Patrick McLaughlin

The effect of muscle energy technique on hamstring extensibility: the mechanism of altered flexibility

Purpose: To investigate the effectiveness of muscle energy technique in increasing passive knee extension and to explore the mechanism behind any observed change. Procedure: 40 asymptomatic subjects were randomly allocated to control or experimental groups. Subjects lay supine with their thigh fixed at 90° flexion, and the hamstring muscle stretched to the onset of discomfort by passive knee extension. Knee range of motion was recorded with digital photography and passive torque recorded with a hand-held dynamometer. The experimental group received muscle energy technique to the hamstring muscle, after which the resistance to stretch and the range of motion were again measured. The knee was extended to the original passive torque and the angle at the knee recorded. If the onset of discomfort was not produced at this angle, the knee was further extended and the new angle was recorded. Results: A significant increase in range of motion was observed at the knee (p< 0.019) following a single application of MET to the experimental group. No change was observed in the control group. When an identical torque was applied to the hamstring both before and after the MET, no significant difference in range of motion of the knee was found in the experimental group. Conclusions: Muscle energy technique produced an immediate increase in passive knee extension. This observed change in range of motion is possibly due to an increased tolerance to stretch as there was no evidence of visco-elastic change.

The effect of muscle energy technique on gross trunk range of motion.

Muscle Energy Technique (MET) is used commonly by osteopaths and other musculoskeletal therapists but despite its widespread use there is little evidence to support its effectiveness in the treatment of spinal dysfunction. This study examined whether a single application of thoracic MET could significantly increase the range of motion in asymptomatic volunteers with restricted active trunk rotation. Fifty-nine volunteers were randomly assigned to either treatment (MET) or control groups and blinded pre and post active trunk rotation measures were recorded using a reliable measuring device. Volunteers in the treatment group received a single application of thoracic MET to correct their rotation restriction. MET applied to the thoracic spine in the direction of restricted rotation significantly produced increased range of active trunk rotation (p<0.0005), but not on the non-restricted side or in the untreated controls. This study supports the use of MET to increase restricted spinal rotation range of motion.

The amelioration of atlanto-axial rotation asymmetry using high velocity low amplitude manipulation" Is the direction of thrust important?

Abstract Background: The use of high velocity low amplitude (HVLA) manipulation has been advocated in the treatment of range of motion disorders. However, there remains speculation as to which direction of HVLA manipulative thrust is most effective in the amelioration of range of motion restriction. Objective: To investigate the effect of various directions of HVLA manipulation on the amelioration of goniometrically verified passive atlanto-axial (AA) rotation asymmetry. Methods: 40 asymptomatic subjects (mean age=28) who displayed a persistent unilateral passive atlanto-axial rotation asymmetry of 8° or more were randomly allocated to one of three treatment groups. The first group (n=14) received a single HVLA manipulation to the atlanto-axial joint with the thrust directed towards the most restricted range. The second group (n=14) received a single HVLA manipulation to the atlanto-axial joint with the thrust directed away from the most restricted range i.e. manipulated into the direction of greatest range. The third group (n=12) received bilateral manipulation to the atlanto-axial joint with the direction of initial thrust being determined randomly. For the purpose of this study a successful HVLA manipulation was defined as being accompanied by audible cavitation. HVLA manipulation was not accompanied by audible cavitation in 4 subjects. Measures of passive atlanto-axial end-range asymmetry were performed pre and post-manipulation. Results: HVLA manipulation of the atlanto-axial joint was found to produce a statistically significant immediate amelioration of atlanto-axial rotation asymmetry for all three-treatment groups. Conclusion: HVLA manipulation of the atlanto-axial articulation produces a significant immediate amelioration of passive atlanto-axial rotation asymmetry. The reduction in AA rotation asymmetry occurred regardless of whether the HVLA manipulation was applied unilaterally either towards or away from the restricted rotation ROM or bilaterally.

Changes in gait performance over several years are associated with recurrent falls status in community-dwelling older women at high risk of fracture

BACKGROUND Gait analysis is a recommended geriatric assessment for falls risk and sarcopenia; however, previous research utilises measurements at a single time point only. It is presently unclear how changes in gait over several years influence risk of recurrent falls in older adults. METHODS We investigated 135 female volunteers (mean age±SD: 76.7±5.0 years; range: 70-92 years) at high risk of fracture. Gait parameters (speed, cadence, step length, step width, swing time and double support phase) were assessed using the GAITRite Electronic Walkway System at four annual clinics over ∼3.7±0.5 years. Participants reported incident falls monthly for 3.7±1.2 years. RESULTS Increasing gait speed (odds ratio: 0.96; 95% confidence interval 0.93, 0.99) and step length (0.87; 0.77, 0.98) from baseline to final follow-up was associated with reduced likelihood of being a recurrent faller over the study period. No significant associations were observed for baseline gait parameters (all P≥0.05). At the second follow-up (2.8±0.6 years), an increase in swing time (0.65; 0.43, 0.98) was associated with reduced likelihood, while an increase in double support phase (1.31; 1.04, 1.66) was associated with increased likelihood, for being a recurrent faller in the subsequent 1.3 years following this time point. CONCLUSION Changes in gait parameters over several years are significantly associated with the likelihood of being a recurrent faller among community-dwelling older women at high risk of fracture. Further research is required to develop gait monitoring guidelines and gait parameter decline cut points that may be utilised by clinicians to identify older adults at risk of incident falls and sarcopenia.

Changes in center of pressure displacement with the use of a foot drop stimulator in individuals with stroke.

BACKGROUND Center of pressure measured during gait can provide information about underlying control mechanisms and the efficacy of a foot drop stimulator. This investigation evaluated changes in center of pressure displacement in individuals with stroke with and without a foot drop stimulator. METHODS Individuals with stroke-related foot drop (n=11) using a foot drop stimulator and healthy controls (n=11). Walking speed and bilateral center of pressure variables: 1) net displacement; 2) position and maximum displacement; and 3) mean velocity during walking. FINDINGS On the affected limb with the foot drop stimulator as compared to the affected limb without the foot drop stimulator: 1) increased anterior/posterior maximum center of pressure excursion 8% during stance; 2) center of pressure at initial contact was 6% more posterior; 3) medial/lateral mean, maximum and minimum center of pressure position during stance all significantly decreased; 4) anterior/posterior net displacement increased during stance and single support; and 5) anterior/posterior velocity of the center of pressure increased during stance. INTERPRETATION Individuals with stroke using a foot drop stimulator contacted the ground more posterior at initial contact and utilized more of the anterior/posterior plantar surface of the foot on the affected limb during stance. With the foot drop stimulator there was a shift in center of pressure toward the medial side possibly indicating an improvement in equinovarus gait where there is a tendency to load the lateral foot throughout stance. For individuals with stroke a foot drop stimulator can improve displacement of the center of pressure which indicates improved forward progression and stability during walking.

The DREEM, part 2: psychometric properties in an osteopathic student population

BackgroundThe Dundee Ready Educational Environment Measure (DREEM) is widely used to assess the educational environment in health professional education programs. A number of authors have identified issues with the psychometric properties of the DREEM. Part 1 of this series of papers presented the quantitative data obtained from the DREEM in the context of an Australian osteopathy program. The present study used both classical test theory and item response theory to investigate the DREEM psychometric properties in an osteopathy student population.MethodsStudents in the osteopathy program at Victoria University (Melbourne, Australia) were invited to complete the DREEM and a demographic questionnaire at the end of the 2013 teaching year (October 2013). Data were analysed using both classical test theory (confirmatory factor analysis) and item response theory (Rasch analysis).ResultsConfirmatory factor analysis did not demonstrate model fit for the original 5-factor DREEM subscale structure. Rasch analysis failed to identify a unidimensional model fit for the 50-item scale, however model fit was achieved for each of the 5 subscales independently. A 12-item version of the DREEM was developed that demonstrated good fit to the Rasch model, however, there may be an issue with the targeting of this scale given the mean item-person location being greater than 1.ConclusionsGiven that the full 50-item scale is not unidimensional; those using the DREEM should avoid calculating a total score for the scale. The 12-item ‘short-form’ of the DREEM warrants further investigation as does the subscale structure. To confirm the reliability of the DREEM, as a measure to evaluate the appropriateness of the educational environment of health professionals, further work is required to establish the psychometric properties of the DREEM, with a range of student populations.

Taxonomy of golf putting: Do different golf putting techniques exist?

Abstract This study is a preliminary investigation into the use of cluster analysis to determine if different putting techniques existed in a group of club level golfers. Putting at a hole 4 m away, the performances of 34 experienced golfers (age 55.3 ± 17.8 years and handicap 15.3 ± 6.9, range 3–27) were analysed using putter head kinematic and centre of pressure data. Two distinct putting techniques were identified (named as Arm putting and Body putting), this being the first time different putting techniques have been reported in the research literature. These techniques were defined by parameters related solely to movement of the centre of pressure along the line of the putt. Some players (17 of 34) moved between techniques when performing their putting trials. Neither technique produced more accurate putt results (P = 0.783). Putting technique was further analysed after grouping players according to handicap (similar skill level) or accuracy (similar putting performance). The lack of significant findings when players were re-analysed according to handicap or accuracy highlights the importance of the correct methodological approach to detecting technique differences.

A novel approach to mapping load transfer from the plantar surface of the foot to the walls of the total contact cast: a proof of concept study

BackgroundTotal contact casting is regarded as the gold standard treatment for plantar foot ulcers. Load transfer from the plantar surface of the foot to the walls of the total contact cast has previously been assessed indirectly. The aim of this proof of concept study was to determine the feasibility of a new method to directly measure the load between the cast wall and the lower leg interface using capacitance sensors.MethodsPlantar load was measured with pedar® sensor insoles and cast wall load with pliance® sensor strips as participants (n=2) walked along a 9 m walkway at 0.4±0.04 m/sec. The relative force (%) on the cast wall was calculated by dividing the mean cast wall force (N) per step by the mean plantar force (N) per step in the shoe-cast condition.ResultsThe combined average measured load per step upon the walls of the TCC equated to 23-34% of the average plantar load on the opposite foot. The highest areas of load on the lower leg were located at the posterior margin of the lateral malleolus and at the anterior ankle/extensor retinaculum.ConclusionsThese direct measurements of cast wall load are similar to previous indirect assessment of load transfer (30-36%) to the cast walls. This new methodology may provide a more comprehensive understanding of the mechanism of load transfer from the plantar surface of the foot to the cast walls of the total contact cast.

Assessing fitness-to-practice of overseas-trained health practitioners by Australian registration & accreditation bodies.

BackgroundAssessment of fitness-to-practice of health professionals trained overseas and who wish to practice in Australia is undertaken by a range of organisations. These organisations conduct assessments using a range of methods. However there is very little published about how these organisations conduct their assessments. The purpose of the current paper is to investigate the methods of assessment used by these organisations and the issues associated with conducting these assessments.MethodsA series of semi-structured interviews was undertaken with a variety of organisations who undertake assessments of overseas-trained health professionals who wish to practice in Australia. Content analysis of the interviews was used to identify themes and patterns.ResultsFour themes were generated from the content analysis of the interviews: (1) assessing; (2) process; (3) examiners; and (4) cost-efficiency. The themes were interconnected and each theme also had a number of sub-themes.ConclusionsThe organisations who participated in the present study used a range of assessment methods to assess overseas trained health professionals. These organisations also highlighted a number of issues, particularly related to examiners and process issues, pre- and post-assessment. Organisations demonstrated an appreciation for ongoing review of their assessment processes and incorporating evidence from the literature to inform their processes and assessment development.

A new orthosis reduces pain and mechanical forces in prone position in women with augmented or natural breast tissue: A pilot study

BACKGROUND Breast augmentation, post-mastectomy patients as well as some women with natural breast tissue, and lactating, women often experience discomfort in prone activities. Our study, for the first time, examines pain levels, mechanical force and peak pressure in natural, reconstructed and augmented breast tissues with and without a new orthosis designed for reduction of displacement, compression and loading forces through the breast tissue during prone activities. METHODS Twelve females with natural, lactating or augmented breast tissue, and cup-sizes C-F volunteered for the study. Pain perception was measured using an 11-point visual-analogue-scale without and with different sizes/textures of the orthosis. Magnetic-Resonance-Imaging captured segmental transverse and para-sagittal mid-breast views, and provided linear measurements of breast tissue displacement and deformation. Capacitance-pliance® sensorstrips were used to measure force and pressure between the breast tissue and the surface of a standard treatment table. Measurements were taken whilst the participants were load bearing in prone positions with and without the orthosis. RESULTS The new orthosis significantly reduced pain and mechanical forces in participants with natural or augmented breast tissue with cup-sizes C-F. Larger orthotic sizes were correlated with greater reduction in pain and mechanical forces, with all participants reporting no pain with the largest size orthotic. A size-3 orthotic decreased load on the breast tissue by 82% and reduced peak pressure by 42%. The same orthotic decreased medio-lateral spread of breast tissue and implant whilst increasing height. CONCLUSIONS The new orthosis significantly reduced pain and mechanical forces in all women with natural or augmented tissues. Results are of clinical significance, as reduced mechanical forces are associated with greater comfort and reduced pressure and displacement which may lower the probability of breast implant complication. In clinical settings the orthosis is recommended for all augmentation patients when undergoing prone treatment by therapists and clinicians for improved comfort and safety.