Peronei longus and brevis had a nearly identical moment arm at the subtalar joint (21.8 and 20.5 mm).

Registration of 6-DOFs electrogoniometry and CT medical imaging for 3D joint modeling

The paper describes a method in which two data-collecting systems, medical imaging and electrogoniometry, are combined to allow the accurate and simultaneous modeling of both the spatial kinematics and the morphological surface of a particular joint. The joint of interest (JOI) is attached to a Plexiglas jig that includes four metallic markers defining a local reference system (R(GONIO)) for the kinematics data. Volumetric data of the JOI and the R(GONIO) markers are collected from medical imaging. The spatial location and orientation of the markers in the global reference system (R(CT)) of the medical-imaging environment are obtained by applying object-recognition and classification methods on the image dataset. Segmentation and 3D isosurfacing of the JOI are performed to produce a 3D model including two anatomical objects-the proximal and distal JOI segments. After imaging, one end of a custom-made 3D electrogoniometer is attached to the distal segment of the JOI, and the other end is placed at the R(GONIO) origin; the JOI is displaced and the spatial kinematics data is recorded by the goniometer. After recording, data registration from R(GONIO) to R(CT) occurred prior to simulation. Data analysis was performed using both joint coordinate system (JCS) and instantaneous helical axis (IHA).Finally, the 3D joint model is simulated in real time using the experimental kinematics data. The system is integrated into a computer graphics interface, allowing free manipulation of the 3D scene. The overall accuracy of the method has been validated with two other kinematics data collection methods including a 3D digitizer and interpolation of the kinematics data from discrete positions obtained from medical imaging. Validation has been performed on both superior and inferior radio-ulna joints (i.e. prono-supination motion). Maximal RMS error was 1 degrees and 1.2mm on the helical axis rotation and translation, respectively. Prono-supination of the forearm showed a total rotation of 132 degrees for 0.8mm of translation. The method reproducibility using JCS parameters was in average 1 degrees (maximal deviation=2 degrees ) for rotation, and 1mm (maximal deviation=2mm) for translation. In vitro experiments have been performed on both knee joint and ankle joint. Averaged JCS parameters for the knee were 109 degrees, 17 degrees and 4 degrees for flexion, internal rotation and abduction, respectively. Averaged maximal translation values for the knee were 12, 3 and 4mm posteriorly, medially and proximally, respectively. Averaged JCS parameters for the ankle were 43 degrees, 9 degrees and 3 degrees for plantarflexion, adduction and internal rotation, respectively. Averaged maximal translation values for the ankle were 4, 2 and 1mm anteriorly, medially and proximally, respectively.

Three-dimensional motion patterns of the carpal bones: an in vivo study using three-dimensional computed tomography and clinical applications.

A three-dimensional (3D) CT technique was developed to analyze in vivo segmental carpal kinematics. Transverse CT data of the distal forearm, carpals and proximal metacarpals was acquired and 3D reconstructed in various wrist positions. Carpal kinematics were analyzed in two groups of 20 asymptomatic volunteers, one group in neutral position, flexion and extension (45°), and the other group in neutral position, radial (15°) and ulnar deviation (30°). Qualitative analysis included the 3D study of carpal anatomy, and comparison of carpal bone position between the different sets of data obtained. Carpal bone motion was quantified using rigid body and finite helical axis concepts. The results, although agreeing in principle with previous findings, showed important individual variations in carpal bone motion. Clinical applications were conducted in a series of 25 patients with various wrist disorders. There was no significant difference between the injured wrist and the heterolateral, asymptomatic wrist, but there was a significant difference between asymptomatic volunteers and both the injured wrist and heterolateral wrist of patients. In particular, scaphoid motion was altered bilaterally in our patient group, suggesting the existence of anatomic and/or kinematic factors predisposing to certain carpal pathologies. This hypothesis needs to be confirmed and refined.

The use of disharmonic motion curves in problems of the cervical spine.

Abstract Cervical spine motion was investigated by three-dimensional electrogoniometry in 257 asymptomatic volunteers and in 32 patients with cervical disc hernia or whiplash syndrome. Maximal ranges of main and coupled motions were considered. Motion curves were analysed qualitatively and using fitting of sixth degree polynomials. Motion ranges obtained were in agreement with previous observations. Significant differences between patients and volunteers concerned several primary and coupled components but not all. Qualitatively, patients displayed less harmonic curves, with irregularities and plateau-like appearances. Root mean square differences between data and fit were significantly modified in patients. Although cervical spine motion ranges may remain within normal limits in patients, motion patterns were altered qualitatively and quantitatively. Motion pattern analysis might prove a useful discrimination parameter in patients in whom anatomical lesions are not clearly identifiable.Résumé Les mouvements cervicaux ont étéétudiés par électrogoniométrie tridimensionnelle chez 257 volontaires asymptomatiques et chez 32 patients (hernie discale ou TAEC). Les amplitudes maximales des mouvements principaux et couplés ont été considérées. Les courbes de mouvement ont été analysées qualitativement et par ajustement polynomial du sixième ordre. Les amplitudes de mouvement étaient en accord avec les observations antérieures. Des différences significatives entre patients et volontaires concernaient plusieurs composantes prin-cipales et couplées, mais pas toutes. Qualitativement, les patients présentaient des courbes moins harmonieuses, avec des irrégularités et des apparences en plateau. Les écarts quadratiques moyens entre les données et l’ajustement étaient significativement modifiés chez les patients. Bien que les amplitudes de mouvement puissent rester dans les limites normales chez les patients, les schémas de mouvement étaient qualitativement et quantitativement altérés. L’analyse des schémas de mouvement pourrait s’avérer être un paramètre de discrimination utile chez les patients chez qui les lésions anatomiques ne sont pas clairement identifiables.

Head repositioning accuracy in patients with whiplash-associated disorders.

Study Design. Controlled study, measuring head repositioning error (HRE) using an electrogoniometric device. Objective. To compare HRE in neutral position, axial rotation and complex postures of patients with whiplash-associated disorders (WAD) to that of control subjects. Summary of Background Data. The presence of kinesthetic alterations in patients with WAD is controversial. Methods. In 26 control subjects and 29 patients with WAD (aged 22–74 years), head kinematics was sampled using a 3-dimensional electrogoniometer mounted using a harness and a helmet. All tasks were realized in seated position. The repositioning tasks included neutral repositioning after maximal flexion-extension, eyes open and blindfolded, repositioning at 50° of axial rotation, and repositioning at 50° of axial rotation combined to 20° of ipsilateral bending. The flexion-extension, ipsilateral bending, and axial rotation components of HRE were considered. A multiple-way repeated-measures analysis of variance was used to compare tasks and groups. Results. The WAD group displayed a reduced flexion-extension range (P = 1.9 × 10−4), and larger HRE during flexion-extension and repositioning tasks (P = 0.009) than controls. Neither group nor task affected maximal motion velocity. Neutral HRE of the flexion-extension component was larger in blindfolded condition (P = 0.03). Ipsilateral bending and axial rotation HRE components were smaller than the flexion-extension component (P = 7.1 × 10−23). For pure rotation repositioning, axial rotation HRE was significantly larger than flexion-extension and ipsilateral bending repositioning error (P = 3.0 × 10−23). Ipsilateral bending component of HRE was significantly larger combined tasks than for pure rotation tasks (P = 0.004). Conclusions. In patients with WAD, range of motion and head repositioning accuracy were reduced. However, the differences were small. Vision suppression and task type influenced HRE.

Joint kinematics simulation from medical imaging data

A method for joint kinematics simulation is described. Kinematics parameters are determined from the relative displacement of marker sets placed on anatomical landmarks of surface models generated from medical imaging contour data. The landmarks are identified manually on fingers in multiple positions. A mathematical algorithm was then used to ascertain the kinematics axes of motion of the fingers. Once these axes are located, they are used as the base of a real time interactive simulation of the finger. The entire simulation was accomplished in a high-resolution graphics environment. A full complement of interactive tools (virtual dials and buttons controlled via mouse) was used to enhance the user interface. The development of the system, the model and the advantages and disadvantages of the method are discussed.

Theoretical study of the decrease in the femoral neck anteversion during growth

This theoretical analysis tries to explain the decrease of the femoral neck anteversion during growth according to well-established concepts. In the frontal plane, it was demonstrated that the capital epiphyseal plate inclination allows the plate to remain perpendicular to the resultant force applied to the hip during gait. In the transversal plane, the projection of this force varies from –24°, outwards and forwards (heel strike), to 20°, outwards and backwards (toe off). A mathematical formula calculates the instantaneous coordinates of the plate in this plane during gait. This kinematic study points out that the physiological value of the capital epiphyseal plate anteversion at the end of the growth is theoretically the ideal value to obtain in the transversal or horizontal plane a perpendicular relation between the orientation of this plate and the projection of the resultant force during walking.

Global 3D head-trunk kinematics during cervical spine manipulation at different levels

OBJECTIVE Determination of the three-dimensional kinematics of the head relative to the upper trunk obtained during a manipulation applied on two different cervical levels and on both sides. DESIGN Descriptive study performed on 14 asymptomatic volunteers. The range of motion was measured by a 3D electrogoniometer during manipulation executed by the same practitioner. BACKGROUND Spinal manipulative therapy is a common treatment approach in patients suffering from some spinal disorders. Complications exist; they are thought to be related to the force applied by the practitioner and the range of spinal motion obtained during the manipulation. Yet, little is known about cervical spine motion during manipulation. METHODS Three dimensional electrogoniometry using a 6 degree-of-freedom spatial linkage fixed between the head and the upper trunk was used to record the pattern of motion and the amplitudes obtained during a manipulation on two cervical levels (C3 and C5) and on left and right sides. On single practitioner applied the same technique to all subjects in a seated position. RESULTS The side and the spinal level manipulated did not influence 3D ranges of motion. The mean ranges of motion obtained were 30 degrees axial rotation, 46 degrees lateral bending and 2 degrees flexion. A significant difference of the flexion-extension range existed between manipulations with and without audible release. Axial rotation and lateral bending ranges were correlated. Except for lateral bending which was close to active range, the motion ranges obtained during manipulation were well below active range of motion reported in literature. CONCLUSIONS The results of this study suggest that for the kind of manipulation applied, maximal amplitude between head and trunk does not exceed physiological active range of motion. The amplitude for rotation, which is generally assumed to involve greatest risks for negative side effects, is significantly lower than during active motion. As the study was performed with one practitioner, this result may only be generalized with care. RELEVANCE In spinal manipulative therapy, extreme range of motion as the result of the forces applied is generally believed to represent a major risk for negative side effects, especially with regard to the cervical spine. With a multiple component technique, amplitudes between head and upper trunk were shown not to differ significantly with regard to the side nor to the spinal level. Recorded ranges of motion did not exceed those reported for active motion in literature.