Roongtiwa Vachalathiti

Patterns of spinal motion during walking

We present the results of a study in which we investigated the patterns of movement of the lower thoracic and lumbar spinal segments and the pelvis in subjects walking at a self-selected speed. Our subjects were 108 healthy adults aged from 20 to 82 years and were equally divided with respect to gender. Measurements were carried out using a video-based system by which the trunk was partitioned into segments and the movements of these segments about three orthogonal axes recorded. We found consistent patterns within and between segments and movements, with apparent consequential trunk motion following pelvic displacements. This suggests that the spinal movements associated with walking are linked to the primary motions of the pelvis and the lower limbs.

Age, gender and speed effects on spinal kinematics during walking

We present the results of a study in which we investigated the patterns and ranges of movement of the lower thoracic and lumbar spinal segments and the pelvis in subjects walking at two self-selected speeds. Our subjects were aged from 20 to 82 years and both genders were equally represented. Measurements were carried out using a video-based system. We detected increased range of motion in each segment with increased walking speed, few gender-related differences in patterns or ranges of motion and significant reduction in spinal range of motion with advancing age. Our findings suggest, however, that these age-related changes are more likely to be step-length dependent than an intrinsic feature of aging.

The immediate effects of mobilization technique on pain and range of motion in patients presenting with unilateral neck pain: a randomized controlled trial.

OBJECTIVE To determine the immediate effects on both pain and active range of motion (ROM) of the unilateral posteroanterior (PA) mobilization technique on the painful side in mechanical neck pain patients presenting with unilateral symptoms. DESIGN Triple-blind, randomized controlled trial. SETTING Outpatient physical therapy, institutional clinic. PARTICIPANTS Patients (N=60), 2 physical therapists, and 1 assessor involved in this study. INTERVENTIONS The patients were randomly allocated into either preferred or random mobilization group by using an opaque concealed envelope. The first therapist performed the screening, assessing, prescribing the spinal level(s), and the grade of mobilization. The second therapist performed the mobilization treatment according to their allocated group stated in an envelope. The assessor who was blind to the group allocation conducted the measurements of pain and active cervical ROM. MAIN OUTCOME MEASURES Pain intensity, active cervical ROM, and global perceived effect were measured at baseline and 5 minutes posttreatment. RESULTS After mobilization, there were no apparent differences in pain and active cervical ROM between groups. However, within-group changes showed significant decreases in neck pain at rest and pain on most painful movement (P<0.001) with a significant increase in active cervical ROM after mobilization on most painful movement (P=0.002). CONCLUSIONS The results of this study did not provide support for the preference of the unilateral PA mobilization on the painful side to the random mobilization.

Recent developments in clinimetric instruments

Summary.  Assessment of impairment and function is essential in order to monitor joint status and evaluate therapeutic interventions in patients with haemophilia. The improvements in the treatment of haemophilia have required the development of more sensitive tools to detect the more minor dysfunctions that may now be apparent. This paper outlines some of the recent developments in this field. The Haemophilia Joint Health Score (HJHS) provides a systematic and robust measure of joint impairment. The MRI Scoring System has been designed to provide a comprehensive scoring system combining both progressive and additive scales. The Functional Independence Score for Haemophilia (FISH) has been developed to assess performance of functional activities and can be used in conjunction with the Haemophilia Activities List (HAL) which provides a self report measure of function. It is recommended that both measures are evaluated as these tools measure different constructs. Further refinement and testing of the psychometric properties of all of these tools is in progress. More widespread use of these tools will enable the sharing of data across the world so promoting best practice and ultimately enhancing patient care.

Synchrony of pelvic and hip joint motion during walking

Abstract We report a study into the coordination of the movements of the pelvis and hip joints during walking at two speeds. 108 healthy subjects were filmed using an automated video-based system. Movements of the pelvis and the lower limbs and their contribution to step length were analysed and the coordination of the movements with respect to one another was investigated using cross-correlational analysis. We found strong evidence of consistent temporal relationships within some of the movements with no gender or age effect. Increasing walking speed to a fast comfortable pace tended to produce tighter phase locking of movement patterns. We conclude that expression of the biomechanical determinants of walking ought to include temporal interactions and that axial rotation of the pelvis is probably of little consequence as an essential component of normal gait.

Immediate effects of the central posteroanterior mobilization technique on pain and range of motion in patients with mechanical neck pain

Purpose. To determine the immediate effects of the central posteroanterior (PA) mobilization technique on both pain and active cervical range of motion in patients with mechanical neck pain presenting with central or bilateral symptoms. Methods. A randomized controlled trial was conducted in 60 patients who were randomly allocated into either ‘central PA’ or ‘random’ mobilization group. Two physical therapists and one assessor participated. Outcome measures included neck pain at rest, pain on the most painful movement, and active cervical range of motion taken before and immediately 5 min after the mobilization treatment. Results. Significant reductions in pain at rest and on the most painful movement were noted within-group comparisons (p < 0.001). However, the ‘central PA’ mobilization group obtained a significantly greater reduction in pain on the most painful movement than the ‘random’ mobilization group (p < 0.05). Both mobilization techniques had no effects on the active cervical range of motion. However, the differences in the means of pain reduction between both mobilization techniques were modest (<10 mm). Conclusion. The clinical recommendation regarding the selection of the central PA mobilization technique for treating patients with central or bilateral mechanical neck pain is therefore arguably.

Patellofemoral Joint Forces and Stress During Forward Step-up, Lateral Step-up, and Forward Step-down Exercises

STUDY DESIGN Controlled laboratory study using a repeated-measures design. OBJECTIVE To quantify patellofemoral joint reaction force (PFJRF) and stress (PFJS) during forward step-up (FSU), lateral step-up (LSU), and forward step-down (FSD) exercises. BACKGROUND Although FSU, LSU, and FSD exercises are commonly used in patellofemoral joint rehabilitation programs, the influence of these stepping tasks on patellofemoral joint kinetics has not been quantified. METHODS Three-dimensional lower extremity kinematics and kinetics and electromyographic (EMG) data were obtained from 20 healthy adults during their performance of FSU, LSU, and FSD exercises. The step height for each participant was adjusted to permit a standardized knee flexion angle of 45°. A previously described biomechanical model of the patellofemoral joint was used to quantify PFJRF and PFJS during each task. Peak PFJRF and PFJS during the concentric and eccentric phases of each step task were compared using a 2-factor analysis of variance (ANOVA). RESULTS When collapsed across concentric and eccentric phases, peak PFJS was significantly greater during the FSD (mean ± SD, 13.8 ± 0.4 MPa) compared to the LSU (11.5 ± 0.8 MPa; P<.001) and FSU (11.2 ± 0.6 MPa; P = .002) exercises. Peak PFJRF also was significantly greater during the FSD (51.1 ± 2.7 N/kg) compared to the LSU (44.1 ± 3.4 N/kg; P<.001) and FSU (43.6 ± 2.3 N/kg; P = .023) exercises. CONCLUSION In selecting exercises that promote lower extremity muscle strengthening while minimizing patellofemoral joint loading, LSU and FSU should be considered over FSD exercises, if the same step height is used.

Effects of Strength and Endurance Training of Superficial and Deep Neck Muscles on Muscle Activities and Pain Levels of Females with Chronic Neck Pain

[Purpose] To compare muscle activities and pain levels of females with chronic neck pain receiving different exercise programs. [Subjects and Methods] One hundred females with chronic neck pain participated in this study. They were randomly allocated into 4 groups (n = 25) on the basis of the exercises performed as follows: strength-endurance exercise, craniocervical flexion exercise, combination of strength-endurance and craniocervical flexion exercise and control groups. Pain, disability levels and changes in the muscle activities of the cervical erector spinae (CE), sternocleidomastoid (SCM), anterior scalenes (AS) and upper trapezius (UT) muscles were evaluated before and after the interventions. [Results] After 12 weeks of exercise intervention, all three exercise groups showed improvements in pain and disability. The muscle activities during the typing task were significantly different from the control group in all three exercise groups for all muscles except those of the extensor muscles in the craniocervical flexion exercise group. [Conclusion] The results of this study indicate that exercises for the cervical muscles improve pain and disability. The exercise programs reduced the activities of almost all cervical muscles.

Different Sagittal Angles and Moments of Lower Extremity Joints during Single-leg Jump Landing among Various Directions in Basketball and Volleyball Athletes

[Purpose] The purpose of this study was to assess the sagittal angles and moments of lower extremity joints during single-leg jump landing in various directions. [Subjects] Eighteen male athletes participated in the study. [Methods] Participants were asked to perform single-leg jump-landing tests in four directions. Angles and net joint moments of lower extremity joints in the sagittal plane were investigated during jump-landing tests from a 30-cm-high platform with a Vicon™ motion system. The data were analyzed with one-way repeated measures ANOVA. [Results] The results showed that knee joint flexion increased and hip joint flexion decreased at foot contact. In peak angle during landing, increasing ankle dorsiflexion and decreasing hip flexion were noted. In addition, an increase in ankle plantarflexor moment occurred. [Conclusion] Adjusting the dorsiflexion angle and plantarflexor moment during landing might be the dominant strategy of athletes responding to different directions of jump landing. Decreasing hip flexion during landing is associated with a stiff landing. Sport clinicians and athletes should focus on increasing knee and hip flexion angles, a soft landing technique, in diagonal and lateral directions to reduce risk of injury.

Feasibility investigation of the Accelerated Skill Acquisition Program (ASAP): insights into reach-to-grasp coordination of individuals with postacute stroke.

Abstract Background: Skill acquisition, capacity building, and motivational enhancements are the basis of the Accelerated Skill Acquisition Program (ASAP) and form the foundation for effective incorporation of the paretic upper extremity into life activities. This is the first phase I trial to deliver ASAP during the postacute interval in mildly to moderately impaired stroke survivors and to include an assessment of paretic reach-to-grasp (RTG) coordination using RTG task and cross-correlation analyses. Methods: Two baseline and posttreatment evaluations consisted of RTG actions, the Wolf Motor Function Test (WMFT), and the Stroke Impact Scale (SIS). An individualized arm therapy program using ASAP principles was administered for a total of 30 hours, 2 hours per day, for 2 to 4 days per week over 5 weeks. Dependent measures were kinematics of RTG actions, RTG coordination, total time score of WMFT, and stroke recovery score of SIS. Results: All participants tolerated ASAP well, and none reported any adverse effects during or after the protocol. When the 2 baseline evaluations were compared, there were no changes in any RTG kinematics or RTG coordination. In contrast, after 30 hours of ASAP, total movement time and deceleration time of RTG actions markedly decreased, maximum reach (transport) velocity strikingly increased, and time of maximum aperture was accomplished later. Additionally, the maximal RTG correlation coefficient increased with a shorter associated time lag. A similar pattern was observed for the clinical outcome measures of WMFT and SIS. Conclusions: The findings demonstrate the feasibility of using an ASAP protocol for patients 1 to 3 months post stroke. Under ASAP, WMFT tasks and RTG actions were performed faster with higher peak transport velocity and a more coordinated RTG pattern. The next step is to determine whether the immediate gains in the skilled RTG actions persist 6 months alter.