Véronique Feipel

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.

The EuroPhysiome, STEP and a roadmap for the virtual physiological human.

Biomedical science and its allied disciplines are entering a new era in which computational methods and technologies are poised to play a prevalent role in supporting collaborative investigation of the human body. Within Europe, this has its focus in the virtual physiological human (VPH), which is an evolving entity that has emerged from the EuroPhysiome initiative and the strategy for the EuroPhysiome (STEP) consortium. The VPH is intended to be a solution to common infrastructure needs for physiome projects across the globe, providing a unifying architecture that facilitates integration and prediction, ultimately creating a framework capable of describing Homo sapiens in silico. The routine reliance of the biomedical industry, biomedical research and clinical practice on information technology (IT) highlights the importance of a tailor-made and robust IT infrastructure, but numerous challenges need to be addressed if the VPH is to become a mature technological reality. Appropriate investment will reap considerable rewards, since it is anticipated that the VPH will influence all sectors of society, with implications predominantly for improved healthcare, improved competitiveness in industry and greater understanding of (patho)physiological processes. This paper considers issues pertinent to the development of the VPH, highlighted by the work of the STEP consortium.

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.

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.

Postero-anterior radiography of the wrist normal database of carpal measurements

This study aims to establish a normal database of carpal postero-anterior radiographic measurements that might be a useful alternative to lateral film measurements in clinical practice. Selected landmarks were digitised on 80 postero-anterior wrist radiographs of asymptomatic volunteers. Carpal bone dimensions, ulnar variance, carpal height ratios, radial slope and various carpal angles were computed. Moreover, we describe two new parameters, the scapho-lunate ratios, that may prove useful in the diagnosis of carpal instability. Average values for carpal height, length of metacarpal III, capitate length, ulnar variance, radial slope and classical and revised carpal height ratios agreed with previous findings. Scaphoid length averaged 22 ± 3 mm, lunate anterior and posterior horn lengths 11 ± 1 mm and 16 ± 2 mm respectively. Except for carpal height and length of metacarpal III, standard deviations did not exceed 3 mm. Some of the variation coefficients reached 30% of the average dimension, so that variations, compared to means were not negligible. The standard deviations of angular measurements ranged from 3° to 13°. Further investigations are needed to confirm the usefulness of scapho-lunate ratios.

Radiocapitellar joint contacts after bipolar radial head arthroplasty.

PURPOSE The purpose of this study was to determine radiocapitellar contacts before and after radial head replacement, using the bipolar design of Judet. METHODS Joint contacts were measured by moulding the joint surfaces of 6 fresh-frozen cadaveric specimens, in various positions of elbow flexion and forearm rotation. RESULTS Expressed as function of the radial cup, contact areas averaged 44% in the normal elbow, decreasing with flexion and increasing with supination (P < .05). After prosthetic implantation, contact areas averaged 33% and remained quite similar, irrespective of elbow position. Subluxation of the prosthetic head over the lateral margin of the trochlea was seen systematically with supination. CONCLUSIONS Because of intraprosthetic mobility, contact areas were not dependant on elbow position. This adaptability, however, also led to abnormal positioning of the prosthetic radial head with supination, subluxing over the trochlea lateral margin.

In vivo registration of both electrogoniometry and medical imaging: development and application on the ankle joint complex

An in vivo method for joint kinematics visualization and analysis is described. Low-dose computed tomography allowed three-dimensional joint modeling, and electrogoniometry collected joint kinematic data. Data registration occurred using palpated anatomical landmarks to obtain interactive computer joint simulation. The method was applied on one volunteers ankle, and reproducibility was tested (maximal discrepancy: 3.6 deg and 5.5 mm for rotation and translation respectively).

Development of kinematics tests for the evaluation of lumbar proprioception and equilibration

OBJECTIVE This study aimed at developing lumbar repositioning and seated equilibration tests. DESIGN 3D-electrogoniometric study of trunk repositioning and equilibration in seated position. BACKGROUND Postural equilibrium and lumbar proprioception alterations have been shown in patients with low-back pain. METHODS In 21 healthy volunteers, pure flexion and flexion+rotation repositioning error was measured using 3D-electrogoniometry. Lumbar kinematics was analysed (time and frequency domain) during antero-posterior and lateral equilibration tests in seated position. Reproducibility and stability of the protocol were evaluated. RESULTS Reproducibility and stability were good. Pure flexion repositioning error was similar to previous reports. For flexion+rotation tests, repositioning error was 3 degrees for flexion and 1 degrees for rotation. Amplitude, imbalance time and power spectrum were significantly larger in lateral than in antero-posterior equilibration tests. CONCLUSIONS The feasibility of kinematic analysis of lumbar repositioning and equilibration was shown. Repositioning error values were in agreement with previous studies. New tests and parameters were proposed. Lateral equilibration tests appeared more demanding than antero-posterior tests. RELEVANCE In patients with low-back pain, lumbar repositioning and equilibration tests may be of use to define rehabilitation strategies and to evaluate treatment outcome.