Thomas W. Findley

Measurement of balance in computer posturography: Comparison of methods—A brief review

Some symptoms related to disequilibrium may not be detected by a clinical exam. Therefore, objective study is important in assessing balance. In this paper, methods to measure balance in computer posturography are compared. Center of pressure (COP) displacement, equilibrium score (ES) and postural stability index (PSI), the main measures of assessing balance are described and their merits and disadvantages are discussed. Clinicians should apply that measure which suits the specific strategies in a specific situation. Measuring devices such as Force plate, Balance Master and Equitest are also discussed. Although the Balance Master and Equitest devices are more costly compared to the force plate only, they are more useful for assessing balance relevant to daily life activities that might result in falls.

Risk of Stroke, Heart Attack, and Diabetes Complications Among Veterans With Spinal Cord Injury

OBJECTIVES To compare the rates of diabetes and macrovascular conditions in veterans with spinal cord injury (SCI) and to examine variations by patient-level demographic, socioeconomic, access, and health status factors. DESIGN A retrospective analysis. Diabetes status was classified by merging with diabetes epidemiology cohort using a validated algorithm. Chi-square tests and logistic regressions used to compare rates in macro- and microvascular conditions in veterans with and without diabetes. SETTING Veteran Health Administration clinic users in fiscal year (FY) 1999 to FY 2001. PARTICIPANTS SCI patients (N=8769) with diabetes (n=1333), in FY 2000, identified through the SCI registry. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Macrovascular and microvascular conditions in the next year (February 2001). Derived from International Statistical Classification of Diseases, 9th Revision, Clinical Modification, codes in the patient treatment files. RESULTS Overall, 15% of SCI veterans were identified with diabetes but this was an underestimate due to high mortality (8%). Among SCI veterans with diabetes, 49% had at least one macrovascular condition and 54% had microvascular conditions compared with 24% and 25% of those without diabetes (P<.001). CONCLUSIONS Our study highlights the highly significant relationship between diabetes and macro- and microvascular conditions in veterans with SCI. Neurologic deficit combined with increased insulin resistance has a greater macrovascular impact on SCI veterans than on those who do not have diabetes. Increasing age and physical comorbidities compound the problem.

Functional outcome and comorbidity indexes in the rehabilitation of the traumatic versus the vascular unilateral lower limb amputee.

This study compared the Functional Independence Measure (FIM) scores of traumatic (n=12) and vascular (n=12) unilateral lower limb amputees at admission and discharge from a rehabilitation facility. FIM scores that were measured were amputation FIM subscores and total FIM scores. Comorbidity indexes were developed to weight the stump condition and comorbidities seen in both groups. The vascular group was significantly (P<0.01) greater stump comorbidity, but there was no significant difference with respect to length of stay, medical comorbidity score, and amputation and total FIM scores both at admission and discharge between the two groups. Medical comorbidity was significantly (P<0.05) correlated with amputation and total FIM scores at discharge for traumatic amputees with r = -0.64 and r = -0.66, respectively. Stump comorbidity was significantly (P<0.05) correlated with total FIM at discharge with r = -0.64 for vascular amputees. Medical comorbidity was a good predictor of discharge FIM scores for traumatic amputees, whereas stump comorbidity predicted discharge FIM scores for vascular amputees, although not as well. In conclusion, inpatient traumatic amputees may be younger than vascular amputees, but traumatic amputees may not necessarily be healthier or do better functionally at discharge than vascular amputees.

Fascia research – A narrative review

This article reviews fascia research from our laboratory and puts this in the context of recent progress in fascia research which has greatly expanded during the past seven or eight years. Some readers may not be familiar with the terminology used in fascia research articles and are referred to LeMoon (2008) for a glossary of terms used in fascia-related articles.

Postural stability index is a more valid measure of stability than equilibrium score.

Researchers, therapists, and physicians often use equilibrium score (ES) from the Sensory Organization Test, a key test in the NeuroCom EquiTest System (a dynamic posturography system) to assess stability. ES reflects the overall coordination of the visual, proprioceptive, and vestibular systems for maintaining standing posture. In our earlier article, we proposed a new measure of anterior-posterior (A-P) postural stability called the Postural Stability Index (PSI), which accounts for more biomechanical aspects than ES. This article showed that PSI provides a clinically important adjunct to ES. In the present article, we show that PSI can provide an acceptable index even if a person falls during the trial, whereas ES assigns a zero score for any fall. We also show that PSI decreases as ankle stiffness increases, which is intuitive, while ES exhibits the opposite behavior. Ankle stiffness is generally recognized as an indicator of postural stability. These results suggest that PSI is a more valid measure of A-P stability than ES.

Rolfing structural integration treatment of cervical spine dysfunction.

BACKGROUND Misalignments in the body compromise the architectural integrity. At the tissue level, fascia shortens and thickens as the body engages in compensatory strategies to maintain itself upright; these changes are known as myofascial contractions. In physical therapy, there are several methods by which practitioners treat neck dysfunction. However, studies showing the effect of those techniques are limited. PURPOSE The purpose of this study was to investigate the effect of rolfing structural integration (RSI) in neck motion and pain levels of 31 subjects who received RSI. RSI is a type of therapy that focuses on aligning the human body with gravity. METHODS This retrospective study, over a period of 3 years of clinical practice, analyzes changes in motion and pain levels at the neck for 31 subjects who completed the RSI in 10 basic sessions. Participants were evaluated before and after they received RSI. The data collected included: age, sex, occupation, referral source, diagnosis, height, weight, photographs of postural views, range of motion (ROM), pain, and functional complaints. ROM was assessed with the use of an arthordial protractor. Data analysis using three-way analysis of variance (ANOVA) tested the hypothesis at a significance of 0.5. RESULTS The mean pain levels and active range of motion (AROM) of the neck before RSI significantly changed after the treatment (p<0.5): there was a decrease in pain and an increase in AROM. Pain levels/AROM-Age within-subject effect demonstrated significant difference only in pain at best and rotation right; the mean pain levels in the older group decreased by 67%, and the mean AROM for rotation right in the younger group increased by 34%. DISCUSSION In this sample, pain now was reduced more than pain best and pain worst. Increased motion for lateral flexion was more than rotation, extension, and flexion. CONCLUSION This investigation demonstrates that the basic 10 sessions of RSI, when applied by a physical therapist with advanced RSI certification, is capable of significantly decreasing pain and increasing AROM in adult subjects, male and female, with complaints of cervical spine dysfunction regardless of age.

Fascia Research Congress Evidence from the 100 year perspective of Andrew Taylor Still

More than 100 years ago A.T. Still MD founded osteopathic medicine, and specifically described fascia as a covering, with common origins of layers of the fascial system despite diverse names for individual parts. Fascia assists gliding and fluid flow and is highly innervated. Fascia is intimately involved with respiration and with nourishment of all cells of the body, including those of disease and cancer. This paper reviews information presented at the first three International Fascia Research Congresses in 2007, 2009 and 2012 from the perspective of Dr Still, that fascia is vital for organisms growth and support, and it is where disease is sown.

Research in physical medicine and rehabilitation. III. The chart review or how to use clinical data for exploratory retrospective studies.

This article guides the design and execution of a small research project using existing clinical data. The most important point in experimental design is to identify potential difficulties and limitations before you start by 1) review of published studies, 2) use of your clinical experience and 3) review of individual case records. Some of these can be addressed by changes in the study design, but some are inherent in the data and methods we are forced to use. The choice of study design may be based primarily on the quality of the clinical data and available resources for additional data collection. The level of measurement (nominal, ordinal, interval or ratio) of your data must first be determined as it limits the descriptive and statistical techniques you can use. After you decide how many variables to include, a rough guess of sample size will help you select your charts for review. Actual review of three charts will further pinpoint any difficulties and will allow you to revise your study and make an accurate estimate of time to completion. Given the long time span of most projects, accurate record keeping is essential.

Mathematical analysis of the flow of hyaluronic acid around fascia during manual therapy motions.

CONTEXT More research is needed to understand the flow characteristics of hyaluronic acid (HA) during motions used in osteopathic manipulative treatment and other manual therapies. OBJECTIVE To apply a 3-dimensional mathematical model to explore the relationship between the 3 manual therapy motions (constant sliding, perpendicular vibration, and tangential oscillation) and the flow characteristics of HA below the fascial layer. METHODS The Squeeze Film Lubrication theory of fluid mechanics for flow between 2 plates was used, as well as the Navier-Stokes equations. RESULTS The fluid pressure of HA increased substantially as fascia was deformed during manual therapies. There was a higher rate of pressure during tangential oscillation and perpendicular vibration than during constant sliding. This variation of pressure caused HA to flow near the edges of the fascial area under manipulation, and this flow resulted in greater lubrication. The pressure generated in the fluid between the muscle and the fascia during osteopathic manipulative treatment causes the fluid gap to increase. Consequently, the thickness between 2 fascial layers increases as well. Thus, the presence of a thicker fluid gap can improve the sliding system and permit the muscles to work more efficiently. CONCLUSION The mathematical model employed by the authors suggests that inclusion of perpendicular vibration and tangential oscillation may increase the action of the treatment in the extracellular matrix, providing additional benefits in manual therapies that currently use only constant sliding motions.

Transmission of muscle force to fascia during exercise

OBJECTIVE As the muscle contracts, fibers get thicker, forcing the fascial tubular layers surrounding the muscle (endomysium, perimysium and epimysium) to expand in diameter and hence to shorten in length. We develop a mathematical model to determine the fraction of force generated by extremity muscles during contraction that is transmitted to the surrounding tubes of fascia. METHODS Theory of elasticity is used to determine the modulus of elasticity, radial strain and the radial stress transmitted to the fascia. RESULTS Starting with published data on dimensions of muscle and muscle force, we find radial stress is 50% of longitudinal stress in the soleus, medial gastrocnemius, and elbow flexor and extensor muscles. CONCLUSION Substantial stress is transmitted to fascia during muscular exercise, which has implications for exercise therapies if they are designed for fascial as well as muscular stress. This adds additional perspective to myofascial force transmission research.