Peter J. Rundquist

Three-dimensional shoulder complex kinematics in individuals with upper extremity impairment from chronic stroke

Purpose: To evaluate shoulder complex kinematics in persons with chronic upper extremity (UE) impairments due to stroke and determine if kinematics predicts motor function based on the Fugl-Meyer Motor Assessment (FMA). Methods: Sixteen stroke survivors with chronic UE impairments (age range = 46–80 years, male = 8, female = 8, mean (SD) 66 (40) months post-stroke) performed the UE portion of the FMA with the shoulder/elbow subscale (FM_se) documented. Three-dimensional kinematics of the shoulder complex was collected with the Motion Monitor™ (Innsport, Chicago, IL, USA). Participants performed three repetitions of arm elevation in the frontal, sagittal and self-selected planes. The third repetition was analyzed. Scapular and humeral kinematics were calculated in the self-selected plane. Scapulohumeral rhythm was analyzed at peak elevation. Backward stepwise regression analysis predicted kinematic contributions to the FM_se. Results: Mean (SD) FM_se score was 25.3 1(10.9). Peak humeral elevation ranged from 45.6° to 129.2° (median 106.7°). Scapulohumeral rhythm was 4.1:1 when humeral elevation ranged from 45° to 50°, 1.5:1 from 80° to 95° and 2.1:1 from 105° to 130°. Humeral elevation, scapular upward rotation and scapular internal rotation predicted 65.4% of FM_se score variability. Conclusions: Persons with chronic UE impairments from stroke demonstrated reduced peak elevation and altered scapulohumeral rhythm. Three predictors of the FM_se were humeral elevation, scapular upward rotation and scapular internal rotation. Implications for Rehabilitation Three-dimensional analyses of shoulder elevation in stroke survivors with chronic upper extremity impairments reveal altered scapulohumeral rhythm in their paretic limb. Those with greater elevation limitations demonstrate larger scapular contribution. Humeral elevation, scapular upward rotation and scapular internal rotation predict motor function as measured by the Fugl-Meyer Motor Assessment. Clinicians should include examination of and intervention to all the components of the shoulder complex to address functional deficits.

Validation of spinal motion with the spine reposition sense device

BackgroundA sagittal plane spine reposition sense device (SRSD) has been developed. Two questions were addressed with this study concerning the new SRSD: 1) whether spine movement was occurring with the methodology, and 2) where movement was taking place.MethodsSixty-five subjects performed seven trials of repositioning to a two-thirds full flexion position in sitting with X and Y displacement measurements taken at the T4 and L3 levels. The thoracolumbar angle between the T4 and the L3 level was computed and compared between the positions tested. A two (vertebral level of thoracic and lumbar) by seven (trials) mixed model repeated measures ANOVA indicated whether significant differences were present between the thoracic (T4) and lumbar (L3) angular measurements.ResultsCalculated thoracolumbar angles between T4 and L3 were significantly different for all positions tested indicating spinal movement was occurring with testing. No interactions were found between the seven trials and the two vertebral levels. No significant findings were found between the seven trials but significant differences were found between the two vertebral levels.ConclusionThis study indicated spine motion was taking place with the SRSD methodology and movement was found specific to the lumbar spine. These findings support utilizing the SRSD to evaluate changes in spine reposition sense during future intervention studies dealing with low back pain.

A Comparison of 3-D Shoulder Kinematics to Perform ADLs Between Older and Younger Adults

ABSTRACT The primary purpose of this study was to compare the 3-D kinematics of older and younger adults during activities of daily living. Twenty-five older and 27 younger asymptomatic participants were evaluated. The MotionMonitor was used to collect humerus, scapula, and trunk kinematic data. Multivariate analyses of variance (MANOVA) were used to analyze kinematic differences. Significant differences between groups were found. In several comparisons, the older participants had significantly less shoulder joint complex motion than the younger participants. For feeding, the older participants had 16.3° less glenohumeral external rotation, 5.0° less scapular upward rotation, and 8.6° less scapular internal rotation. For reaching an overhead shelf, the older group had 8.1° less glenohumeral flexion, 11.8° less external rotation and 16.0° less scapular internal rotation. For hair combing, the older participants had 13.3° less glenohumeral external rotation, and 6.6° less scapular internal rotation. For washing the contralateral axilla, the older group had 7.7° less scapular internal rotation. In several other comparisons, the older group had significantly more shoulder complex motion than the younger participants. For hair combing, the older group had 14.6° more glenohumeral flexion. For washing the contralateral axilla, the older group demonstrated 7.8° more glenohumeral flexion and 13.0° more glenohumeral internal rotation. Overall, older and younger participants demonstrated significantly different shoulder joint complex kinematics. Age specific values should be considered when interacting with a patient presenting with shoulder dysfunction.

Shoulder Kinematics and Function in Breast Cancer Survivors with Unilateral Lymphedema: An Observational Study

Background: Breast cancer is the second most common cancer among women in the United States. Lymphedema develops secondary to breast cancer surgery in an estimated 26.8% of patients. There is limited research on how lymphedema effects shoulder function. Purpose/Objective: To evaluate the effects of a unilateral mastectomy on ipsilateral shoulder kinematics, the correlation between the lymph‐ICF and Penn Shoulder Score (PSS), and the correlation among shoulder kinematics and the PSS and lymph‐ICF. Methods: Design: Observational study. Setting: Research laboratory. Patients: 30 participants with unilateral lymphedema post‐mastectomy. Average age was 58.0 years (range 36‐76). Average time since lymphedema diagnosis was 46.9 months (range 1‐171 months). Measurements: Shoulder motions were measured in both the involved and uninvolved upper extremities using the MotionMonitor 3‐D electromagnetic motion capture system. Volumetric analysis of bilateral upper extremities was done using a volumeter. Shoulder function was assessed via the PSS and lymph‐ICF. Matched paired t‐tests compared motions of involved and uninvolved upper extremities. Correlations were calculated between kinematics, PSS, and lymph‐ICF. Results: There was a significant difference in ER (p = 0.026) and volume (P < 0.001) between involved and uninvolved upper extremities. Mean ER was 11.2° less in the involved side. The mean difference in arm volume was 368.8 mL greater in the involved side. Limitations: The primary limitation was a small sample size. Conclusions: There were significant differences in ER between involved and uninvolved arms. Further research with greater number of participants is recommended to identify functional differences in this population.

Effects of Lymphedema on Shoulder Kinematics and Function in Survivors of Breast Cancer: An Observational Study

Purpose/Hypothesis: To determine if upper extremity lymphedema alters shoulder kinematics and if there is an association between shoulder function and demographics, kinematics, and volume. It was hypothesized that lymphedema would alter the shoulder kinematics and involved shoulder function would correlate to factors of interest. Participants: 20 females (mean age = 57.1 years) with unilateral lymphedema postmastectomy. Materials/Methods: Three‐dimensional shoulder kinematics were measured with an electromagnetic motion capture system. Volume was measured using a volumeter. Shoulder function was assessed via the Penn Shoulder Score (PSS). Results: There were significant differences between the involved and noninvolved sides in total rotational excursion (p = 0.028, mean difference 16.1°) and arm volume (p < 0.001, mean difference 350 mL). Scapulothoracic anterior tipping was significantly correlated to the PSS (p = 0.003). Clinical Relevance: This information may guide humerothoracic and scapulothoracic treatment for patients with lymphedema. Further research with a greater number of participants and the use of a lymphedema‐specific outcome measure is recommended.