Dissertations / Theses on the topic 'Joints – Range of motion – Testing'

Joint Position Sense (JPS) of the shoulder as determined by repeated repositioning tasks has been performed under different constrained testing conditions. The variability in the testing protocols for JPS testing of the gleno-humeral joint may incorporate different movement patterns, numbers of trials used to derived a specific JPS variable and range of motion. All of these aspects may play an important role in the assessment of G-H JPS testing. When using a new instrument for assessing JPS all of these issues need to be examined to document the optimal testing protocols for subsequent clinical assessments. By undertaking these studies future clinical trials may be more optimally assessed to determine if there are differences between dominant and non-dominant arms as well as the presence of JPS changes in performance associated with pathology and rehabilitation. This study used a 3-dimensional tracking system to examined gleno-humeral JPS using 2 open kinetic chain movement patterns. The 'conventional' 90 degree abducted, externally rotated movement was compared to the hypothetically more functional D2 movement pattern used in proprioceptive neuromuscular facilitatory techniques. These two patterns were tested at different ranges (low and high). Two cohorts (n=12, n=16) of normal healthy athletic males aged 17-35 years, performed matching tasks of both left and right arms. The second cohort (n=16) were assessed with and without strapping the gleno-humeral joint with sports tape. Accuracy (overall bias) and precision (variability) scores were determined for progressively greater numbers of trials. The findings of the study show that estimates of JPS accuracy and precision become more stable from data derived from 5 to 6 matching trials. There were no statistical differences between sides [95%CI ± 1.5cm]. The accuracy but not precision improved as subjects approximated the 'high' end of range in the 'conventional' or D2 pattern. Furthermore, no systematic differences were detected at different ranges of movement or movement patterns with or without the application of sports tape. These findings provide a guide to the number of trials that optimise the testing of the gleno-humeral joint and also suggest that in normal controls the magnitude of differences between sides and movement patterns is similar. These findings also iii indicate that sports tape applied to the shoulder may not significantly change the JPS performance in healthy, athletic males.

Previous research investigating the stability of the ankle joint complex may be categorised into two methodological groups, employing either an actuator to perturb the limb, or a form of standing balance disturbance such as a tilting platform, both of which test the joint in single degree of freedom (DOF). The aim of this thesis was to investigate how we control foot position and stabilise the joint when there is potential for movement in three DOF. A secondary aim of the thesis was to model the intrinsic mechanical properties of the ankle joint complex in three dimensions when coupled movement of the tibio-talar and talo-calcaneal joints are possible. This thesis details (i) the development of a perturbation rig that allows foot movement in single- or three-DOF with associated real-time visual target-matching software, and (ii) the use of the rig to investigate the stabilisation of the ankle joint complex in single- and three-DOF. The experimental procedure used a common task performed in three experimental conditions. Subjects were required to maintain a neutral foot position while developing varying levels of plantar-flexion torque. A perturbation was applied to the foot if subjects were within specified tolerance for both foot position and torque, represented by the visual display. Performance of the task in the first condition required the subject to only match torque as the foot position was fixed, with the perturbation being applied in dorsi-flexion (ie, single-DOF). The second experimental condition allowed the foot to move in the sagittal plane, hence subjects were required to control both torque and foot position in single-DOF, with perturbation applied in dorsi-flexion. The third condition enabled movement in dorsi/plantar-flexion, inversion/eversion and adduction/abduction (three-DOF) in both task and perturbation. Subjects were required to maintain the neutral foot position and the necessary torque level. There were three areas of interest common to each experimental protocol. The muscle strategy used to complete the task was investigated using a combination of surface and fine-wire electromyography on lower leg and thigh muscles. The 500ms period prior to perturbation was investigated to determine if synergies were evident between muscles such as medial and lateral gastrocnemius, soleus and peroneus longus. Two classes of activation strategies for the three-DOF condition emerged from the subject population: differential activation of the triceps surae group, and co-contraction. The former strategy may take advantage of the distinct morphology of the lateral gastrocnemius and peroneus longus muscles to best perform the position-matching component of the 3D task. The results suggest that the ankle joint is mostly stabilised in 3D by the intrinsic mechanical actions of the muscles producing plantar flexion moments. The muscles stabilised the foot in inversion, but not in eversion where there was very little motion. However, the different activation strategies employed may have varied efficacy in contributing to joint stability. This form of active stabilisation means that the previous literature focus on reflexes to stabilise the joint may need to be reassessed. Likewise, it may be appropriate to use the perturbation rig to quantify active ankle joint stability in order to assess the probability of ankle injury, rather than the current clinical measures employed. The reflexive response due to the perturbation was examined in the 200ms following perturbation. Variation in the modulation of monosynaptic reflexes was observed between subjects in various muscles in the higher DOF tasks. This is likely due to the differing activation strategies used to perform the task, and the variability in the kinematic response to perturbation. An attempt was made to calculate the intrinsic mechanical properties of the joint in 3-D using the kinematic and kinetic data during the first 15 ms period of perturbation. The system was modelled as a spring-damper using a constrained non-linear least squares, with stiffness and viscous terms for each axis, and inertial tensor elements as variables in the routine. The effect of increased muscle activation on the displacement of the foot about each of the anatomical axes was to significantly lower the movement of the sub-talar joint.

Assessment of finger range of motion (ROM) is often required for monitoring the effectiveness of rehabilitative treatments and for evaluating patients' functional impairment. There are several devices which are used to measure this motion, such as wire tracing, tracing onto paper and mechanical and electronic goniometry. These devices are quite cheap, excluding electronic goniometry; however the drawbacks of these devices are their lack of accuracy and the time- consuming nature of the measurement process. The work described in this thesis considers the design, implementation and validation of a new medical measurement system utilized in the evaluation of the range of motion of the human finger joints instead of the current measurement tools. The proposed system is a non-contact measurement device based on computer vision technology and has many advantages over the existing measurement devices. In terms of accuracy, better results are achieved by this system, it can be operated by semi-skilled person, and is time saving for the evaluator. The computer vision system in this study consists of CCD cameras to capture the images, a frame-grabber to change the analogue signal from the cameras to digital signals which can be manipulated by a computer, Ultra Violet light (UV) to illuminate the measurement space, software to process the images and perform the required computation, a darkened enclosure to accommodate the cameras and UV light and to shield the working area from any undesirable ambient light. Two calibration techniques were used to calibrate the cameras, Direct Linear Transformation and Tsai. A calibration piece that suits this application was designed and manufactured. A steel hand model was used to measure the fingers joint angles. The average error from measuring the finger angles using this system was around 1 degree compared with 5 degrees for the existing used techniques.

Understanding the control strategies that underlie multijoint limb movements is important to researchers in motor control, robotics, and medicine. Due to dynamic interactions between limb segments, choosing appropriate muscle activations for initiating multijoint arm movements is a complex problem, and the rules by which the nervous system makes such choices are not yet understood. The aim of the dissertation studies was to evaluate some proposed initiation rules based on their ability to correctly predict which shoulder and elbow muscles initiated planar, two-joint arm movements in various directions. Kinematic and electromyographic data were collected from thirteen subjects during pointing movements involving shoulder and elbow rotations in the horizontal plane. One of the rules tested, which is based on statics, predicted that the initial muscle activity at each joint is chosen such that the hand exerts an initial force in the direction of the target, while another rule, based on dynamics, predicted initial muscle activity such that the initial acceleration of the hand is directed toward the target. For both rules, the data contradict the predicted initial shoulder muscle activity for certain movement directions. Moreover, the effects of added inertial loads predicted by the latter rule were not observed when a 1.8 kg mass was added to the limb. The results indicated, however, that empirically derived rules, based on ψ, the target direction relative to the distal segment, could predict which muscles would be chosen to initiate movement in a given direction. Furthermore, the relative timing and magnitude of initial muscle activity at the shoulder and elbow varied systematically with ψ. Thus, the target direction relative to the forearm may be an important variable in determining initial muscle activations for multijoint arm movements. These findings suggest a control scheme for movement initiation in which simple rules suffice to launch the hand in the approximate direction of the target by first specifying a basic motor output pattern, then modulating the relative timing and magnitude of that pattern.

An experiment was performed to evaluate the relations between active range of motion (ROM) and upper limb anthropometric dimensions. Eight anthropometric dimensions, forearm length, distal and proximal forearm circumferences, wrist breadth, wrist thickness, wrist circumference, hand breadth, and hand length in combination with gender, wrist position, and direction of motion or exertion were evaluated to determine their effects on instant center of rotation (ICOR) and the magnitude of force exertion. The knowledge gained from analysis of the study data will be the first step in the formulation of a biomechanical model of wrist flexion and extension. Such a model would predict forces and torques at specific wrist postures and be employed to reduce cumulative trauma disorders of the wrist. Sixty right-hand dominant subjects (30 male, 30 female) between 20 and 30 years of age all reporting no prior wrist injury and good to excellent overall physical condition, were employed in this study. The upper limb anthropometric dimensions and ROM were measured and recorded for each subject. The anthropometric dimensions were compared to tabulated data. The measured active ROM values were compared with values in the literature. Correlation coefficients between pairs of anthropometric variables (by gender) were calculated. The mean active ROM measures, 164.0 deg for females and 151.8 deg for males, were significantly different (Z = 2.193, p = 0.014). The relationships between the anthropometric variables and active ROM were analyzed by three methods: correlation between ROM and each anthropometric dimension, prediction (regression) equations, and analysis of variance (ANOVA). No correlation coefficient between ROM and any anthropometric dimension was greater than 0.7. No prediction equation, based upon linear and quadratic combinations of anthropometric dimensions variables, was above the threshold of acceptability (R² ≥ 0.5). The results of the ANOVA showed a significant effect for gender. The ICOR had been hypothesized to be either in the head or neck of the capitate. The Method of Reuleaux was employed to locate the leOR points for flexion and extension (over the ROM) of the wrist with three load conditions, i.e., no-load, palmar resistance, and dorsal resistance. Analysis of the data, using ANOYA, showed that wrist position was the only significant variable. Thus, in future wrist models, the assumption cannot be made that the wrist is a pin-centered joint for flexion and extension. The static maximal voluntary contractile forces that can be generated by recruiting only the six wrist-dedicated muscles in various wrist positions were measured. There was a significant gender difference for the mean flexion force (Z = 4.00, p = 0.0001) and for the mean extension force (Z = 4.58, p = 0.0001). Females averaged 76.3 percent of the mean male flexion force and 72.4 percent for extension. The force data, categorized by gender, were then analyzed using three methods: correlation of variable pairs, regression equations, and ANOVA. None of the eight anthropometric dimensions and ROM was correlated with flexion or with extension force at an acceptable level. The prediction equations, linear and quadratic combinations of all possible subsets of anthropometric dimension values, ROM, and wrist position did not meet the minimum acceptable level of R² ≥ 0.5. The ANOVA procedure showed gender, wrist position, direction of force exertion, and the wrist position interaction with direction to have significant effects upon maximal force exertion.
Ph. D.

Empirical and modelling studies are reported which explore ways in which the central nervous system might consider musculo-skeletal geometry when generating commands for single degree of freedom elbow flexion and extension movements. In a series of experiments it is shown that subjects do not perform rapid, goal-directed flexion and extension movements equally accurately in different parts of the elbow's workspace. In these experiments, movements of 10, 20 and 30 degrees in amplitude were tested using up to five different initial elbow angles. When performing flexions, subjects tended to overshoot targets when starting from extended positions, to undershoot targets when starting from more flexed positions, and to perform relatively accurate movements when starting from the centre of the workspace. Final position accuracy was more variable for extensions. When reliable differences existed for extensions, subjects tended to produce a pattern of results opposite to that of flexions: subjects overshot targets when starting from flexed positions and undershot targets when starting from more extended positions. A model of elbow movement based on the $ lambda$ version of the equilibrium-point hypothesis was used to assess the extent to which the pattern of errors obtained in the empirical studies could be reproduced by a control scheme that does not adjust commands in response to changing musculo-skeletal geometry, but rather uses one single invariant command throughout the workspace. The motivation for testing the invariant command notion was to explore the possibility that motion planning might be achieved without an explicit representation of musculo-skeletal geometry. Predicted patterns of final position errors across the workspace matched empirically obtained error patterns for flexions, but the model performed less well when predicting the pattern of errors observed for extension movements.

The present study quantifies electromyographic variables in one and two degree of freedom elbow movements involving flexion/extension and pronation/supination, in order to understand the associated central commands. Agonist burst magnitude varied with motion in a second degree of freedom for some muscles but not for others. In movements for which a biarticular muscle acted as agonist in two degrees of freedom, agonist burst magnitudes were approximately the sum of the magnitudes in the component movements. Agonist burst magnitude varied with motion in a second degree of freedom for some, but not all, monoarticular muscles. When biarticular muscles acted as agonist in one degree of freedom and antagonist in the other, the muscle often displayed both components simultaneously. The additivity of EMG burst magnitudes in two degree of freedom movements and the presence of both agonist and antagonist bursts in a muscle suggest that central commands associated with motion in individual degrees of freedom are superimposed in producing two degree of freedom movements.

[Truncated abstract] Measuring the kinematics of joints and implants following orthopaedic surgery is important since joint motion directly influences the functional outcome of the patient and the longevity of the implant. Radiostereometric Analysis (RSA) has been used to assess the motion over time of various joints and implant designs following corrective orthopaedic and joint replacement surgery for more than 20 years in more than 10,000 patients around the world. While the use of RSA reduces the risk of implanting potentially inferior prostheses on a large scale, conventional methodological procedures are based on the acquisition of static, stereographic x-ray images that are not suitable for measuring skeletal kinematics in a dynamic manner. The purpose of this thesis was to design, validate and test a novel technique for dynamically assessing the skeletal motion of human subjects using RSA and single-plane digital x-ray video fluoroscopy. The validation procedure utilised two in-vitro phantom models of human joints capable of simulating normal kinematic motion. These phantom models were supplied with realistic spatial displacement protocols derived from cadaveric specimens. The spatial positions of a series of tantalum markers that were implanted in each skeletal segment were measured using RSA. Skeletal motion was determined in x-ray fluoroscopy images by minimising the difference between the markers measured and projected in the single image plane. Accuracy was determined in terms of bias and precision by analysing the deviation between the applied displacement protocol and measured pose estimates. ... The RSA and low dose single-plane fluoroscopy technique developed, validated and tested in this thesis is capable of dynamically measuring the kinematics of any joint in the human body, following the implantation of small metallic markers in the surrounding bone during corrective orthopaedic surgery. The kinematics of joints with replacement prostheses, such as the total knee replacement (TKR), can be analysed in addition to the kinematics of joints without replacement prostheses, such as the sacroiliac joint. The technique may be used in the future on groups of human subjects enrolled in controlled trials that are designed to analyse the kinematics of the shoulder, spine, hip, knee, patella or ankle joints for the purposes of quantitatively comparing the kinematics of different prosthesis designs and various corrective orthopaedic procedures.

Human balance and locomotion control is highly complex and not well understood. To understand how the nervous system controls balance and locomotion works, we test how the body responds to controlled perturbations, the results are analyzed, and control models are developed. However, to recreate this system of control there is a need for a robot with human-like kinematics. Unfortunately, such a robotic testbed does not exist despite the numerous applications such a design would have in mobile robotics, healthcare, and prosthetics. This thesis presents a robotic testbed model of human lower legs. By using MRI and CT scans, I designed joints that require lower force for actuation, are more wear resistant, and are less prone to catastrophic failure than a traditional revolute (or pinned) joints. The result of using this process is the design, construction, and performance analysis of a biologically inspired knee joint for use in bipedal robotics. For the knee joint, the design copies the condylar surfaces of the distal end of the femur and utilizes the same crossed four-bar linkage design the human knee uses. The joint includes a changing center of rotation, a screw-home mechanism, and patella; these are characteristics of the knee that are desirable to copy for bipedal robotics. The design was calculated to have an average sliding to rolling ratio of 0.079, a maximum moment arm of 2.7 inches and a range of motion of 151 degrees. This should reduce joint wear and have kinematics similar to the human knee. I also designed and constructed novel, adjustably-damped hip and ankle joints that use braided pneumatic actuators. These joints provide a wide range of motion and exhibit the same change in stiffness that human joints exhibit as flexion increases, increasing stability, adaptability, and controllability. The theoretical behaviors of the joints make them desirable for use in mobile robotics and should provide a lightweight yet mechanically strong connection that is resistant to unexpected perturbations and catastrophic failure. The joints also bridge the gap between completely soft robotics and completely rigid robotics. These joints will give researchers the ability to test different control schemes and will help to determine how human balance is achieved. They will also lead to robots that are lighter and have lower power requirements while increasing the adaptability of the robot. When applying these design principles to joints used for prosthetics, we reduce the discomfort of the wearer and reduce the effort needed to move. Both of which are serious issues for individuals who need to wear a prosthetic device.

The purpose of this study was to compare the protective characteristics of four different ankle braces and one form of ankle taping. An inversion and plantar flexion platform was used to induce ankle movements. The subjects used in this study consisted of 10 volunteer male students. The subjects had no sprains five months prior to testing. All subjects were tested in the same size 10 shoes, high tops and low tops. A Certified Athletic Trainer applied all ankle braces and ankle tapings. A closed basketweave with heel locks, adherent spray, and pre-wrap was used for all taping conditions.After the application of the ankle braces or taping, each subject performed two tests on the inversion and plantar flexion platform. A random order was used among the subjects. An ankle inversion platform was modified to induce 30 degrees of inversion and 35 degrees of plantar flexion simultaneously. The subjects will be filmed using a Locam 16mm at 200 frame/second. All subjects were filmed from the posterior plane with markings on the posterior aspect of the lower leg to help analyze the movement at the subtalar joint. A Calcomp 9100 series digitizer that was interfaced with a VAX computer was used to analyze the data and calculate the amount of angular displacement at the subtalar joint. An ANOVA with repeated measures was used to determine significant differences between support techniques. University procedures for the protection of human subjects was followed. ANOVA procedures indicated no significant difference in angular displacement between braces. A statistical analysis indicated that low top shoes provided significantly more support than high top shoes in braced ankles.
School of Physical Education

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Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
A busca pela estratégia mais eficaz capaz de prevenir, modificar e controlar fatores de risco e doenças crônicas por meio de mudança no estilo de vida (MEV) tornou-se um grande desafio, além de conseguir a adesão, em longo prazo, e principalmente sem supervisão, aos bons hábitos adquiridos durante a intervenção com MEV. Diante disso, o objetivo do presente estudo foi avaliar o efeito da participação e do desligamento do programa de mudança do estilo de vida sobre nível de atividade e aptidão física, percepção de saúde e presença de Síndrome Metabólica em adultos da comunidade de Botucatu-SP. Estudo do tipo transversal com base na comunidade contou com 153 indivíduos previamente participantes de programa de MEV e alocados em grupos Controle, Adesão e Não-Adesão. As avaliações incluíram medidas antropométricas (peso corporal e estatura para cálculo do índice de massa corporal (IMC), circunferência abdominal, percentual de gordura, massa muscular e índice de massa muscular (IMM)), aptidão física (flexibilidade de tronco (sentar e alcançar) e força de preensão manual (dinamometria)) e nível de atividade física e estado de saúde (IPAQ longo, versão 8). Amostra sanguínea de jejum foi utilizada para análise bioquímica (glicemia, HDL-C e triglicerídios), aferição da pressão arterial (técnica auscultatória) e o diagnóstico da Síndrome Metabólica (SM) seguiu as recomendações do NCEP-ATPIII (2001) com adaptação da glicemia (≥ 100 mg/dL) em três momentos (pré-participação (M0), após intervenção de seis meses (M1) e após desligamento (M2) do programa de MEV). Análise de variância e modelo linear generalizado em medidas repetidas para comparação entre momentos e grupos, qui-quadrado, teste de proporção e modelo de regressão logística com nível de significância de 5%. O programa de MEV...
The search for more effective strategy able to prevent, control and modify risk factors and chronic diseases through lifestyle change (LSC) has become a major challenge, beyond to achieving the adherence in long term, especially without supervision, the good habits acquired during the LSC intervention. Thus, the purpose of this study was to evaluate the participation and disconnexion effects of lifestyle change program on physical activity level and fitness, on self-perceived health and metabolic syndrome presence in adults from Botucatu-SP’s community. Cross-sectional study of community-based had 153 subjects previously LSC program participants and allocated in Control, Adherence and Non-Adherence. The assessments included anthropometric measurements (weight and height to calculate body mass index (BMI), waist circumference, fat percentage, muscle mass and muscular mass index (MMI)), fitness (trunk flexibility (sit and reach) and handgrip strength (dynamometry)) and physical activity level and health status (IPAQ long version 8). Fasting blood sample was used for biochemical analysis (glucose, HDL-C and triglycerides), blood pressure measurement (auscultatory technique) and metabolic syndrome (MetS) diagnosis followed the NCEP-ATPIII (2001) recommendations with glucose adaptation (≥ 100 mg / dL) in three moments (pre-participation (M0), six months after intervention (M1) and after LSC program disconnexion (M2)). Variance analysis and generalized linear model for repeated measures to compare moments and groups, chi-square and proportions test and logistic regression model with 5% significance level. The LSC program significantly reduced work and housework physical activity, poor health perception and low physical activity level and increased leisure physical activity and flexibility, beyond to attenuate... (Complete abstract click electronic access below)

Orientador: Roberto Carlos Burini
Banca: Kátia Cristina Portero McLellan
Banca: Ismael Forte Freitas Junior
Banca: Alex Antonio Florindo
Banca: Aguinaldo Gonçalves
Resumo: A busca pela estratégia mais eficaz capaz de prevenir, modificar e controlar fatores de risco e doenças crônicas por meio de mudança no estilo de vida (MEV) tornou-se um grande desafio, além de conseguir a adesão, em longo prazo, e principalmente sem supervisão, aos bons hábitos adquiridos durante a intervenção com MEV. Diante disso, o objetivo do presente estudo foi avaliar o efeito da participação e do desligamento do programa de mudança do estilo de vida sobre nível de atividade e aptidão física, percepção de saúde e presença de Síndrome Metabólica em adultos da comunidade de Botucatu-SP. Estudo do tipo transversal com base na comunidade contou com 153 indivíduos previamente participantes de programa de MEV e alocados em grupos Controle, Adesão e Não-Adesão. As avaliações incluíram medidas antropométricas (peso corporal e estatura para cálculo do índice de massa corporal (IMC), circunferência abdominal, percentual de gordura, massa muscular e índice de massa muscular (IMM)), aptidão física (flexibilidade de tronco (sentar e alcançar) e força de preensão manual (dinamometria)) e nível de atividade física e estado de saúde (IPAQ longo, versão 8). Amostra sanguínea de jejum foi utilizada para análise bioquímica (glicemia, HDL-C e triglicerídios), aferição da pressão arterial (técnica auscultatória) e o diagnóstico da Síndrome Metabólica (SM) seguiu as recomendações do NCEP-ATPIII (2001) com adaptação da glicemia (≥ 100 mg/dL) em três momentos (pré-participação (M0), após intervenção de seis meses (M1) e após desligamento (M2) do programa de MEV). Análise de variância e modelo linear generalizado em medidas repetidas para comparação entre momentos e grupos, qui-quadrado, teste de proporção e modelo de regressão logística com nível de significância de 5%. O programa de MEV... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The search for more effective strategy able to prevent, control and modify risk factors and chronic diseases through lifestyle change (LSC) has become a major challenge, beyond to achieving the adherence in long term, especially without supervision, the good habits acquired during the LSC intervention. Thus, the purpose of this study was to evaluate the participation and disconnexion effects of lifestyle change program on physical activity level and fitness, on self-perceived health and metabolic syndrome presence in adults from Botucatu-SP's community. Cross-sectional study of community-based had 153 subjects previously LSC program participants and allocated in Control, Adherence and Non-Adherence. The assessments included anthropometric measurements (weight and height to calculate body mass index (BMI), waist circumference, fat percentage, muscle mass and muscular mass index (MMI)), fitness (trunk flexibility (sit and reach) and handgrip strength (dynamometry)) and physical activity level and health status (IPAQ long version 8). Fasting blood sample was used for biochemical analysis (glucose, HDL-C and triglycerides), blood pressure measurement (auscultatory technique) and metabolic syndrome (MetS) diagnosis followed the NCEP-ATPIII (2001) recommendations with glucose adaptation (≥ 100 mg / dL) in three moments (pre-participation (M0), six months after intervention (M1) and after LSC program disconnexion (M2)). Variance analysis and generalized linear model for repeated measures to compare moments and groups, chi-square and proportions test and logistic regression model with 5% significance level. The LSC program significantly reduced work and housework physical activity, poor health perception and low physical activity level and increased leisure physical activity and flexibility, beyond to attenuate... (Complete abstract click electronic access below)
Doutor

Pedicle screw-rod instrumentation is considered a standard treatment for spinal instability, and titanium is the most common material for this application. Cobalt-chromium has several advantages over titanium and is generating interest in orthopedic practice. The aim of this study was to compare titanium versus cobalt-chromium rods in posterior fusion, with and without transverse connectors, through in vitro biomechanical testing and determine the optimal configuration. Six cadaveric lumbar spines (L1-S1) were used. Posterior and middle column injuries were simulated at L3-L5 and different pedicle screw constructs were implanted. Specimens were subjected to flexibility tests and range of motion, intradiscal pressure and axial rotation energy loss were statistically compared among the following conditions: intact, titanium rods (without transverse connectors), titanium rods with transverse connectors, cobalt-chromium rods (without transverse connectors) and cobalt-chromium rods with transverse connectors. The novel measurement of energy loss was examined to determine its viability in fusion investigations. All fusion constructs significantly (p0.05) were observed in axial rotation among all conditions. Intradiscal pressure significantly increased (p≤0.01) after fusion, except for the cobalt-chrome conditions in extension (p≥0.06), and no significant differences (p>0.99) were found among fixation constructs. Energy loss, differences became significant between the cobalt-chrome with transverse connector condition with respect to the cobalt-chrome (p=0.05) and titanium (p There is not enough evidence to support that the cobalt-chrome rods performed biomechanically different than the titanium rods. The use of titanium rods may be more beneficial because there is a lower probability of corrosion. The inclusion of the transverse connector only increased stability for the cobalt-chromium construct in axial rotation, which suggests that it is beneficial in complete facetectomy procedures.

The purpose of this study was to examine the criterion-related validity of the sit and reach test as a measure of hamstring and low back flexibility in adult males and females. Subjects were 52 males and 52 females, 20 to 45 years of age. Hamstring flexibility was measured using a goniometer. Spinal flexibility was measured using a tape measure and an inclinometer. The sit and reach test was performed according to the AAHPERD Health Related Fitness Test Manual. Data were analyzed using correlations and appropriate descriptive statistics. Conclusions of the investigation were: 1) in adult males 20 to 45, the sit and reach test is a valid measure of hamstring flexibility but has questionable validity as a measure of low back flexibility, 2) in adult females 20 to 45, the sit and reach test is a moderately valid measure of hamstring flexibility and is not a valid measure of low back flexibility.

The purpose of the study was to quantify the relative contribution of low back flexibility and hamstring flexibility in the sit and reach test item of the AAHPERD Health Related Fitness Test in order to examine the validity of the sit and reach test. Subjects were 100 female students, 13 to 15 years of age in physical education classes. Hamstring flexibility was measured using the Leighton flexometer. Spinal mobility was measured using a tape measure. The sit and reach test was performed according to instructions given in the AAHPERD Test Manual. Data were analyzed using correlation, linear regression, and multiple regression. Conclusions of the investigation were (1) hamstring flexibility is moderately related to the sit and reach test, (2) low back flexibility has a very small relationship to the sit and reach test, and (3) the sit and reach test is an inadequate measure of low back and hamstring flexibility.

Biomechanical testing of cadaveric spinal segments forms the basis for our current understanding of healthy, pathological, and surgically treated spinal function. Over the past 40 years there has been a substantial amount of data published based on a spinal biomechanical testing regimen known as the flexibility method. This data has provided valuable clinical insights that have shaped our understanding of low back pain and its treatments. Virtually all previous lumbar spinal flexibility testing has been performed at room temperature, under very low motion rates, without the presence of a compressive follower-load to simulate upper body weight and the action of the musculature. These limitations of previous work hamper the applicability of published spinal biomechanics data, especially as researchers investigate novel ways of treating low back pain that are intended to restore the spine to a healthy biomechanical state. Thus, the purpose of this thesis work was to accurately characterize the rate-dependent flexibility of the lumbar spine at body temperature while in the presence of a compressive follower-load. A custom spine simulator with an integrated environmental chamber was developed and built as part of this thesis work. Cadaveric spinal motion segments were tested at 12 different rates of loading spanning the range of voluntary motion rates. The testing methodology allowed for comparison of spinal flexibility at room and body temperatures in the three primary modes of spinal motion, both with and without a compressive follower-load. Additionally, the work developed a stochastic model for rate-dependent spinal flexibility that allows for accurate prediction of spinal flexibility at any rate within the range of voluntary motion, based on a single flexibility test. In conclusion, the biomechanical response was significantly altered due to testing temperature, loading-rate, and application of a compressive follower-load. The author emphasizes the necessity to simulate the physiological environment during ex vivo biomechanical analysis of the lumbar spine in order to obtain a physiological response. Simplified testing procedures may be implemented only after the particular effect is known.

Stenosis is one of the most common causes for spinal surgery. Laminectomy decompression and fusion are surgical procedures prescribed for this condition. The intention of this work was to investigate the effects of a laminectomy decompression, followed by fusion, on a lumbar functional spinal unit (FSU) through in vitro dynamic (±8Nm at 0.125Hz) and quasi-static (±7.5Nm at 0.1Hz) biomechanical tests, for flexion, extension, bending and rotation motions. Six FSUs where disarticulated from four human cadaveric lumbar spines (63 ± 12 years) and were tested under the following sequence: (1) intact, (2) laminectomy decompression, and (3) Pedicle Screw System (PSS), using a load-displacement controlled system. Dynamic neutral zone (NZ), dynamic neutral zone stiffness (NZS) and the range of motion (ROM) were the parameters evaluated. Since only 6 FSUs from different spinal levels were used, any effect related to the spinal level could not be evaluated. This limitation enforced to consider normalized data (with respect to intact) as an alternative analysis, but large standard deviations after transforming the data forced us to contemplate this "a pilot study". Dynamic testing revealed that there were no significant differences in the neutral zone magnitude for any motion after a laminectomy decompression, while its magnitude for flexion-extension was significantly affected by PSS treatment (p<0.004). The change in dynamic NZ (normalized data) was significantly different (p<0.03) after both treatments for flexion-extension motion. The reduction in stiffness (normalized data) for extension after a laminectomy, and the increase in stiffness (normalized data) for flexion and extension after PSS treatment, were both significant (p<0.03 and p<0.05, respectively). The ROM were not statistically significant for the three treatments, but normalized data showed significant differences (p<0.05) for all motions, except for right bending after laminectomy and right rotation after PSS. Non-normalized data from quasi-static testing didn't show any statistically significant difference between the treatments for any motion. Normalized data suggested significant differences for the change in ROM for all motions at multiple load conditions, especially for flexion and extension. This pilot study suggests there may be a considerable effect of a laminectomy on the stability of a lumbar FSU. Dynamic data suggested the changes in neutral zone stiffness triggered by a laminectomy procedure may be significant for extension. PSS treatment increased segment's NZ stiffness by more than double. The changes in ROM from quasi-static loading caused by a laminectomy decompression may be significant as well, especially for flexion (20%) and extension (greater than 10%). It is suggested that further studies involving spine biomechanics should consider and report, but not be limited to the following variables: exposure time of the specimen to room temperature, preservation and testing conditions, ligaments and joints conditions, testing protocol, and loading history.

O Teste de Sentar e Alcançar (TSA) é o teste mais utilizado para avaliação de flexibilidade dos isquiotibiais, contudo, alguns fatores influenciam o seu resultado como o comportamento da coluna vertebral. Esta pesquisa objetiva determinar a contribuição da articulação do quadril, da coluna lombar e da coluna torácica na execução do TSA em jovens brasileiros. Foi realizado um estudo observacional descritivo com uma amostra composta por 195 rapazes de 18 a 19 anos. Para identificar a contribuição dos segmentos corporais no movimento de flexão do tronco, realizou-se juntamente com o TSA uma análise cinemática angular por meio de Fotogrametria. Para tanto, foi desenvolvido um protocolo de avaliação de ângulos de referência que foram transformados em percentuais de contribuição dos segmentos. Os ângulos e percentuais foram classificados em dois padrões de referência do TSA, os quais permitiram identificar que quanto melhor a classificação no TSA, maior a utilização do quadril e menor a utilização da coluna torácica. A coluna lombar manteve-se estável durante o movimento. Os ângulos e percentuais foram classificados também nas categorias de IMC, revelando que indivíduos obesos utilizam mais o quadril para realizar o movimento, pois não conseguem fazer compensação com a coluna torácica. Com base nos resultados, foi possível criar uma tabela de classificação dos ângulos e percentuais, que permitiu identificar compensações e padrões de movimento conforme a condição das musculaturas envolvidas. Pôde-se concluir que as contribuições médias da coluna torácica, da coluna lombar e do quadril na realização do TSA são respectivamente: 46,014%, 12,676%, 41,309%. Entretanto, a medida do TSA propriamente dita não permite esse detalhamento, pois seu resultado faz referência à flexão total do tronco juntamente com a flexão do quadril. Assim, recomenda-se que a avaliação da flexão da coluna torácica, da coluna lombar e do quadril seja realizada separadamente, por fotogrametria, com base no protocolo e parâmetros médios estabelecidos neste estudo, por meio da classificação de seus valores nas categorias propostas.
The Sit and Reach Test (SR) is the most widely used assessment of hamstrings flexibility, however, some factors can influence their results as a behavior of the spine. This research aims to determine the contribution of the hip joint, of the lumbar and thoracic spine in the execution of SR in young Brazilians. The descriptive observational study subjects were 195 young men from 18 to 19 years. To identify the contribution of body segments in flexion of the trunk it was evaluated the SR together with angular kinematic analysis through of Photogrammetry. To that end, we developed a protocol for evaluating reference angles that were transformed into percentage contribution of the segments. The angles and percentages were classified into two reference standards of the SR, which identified that the best ranking in SR, greater use of hip and lower utilization of the thoracic spine. The lumbar spine was stable during movement. The angles and percentages were also classified in the categories of BMI, revealing that obese people use more hip to perform the movement, because they cannot make compensation with thoracic spine. Based on the results, it was possible to create a table of classification of angles and percentages, which allowed for the identification and compensation movement patterns in accordance with the condition of the muscles involved. It can be concluded the contributions of the thoracic spine, lumbar spine and hip in performing the SR are respectively 46.014%, 12.676%, 41.309%. However, only the measure of the SR does not permit this detail because its result refers to the total trunk flexion and hip flexion. Thus, it is recommended that evaluation of flexion of the thoracic spine, lumbar spine and hip joint are performed separately by photogrammetry, based on the average parameters and protocol established in this study, through the classification of their values in the proposed categories.

Esta dissertação descreve o desenvolvimento de um goniômetro de enlace indutivo para medição de ângulos articulares. O goniômetro tem por objetivo medições de ângulos até 360° e a possibilidade de medição em articulações com mais de um grau de liberdade. Para isto utiliza como base o trabalho de Laskoski (2010) e os sistemas de navegação aeronáuticas. O experimento realizado por Laskoski (2010) efetua medições até 180° as bobinas precisam estar alinhadas. Os sistemas utilizados em navegações aeronáuticas utilizam a bússola eletrônica e o automatic direction finder, estes sistemas trabalham com grandezas na ordem de quilômetros. Este experimento visa adaptar os sistemas de navegação utilizando o campo magnético para poder efetuar medições de ângulo em pequenas distâncias. Os testes foram satisfatórios comparando os erros encontrados com os resultados dos experimentos de Laskoski (2010) e Carbonaro et al. (2014). O erro máximo em uma distância de 7,5 cm é de 10,6°e o desalinhamento entre a bobinas de +20° e -20° gera um erro de no máximo 1,71°.
This dissertation describes the development of an inductive goniometer for the measurement of joint angle. The goniometer aims to measure angles up to 360 ° and the possibility of measurement in joints with more than one degree of freedom. For this it uses as base the work of Laskoski (2010) and aeronautical navigation systems. The experiment performed by Laskoski (2010) makes measurements up to 180 ° and the coils need to be aligned. The systems used in aeronautical navigations use the electronic compass and the automatic direction finder, that systems work with magnitudes in the order of kilometers. This experiment aims to adapt the navigation systems using the magnetic field to be able to measure angles at small distances. The tests were satisfactory comparing the errors found with the results of the experiments of Laskoski (2010) and Carbonaro et al. (2014). The maximum error over a distance of 7.5 cm is 10.6 ° and the misalignment between the coils of + 20 ° and -20 ° generates an error of at most 1.71 °.

While military body armor is used among warfighters for protection on and off the battlefield, it has been suggested to impede performance and act as a risk factor for the development of musculoskeletal disorders, especially low back pain. Apart from personal suffering, low back pain in soldiers is a great economic burden on the US economy. The objective of this study was to quantify the changes in trunk mechanical and neuromuscular behavior following prolonged exposure to body armor compared to exposure without. A crossover study design was used where 12 sex-balanced participants completed a series of tests before and after 45 minutes of treadmill walking with and without body armor. The tests included range of motion, isometric trunk tests, sudden perturbations, and stress relaxation. As a whole, exposure duration considered in this study resulted in no significant differences in performance between armor and no armor conditions. However, comparing the effects of body armor among the sex-differentiated groups showed a body armor -induced increase in range of trunk motion in the sagittal plane among females (p = 0.0018) and a decrease in pelvic range of motion in the transverse plane among both males (p=0.025) and females (p=0.004).

The purpose of this study was to investigate the effects of different strength training modes on joint range of motion. The problem of the study was to compare Nautilus to free-weight training modes in terms of selected joints' ranges of motion before and after an eight-week strength training program. The hypothesis asserted was that there was no difference between pre-test and post-test scores when comparing Nautilus to free-weight training modes. Subjects were thirty college-age students enrolled in beginning weight-training classes at the University of the Pacific. The subjects were acquired from intact classes and comprised two groups of 9 males and 6 females each. Pre-test and post-test flexibility measures were acquired by use of a Leighton Flex-o-meter and sit-and-reach protocols. Single joint measures of shoulder flexion, extension and abduction, hip flexion, extension and abduction, elbow flexion, knee flexion, and low back flexion were acquired. For eight weeks, two times per week, each class completed an 8 to 12 repetitions per each exercise protocol following the principles of training asserted by Nautilus. Pre-test data for all bilateral joints were statistically analyzed with paired t-tests in order to determine any differences. No significant bilateral differences were found; consequently, these data were converted to eight single measures of average range of motion of the joints respectively. Pretest data then were analyzed with two-factor ANOV A (group x gender) in order to determine if the two intact classes initially represented the same population. The only measure in which a group difference was found was shoulder extension (p

TThis thesis looks at the development of a Hand and Wrist Strength Gauge. The gauge was developed by the author at the Flinders Medical Centre Occupational Therapy Department in 1997.
thesis (MApSc(OccupationalTherapy))--University of South Australia, 2003.

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2004.
Includes bibliographical references (leaves 164-170). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

The purpose of this study was to characterize glenohumeral joint laxity and stiffness using instrumented arthrometry. To evaluate the validity of an instrumented measurement system we compared cutaneous and bone-pinned measures of laxity and stiffness that replicate previously reported in vivo methodology. Characterization of capsular laxity was achieved through determination of the sagittal plane translational area at increasing levels of quantified force. Finally, a method for increasing the objectivity of the standard manual laxity examination was developed for the orthopaedic clinician to quantify humeral head translation and capsular volume in vivo. We hypothesized that: 1) cutaneous measures could accurately predict bone-pinned measures, 2) capsular laxity would increase with increasing levels of applied force, and 3) manual cutaneous, manual bone-pinned, and force-displacement bone-pinned measures of translation would be equal. Thirty fresh frozen cadaveric shoulder specimens (mean age=70��14 years) were tested. The shoulders were thawed and mounted to a custom-made shoulder-testing apparatus. Displacement was measured using an electromagnetic tracking system. Sensors were secured cutaneously and with bone-pins to the scapula and humerus. Force-displacement testing was performed using a load applicator and manual displacement testing utilized the anterior/posterior drawer and inferior sulcus tests. A comparison of cutaneous and bone-pinned measures of laxity and stiffness revealed good to excellent criterion validity (r=0.68 to 0.79). Examination of displacement measures at increasing levels of force revealed increasing capsular laxity with symmetric directional compliance. No significant difference was observed between anterior and posterior translation (0.4 mm, p=.55), with significant differences between inferior and anterior (4.6 mm, p<.0001) and between inferior and posterior (5.1 mm, p<.0001). A comparison of manual cutaneous to bone-pinned manual and kinetic measures of translation revealed a significant difference between methods (p=.0024) and between directions (p<.0001) with no significant interaction (p=.0948). Estimations of the force required to achieve clinical end-point suggest that greater force is required in the anterior (173 N) direction compared to posterior (123 N) and inferior (121 N). We have developed two new methods to measure glenohumeral joint kinematics and reported new information regarding normal kinematics of the glenohumeral joint.
Graduation date: 2001

The increase in tissue extensibility and joint range of motion through stretching has often been demonstrated. However, the existence of an optimal stretch duration has not been proven and the identification of an ideal number of repetitions of a stretch has received little attention in the literature. The purpose of this study was to examine and clarify the relationship of duration and number of repetitions of a stretch and their effect on changes in hamstring extensibility (HE) resulting from a stretching program. The HE of 33 subjects who were randomly assigned to a control group or one of three treatment groups was assessed before and after a three-week stretching program. The subjects in the three treatment groups stretched once a day, five times a week, and either once for 15 seconds (1 X 15), twice for 15 seconds (2 X 15), or once for 30 seconds (1 X 30). A repeated measures ANOVA showed no statistically significant effect for treatment group (P=0.181) or for treatment by pre- and post-treatment measurements (P=0.140), but indicated a significant difference between pre- and post-treatment measurements (P<0.001). The HE of the control group (which did not stretch) changed only slightly (0.9��, SD 5.7), the 1 X 15 and 1 X 30 groups improved more clearly (4.2��, SD 3.1 and 3.8��, SD 6.7, respectively), and the 2 X 15 group's HE increased the most (6.8��, SD 3.9). The results suggest that varying durations and repetitions of a stretch may influence the magnitude of improvement of HE. However, with the relatively low power (0.46) in the present study, no statistically significant difference between stretching protocols of 1 X 15 seconds, 2 X 15 seconds, and 1 X 30 seconds could be found.
Graduation date: 1997

M.Tech. (Chiropractic)
Purpose: This study aims to ascertain the extent Chiropractic manipulative therapy increases ROM beyond the joint-separation induced ROM initially experienced via the cavitation phenomenon in the absence of neck pain. Method: Sixty participants between eighteen and thirty-five years of age, thirty male and thirty female whom met the inclusion of no neck pain and perceived decreased ROM were selected for participation. There was a single group with each participant‟s pre-adjustment readings acting as a baseline. Procedure: Participants were assessed for hypomobility and joint dysfunction. Those who met the inclusion criteria underwent a detailed history, physical and cervical spine regional examination on the initial consult. A pre-adjustment objective measurement was acquired using a cervical spine range of motion (CROM) device. Once the consent form was signed participants received Chiropractic cervical spine manipulative therapy to the area/s of the cervical spine found to be restricted on motion palpation by the researcher. Post-adjustment objective measurements were taken at one, twenty, forty and sixty minutes using the CROM device. Participants were required to remain in the researcher‟s examination room for 60 minutes post-adjustment with continuation of regular day to day activity and no strenuous activity during the twenty-four hour period of the study. The participant was required to return for a single follow up visit within a time frame of twenty-four hours of the initial visit. The follow-up visit required no treatment. At twenty-four hours, the participant was objectively measured for cervical spine ROM using the CROM. The results were based on objective data in the form of cervical spine ROM measurements. Results: Clinical analysis of the percentage change in cervical spine ROM values revealed that clinically and statistically significant improvement was seen in all ranges of motion post-adjustment. General consensus showed that a peak value of improved ROM was seen post-adjustment at the one minute interval for all ranges of motion except flexion. Flexion demonstrated a peak ROM value at the twenty minute post-adjustment interval.

Ankle injuries comprise more than 15% of all sports injuries worldwide. The efficacy of the ankle taping for injury prevention has long been under scrutiny as numerous studies have shown that tape rapidly loses its ability to constrain ankle motion with exercise. Consequently, ankle braces (orthoses) are being used with increasing frequency for the prevention and functional management of ankle injuries. However, the motion restraining qualities of ankle orthoses have not been widely evaluated in closed kinetic chain environments under physiologic loads. The primary purpose of this study was to compare the abilities of four ankle orthoses (ankle taping, lace-up brace, semirigid orthosis and hybrid brace) against a control condition (no brace or tape) to control subtalar and talocrural motion during running on a laterally-tilted treadmill at 16.2 km/h before and after exercise. It has been hypothesized that ankle orthoses make a secondary contribution to injury prevention through enhanced proprioception. The secondary purpose of this study was to quantify the effects of the aforementioned ankle orthoses on postural stability during single-limb stance following a bout of exercise. Fifteen healthy university students (8 men and 7 women) with no history of significant ankle injuries (age, mean �� SD: 22.9 �� 3.9 years) volunteered to participate in this study. Three-dimensional kinematic data were captured with an active infrared digital camera system sampling at 120 Hz. To address the first question, data analyses were performed using 2way univariate (Ankle Orthoses x Pre/Post-Exercise x Subjects) (5 x 2 x 15) repeated measures analysis of variance (ANOVA) to determine the existence of differences among three closed and four open kinematic chain dependent measures before and after exercise. Maximum inversion angles (MAXINV) were similar for all ankle orthoses, with no orthosis limiting inversion during tilted treadmill running significantly more than another, or compared to the control condition, either before or after exercise (p>.05). Pre-exercise MAXINV group means and standard deviations during treadmill running ranged from 6.8 �� 3.4 deg with the Royce Medical Speed Brace to 9.5 �� 4.1 deg in the tape condition; post-exercise MAXINV mean values ranged from 7.6 �� 3.2 deg for the Aircast Sport Stirrup to 9.1 �� 4.6 deg with closed basketweave tape. While not statistically significant (p=0.10), ankle taping provided the least amount of inversion restraint, both before and after the exercise bout. The MAXINV angles measured during treadmill running (8.2 �� 4.0 deg) and open chain inversion AROM measured with a goniometer (34.5 �� 6.2 deg) were not related (r=-0.0003). The compressive forces present during closed kinetic chain activity are known to increase joint stability and thus may explain why MAXINV under dynamic varus loads was so much less in magnitude than inversion AROM measured under open kinetic chain conditions. The nonlinear relationship of these two variables supports our contention that reports of the motion controlling properties of ankle orthoses measured in open kinetic chain environments should not be used to infer the response characteristics of these same orthoses under dynamic, physiologic loads. To address the second question, data were analyzed using 3-way univariate (Ankle Orthoses x Pre/Post-Exercise x Eyes Open/Closed x Subjects) (5 x 2 x 2 x 15) repeated measures ANOVAs. Subjects' postural stability was assessed using a Biodex Balance System with eyes open and eyes closed conditions, before and after an exercise bout. The ankle orthoses evaluated did not influence postural stability as measured by mediolateral sway index, anteroposterior sway index, and overall sway index. Removal of visual perception via blindfolding resulted in significant decreases in all three measures of postural stability (p=.001). There was poor association among the closed chain postural stability parameters and the open chain AROM measures. These correlations ranged from r=.04 to .17, indicating minimal relationship between the amount of AROM permitted by the orthoses and postural stability as quantified by this method.
Graduation date: 2000

Fast medio-lateral movements, frequent in a number of sports activities, are associated with lower extremity injuries. These injuries may occur as a result of excessive musculoskeletal stresses on the joints and their associate structures. The purpose of this study was to investigate the effect of running speed and turning movement on the three-dimensional moments at the ankle, knee, and hip joints. Data were collected using video cameras and force plate. Eight male recreational basketball players were tested during slow (1.5 m/s), moderate (3.0 m/s), and fast running (4.5 m/s) and when cutting to the right or left (+60, +30, 0, -30, and -60��). The inverse dynamics approach was used to integrate the body segment parameter, kinematic and force plate data, and to solve the resultant joint moments. At the ankle joint, inversion/eversion, dorsi/plantar flexion, and internal/external rotation moments of the ankle joint increased with running speed (p<.05). At the knee joint, flexion/extension and abduction/adduction moments increased with running speed except flexion moment that decreased with running speed (p<.05). At the hip joint, internal/external rotation, flexion/extension, and abduction/adduction moments increased with running speed (p<.05). In medial cutting movements, greater abduction moments of the ankle, adduction moments of the knee and external rotation and adduction of the hip were found (p<.05). In lateral cutting movements, greater inversion and adduction moments of the ankle, abduction moments of the knee and hip were found (p<.05). These findings reinforce the intuitive notion that fast medio-lateral turning movements produce substantially greater musculoskeletal loading on the joint structures than does straight running and consequently have greater potential for inducing lower extremity injuries such as ankle sprain or anterior cruciate ligament injury.
Graduation date: 1999

M.Tech.
Soccer is the most widely played sport in the world and, of all the skills required to participate, the instep soccer kick is considered to be the primary offensive action within the game of soccer. Biomechanical analysis of the instep soccer kick has revealed that the action of kicking is characterised by a proximal to distal series of multi-articular movements with distal segmental movements being predetermined by more proximal ones (Kellis and Katis, 2007). According to Smith, Gilleard, Hammond and Brooks (2006), the lower spine and pelvis play a pivotal role in determining the placement and actions of distal segmental motion during the action of the instep soccer kick. The aim of this study was to determine the effectiveness of chiropractic adjustments in soccer players with lumbar facet and sacroiliac joint dysfunctions by assessing the resultant speed of a soccer ball once kicked with an instep soccer kick. By correcting the lumbar facet and sacroiliac joint dysfunction of the affected soccer players, it was postulated that with restoration of joint motion and reduction of pain, the speed of the soccer ball, when kicked, would improve. When kicked the resultant ball speed is indicative of biomechanical kicking success. Thirty male professional soccer players from the Jomo Cosmos football establishment who met the study’s selection criteria were selected and randomly divided into one of two groups. The study group received chiropractic adjustments of dysfunctional lumbar facets and sacroiliac joints and the control group received a placebo treatment in form of a de-tuned stationary ultra-sound head over the effected facets joints for five minutes. Treatment for both groups occurred over a two week period with treatment being administered twice a week, totalling of four treatments per participant. Data capture was collected 3 times over the 2-week period; 1st reading done before the 1st treatment, the 2nd reading before the 3rd treatment and the final reading taken after the 4th and final treatment. Data capture consisted of both subjective and objective readings. The subjective data consisted of the measurements of pain experienced by the participants in the form of a Numerical Pain Rating Scale. Objective data involved the measurement of ball speed once kicked, with the use of a radar speed gun as well as lumbar spine range of motion measurements by means of a Digital Inclinometer. In executing the group comparisons, it was found that both groups would present with contrasting results. The group undergoing the chiropractic adjustments would show an improvement in their ball speed, reduction in their overall pain and increased lumbar spine extension and rotation ROM; where as the group undergoing the placebo treatment experienced a decrease in their ball speed, an increase in their overall pain and decreased lumbar spine ROM. The results obtained from the study demonstrated that the majority of the data was not statistically significant in either of the groups however, from a clinical perspective there was a definite effect on the lumbar spine range of motion, ball speed and pain reduction as a result of the Chiropractic adjustments that would warrant further investigation. There is a definite link with the negative effects that lumbar facet and sacroiliac joint dysfunctions have on the proximal to distal sequence of events that take place during the instep soccer kick. Therefore, treating the lumbar facet and sacroiliac joint dysfunction with chiropractic adjustments allows for better transfer of energy between segments and for greater resultant ball speed. In conclusion, the study demonstrated that chiropractic adjustment of lumbar facet and Sacroiliac joint dysfunctions showed good improvement in the resultant ball speed, reduction in lower back pain and improved lumbar spine extension and rotation ROM. From these results, it would be prudent to incorporate more chiropractic treatment into mainstream soccer and encourage further research into the advantages that chiropractic treatment has in better understanding the biomechanics involved in the instep soccer kick.

Osteoarthritis (OA) of the knee is a common condition. The condition causes pain and swelling in the knee joint and as a consequence knee range of motion, particularly knee extension, can be decreased. While a number of studies have indicated increases in knee extension range of motion (ROM) can be achieved following stretching interventions, these studies have been undertaken in young healthy populations mostly. To date, there have been no investigations of stretching as a single intervention in people with OA knee. Review of Literature: To gain an appreciation of the literature in this area, three structured literature reviews were undertaken. The first examined the efficacy of acute stretching interventions on lower limb joint ROM in young and elderly subjects, the second examined the efficacy of periodic muscle stretching interventions on lower limb joint ROM in elderly subjects and the third examined the efficacy of periodic muscle stretching interventions on ROM in subjects with OA of the knee joint. The results of the first review indicated that there is strong evidence for acute stretching interventions to increase joint ROM in the lower limb of young and elderly subjects. The results of the second review indicated that there is strong evidence for periodic stretching interventions to increase joint ROM in the lower limb of elderly subjects. The result of the third review indicated that there is limited evidence for stretching interventions alone to improve ROM in the lower limb in subjects with OA of the knee joint. As consequence of these findings two studies were designed to investigate the effects of acute and periodic stretching in people with OA of the knee joint. Study 1 Objective: The objective of this study was to investigate the effects of an acute hamstring-stretching programme on knee extension range of motion in individuals with osteoarthritis (OA) of the knee and compare them to individuals of a similar age without OA of the knee. Study Design: A cross sectional study design was used. Participants: Thirty one subjects (16 male and 15 female) with OA of the knee were recruited from the local population (mean age 67.8 yrs SD: 5.0, mass 81.4 kg, SD: 15.2, height 168.5 cm, SD 11.1). Thirty one subjects of a similar age (9 male and 23 female) were also recruited who were otherwise fit and healthy and did not have OA of the knee (mean age 68.8 yrs SD: 5.2, mass 71.4 kg, SD: 13.2, height 163.8 cm, SD 8.1). Method: Hamstring extensibility was assessed by a passive knee extension test using a Kincom® isokinetic dynamometer. Subjects undertook two trials of maximum knee extension. The Kincom® then stretched the hamstrings to a point determined as 80% of the initial maximum knee extension test. Three sets of 60 seconds stretching were undertaken with 60 seconds rest between sets. Two further maximal knee extension tests were performed after the stretching intervention. The variables of interests were maximal knee extension, peak passive torque and stiffness. Analysis: A 2-factor repeated measures ANOVA model was utilised. The alpha level was set at 0.05. Results: There was a significant main effect by time for knee extension ROM, peak passive torque and stiffness (p<0.05). There was no interaction effect between groups across time (p>0.05). Knee extension range of motion (ROM) in the OA group increased significantly from 75.6 (SD: 17.2) degrees to 80.5 (SD: 22.3) degrees after the intervention (p<0.05). Subjects in the non OA group increased significantly from 77.5 (SD: 15.5) degrees to 81.9 (SD: 18.2) degrees after the intervention (p<0.05). The knee extension ROM recorded at 50% of the peak torque level pre intervention for the OA group was 60.3 (SD: 18.7) degrees and this increased significantly to 67.2 (SD 16.7) degrees post intervention (p<0.05). For the non OA group, knee extension ROM at 50% of peak torque increased significantly from 60.1 (SD: 15.2) degrees to 65.8 (SD 16.0) degrees (p<0.05). Peak passive torque in the OA group increased significantly from 18.1 (SD: 9.6) Nm to 22.5 (SD: 12.9) Nm after the intervention (p<0.05). Subjects in the non OA group increased significantly from 21.05 (SD: 11.6) Nm to 22.05 (SD: 12.8) Nm after the intervention (p<0.05). For stiffness, there was a significant interaction effect (p <0.05) between groups across time. The OA group increased significantly from 0.70 (SD: 0.35) Nm/deg to 0.89 (SD: 0.5) Nm/deg after the intervention (p<0.05). Subjects in the non OA group increased significantly 0.78 (SD: 0.36) Nm/deg to 0.82 (SD: 0.42) Nm/deg after the intervention (p<0.05). Conclusions: The study demonstrated that knee extension ROM, passive resistive torque and stiffness increased with a single bout of stretching. These results indicate that both elderly subjects and those with degenerative joint disease are able to demonstrate immediate tissue adaptations with acute stretching interventions. This is important as clinicians often prescribe acute stretching exercises in the preparation for other activities such as strengthening and walking programmes. Improving joint range of motion prior to other subsequent activities may be beneficial to those people with OA in particular, as management guidelines for these populations recommend regular exercise to reduce the deterioration of the condition. Study 2 Objective: The purpose of this study was to investigate the effects of a six week stretching intervention to the key muscles of the lower limb, in people with osteoarthritis (OA) of the knee joint and compare them to individuals of a similar age without OA of the knee. A 12 week follow up was undertaken to see if these effects were maintained following the intervention. This study builds on the effects of an acute stretching intervention as demonstrated in Study 1. Study Design: A randomised control trial design was used. Participants: Forty three subjects (24 OA and 19 non OA) were recruited from the local population (mean age 68.8 yrs SD: 5.0, mass 79.5 kg, SD: 14.6, height 166 cm, SD 9.8). Subjects were randomly allocated by condition to either a stretch group or a control group. Methods: Hamstring extensibility was assessed by a passive knee extension test using a Kincom® isokinetic dynamometer at baseline, following the intervention and at a 12 week follow-up. Subjects in the intervention groups stretched the main lower limb muscles 3 x 60 seconds, 5 days a week for 6 weeks. The control groups did not stretch but received a placebo intervention of interferential current. The variables of interest were maximal knee extension, peak passive torque and stiffness. The following outcome measures were also used to assess activity levels: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Lower Limb Task Questionnaire (LLTQ) and the Aggregated Locomotor Functional (ALF) score. Analysis: A 3-factor (group x condition x time) repeated measures ANOVA model was utilised. The alpha level was set at 0.05. Results: There was a significant main effect for time and a significant interaction effect for group (stretch and control) by time for knee extension ROM, peak passive torque and stiffness (p<0.05). There was no significant interaction for condition (OA vs non OA) (p>0.05). Subjects in the stretch group had 68.9 (SD: 15.5) degrees of knee extension before the intervention and this increased significantly to 76.8 (SD: 14.4) degrees after the intervention (p<0.05). At the 12 week follow up assessment, subjects had a mean of 72.5 (SD: 20.51) degrees. This difference was not significant when compared to the post intervention assessment (p>0.05). Subjects in the control group were not significantly different for knee extension ROM following the intervention or at the 12 week follow up (p>0.05). For the knee extension ROM at 50% of the maximum torque level, there was a significant main effect for time (p<0.05) but no significant interaction effect between groups across time (p >0.05). The mean knee extension ROM recorded at 50% of the peak torque level for the stretch group pre intervention was 55.9 (SD: 15.0) degrees and this decreased significantly to 50.8 (SD 12.3) degrees post intervention (p<0.05). The mean knee extension ROM recorded at 50% of the peak torque level pre intervention for the control group was 60.2 (SD: 11.4) degrees and this decreased significantly to 57.1 (SD 11.0) degrees post intervention (p<0.05). With respect to peak passive torque subjects in the stretch group were 13.2 (SD: 7.7) Nm before the intervention and increased significantly to 19.7 (SD: 9.5) Nm after the intervention (p<0.05). At the 12 week follow up assessment, the subjects in the stretch group generated a mean peak torque of 20.2 (SD: 11.5) Nm. This difference was not significant when compared to the post intervention assessment (p>0.05). With respect to stiffness, subjects in the stretch group were 0.62 (SD: 0.3) Nm/deg before the intervention and this increased significantly to 0.84 (SD: 0.3) Nm/deg after the intervention (p<0.05). At the 12 week follow up time point, the subjects in the stretch group had a mean stiffness of 0.88 (SD: 11.5) Nm/deg. This increase was not significant when compared to the post intervention assessment (p>0.05). Subjects in the control group were not significantly different for peak passive torque or stiffness following the intervention or at the 12 week follow up. There was no significant difference for time or condition for the WOMAC or LLTQ scores. There was a significant main effect for time for both groups for the ALF score (p<0.05), however there was no significant interaction for time by condition (p>0.05). Subjects in the stretch group had a mean ALF score of 23.1 (SD: 3.9) seconds pre intervention and this reduced significantly to 19.8 (SD: 5.4) seconds post intervention (p<0.05). Subjects in the control group had a mean AFL score of 24.8 (SD: 3.1) seconds pre intervention and this reduced significantly to 22.3 (SD: 3.0) seconds post intervention (p<0.05). Conclusions: The study demonstrated that knee extension range of motion, peak passive torque and stiffness increased in those subjects who undertook the six week stretching programme. Knee extension ROM was not maintained at the 12 week follow up assessment, however peak passive torque and stiffness were. These results indicate that both elderly subjects and those with degenerative joint disease are able to demonstrate long term adaptations with periodic stretching interventions. Functional improvements were also observed following the intervention in the stretch groups and the control groups. As previous studies investigating exercise interventions in subjects with OA of the knee joint have combined stretching and strengthening exercises, this study has provided a clear picture of the effects of stretching alone in this population. However, to gain a more obvious change in function in subjects with OA of the knee joint, the combination of stretching with other exercises such as strengthening, may be required in future studies.

M.Tech. (Chiropractic)
Background: In sporting activity, especially rugby, soccer, cricket and hockey, re-occurring hamstring injuries are a common sight that suggests that there is an opening for an improvement in the treatment and management of these injuries. This can be debilitating to any sportsman as it results in recurrent time away from his/her sporting activity. A study by Fyfer, Yelverton and Sher (2005), found that sacroiliac manipulation alone had a positive effect in the treatment of recurrent hamstring injuries. Cibuklka, Rose, Delitto and Sinacore (1986), proposed a possible link between hamstring muscle injuries and sacroiliac joint dysfunction. A study conducted by Donahue, Docherty and Schrader (2010), on the effects of Graston technique on pressure pain threshold, revealed a significant improvement in the patient’s pain threshold due to the fact that the instrument assisted technique effectively broke down scar tissue and correct fascial restrictions. The FAKTR approach to soft tissue dysfunction combines instrument-assisted soft tissue mobilization (Graston Technique) with proprioceptive (functional) techniques to reduce pain and return to function (Hyde and Doerr, 2012). Objective: This blinded, randomised pilot study was done to investigate the effects of sacroiliac joint manipulative therapy versus functional and kinetic treatment with rehabilitation on hamstring flexibility in previously injured hamstring muscle. Design: The study consisted of 30 participants recruited from the University of Johannesburg by word of mouth and posters, which met the inclusion criteria. They were equally and randomly divided into 2 groups. Group 1 received chiropractic therapy of the sacroiliac joint. Group 2 received functional and kinetic treatment with rehabilitation. Objective measurements consisted of digital inclinometer which measured the flexibility and range of motion of the hamstring muscle. The pressure algometry was used to measure pain pressure threshold. Procedure: Both group participants hamstring flexibility and ranges of motion were tested. Group 1 participants were motion palpated to determine sacroiliac joint dysfunction and treated with a high velocity, low amplitude trust to restricted segment, group 2 received functional and kinetic treatment with rehabilitation. Results: The statistical results should be viewed with regards that this study only represent a small group of thirty participants and therefore no assumption can be made with respect to whole population. The p-value was set at 0.05 and represents the level of significance of the results. If the p-value was less or equal to 0.05 (p≤0.05) there was a statistical significance finding. If the p-value is greater than 0.05 (p>0.05) vi there was no statistical finding. Statistical significance only means that a given result is unlikely to have occurred by chance. Analysis included demographic data analysis of age and gender. Objective data were collected using Digital Inclinometer and Pressure Algometry. Intra-group and inter-group analysis was done on straight leg raise, passive knee extension, hip extension, lateral rotation of the hip and medial rotation of the hip. The Shapiro-Wilk test was performed to determine normality. As normality could not be assumed, non-parametric testing were used to do intra-group analysis. The Non-parametric Friedman test was used to determine if a change occurred over time. As change did occur over time the Wilcoxon Signed Rank Test was use to determined where the change within each group occurred. The Mann-Whitney U test was also used to determine if any difference between the groups were present at any given time. At the end of the study both test groups showed significant clinical as well as statistical improvement over the three week course of the study. Conclusion: The FAKTR treatment did clinically have the greatest improvement, however the changes seen was not statistically superior to those seen with the sacroiliac joint manipulation treatment. A statistical significant improvement was seen in both treatment protocols, concluding that both the spinal manipulative therapy and the functional and kinetic treatment with rehabilitation could be proficient protocols in treating hamstring flexibility.

碩士
中山醫學大學
醫學檢驗暨生物技術學系碩士班
100
Background:Mandibular joints are correlated with many physiological functions and are important structures of the stomatognathic system. Changes in the range of motion(ROM) of mandibular joints may be caused by disorder, lesion, nerve palsy or sequelae of stroke. Purpose: To assess(1) the differences in the range of motion of mandibular joints between patients with stroke and healthy adults,(2) and to assess the effectivenessof neuromuscular electrical stimulationin patients with stroke.Methods: A total of 22 patients with stroke and 18 healthy adultsparticipated in this study and only 7 patients with stroke receivedneuromuscular electrical stimulation. The range of motion of the mandibular and condylar joints were measured by the Zebris Jaw Motion Analyzer; the lip closing and biting forcewere measured by theForce Sensing Resistor; electromyography(EMG) of the lip and masseter muscleswere recorded by the Zebris Bluetooth EMG analysis system; and neuromuscularelectrical stimulationwas applied on lip and masseter musclesin7 patients with stroke.Results: The ROM of opening, lateralization, and right condylarjoints, displacement index(DI), the EMGdifference ratio in bilateral lip and masseter muscles, as well as the DI ofaffected and unaffected mandibular joints had statistically significant differences between the patients with stroke and healthy adults.After intervention byneuromuscular electrical stimulation, the ROM of opening, lateralization to left, and condylar joints, lip closing force, andlateralization to theaffected side showed statistically significant differencesbetween affected and unaffected mandibular jointsin patients with stroke. Conclusion: Patients with stroke presentedless ROM in the mandibular joints than those of healthy adults. However, increased ROM in mandibular joints and symmetrywas observed after neuromuscularelectrical stimulationintervention.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014.
Aim: To determine the effect of long axis manipulation of the third metacarpophalangeal joint (MCP) on articular surface separation, peri-articular soft tissue movement and joint cavitation. Participants: Forty two right-handed healthy individuals between 18 and 28 years of age from the Durban University of Technology campuses, KwaZulu Natal. Methodology: Written informed consent was obtained from each participant. A case history, physical examination and a hand and wrist orthopaedic assessment was conducted for each participant. Study specific data, such as sex, age, height and weight were recorded. A diagnostic ultrasound (US) scan was done to the left third MCP joint for each participant while distractive manipulation was applied to the joint. The presence or absence of audible release was noted and the tension levels applied to the joint was measured with a digital tension meter. Joint surface separation (JSS), synovial membrane position (SMP), gas bubble presence and location were assessed on the US recordings at baseline, just prior to cavitation, at maximum traction and in the post-traction resting joint. IBM SPSS version 20 was used to analyse the data. Independent sample t-tests were used to compare the means between the two groups and the associations were compared using Pearson’s chi square tests. A p value <0.05 was considered as statistically significant. Results: Long axis manipulation resulted in audible release in 22 of the participants (Group and no audible release in 20 of the participants (Group 2). No significant difference in joint surface separation or the synovial membrane position could be established between MCP joints that cavitated and MCP joints that did not cavitate at the baseline, as well as in maximum traction and in the post-procedure resting joint (p > 0.05; t-test). Hyperechoic gas bubbles were present in 21 of the 22 participants of Group 1 and no gas bubbles could be visualised in the participants in Group 2. The presence of intra-articular hyperechoic gas bubbles was highly associated with audible release (p < 0.001; Pearson’s chi square test). Due to the predefined features of cavitation, gas bubble inception was could not be detected in the Group 1 participants prior to cavitation. In Group 1, 95.5% of the gas bubbles were present in the middle third of the joint at maximum traction. At the post traction resting joint evaluation, no gas bubble was evident in 42.9% (n = 9) of the joints; 42.9% (n = 9) indicated bubbles were present only in the dorsal third, whilst 9.5% (n = 2) presented bubbles in the middle and dorsal third; and in one case gas bubbles were seen in the dorsal, middle and ventral thirds of the joint space. The mean manipulative force recorded in participants in which gas bubble inception took place during manipulation was 5.7 kg, and in those with no gas bubble inception was 12 kg. There was a significant difference between the mean traction force applied to those with and to those without a gas bubble appearance (p < 0.001; t-test). Conclusion: No significant differences were observed between the cavitation and non-cavitation groups for the joint surface separation and synovial membrane movement at various stages of manipulation. A significant association was established between the audible release of a joint that was manipulated and the appearance of intra-articular gas bubbles or micro-bubbles. The mean traction force that was required to cause cavitation was significantly lower than the force to which joints with no cavitation were tensioned. The findings concur with those of previous studies that cavitation is a necessary component of joint manipulation.