Mit einer elektronischen Messanlage nach dem kapazitiven Prinzip wurden die Belastungs- und Flächenverhältnisse zwischen den Innen- und Außenklauen sowie die punktuelle Druckverteilung unter den Klauen der rechten Vorder- und linken Hintergliedmaße bei 11 weiblichen Rindern der Rasse Deutsche Holsteins ermittelt.
Die Daten wurden über einen Zeitraum vom 2. bis zum 24. Lebensmonat in Abständen von vier bis sieben Wochen erfasst. Neben dem Körpergewicht wurden jeweils für die mediale und die laterale Klaue das absolute und relative Gewicht, die absolute und relative Fläche, der mittlere Druck und die prozentuale Verteilung der verschieden hohen Drücke erfasst. Im Alter von zwei Monaten wiesen die Tiere an den medialen Klauen von Vorder- und Hintergliedmaße eine deutlich größere prozentuale Gewichtslast und Fußungsfläche auf als an den lateralen Klauen. Diese ungleiche Verteilung scheint physiologisch zu sein. Im Alter von zwei Jahren waren bei den Rindern die Belastungs- und Flächenverhältnisse unter der medialen und lateralen Klaue an der Vordergliedmaße relativ ausgeglichen, an der Hintergliedmaße wies die laterale Klaue eine geringgradig stärkere Belastung auf. Die Fußungsflächen der Klauen schienen sich tendenziell dem auf ihnen lastenden Gewicht anzupassen.
Die Veränderungen der prozentualen Fußungsfläche fielen jedoch geringer aus als die des prozentualen Gewichts. Der mittlere Druck verdoppelte sich etwa zwischen dem 2. und dem 24. Lebensmonat. Er war während des gesamten Untersuchungszeitraumes an der Vordergliedmaße höher als an der Hintergliedmaße und an der medialen Klaue höher als an der lateralen Klaue. Bei der prozentualen Verteilung der Drücke nahmen die niedrigsten Drücke mit zunehmendem Alter stark ab, die höchsten Drücke stiegen dagegen überproportional an.
Die laterale Klaue der Hintergliedmaße, die in der Literatur als die am häufigsten erkrankte Klaue beschrieben wird, wies im Vergleich mit den anderen Klauen während der gesamten Zeit den niedrigsten Anteil an hohen Drücken auf. Es erscheint unwahrscheinlich, dass, zumindest in den ersten zwei Lebensjahren, die absolute Höhe des Drucks oder dessen prozentualer Anteil und somit die Anzahl hoher Drücke für die hohe Erkrankungshäufigkeit der lateralen Klaue der Hintergliedmaße bei Rindern verantwortlich sind.

vetline.de (© Published by Schlütersche Verlagsgesellschaft mbH & Co. KG)

X-ray study to verify clinical findings in patients with scoliosis and other deformities of the spine is associated with considerable radiation exposure as well as a variety of other problems, particularly as regards assessing disease progression. Hence, in the course of the past few years a number of alternative, supplementary spinal diagnostic procedures have been developed which are based on analysis of the surface of the back: Moiré topography, photogrammetry/ raster stereometry, opTRImetric system, ISIS system, video raster stereometry (formetrics), ultrasound-guided spine analysis (Zebris) and ultrasound topometry.
To assess the effectiveness of screening, diagnosis, and progression of scoliosis the formetric system of video raster stereometry and the Zebris system for ultrasound-guided spine analysis were tested. It was shown that the results of screening tests, diagnostic study, and progression evaluation of scoliosis and sagittal deformities were exact enough using these systems. Furthermore, the ultrasound-guided Zebris system offers the option of dynamic analysis of spinal movement. Limitations in measurement precision were found in obese patients, asymmetric muscle surfaces, and in patients who had undergone surgery, although in the latter group progression could be reliably monitored if the radiological angle was known. We can asssume that surface analysis procedures will gain in importance clinically and in practice.

Publisher © Springer

The aim of this work is to characterize quantitatively the performance of a body of techniques in the frequency domain for the estimation of cortical connectivity from high-resolution EEG recordings in different operative conditions commonly encountered in practice. Connectivity pattern estimators investigated are the Directed Transfer Function (DTF), its modification known as direct DTF (dDTF) and the Partial Directed Coherence (PDC). Predefined patterns of cortical connectivity were simulated and then retrieved by the application of the DTF, dDTF, and PDC methods. Signal-to-noise ratio (SNR) and length (LENGTH) of EEG epochs were studied as factors affecting the reconstruction of the imposed connectivity patterns. Reconstruction quality and error rate in estimated connectivity patterns were evaluated by means of some indexes of quality for the reconstructed connectivity pattern. The error functions were statistically analyzed with analysis of variance (ANOVA). The whole methodology was then applied to high-resolution EEG data recorded during the well-known Stroop paradigm. Simulations indicated that all three methods correctly estimated the simulated connectivity patterns under reasonable conditions. However, performance of the methods differed somewhat as a function of SNR and LENGTH factors. The methods were generally equivalent when applied to the Stroop data. In general, the amount of available EEG affected the accuracy of connectivity pattern estimations. Analysis of 27 s of nonconsecutive recordings with an SNR of 3 or more ensured that the connectivity pattern could be accurately recovered with an error below 7% for the PDC and 5% for the DTF. In conclusion, functional connectivity patterns of cortical activity can be effectively estimated under general conditions met in most EEG recordings by combining high-resolution EEG techniques, linear inverse estimation of the cortical activity, and frequency domain multivariate methods such as PDC, DTF, and dDTF.

Publisher Hum. Brain Mapp, 2007. © 2006 Wiley-Liss, Inc.

FRAGESTELLUNG: In der klinischen Praxis stützt sich die Bewertung der Hüftgelenksfunktion vorwiegend auf subjektive Kriterien wie Schmerz und Mobilität, während als objektive Parameter nur die Gelenkbeweglichkeit beurteilt und weitere sensitive Kenngrößen wie Gelenkbiomechanik und Gangmuster nicht berücksichtigt werden. Ermöglicht die ZEBRIS-Ganganalyse, die bei der HTEP-Implantation vollzogenen Änderungen der Gelenk- und Muskelgeometrie ausreichend zu objektivieren? Können aus dem Gangmuster Rückschlüsse auf die Prothesenfunktion und Rehabilitation gezogen werden?
METHODIK: Es wurden 6 Patienten mit Dysplasiekoxarthrose vor und 6 Monate nach der TEP-Plastik einer Ganganalyse auf dem Laufrad unterzogen und die ermittelten Gangparameter sowohl mit den klinischen Ergebnissen als auch mit der biomechanischen Gelenksituation verglichen.
ERGEBNISSE: Von den kinematischen Parametern zeigen die maximale Hüft- und Knieflexion in der Schwungphase, das Verhältnis zwischen Standbein- und Schwungbeinphase, die Beckenkippung als auch die Schrittlänge deutliche normgerichtete Änderungen im Vergleich zwischen prä- und postoperativem Gangbild. Beinlängenunterschiede unter 1 cm beeinflussen das Gangmuster unwesentlich.
DISKUSSION UND SCHLUSSFOLGERUNG: Die 3D-Ultraschall-Ganganalyse erlaubt ein zuverlässiges Monitoring der wichtigsten kinematischen Gangparameter. So kommt es nach der HTEP-Implantation bei Dysplasiekoxarthrose 6 Monate postoperativ zu einer Verbesserung dieser Kenngrößen, ohne die aus der Literatur bekannten Normbereiche zu erreichen. Die Pilotstudie ermutigt uns zu weiteren Untersuchungen, um weitere Aufschlüsse über bestehende Zusammenhänge zwischen Klinik und Gangmuster zu erbringen. Die Rekonstruktion der Gelenkgeometrie scheint eine der Voraussetzungen für die Normalisierung des Gangbildes zu sein.

© Georg Thieme Verlag Stuttgart New York

Motion analysis of the cervical spine is a sensitive tool in the fields of preventive and clinical biomechanics of whiplash. In the field of preventive biomechanics motion analysis contributes to validation and optimisation of dummy based crash test experiments and simulations. In the clinical field motion analysis up to now is of restricted value. Data exist about restrictions and pathologies of movement and motion of the cervical spine, coordinative disturbances, postural control, TMJ-function and oculomotor disturbances after whiplash. The standardisation of technical and clinical set-ups is necessary to establish a well proven biomechnical model of whiplash and whiplash related biomechanical dysfunction. Without this model the value of motion analysis for clinical use will be restricted due to lack of comparable data on sensitivity and specificity although motion analysis of the cervical spine is neither cost- nor time consuming and free of adverse effects. Within a prospective series of 28 patients (14 m/ 14 f) with a follow-up to six weeks we were lucky to describe numerically two different types of reaction to low energy (?v < 20 km/h) rear end collision: Type I with disturbances in complex movements only, Type II with overall restriction of movement. Control of angular velocity during cyclic movements of the head was disturbed by oscillations of higher frequency in all patients. Recovery from whiplash within 6 weeks could be monitored.

Publisher © Springer

STUDY DESIGN. This biomechanical study using cadaver thoracic spines evaluated the initial stiffness of two different fixation constructs using a new spinal implant: the bipedicular spinal fixation device (BSF).
OBJECTIVE. To compare the biomechanical stiffness of a new construct using BSF with a regular construct using pedicular and laminar hooks.
Summary of Background Data. Disadvantages of thoracic posterior implants and developments in in situ rod contouring led to the creation of a new implant for spine deformity surgery that would provide immediate stiffness to preserve spine correction, allow efficient postoperative rehabilitation, and obtain a good fusion rate.
METHODS. Two age-paired groups of six human thoracic spines each (T3-T12) were compared: a regular group whose construct was in accordance with the Cotrel-Dubousset technique and the BSF group. In both groups, the spines were tested intact and then after injury. An injury was induced by transections of interspinous and anterior longitudinal ligaments and anterior discectomies. A three-dimensional ultrasonic measurement device, the Zebris 3D Motion Analyzer, was used to record the motion of the T6 relative to the T8 vertebra under loads, and to determine the ranges of motion (ROMs) between intact spines and the spine construct.
RESULTS. In flexion-extension, the regular construct showed a significantly greater mean of relative ROMs than the BSF construct for principal rotation (88% and 69% respectively, P = 0.015). However, no significant differences were demonstrated in any of the other motions.
CONCLUSION. The BSF construct showed stiffness similar to that of the regular construct, encouraging clinical investigation.

Publisher © Lippincott Williams & Wilkins, Inc.

It is difficult to identify objective parameters for assessing the joint function when evaluating the outcome of orthopaedic procedures, especially endoprosthetic replacement. Spatial and temporal parameters of gait have clinical relevance in the assessment of motor pathologies, particularly in orthopaedics. However, the influence of gait speed on these biomechanical parameters has been difficult to be taken into consideration so far.
The objective of the present study was to analyse the impact of gait speed on gait parameters and to set a standard walking speed for patients with osteoarthritis by means of a special treadmill control mechanism. The second objective is to compare the gait patterns in patients with unilateral osteoarthritis of the hip joint or of the knee joint to the gait pattern of healthy control subjects. A total of 20 patients with severe unilateral osteoarthritis of the hip, 20 patients with severe unilateral osteoarthritis of the knee and 20 healthy elderly subjects without any history of lower extremity joint pathology were investigated at four different gait speeds.
The gait analysis equipment used consisted of an infinitely adjustable force-instrumented treadmill and an ultrasound-based motion analyser system with electromyography. Our data suggest that most of the biomechanical parameters depend on gait speed. The highest gait speed that all our patients with severe osteoarthritis were suitable with, without pain and loss of coordination, was 2.00 km/h.
Our findings indicate that the changes in gait parameters may occur in patients with unilateral osteoarthritis of the hip joint or the knee joint compared to the gait pattern of healthy control subjects. Hip joint or knee joint degeneration was compensated for in part by the pelvis and other joints in the lower limb. Reduced motion of the hip joint or knee joint leads to an increased pelvic motion, which should affect the natural mobility of the lumbar spine and cause pain in the lumbar region of the spine because of their kinematic interaction.

Publisher © Springer

In this paper we describe a medical application where we exploit surface properties (measured in form of 3D-Range scans of the human back) to derive a-priori unknown additional properties of the proband, that otherwise can only be acquired using multiple x-ray recordings or volumetric scans as CT or MRI.
On the basis of 274 data sets, we perform classification using statistical shape analysis methods. Consistent parameterization and alignment is achieved on the basis of only few anatomic landmarks. As our choice of landmarks is easy to detect on the human body, our approach is feasible for screening applications that can be expected to have much impact on the early detection and later treatment of spine deformities, in particular scoliosis.

Publisher © UNION Agency-Science Press

Study Design: The aim of our investigations was to study the question as to what extent the mono- and multisegmental mobility of the lumbar spine (LS) differs after implantation of a disc prosthesis (DP) and if, in case of postoperative complications (dislocation or migration of the disc prosthesis), a sufficient stability of the motion segment can be achieved with a spinal fusion. To answer these questions we examined in corpse the mobility of the LS before and after DP implantation as well as after spinal fusion by using a load simulator for mobility and stability investigations of the lumbar spine.
Method: After radiological exclusion of higher degenerative changes (X-ray in two planes) and exclusion of high-grade osteoporosis by using a pQ-CT scan with measurement of the bone mineral density (T score > -3.0), the first step was the multisegmental measurement of the thirteen unfixated LS specimens without DP by automatic electromechanical load-bearing. The measurements of mobility of the LS were done in flexion, extension, side-bending and side-rotation with a reproducible load of 10 Nm. The analysis of the movements during flexion and extension as well as side-bending and side-rotation were done by an ultrasonic detection system (zebris®). In the second step the excursions were measured after implantation of the DP in L3/4 and in the third step after additional dorsal spinal fusion.
Results: After implantation of the artificial disc in L3/4 the mobility in side-bending and side-rotation increases in comparison to the LS without surgery. For side-bending we found an increasing amount up to +74 % for the single motion segment L3/4 and +3 % for the total LS, respectively, for the side-rotation an increase of mobility up to +72 % for the single motion segment L3/4 and +30 % for the total LS. On the other hand a decreased mobility of -11 % for flexion and extension was found with an artificial disc in comparison to the lumbar spine. After additional dorsal spinal fusion of L3/4 the mobility obviously decreases in all directions (flexion/extension -74 %, side-bending -75 %, side-rotation -51 %).
Conclusion: The DP preserves (flexion/extension) and, respectively, improves (side-rotation/side-bending) the mobility of the LS. In cases of complications like dislocation or migration of the DP and secondary degenerative changes, the dorsal spinal fusion with restricted movements of the LS afterwards is a possible treatment solution.

Publisher © Georg Thieme Verlag KG Stuttgart · New York

INTRODUCTION: An edema of the infrapatellar fat pad following knee arthroscopy or in case of chronic anterior knee pain syndrome is suspected to increase the patellofemoral pressure by a modification of the patellofemoral glide mechanism. The study was performed to evaluate this hypothesis.
MATERIALS AND METHODS: Isokinetic knee extension from 120 degrees of flexion to full extension was simulated on 10 human knee cadaver specimens (six males, four females, average age at death 42 years) using a knee kinemator. Joint kinematics was evaluated by ultrasound sensors (CMS 100, Zebris, Isny, Germany), and retro-patellar contact pressure was measured using a thin-film resistive ink pressure system (K-Scan 4000, Tekscan, Boston). Infrapatellar tissue pressure was analyzed using a closed sensor cell which was implanted inside the fat pad (GISMA, Buggingen, Germany). An inflatable fluid cell was implanted by ultrasound control in the center of the infrapatellar fat pad and filled subsequently with water to simulate a fat pad edema. All parameters were recorded and analyzed from 0 to 5 ml volume of the fluid cell.
RESULTS: Simulating a fat pad edema resulted in a significant (P < 0.01) increase of the infrapatellar fat pad pressure (247 mbar at 0 ml to 615 mbar at 5 ml volume). In knee extension and flexion the patella flexion (sagittal plane) was decreased while we did not find any other significant influence of the edema on knee kinematics. During the analysis of the patellofemoral biomechanics, a simulated fat pad edema resulted in a significant (P < 0.05) decrease of the patellofemoral force between 120 degrees of knee flexion and full extension. The contact area was reduced significantly near extension (0 degree-30 degrees) by an average of 10% while the contact pressure was reduced at the entire range of motion up to 20%.
CONCLUSION: An edema of the infrapatellar fat pad does not cause an increase of the patellofemoral pressure or a significant alteration of the patellofemoral glide mechanism. Anterior knee pain in case of a fat pad edema may be related to a significant increase of the tissue pressure and possible histochemical reactions.

Publisher © SpringerLink

INTRODUCTION: The purpose of this study was to examine the effects of verbal instructions and real-time visual feedback strategies based on thoracic spine kinematics for gait rehabilitation of patients following total hip replacement arthroplasty.
METHODS: 12 hip arthroplasty patients (44-79 yrs) participated in the study. The 3D-ultrasonic movement analysis system was used to calculate the average lateral thorax deviation as well as the thorax and pelvis side-to-side displacements during four trials in balanced order (free walking, real-time video feedback, mirror, verbal instruction).
RESULTS: During regular walking patients ambulated with an average lateral thorax deviation of 2.2±1.9°. During real-time visual feedback 7 patients demonstrated significant (p<0.05) reductions in the average lateral trunk bending position (-0.3°±3.3). Receiving verbal cues, 7 subjects showed a significantly (p<0.05) decreased lateral thorax deviation throughout the gait cycle (0.2°±2.2). During the mirror feedback trial 8 subjects reduced their medio-lateral thorax excursions (0°±2.6). However, no significant reductions in thorax and pelvis side-to-side displacements were noted.
CONCLUSIONS: The results demonstrated that the thorax gait kinematics of arthroplasty patients could be addressed immediately by all treatments. While all techniques seem to be useful as an adjunct to standard rehabilitation programmes, verbal instructions could additionally facilitate the patient’s capability to deal with the intrinsic information naturally present during everyday practice.

BACKGROUND AND PURPOSE: Rest tremor is the most frequent sign of Parkinson's disease (PD) after bradykinesia, occurring with various severity in about 75% of patients. An objective assessment of rest tremor is difficult. The aim of the study was to analyze rest tremor in PD with the three-dimensional gauging system CMS 10; more specifically, the impact of levodopa treatment on rest tremor, the influence of clinical factors, and the correlation between rest tremor and clinical scales were assessed.
MATERIAL AND METHODS: Ninety-five patients with PD (mean age 67.6 years) and 30 healthy people in a control group (mean age 59.3 years) were examined. Clinical scales (UPDRS, Hoehn and Yahr, Schwab and England, as well as Webster scale) were used to assess severity of PD. The assessment of rest tremor was performed within the more and less affected upper limb with the three-dimensional gauging system CMS 10 (Zebris GmbH) before and 1-2 hours after levodopa intake. Frequency (Hz), amplitude (deg), velocity (deg/ms) and acceleration (deg/s2) of the tremor were evaluated. Results were compared with averaged results for left and right upper limb in the control group.
RESULTS: The method used in this study objectively showed asymmetry in rest tremor. After levodopa intake, all evaluated parameters of rest tremor were decreased (mainly the amplitude and frequency, and to a lesser degree, velocity and acceleration). The motor part of UPDRS showed the best correlation with rest tremor.
CONCLUSIONS: The three-dimensional measuring system CMS 10 is useful in the objective assessment of rest tremor in PD. Rest tremor in PD is under the influence of PD form, the intake of levodopa dose, the amount of levodopa, gender and level of education.

PubMed.gov (© Published by Termedia sp. z o.o.)

OBJECTIVE: The first aim of this study was to determine the reliability of the Zebris (Achen, Germany) ultrasound-based testing of cervical range of motion (ROM). The second aim was to develop a normative database in a healthy sample of 96 volunteers. The third aim was to evaluate, with the Zebris system, the ROM in a sample of patients with chronic neck pain compared to healthy controls to determine if cervical ROM could discriminate between these groups and between subgroups of pain patients (with or without whiplash injury).
METHODS: The study participants were 96 healthy volunteers, 14 patients with idiopathic neck pain, and 16 patients with chronic whiplash. Cervical ROM was measured in the 3 planes with the Zebris CMS 70P ultrasound-based motion analysis system. The intra- and interrater reliability of the protocol was tested in 12 volunteers.
RESUTS: Full-cycle measurements showed high reliability (intraclass correlation coefficient, 0.80-0.94) with the SE of measurement ranging from 4.25° to 7.88°. The distribution of ROM measures showed a great individual variation, with a significant age-related decrease in ROM in all directions. Range of motion was reduced in patients with chronic whiplash in all primary movements, compared to healthy subjects, whereas in patients with idiopathic neck pain, only rotation showed reduced ROM.
CONCLUSION: Results demonstrate a high degree of test-retest reliability in measuring cervical ROM. The use of normative data for ROM when evaluating patients with neck disorders needs to take age into account. The current study has demonstrated that patients with chronic neck pain demonstrate reduced ROM, which differs between patients with idiopathic neck pain and those with chronic whiplash.

Journal of Manipulative and Physiological Therapeutics (© Published by Elsevier Inc.)

STUDY DESIGN: Experimental examination in vivo. OBJECTIVES: To determine the precision of the ultrasound-based Coordinate Measuring System (CMS 50; Zebris Medizintechnik GmbH, D-88316, Isny, Germany) and then to establish a reference range for the active range of motion of the cervical spine in normal test subjects grouped according to age and sex.
SUMMARY OF BACKGROUND DATA: Many different devices such as inclinometers, goniometers, potentiometers, computer-aided devices, and radiographic procedures have been developed to examine the range of motion of the cervical spine. All of them have more or less inherent limitations.
METHODS: To assess the precision of this examination method, preliminary experiments were performed including intraobserver retest and two-observer repeatability, intraindividual variability, a daily profile, and a comparison between active and passive motions. In the subsequent main experiment 157 persons (86 women and 71 men) were examined during active motion. The sex groups were further subdivided into age groups of 10 years each. A comparison of weight and athletic activity was also performed.
RESULTS: The range of motion decreased with increasing age, increasing body weight, and decreasing athletic activity. The rotation in the upper cervical spine increases with age to compensate for the reduced range of motion in the lower levels. Women showed significantly better mobility than men of the same age, only above the age of 70.
CONCLUSIONS: The CMS 50 device provides precise reproducible measurements of the active range of motion of the cervical spine in all three planes. Criteria such as age, sex, body weight, and athletic activity influence the range of motion of the cervical spine.

PubMed.gov (© Published by Lippincott Williams & Wilkins, Inc.)

INTRODUCTION: The reproducibility of the 3-dimensional (3D) kinematic aspects of motion coupling patterns of segmental manual mobilizing techniques is not yet known. This study analyzes the segmental 3D aspects of manual mobilization of the atlanto-axial joint in vitro.
METHODS AND MATERIALS: Twenty fresh human cervical specimens were studied in a test-retest situation with two examiners. The specimens were manually mobilized using three different techniques: a regional mobilization technique, a segmental mobilization technique on the atlas with manual fixation of the axis and a segmental mobilization applying a locking technique. Segmental kinematics were registered with a Zebris CMS20 ultrasound-based tracking system. The 3D aspects of motion coupling between main axial rotation and coupled lateral bending were analyzed by six parameters: the range of motion the three motion components, the cross-correlation, the ratio and the shift.
RESULTS: The results indicate stronger intra- than inter-examiner reproducibility. The range of motion of the axial rotation component shows a substantial level of intra- and inter-examiner reproducibility (ICC's 0.67-0.76). The parameters describing the coupling patterns show only moderate to substantial intra-examiner reproducibility for the more experienced of the two examiners (ICC's 0.55-0.68). All other correlations were not significant and no differences could be observed between regional versus segmental techniques.
CONCLUSION: Reproducibility of segmental 3D-aspects of manual mobilization of the atlanto-axial joint in an in vitro situation can differ between examiners. The results of the present study may indicate a possible tendency to higher reproducibility if mobilizations are performed by an examiner with high expertise and experience in applying the specific techniques. Continued investigation including more examiners with different levels of experience and different techniques is necessary to confirm these observations.

PubMed.gov (© Published by Elsevier Inc.)

The kinematic analysis system ZEBRIS CMS-HS allows to calculate, in real time, the 3D coordinates of kinematic markers using the principle of ultrasonic triangulation. However ultrasounds propagation may be altered by external factors. Several disruptive conditions (reflection of ultrasonic waves, wind, temperature variations, shifting of the transmitters relative to the microphones) have been tested. The 3D coordinates of six immobile markers have been measured and theoretically invariable angles and distances have been calculated. The precision was evaluated according to the standard deviation of each series. In standard laboratory conditions, the precision was ± 0.14 mm for distances and ± 0.16° for angles. Ultrasound reflections can induce systematic errors (about 0.2°) and impair the repeatability of the measures. Wind decreases the precision of the measures in proportion to its speed. Configuring temperature in the software is necessary because it conditions the accuracy of the measures. A decrease of the precision was also observed when the transmitters were moved away from the microphones, at a distance higher than 1.5 m. This study provides a better knowledge of the causes of alteration of the measures and allows to determine the limitations of the system.

ScienceDirect (© Published by Elsevier Inc.)

OBJECTIVE: To assess the differential effects of bilateral deep brain stimulation of the subthalamic nucleus on proximal and distal muscle groups of the upper limb in Parkinson's disease.
METHODS: Eight parkinsonian subjects with chronic bilateral stimulation of the subthalamic nucleus performed index finger tapping (differentially drawing upon distal arm muscles), horizontal pointing (differentially drawing upon proximal arm muscles) and a complex reach-to-grasp task with cubes of different sizes, which involved both proximal and distal arm muscles. An ultrasound based system was used for kinematic motion analysis. Subjects were investigated in two clinical conditions: on and off subthalamic nucleus stimulation. Clinical symptom severity was rated with the Unified Parkinson's Disease Rating Scale (UPDRS) motor subscore.
RESULTS: Stimulation of the subthalamic nucleus improved the UPDRS motor subscore (68 %). Bradykinesia of index finger tapping and horizontal pointing were equally improved by subthalamic nucleus stimulation. In contrast, in a complex reach-to-grasp task bradykinesia was differentially ameliorated for the grasp component.
CONCLUSION: The data suggest that bilateral stimulation of the subthalamic nucleus improves bradykinesia of both distal and proximal muscles of the arm and hand in Parkinson's disease; however, dependent upon task complexity proximal and distal movement components may be affected differentially. Kinematic motion analysis is an efficient tool to objectively evaluate the beneficial effects of subthalamic nucleus stimulation on dexterity in Parkinson's disease.

PubMed.gov (© Published by SpringerLink)

1 Hz rTMS applied over primary motor cortex (M1) reduces cortical excitability outlasting the stimulation period. Healthy right-handed subjects performed finger and hand tapping and a reach-to-grasp movement prior to (baseline) and after 1 Hz rTMS applied over (1) M1 of either the right or the left hemisphere, and (2) the vertex (control stimulation). 1 Hz rTMS applied over the left M1, but not over the vertex, improved movement kinematics of finger and hand tapping as well as grasping with the left hand. 1 Hz rTMS applied over the right M1, but not over the vertex, improved only the kinematics of hand tapping performed with the right hand. These data suggest that 1 Hz rTMS induced inhibition of ipsilateral M1 reduces transcallosal inhibition of contralateral M1 and thereby improves motor performance at the ipsilateral hand. The impact on motor performance of the ipsilateral hand is most pronounced after 1 Hz rTMS over the left M1.

PubMed.gov (© Published by SpringerLink)

Psychogenic tremor is the most common psychogenic movement disorder and accounts for up to 40 % of all psychogenic movement disorders. Patients suffering from psychogenic tremor may show positive clinical criteria like acute onset, distractibility, inconsistent frequency and amplitude of tremor or an intermittent occurrence. Moreover, there exist a few supportive clinical tests and diagnostic tools, which help to suggest a psychogenic origin of the disease, e. g., electromyographic or kinematic recordings. In this review the clinical presentation of psychogenic tremor and diagnostic approaches are discussed. In addition, novel therapeutic approaches, e. g., application of transcranial magnetic stimulation techniques are introduced.

Publisher © Georg Thieme Verlag KG Stuttgart New York

STUDY DESIGN: Exploratory experimental design.
OBJECTIVE: To assess cervical range of motion (ROM) and ability to return the head to a neutral position in healthy subjects according to age and sex.
SUMMARY OF BACKGROUND DATA: Cervical ROM and ability to return the head to a neutral position have been studied, but no data on the influence of age and sex in this movement is available.
METHODS: We divided 232 healthy volunteers able to sit for 20 minutes into 6 age groups: 15-24, 25-34, 35-44, 45-54, 55-65, and older than 65 years. Zebris 3-dimensional ultrasonography measured the active cervical ROM and ability to return the head to the neutral position. Bone landmarks and vertical position were defined for each subject. Recorded data were neutral position, lateral bending (right and left), flexion-extension, and axial rotation (right and left). We evaluated patients' ability, without external intervention, to return the head to a self-defined neutral position.
RESULTS: ROM was affected by age as assessed by analysis of variance (F = 27.8 in the sagittal plane, F = 12.1 in the frontal plane, and F = 19.7 in the axial plane; all P < 0.0001), but neither sex nor age affected ability to return the head to a neutral position (F = 0.615, P = 0.688 on the left; F = 0.808, P = 0.545 on the right). Maximal ROM was observed for right axial rotation.
CONCLUSIONS: We provide a database by age and sex for patient ability to return the head to the neutral position and for cervical ROM. This database could be used as a reference in clinical applications.

PubMed.gov (© Published by Lippincott Williams & Wilkins, Inc.)

Study Design. Test-retest of cervical motion in patients with chronic disorders of the cervical spine.
Objectives. To determine the reproducibility of cervical motion and examine the feasibility of its representation by a single parameter.
Summary of Background Data. Reproducibility of cervical motion findings has been largely limited to normal subjects, leaving a conspicuous void regarding the measurement error in clinical groups.
Methods. There were 2 groups of 25 chronic patients with whiplash and degenerative changes of the cervical spine tested twice (4-7 days). Head movement was measured along the 6 directions, as well as during rotation out of flexion and extension (cervical degenerative changes only).
Results. Compared to normal subjects, both groups had a 25% to 35% reduction in cervical motion. High intraclass correlation coefficients (ICCs) (range 0.8-0.92) were derived for all directions. The ICCs for rotation out of flexion and extension were low. The relative standard error of measurement ranged from 15% to 28% for all directions, whereas the corresponding scores of the total cervical motion excursion were 10.6 (cervical degenerative changes) and 13.6% (whiplash).
Conclusions. Judged by the ICCs cervical motion, findings were reproducible. However, in view of the measurement error as well as the homogenous reductions, total cervical range of motion should be considered a suitable parameter for interpretation of cervical motion limitations in these patients.

Publisher © Lippincott Williams & Wilkins, Inc.

OBJECTIVE: To report instrument validity of CMS 70P, a new ultrasonography-based system for spatial kinematic analysis of the spine and its application in studying the reproducibility of cervical motion findings in healthy subjects.
BACKGROUND: Reproducibility of cervical motion has been investigated using various instruments and consisting in most cases of short test-retest time intervals of between minutes to days.
METHODS: Performance of the instrument was validated against a digital inclinometer, at ranges of motion compatible with actual cervical motion. To study reproducibility, 25 healthy individuals, 22 women and 3 men aged 26-48 were tested twice within an average time interval of 3.3 weeks. Performed in the seated position and at a self-determined pace, cervical motion was defined in terms of head motion relative to a sternal (reference) system, in all six primary motions: flexion, extension, right rotation, left rotation, right lateral flexion and left lateral flexion.
RESULTS: The system exhibited excellent agreement with the digital inclinometer, establishing its instrument validity for testing cervical motion. No significant differences were indicated between the test and retest for both the net maximal displacements and average velocities. The correlation coefficients for the single plane motions (e.g. flexion+extension) were higher than those derived for the primary motions, and ranged between 0.78 (sagittal plane) and 0.88 (frontal plane). The magnitude of the standard error of the measurement reflected the same trend with the lowest value recorded for the frontal plane. The self-selected velocity at which these motions were performed was similar in the frontal and saggital planes but was significantly higher for the transverse plane (rotations).
CONCLUSIONS: This study indicates that spanned over time intervals that are measured in weeks, cervical motion findings derived from the CMS 70P are well reproducible. Findings also imply the need for a more stringent control of subject positioning and stabilization.
RELEVANCE: Reduction of range of motion and average is typically observed in various pathologies of the cervical spine and is regarded, together with pain, as a major impairment. Therefore, valid assessment of cervical motion which is essential for follow-up and treatment outcome strongly depends on reproducibility of the findings. This study indicates that acceptable reproducibility is maintained over periods of time which are clinically meaningful using the system described herewith.

PubMed.gov (© Published by Elsevier Inc.)

Study Design. Maximal and submaximal (feigned) cervical motions in healthy patients were compared.
Objective. To test the efficiency of the coefficient of variation in differentiating maximal (sincere) from submaximal (feigned) cervical motion in healthy patients.
Summary of Background Data. Although limitation of cervical motion is a recognized impairment, no well-founded approach for verifying the degree to which a patient is maximizing his or her performance is available currently.
Methods. A new ultrasound-based system for three-dimensional motion analysis of the head was used to test 25 healthy patients (22 women and 3 men) ages 26 to 48 years. During the first test, (Test 1), the patients were asked initially to move the head maximally at a self-determined velocity in all the primary directions: flexion, extension, right and left rotation, and right and left lateral flexion. They then were presented with a short vignette describing a fictitious accident and asked, using the same protocol, to perform the same types of cervical motions as if they had experienced an injury. No further instructions were provided. A retest (Test 2) in reverse order (feigned effort first) took place 1 to 16 weeks (mean, 3.3 weeks) later.
Results. The range of motion and average velocity were significantly smaller (P = 0.0001) in the feigned than in the maximal performance in all directions and on both tests. Feigned range of motion and velocity also were significantly reduced in Test 2 (P = 0.006), as compared with those in Test 1 (P = 0.0001). The range of motion coefficient of variation in the feigned performance (CVf) remained stable on the retest, but was significantly larger on both tests (P < 0.001) than the corresponding CV derived from maximal performance (CVm). Furthermore, a case-by-case analysis showed that whereas the American Medical Association guidelines identified only 16% of the feigned cases, the use of CVf and CVm resulted in a corresponding rate of 87%. Tolerance intervals at 95% and 99% indicated total separation between the distributions of CVf and CVm, respectively. The average velocity-based CVf and CVm were not of a comparable differentiating power.
Conclusions. This study indicates that in healthy patients, feigned performance may be differentiated from maximal (sincere) performance effectively and reproducibly using the coefficient of variation.

Publisher © Lippincott Williams & Wilkins, Inc.

OBJEKTIVE: The efficacy of a flexible trunk brace in osteoporosis patients was investigated.
MATERIAL AND METHOD: An open observational study was performed on 50 osteoporosis patients, in order to investigate the efficacy of a new osteoporosis brace (Osteomed, Thaemert). The outcome parameters were pain, daily activity and individual compliance. The period of observation was ca. 2.5 months and the brace was worn continuously during the day.
RESULTS: At the end of the period of observation, there was a highly significant reduction in pain in all 50 patients. Pain under stress decreased from 6.1 ± 1.7 to 4.5 ± 1.4 (p < 0.00001); pain when driving decreased from 5.2 ± 2.4 to 3.8 ± 1.9 (p < 0.00001); pain at rest decreased from 4.1 ± 2.4 to 3.1 ± 1.9 (p < 0.0001). More than 50 % of the patients estimated that their ability to perform everyday activities was „clearly better” or „better”. In addition to the main outcome parameter of pain and activity of daily living, the aspects of „comfort”, „handling”, „fit”, „skin tolerability” and „feeling of safety” were rated as being better by patients who had been previously treated with other braces or bandages than by patients without previous treatment. These differences were statistically significant for the first four aspects. Furthermore, there was an influence of concurrent physiotherapy on the treatment outcome: In patients with continuous physiotherapy the improvement was significantly more pronounced than after its abruption (p = 0.023).
CONCLUSION: This osteoporosis brace could be a useful addition to the medical care of osteoporosis patients and a complement to drug treatment and physiotherapy with regular exercises. According to the results of this study, a present physiotherapy should be accompanied rather than replaced by the orthosis treatment because both modalities seem to enhance each other's effects.

Publisher © Georg Thieme Verlag KG Stuttgart · New York

Postural control ensures stability during both static posture and locomotion by initiating corrective adjustments in body movement. This is particularly important when the conditions of the support surface change. We investigated the effects of standing on a compliant foam surface using 12 normal subjects (mean age 26 years) in terms of: linear movements at the head, shoulder, hip and knee; EMG activity of the tibialis anterior and gastrocnemius muscles and torques towards the support surface. As subjects repeated the trials with eyes open or closed, we were also able to determine the effects of vision on multi-segmented body movements during standing upon different support surface conditions. As expected, EMG activity, torque variance values and body movements at all measured positions increased significantly when standing on foam compared with the firm surface. Linear knee and hip movements increased more, relative to shoulder and head movements while standing on foam. Vision stabilized the head and shoulder movements more than hip and knee movements while standing on foam support surface. Moreover, vision significantly reduced the tibialis anterior EMG activity and torque variance during the trials involving foam. In conclusion, the foam support surface increased corrective muscle and torque activity, and changed the firm-surface multi-segmented body movement pattern. Vision improved the ability of postural control to handle compliant surface conditions. Several essential features of postural control have been found from recording movements from multiple points on the body, synchronized with recording torque and EMG.

IngentaConnect (© Published by Springer Verlag)

Accurate plantar pressure measurements are mandatory in both clinical and research contexts. Differences in accuracy, precision and reliability of the available devices have prevented so far the onset of standardization processes or the definition of reliable reference datasets. In order to comparatively assess the appropriateness of the most used pressure measurement devices (PMD) on-the-market, in 2006 the Institute the author is working for approved a two-year scientific project aimed to design, validate and implement dedicated testing methods for both in-factory and on-the field assessment. A first testing phase was also performed which finished in December 2008. Five commercial PMDs using different technologies—resistive, elastomer-based capacitive, air-based capacitive—were assessed and compared with respect to absolute pressure measurements, hysteresis, creep and COP estimation. The static and dynamic pressure tests showed very high accuracy of capacitive, elastomer-based technology (RMSE<0.5%), and quite a good performance of capacitive, air-based technology (RMSE<5%). High accuracy was also found for the resistive technology by TEKSCAN (RMSE<2.5%), even though a complex ad hoc calibration was necessary.

Publisher © Elsevier, Inc.

Objective: To investigate whether postural stability and adaptation differed after a normal night of sleep, after 24h (24 SDep) and 36h (36 SDep) of sleep deprivation while subjected to repeated balance perturbations. Also, to determine whether there was any correlation between subjective alertness scores and objective posturographic measurements. Lastly, to investigate the effects of vision on the stability during sleep deprivation.
Methods: Body movements at five locations were recorded in 18 subjects (mean age 23.8years) using a 3D movement measurement system while subjected with eyes open and closed to vibratory proprioceptive calf stimulation after a normal night of sleep, 24 and 36 SDep.
Results: The clearest sleep deprivation effect was reduced ability to adapt head, shoulder and hip movements, both with eyes open and eyes closed. Additionally, several near falls occurred after being subjected to balance perturbations for 2–3min while sleep deprived. Unexpectedly, postural performance did not continue to deteriorate between 24 and 36h of sleep deprivation, but showed some signs of improvement. Subjective scores of sleepiness correlated poorly with actual changes in postural control performance.
Conclusions: Sleep deprivation might affect postural stability through reduced adaptation ability and lapses in attention. Subjective alertness might not be an accurate indicator of the physiological effects of sleep deprivation.
Significance: Sleep deprivation could increase the risk of accidents in attention demanding tasks. There is a need for objective evaluation methods to determine actual performance capacity during sleep deprivation.

Clinical Neurophysiology (© Published by Elsevier, Inc.)

The basic question of whether the human brain controls continuous movements intermittently is still under debate. Here we show that 6- to 9-Hz pulsatile velocity changes of slow finger movements are directly correlated to oscillatory activity in the motor cortex, which is sustained by cerebellar drive through thalamus and premotor cortex. Our findings suggest that coupling of 6- to 9-Hz oscillatory activity in the cerebello–thalamo–cortical loop represents the neural mechanism for the intermittent control of continuous movements.

Publisher PNAS

OBJECTIVE: To describe changes in lumbar and cervical range of motion measurements after supine pelvic blocking as used in Sacro Occipital Technique (SOT).
METHODS: Five subjects with sacroiliac distortion and instability were recruited and selected for SOT. Cervical and lumbar ranges of motion were measured before and after category II blocking procedures used to change pelvic mechanics. Pre- and post-measurements were taken by a blinded assessor using a Zebris ultrasonic motion detector.
RESULTS: Changes were found in the lumbar spine only. Increased ranges of lumbar motion occurred in all planes except extension (21%-57%).
CONCLUSION: Supine pelvic blocking as used in SOT affected lumbar ranges of motion in these 5 cases. This may indicate that functional change in the pelvis results in changes in lumbar motion, especially lumbar flexion. Larger data sets are needed for further study.

Journal (© Published by Elsevier Inc.)

The aim of this cross-sectional study was to evaluate pain intensity-related differences in physical performance and fear of falling in elderly women with osteoporosis. A sample of 82 osteoporotic women (73.8±8.1 years) with and without vertebral fractures was included. Numeric rating scale (NRS) measures (0=no pain, 10=unbearable) were applied to obtain actual pain intensity and to stratify between patients with mild (0–3), moderate (4–6) and severe (7–10) pain. Activity-related fear of falling was evaluated with the Falls Efficacy Scale-International Version (FES-I). Physical performance measures included maximum voluntary quadriceps strength, postural sway and gait speed measures. Controlling for age, fractures, and history of falls ANCOVA with Scheffe's post hoc test indicated significant slower walking velocities and greater postural sway for patients with severe pain. Furthermore, significant group differences could be detected for muscle strength and fear of falling. Patients with more intense pain (NRS?5) were 6.4 times (odds ratio; 95%CI: 1.5–26.7) more likely to score below average in fall-related self-efficacy and all physical performance tests. Among women with osteoporosis, heightened back pain intensity increases fear of falling and decreases physical performance irrespective of vertebral fractures and history of falls.

Journal (© 2010 Elsevier B.V. All rights reserved.)

Variances of drawing arm movements between patients with Parkinson's disease and healthy controls were compared. The aim was to determine whether differences in joint synergies or individual joint rotations affect the endpoint (hand position) variance. Joint and endpoint coordinates were measured while participants performed drawing tasks. Variances of arm configurations and endpoints were computed and statistically analyzed for 12 patients and 12 controls. The variance of arm movements for patients (both for arm configuration and endpoint) was overall higher than that for the control group. Variation was smaller for drawing a circle versus a square and for drawing with the dominant versus the nondominant hand within both groups. The ratio of arm configuration variances between groups was similar to the ratio of endpoint variances. There were significant differences in the velocity, but not in the path lengths of movements comparing the two groups. Patients presented less movement stability while drawing different figures in different trials. Moreover, the similarity of the ratios suggests that the ill-coordinated hand movement was caused by the error in the movements of individual body parts rather than by the lack of intersegmental coordination. Thus, rehabilitation may focus on the improvement of the precision of individual joint rotations.

Publisher © BioInfoBank Institute

Die systematische Entwicklung neuer, dienstleistungsorientierter Geschäftsmodelle im Gesundheits- und Wellness-Sektor, die auf technologischen Komponenten fußen, erfordert genaue Kenntnis des Stands der Technik. Die Studie stellt knapp 150 persönliche Gesundheitssysteme (Geräte, Systeme und Projekte) anhand ihrer technischen Eigenschaften vor. Als persönliche Gesundheitssysteme sind in der Studie technische Lösungen zur Gesundheitsüberwachung und Gesundheitserhaltung in Kombination mit Telemedizin eingeflossen. In der Studie sind die persönlichen Gesundheitssysteme anhand ihrer technischen Eigenschaften wie Sensoren, erfasste Gesundheitsparameter, Aktoren, Kommunikationsprotokolle und -schnittstellen katalogisiert. Einen Ausblick auf zu kurz- bis mittelfristig zu erwartende Innovationen gibt die Beschreibung zum Stand der Forschung. Hierzu bietet die Studie eine Übersicht zu kürzlich abgeschlossenen und laufenden öffentlichen F&E-Projekte des BMBF und der EuropäischenUnion (6. und 7. Forschungsrahmenprogramm), die Dienste und Persönliche Gesundheitssysteme zum Gesundheitsmanagement der »Best-Ager«-Generation zum Ziel haben. Die Studie will einem Publikum aus relevanter Wissenschaft, möglichen Anwendern - medizinische Dienstleister, Coaches, Ärzte, Krankenkassen, usw. - und selbstverständlich auch interessierten Endanwendern/-kunden einen möglichst guten Überblick über die am Markt befindlichen Lösungen geben. Die Studie ist - gemäß der Fraunhofer Philosophie - herstellerneutral gehalten und anwenderzentriert. Dem Leser werden verschiedene Anwendungsfälle als Orientierungshilfe geboten, um ihm eine Auswahl zu erleichtern. Dabei nimmt die Studie selbst kein Ranking vor. Eine Bewertung bzw. eine Priorisierung obliegt dem Leser selbst. Informationen zum Verbundprojekt »lifescience.biz« finden Sie unter: www.lifesciencebiz.de

Publisher ©2009 Fraunhofer-Gesellschaft

Gait analysis has provided important information concerning gait patterns and variability of gait in patients with knee osteoarthritis (OA) of varying severity. The objective of this study was to clarify how the variability of gait parameters is influenced by the severity of knee OA. Gait analysis was performed at three different controlled walking speeds in three groups of subjects with varying degrees of knee OA (20 healthy subjects with no OA and 90 patients with moderate or severe OA). The variability of gait parameters was characterized by the coefficient of variance (CV) of spatial-temporal parameters, as well as by the mean coefficient variance (MeanCV) of angular parameters. Based on our results, we conclude that the complexity of gait decreases if the walking speed differs from the self-selected speed. In patients with knee OA, the decreased variability of angular parameters on the affected side represents decreased joint flexibility. This leads to decreased consistency in movements of the lower limbs from stride-to-stride, as shown by increased variability of spatial-temporal parameters. Decreased joint flexibility and consistency of movement can be associated with decreased complexity of movement. Other joints of the kinetic chain, such as joints of the non-affected side and the pelvis, play an important role in compensation and adaptation of step-by step motion and in the ability of secure gait. Results suggest that the variability of gait associated with knee osteoarthritis is gender-dependent. During rehabilitation, particular attention must be paid to improving gait stability and proprioception and gender differences should be taken into account.

Publisher © 2011 Elsevier Ltd.

This research addressed the effect of hip osteoarthritis severity on equilibrium ability after sudden changes in direction among 20 healthy elderly people, 20 with moderate hip osteoarthritis (mOA), and 20 with severe hip osteoarthritis (sOA). The Lehr’s damping ratio calculated from testing while standing on both limbs (View the MathML source; View the MathML source; (View the MathML source) did not differ significantly from results of testing while standing on the dominant limb in healthy subjects (View the MathML source) and on the unaffected limb in patients with varying degrees of osteoarthritis (View the MathML source). Results from testing during standing on the non-dominant limb in healthy subjects (View the MathML source) and on the affected limb in patients with osteoarthritis (View the MathML source, View the MathML source) differed significantly from the results of the other two scenarios, indicating that the healthy side is dominant. In cases of sOA, equilibrium ability decreased with standing on both limbs or on the healthy limb compared to the control group and to the patients with mOA. Furthermore, an increased degree of hip osteoarthritis significantly decreased equilibrium ability on the affected side after sudden changes in direction, based on a comparison of the affected side in patients with sOA to the affected side in patients with mOA. Deterioration of equilibrium ability may indicate an increased risk of falling.

Publisher © 2010 Elsevier Ltd.

Gait analysis has provided important information concerning gait patterns and variability of gait in patients with knee osteoarthritis (OA) of varying severity. The objective of this study was to clarify how the variability of gait parameters is influenced by the severity of knee OA. Gait analysis was performed at three different controlled walking speeds in three groups of subjects with varying degrees of knee OA (20 healthy subjects with no OA and 90 patients with moderate or severe OA). The variability of gait parameters was characterized by the coefficient of variance (CV) of spatial-temporal parameters, as well as by the mean coefficient variance (MeanCV) of angular parameters. Based on our results, we conclude that the complexity of gait decreases if the walking speed differs from the self-selected speed. In patients with knee OA, the decreased variability of angular parameters on the affected side represents decreased joint flexibility. This leads to decreased consistency in movements of the lower limbs from stride-to-stride, as shown by increased variability of spatial-temporal parameters. Decreased joint flexibility and consistency of movement can be associated with decreased complexity of movement. Other joints of the kinetic chain, such as joints of the non-affected side and the pelvis, play an important role in compensation and adaptation of step-by step motion and in the ability of secure gait. Results suggest that the variability of gait associated with knee osteoarthritis is gender-dependent. During rehabilitation, particular attention must be paid to improving gait stability and proprioception and gender differences should be taken into account.

Verlag © 2011 Elsevier Ltd.

This research addressed the effect of hip osteoarthritis severity on equilibrium ability after sudden changes in direction among 20 healthy elderly people, 20 with moderate hip osteoarthritis (mOA), and 20 with severe hip osteoarthritis (sOA). The Lehr’s damping ratio calculated from testing while standing on both limbs (View the MathML source; View the MathML source; (View the MathML source) did not differ significantly from results of testing while standing on the dominant limb in healthy subjects (View the MathML source) and on the unaffected limb in patients with varying degrees of osteoarthritis (View the MathML source). Results from testing during standing on the non-dominant limb in healthy subjects (View the MathML source) and on the affected limb in patients with osteoarthritis (View the MathML source, View the MathML source) differed significantly from the results of the other two scenarios, indicating that the healthy side is dominant. In cases of sOA, equilibrium ability decreased with standing on both limbs or on the healthy limb compared to the control group and to the patients with mOA. Furthermore, an increased degree of hip osteoarthritis significantly decreased equilibrium ability on the affected side after sudden changes in direction, based on a comparison of the affected side in patients with sOA to the affected side in patients with mOA. Deterioration of equilibrium ability may indicate an increased risk of falling.

Publisher © 2010 Elsevier Ltd.

Purpose: The aim of the study was to compare the kinematic parameters and the on–off pattern of the muscles of patients with multidirectional instability (MDI) treated by physiotherapy or by capsular shift and postoperative physiotherapy before and after treatment during elevation in the scapular plane.
Scope: The study was carried out on 32 patients with MDI of the shoulder treated with physiotherapy, 19 patients with MDI of the shoulder treated by capsular shift and postoperative physiotherapy, and 25 healthy subjects. The motion of skeletal elements was modeled by the range of humeral elevation, scapulothoracic angle and glenohumeral angle, scapulothoracic (ST) and glenohumeral (GH) rhythms, and relative displacement between the rotation centers of the humerus and scapula. The muscle pattern was modeled by the on–off pattern of muscles around the shoulder, which summarizes the activity duration of the investigated muscles.
Results: The different ST and GH rhythms and the increased relative displacement between the rotation centers of the scapula and the humerus were observed in MDI patients. The physiotherapy strengthened the rotator cuff, biceps brachii, triceps brachii, deltoid muscles, and increase the neuromuscular control of the shoulder joints. Capsular shift and physiotherapy enabled bilinear ST and GH rhythms and the normal relative displacement between the rotation centers of the scapula and humerus to be restored. After surgery and physiotherapy, the duration of muscular activity was almost normal. Conclusion: The significant alteration in shoulder kinematics observed in MDI patients cannot be restored by physiotherapy only. After the capsular shift and postoperative physiotherapy angulation at 60° of ST and GH rhythms, the relative displacement between the rotation centers of the scapula and humerus and the duration of muscular activity were restored.

Publisher © 2010 Elsevier Ltd.

PROBLEMS: Soccer as a Stop-and-Go-sport goes along with a high level of physical strain on the locomotor system. Compared to similar kinds of sports, soccer is characterized by a high prevalence of overloads/injuries in the pelvic region. Since soccer frequently involves one-sided shot-training, modifications in the pelvic statics are possible.
METHODS: In a pilot study including 15 football-players-FP (age 26.9 ± 3.1 yrs; 4.4 ± 0.4 training units/week+ 1 leaque game) the pelvic statics was measured using the 3-d-recording system CMS70 (Zebris, Germany) directly before and after a defined shot training. The positions of the right and the left posterior superior iliac spines - PSIS were compared. Additionally, the stiffness of selective muscles was analyzed.
RESULTS: Before intervention the right PSIS was heightened in 8 FP. In 4 FP the pelvic statics was balanced and in 3 FP the right PSIS was abased. After the shot training, the pelvic statics was balanced in 4 FP. In contrast, 10 FP showed a higher right PSIS and 1 FP had a lower right PSIS. However, modifications of the pelvic statics were detected in all directions.
DISCUSSION: Our study demonstrates modification of the pelvic statics by asymmetric soccer-specific strains, but the reactions were individually different. It is possible, that changes in the pelvic statics may lead to changed function or overstrain of advertising muscles.

Publisher © Georg Thieme Verlag KG Stuttgart · New York

PROBLEMS: Boxer that take part on contests regularly are characterized by high strains on the locomotor system. Especially the area of shoulder girdle and neck can be overused by the fighting posture and standard techniques, that are often associated with non-physiological patterns.
METHODS: Of 11 young boxers (age 14.6 ± 0.6 years; 7.3 ± 0.6 training units per week) and a control group (CG) of 52 male pupils (age 15.4 ± 0.4 years) the static of head, shoulder girdle, and pelvis was detected by somatoscopy. Additionally, cyclical rotations of the cervical spine were measured using the 3-d-motion recording system CMS70 (Zebris, Germany) and the active range of motion was analysed.
RESULTS: In comparison to the CG, head and shoulder of the boxers were ventralised more often (p < 0.01). Furthermore, highly significant group differences in the bilateral position of the shoulder heights and the iliac crests were detected in the frontal plane. On average, the active maximal rotation of the boxers was decreased by 17.8° (p = 0.006; d = 0.800).
DISCUSSION: Our study was able to detect significant differences in the analysed functional parameters of the locomotor system that may be explained by boxing specific strains and which are prerequisites of optimal performance. As long-term pathologic effects can not be excluded, adequate compensational exercises should be integrated in the training.

Publisher © Georg Thieme Verlag KG Stuttgart · New York

The objective of this study is to determine how kinematical parameters and electromyography data of selected muscles may change as a result of anterior cruciate ligament (ACL) deficiency and following ACL reconstruction. The study was conducted on 25 anterior cruciate ligament deficient subjects prior to and 6 weeks, 4 months, 8 months and 12 months following ACL reconstructive surgery using the bone–patellar tendon–bone technique.
Gait analysis was performed by applying the zebris three-dimensional ultrasound-based system with surface electromyograph (zebris). Kinematic data were recorded for the lower limb. The muscles surveyed include vastus lateralis and medialis, biceps femoris and adductor longus.
The results obtained from the injured subjects were compared with those of 51 individuals without any ACL damage whatsoever. Acute ACL deficient patients exhibited a quadriceps avoidance pattern prior to and 6 weeks following surgery. No quadriceps avoidance phenomenon develops in chronic ACL deficient patients. In operated individuals, tempo-spatial parameters and the knee angle regained a normal pattern for the ACL-deficient limb during gait as early as 4 months following surgery.
However, the relative ACL movement parameter, which describes the tibial translation into the direction of ACL, and the EMG traces show no significant statistical difference compared with the same values of the healthy control group just 8 months following surgery.
The analysis of spatial-temporal parameters and EMG traces show that the development of a quadriceps avoidance pattern is less common than previously reported. These data suggest that anterior cruciate ligament deficiency and reconstruction produce considerable changes in the lower extremity gait pattern. The results suggest that gait parameters tend to shift towards a normal value pattern; and the re-establishment of pre-injury gait patterns—including the normal biphase of muscles—takes at least 8 months to occur.

Journal of Electromyography and Kinesiology (© Published by Elsevier B.V.)

INTRODUCTION: The introduction of fixed-angle plate osteosynthesis techniques has provided us a further means to treat periprosthetic femoral fractures. The goal of this experimental study is to evaluate the biomechanical properties and stability of treated periprosthetic fractures when using two different plate systems, which vary in the locking mechanism and the screw placement (monocortical or bicortical) with respect to the prosthesis stem. MATERIALS and METHODS: Using five pairs of formalin-fixed femora, a Vancouver B1 periprosthetic fracture was treated either with a 13-hole LISS® titanium plate using four monocortical periprosthetic screws or with a non-contact bridging plate (NCB) DF® plate using bicortical angle-stable blocked screws positioned ventrally or dorsally to the prosthesis stem. Bones were loaded under axial and cyclic compression with a progressively increased load until failure. Displacement at the osteotomy gap was measured during loading using an ultra-sound measuring system. RESULTS: The mean displacement in the region of the fracture gap was not significantly different at any time during the experiments for the two models. The mean force resulting in subsequent model failure was similar in both models; the failure morphology varied slightly between the models, however. Four of the five LISS® models exhibited either a tear-out of the monocortical screws or a decortication from the bony shaft of the cortical lamella surrounding the screws. On the other side, two of the NCB models showed macroscopically visible fissures along the osteosynthesis plates at the height of the osteotomy gap, and were hence considered implant failures. Only one NCB model showed tear-out of the bicortically placed screws. CONCLUSION: Bicortical screw placement provides more stable anchoring when compared to monocortical screw fixation. However, in relation to the amount of motion at the osteotomy gap and to failure loads, stabilisation of periprosthetic femoral fractures can be equally well achieved using either the LISS® plate with periprosthetic monocortical screws or the NCB plate with poly-axially placed bicortical screws. Publisher (Published by © 2010 Elsevier Ltd.)

Recently, there has been a rapid increase in the use of cervical spine interbody fusion cages, differing in design and biomaterial used, in competition to autologous iliac bone graft and bone cement (PMMA).
Limited biomechanical differences in primary stability, as well as advantages and disadvantages of each cage or material have been investigated in studies, using an in vitro human cervical spine model. 20 human cervical spine specimens were tested after fusion with either a cubical stand-alone interbody fusion cage manufactured from a new porous TiO2/glass composite (Ecopore) or PMMA after discectomy.
Non-destructive biomechanical testing was performed, including flexion/extension and lateral bending using a spine testing apparatus.
Three-dimensional segmental range of motion (ROM) was evaluated using an ultrasound measurement system.
ROM increased more in flexion/extension and lateral bending after PMMA fusion (26,5 %/ 36,1 %), then after implantation of the Ecopore-cage (8,1 %/7,8%).
In this first biomechanical in vitro examination of a new porous ceramic bone replacement material a) the feasibility and reproducibility of biomechanical cadaveric cervical examination and its applicability was demonstrated, b) the stability of the ceramic cage as a stand alone interbody cage was confirmed in vitro, and c) basic information and knowledge for our intended biomechanical and histological in vivo testing, after implantation of Ecopore in cervical sheep spines, were obtained.

Publisher © 2007-2011. Walter de Gruyter GmbH & Co. KG

The mechanical inefficiency during respiration in scoliosis remains unclear. AIM: To study the three-dimensional motion of the chest wall during deep breathing in healthy and scoliotic individuals.
MATERIALS & METHODS: Three-dimensional chest wall motion during breathing was studied in 17 scoliotic patients (right thoracic curvature) and 9 healthy individuals. Measurements were performed using a Zebris CMS 70P system (Zebris Medizintechnik Gmbll, Isny, Germany) which analyzes the time delay of ultrasound pulses emitted from markers placed on the chest wall. Nine markers were attached on the upper, the middle and the lower chest wall. Subjects were seated on a chair and asked to breathe deeply and slowly with no elevation of the shoulders for one minute.
RESULTS: The amplitudes were symmetric between the two sides in healthy individuals while scoliotic patients exhibited asymmetric chest wall motion. The amplitudes of the right convex side of the chest wall exhibited less motion than those of the left concave side, especially on the lower chest wall.
CONCLUSION: Chest wall motion was asymmetric in the scoliotic patients with diminished motion of the right lower chest wall. This locally diminished ventilation may cause ventilation-perfusion inequality and result in hypoxemia.

PubMed.gov (© Published by IOS Press)

During simple self-paced index finger flexion with and without visual feedback of the finger, we compared the movement-evoked potentials of the completely deafferented patient GL with those of 7 age-matched healthy subjects. EEG was recorded from 58 scalp positions, together with the electromyogram (EMG) from the first dorsal interosseous muscle and the movement trace. We analyzed the movement parameters and the contralateral movement-evoked potential and its source. The patient performed the voluntary movements almost as well as the controls in spite of her lack of sensory information from the periphery. In contrast, the movement-evoked potential was observed only in the controls and not in the patient. These findings clearly demonstrate that the movement-evoked potential reflects cutaneous and proprioceptive feedback from the moving part of the body. They also indicate that in absence of sensory peripheral input the motor control switches from an internal "sensory feedback-driven" to a "feedforward" mode. The role of the sensory feedback in updating the internal models and of the movement-evoked potential as a possible cortical correlate of motor awareness is discussed.

PubMed.gov (© Published by Elsevier B.V.)

Neuroimaging studies have shown that execution of a musical sequence on an instrument activates bilateral frontal opercular regions, in addition to bilateral sensorimotor and supplementary motor areas. During imagining activation of the same areas without primary sensorimotor areas was shown. We recorded EEG from 58 scalp positions to investigate the temporal sequence and the time course of activation of these areas while violin players prepared to execute, executed, prepared to imagine, or imagined a musical sequence on a violin. During the preparation for the sequence in three of seven musicians investigated the bilateral frontal opercular regions became active earlier than the motor areas and in one of them simultaneously with the motor areas. In two of the musicians a rather variable pattern of activation was observed. The frontal opercular regions were also strongly involved throughout the period of music execution or imagining. The supplementary motor area was involved in both preparation for the sequence and during execution and imagining of the sequence. The left primary sensorimotor area was involved in the preparation and termination of the musical sequence for both execution and imagining. The right sensorimotor area was strongly involved in the preparation for and during the execution of the sequence. We conclude that the bilateral frontal opercular regions are crucial in both preparation for and during music execution and imagining. They may have “mirror neurone” properties that underlie observation or imagining of one's own performance. The motor areas are differentially activated during the preparation and execution or imagining the sequence.

ScienceDirect (© Published by Elsevier B.V.)

Introduction: Back pain and posture deficits get more common in childhood and adolescents. Lack of movement, insufficient physical education and high amounts of TV and PC are known as risk factors for chronic low back pain in later life.
Methods: In a cross-sectional study, trunk muscle strength, posture and spinal flexibility were assessed in 200 untrained schoolchildren (117 girls, 83 boys). Independent variables, collected by a standardized questionnaire: age, height, weight, gender, weekly scope of TV, PC and sports (conditional, conditional-coordinative, coordinative). Dependent variables: spinal parameter, tested by the Zebris CMS-System and IPN Back Check.
Outcomes: PC and TV-consumption had negative effects on the spinal parameter, whereas esp. conditional-coordinative sports correlated positively.
Discussion: For general health and preventive reasons, children need a daily minimum of 30 minutes of movement. Conditional-coordinative sports are suited best because of their multifactorial load.

Publisher © Georg Thieme Verlag KG Stuttgart New York

Accurate co-registration of MRI and EEG data is indispensable for the correct interpretation of EEG maps or source localizations in relation to brain anatomy derived from MRI. In this study, a method for the co-registration of EEG and MRI data is presented. The method consists of an iterative matching of EEG-electrode based reconstructions of the scalp surface to scalp-segmented MRIs. EEG-electrode based surface reconstruction is achieved via spline interpolation of individually digitized 3D-electrode coordinates. In contrast to other approaches, neither fiducial determination nor any additional provisions (such as bite bars, other co-registration devices or head shape digitization) are required, and co-registration errors associated with inaccurate fiducial determination are avoided. The accuracy of the method was estimated by calculating the root-mean-square (RMS) deviation of spline interpolated and MRI-segmented surface reconstructions in 20 subjects. In addition, the distance between co-registered and genuine electrode coordinates was assessed via a simulation study, in which surface reconstruction was based on virtual electrodes determined on the scalp surface of a high-resolution MRI data set. The mean RMS deviation of surface reconstructions was 2.43 mm, and the maximal distance between any two matched surface points was 5.06 mm. The simulated co-registration revealed a mean deviation of genuine and co-registered electrode coordinates of 0.61 mm. It is concluded that surface matching using spline interpolated reconstructions of scalp surfaces is a precise and highly practicable method to co-register EEG and MRI data.

Publisher © Springer

By Editorial Staff
Charles "Skip" Lantz,DC,PhD, a respected researcher in Life University's Human Performance Center, was recently loaned state-of-the-art RoM equipment by Zebris, a German company that manufactures motion analysis equipment.
The equipment went to Dr. Lantz out of respect for his work in RoM assessment the past two years, which has been published in Spine, JMPT, and the European Spine Journal. He has established protocols for measuring spinal motion based on robotic systems. Research groups in Zurich, Switzerland; Oxford University; National Health Sciences University; Palmer College of Chiropractic; and the Rehabilitation Center of Cologne, Germany have adopted Dr. Lantz's RoM protocols.
"Our system works with ultrasound waves," explained Wolfgang Brunner of Zebris. "It measures three-dimensional movement in space, and it measures in real time." The value of real-time measurement is that data is collected along the entire motion, rather than at a few fixed points.
The research group headed by Dr. Lantz is working to validate the new technology and integrate RoM and SEMG (spinal electromyography) information to develop more appropriate applications for the chiropractic profession.

Dynamic Chiropractic

Sub-sensory electrical or mechanical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capabilities of elderly. In addition, clinical studies suggest that visual-auditory biofeedback can improve sensory compensation for the elderly. This study hypothesizes that the static balance and gait performance of single leg quiet standing and treadmill walking could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation and visual-auditory biofeedback in amputee subjects. To test this, a computerized foot pressure biofeedback sensory compensation system using sub-threshold low-level electrical stimulation combined with visual-auditory biofeedback was developed. Seven unilateral trans-tibial amputees who wore prostheses over 2 years were recruited. The subjects performed multiple single leg quiet standing trials with sub-sensory electrical stimulation applied at the quadriceps muscle during half of the trials. Static balance performance was characterized by using a Zebris motion analysis system to measure the sway distance and duration of the centre of mass on the second sacral (S2) of the subjects. In addition, multiple treadmill ambulatory trials with or without visual-auditory biofeedback was performed. Dynamic gait performance was characterized with a Zebris instrumented insole to measure the temporal responses of foot pressure sensors. Experimental results showed an improvement in three balance performance indices (Holding Time Index, HTI, Maximum Sway Distance Index, MSDI, and Average Sway Distance Index, ASDI) during single leg quiet standing by applying sub-sensory stimulation. The improvement ratio of these balance performance indices across subjects for single leg quiet standing tests resulted in 132.34% in HTI, 44.61% in MSDI, and 61.45% in ASDI. With visual-auditory biofeedback as a cue for heel contact and toe push-off condition during treadmill ambulation, the improvement of four dynamic gait performance measures (Double Support Period, DSP, Constant Time Cadence, CTC, Single Support Period, SSP, and Stance/Swing Ratio, SSR) in amputees was verified. This resulted in 7.89% in DSP (affected side), 5.09% in CTC, 16.67% in SSP (sound side), 45.30% in SSR (sound side), and 40.30% in SSR (affected side) respectively. These findings suggest that sub-threshold electrical stimulation and visual-auditory biofeedback rehabilitation strategies may be effective in compensating sensory loss and improving static balance and dynamic ambulation performance for amputees.

PubMed.gov (© Published by Informa Plc.)

STUDY DESIGN: Exploratory experimental design. OBJECTIVES: To examine primary and coupled cervical movements, and to study the effects of age, gender, and body mass index in a "neck-healthy" population. These data could serve as a basis for future interventions and to assess normal variations.
SUMMARY OF BACKGROUND DATA: Cervical movements are biomechanically and neurophysiologically complex. Neck disorders and trauma most often influence cervical movements. With 3-dimensional recordings, it is possible to make precise, noninvasive evaluations of how the head moves on the stable trunk, and to analyze primary and coupled movements.
METHODS: A total of 120 subjects (60 men and 60 women, ages 20-79), were tested with Zebris (Zebris Medizintechnik GmbH, Isny, Germany), a 3-dimensional movement analyzer.
RESULTS: Age influences the majority of primary and coupled movements. With increasing age, primary movement size decreases in all cardinal planes. Age most strongly affects the coupled movements of primary rotation and lateral flexion. Gender and body mass index have only slight influences.
CONCLUSIONS: Coupled movements are a natural part of cervical motion together with primary movements and follow specific patterns in subjects with no symptoms of neck disorders. Our study shows that cervical motion alters throughout life according to specific patterns but with individual variations.

PubMed.gov (© Published by Lippincott Williams & Wilkins, Inc.)

The ability to reproduce a specified head-on-trunk position can be an indirect test of cervical proprioception. This ability is affected in subjects with neck pain, but it is unclear whether and how much pain or continuous muscle contraction factors contribute to this effect. We studied the influence of a static unilateral neck muscle contraction task (5 min of lateral flexion at 30% of maximal voluntary contraction) on head repositioning ability in 20 subjects (10 women, 10 men; mean age 37 years) with healthy necks. Head repositioning ability was tested in the horizontal plane with 30 degrees target and neutral head position tests; head position was recorded by Zebris((R)), an ultrasound-based motion analyser. Head repositioning ability was analysed for accuracy (mean of signed differences between introduced and reproduced positions) and precision (standard deviation of the differences). Accuracy of head repositioning ability increased significantly after the muscle contraction task, as the normal overshoot was reduced. An average overshoot of 7.1 degrees decreased to 4.6 degrees after the muscle contraction task for the 30 degrees target and from 2.2 degrees to 1.4 degrees for neutral head position. The increased accuracy was most pronounced for movements directed towards the activated side. Hence, prolonged unilateral neck muscle contraction may increase the sensitivity of cervical proprioceptors.

PubMed.gov (© Published by Elsevier B.V.)

Study Design. Experimental study.
Objectives. To compare two devices for measuring cervical range of motion, a three-dimensional ultrasound motion device (Zebris) and a gravity-reference goniometer (Myrin).
Summary of Background Data. Assessment of cervical range of motion is used to evaluate the effect of different treatments, determine impairment, and ascertain the relationship between neck disorders and cervical spine mobility.
Methods. Sixty neck-healthy volunteers (25 men, 35 women; mean age 38 years, range 22-58 years) performed active maximal movements in flexion-extension, rotation, and lateral flexion. Maximal cervical range of motion was recorded simultaneously with the Zebris and Myrin devices. Intradevice reliability, concurrent validity, intertester comparison, intratester reliability, and intraindividual variability were computed.
Results. Our study showed good agreement of full-cycle cervical range of motion measurement between devices, testers, and the test and retest (intraclass correlation [ICC] was >0.90 for intradevice reliability, >0.93 for concurrent validity, and >0.92 for intratester reliability). Method error, assessed with the within-subject coefficient of variation for 95% of the measurements, was 5.4% to 11.1% for intradevice reliability, 4.4% to 7.6% for concurrent validity, 3.6% to 7.6% for intratester reliability, and 5.3% to 9.9% for individual variability. Individual variability did not increase with an increased cervical range of motion.
Conclusion. Both devices are reliable and showed good agreement. We conclude that the two techniques can be used interchangeably. Our study supports the continued use of the Myrin-a gravity-reference goniometer in routine clinical orthopedic work. The more sophisticated three-dimensional method adds information and allows evaluation of combined motion in two and three dimensions and is suitable for research.

Spine Journal (© Published by 2003 Lippincott Williams & Wilkins, Inc.)

Range of motion tests are often employed in the quantification of musculoskeletal impairment and in the assessment of the efficacy of therapeutic interventions. The aim of the present study was to compare the absolute values for, and the day-to-day reliability of, measures of cervical spinal mobility made with two computerised motion analysis devices. The ranges of cervical flexion, extension, lateral bending, axial rotation, and axial rotation in flexion and extension were determined for 19 volunteers using both the CA6000 Spine Motion Analyser and the Zebris CMS system; all measures were repeated on a second occasion 1-3 days later. The test-retest reliability was good for each instrument: there was no significant difference between the mean values derived on the two separate days (P>0.05), and the corresponding intraclass correlation coefficients were 0.75-0.93 for all pri-O mary movements and 0.57-0.93 for axial rotation in flexion or in extension. For each primary movement, a small but significant difference (1-10%; P<0.05) between the values derived from the two instruments was observed, the systematic nature of which was revealed by the excellent correlation coefficients between them. For the measures of axial rotation in flexion or in extension, however, there was not only a poor correlation between the data obtained from the two devices, but the mean values also differed significantly. Each device is highly reliable in itself and can be used with confidence in longitudinal studies. The establishment of 'normal' values for the primary motions should take account of the slight differences observed between devices. Normal values for rotation in flexion or extension cannot be established until the source of the device-dependent difference is identified.

PubMed.gov (© Published by Springer)

The kinematic magnetic resonance imaging technique has been developed to provide a functional examination of the knee. Technical limitations require this examination to be performed in supine position, and the knee motion is represented by an assembly of static positions at different knee angles. However, the main knee function is to support the body weight and perform continuous motion, e.g. parallel squat. Our study quantified the knee kinematics of 20 healthy subjects in different motion conditions (finite and continuous) and in different mechanical conditions (continuous unloaded and continuous loaded). We evaluated the angular and localisation difference of a finite helical axis of the knee motion for parallel squat, continuous knee extension in supine position and the finite set of knee extension in supine position. We found large inter-individual dispersion. The majority of subjects had equivalent knee kinematics between continuous knee extension and the finite set of knee extension in supine position, but not between continuous knee extension in supine position and the parallel squat. Therefore, results from a functional examination of a finite set of knee extensions in supine position do not represent the knee motion in a parallel squat. Our results suggest that functional examination of the knee from magnetic resonance imaging do not necessarily reflect the physiological kinematics of the knee. Further investigation should focus on a new magnetic resonance imaging acquisition protocol that allows image acquisition during weight bearing or includes a special device which reproduces the loaded condition.

Journal of Biomechanics (© Published by Elsevier Ltd.)

Sub-threshold electrical stimulation can enhance the sensitivity of the human somatosensory system to improve the balance control capability of elderly was shown in recent rehabilitation articles. The purpose of this study was to evaluate the postural sway of trans-tibial amputees when performing single leg quiet standing on firm surface. Four unilateral trans-tibial amputees who consecutively wore prosthetics over 2 years were recruited in this study. Subjects performed single leg quiet standing trails with sub-threshold electrical stimulation applied at the quadriceps muscle during the trails. Spatial co-ordinates for the determination kinematic data (sway distance) of the center of mass (COM) on second sacral (S2) were collected using an ultrasound-based Zebris CMS-HS system. The single leg quiet standing test is measure considered to assess postural steadiness in a static position by a spatial measurement. The common notion is that a better postural steadiness, i.e. less postural sway, allows for longer time single leg quiet standing. However, there is lack of evidence how postural steadiness during single leg quiet standing changes over time. In this article, we hypothesized that the static balance of single leg quiet standing could be improved for providing proprioceptive neuromuscular facilitation using sub-sensory stimulation in amputees. To test this hypothesis, a computerized sub-threshold low-level electrical stimulation device was developed and proposed for clinical study. Experimental results show that reduction in all of the postural sway indices (constant time sway length, max sway distance and average sway distance) and increase in single leg support time index during single leg quiet standing by applying sub-sensory stimulation. The single leg quiet standing test findings suggest that sub-threshold electrical stimulation rehabilitation strategies may be effective in improving static balance performance for amputees.

informaworld (© Published by Taylor & Francis)

Background: Mulligan's mobilisation techniques are thought to increase the range of movement (ROM) in patients with low back pain. The primary aim of this study was to investigate the application of the Mulligan's Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure.
Methods: 49 asymptomatic volunteers participated in this double-blinded study. Subjects were randomly assigned to receive either SNAG mobilisation (n = 25), or a sham mobilisation (n = 24). The SNAG technique was applied at the L3and L4 spinal levels with active flexion in sitting by an experienced manual therapist. Three sets of 10 repetitions at each of the two spinal levels were performed. The sham mobilisation was similar to the SNAG but did not apply the appropriate direction or force. Lumbar ROM was measured by a three dimensional electronic goniometer (Zebris CMS20), before and after each technique. For the reliability, five measurements in two different days (one week apart) were performed in 20 healthy subjects.
Results: When both interventions were compared, independent t tests yielded no statistically significant results in ROM between groups (p = 0.673). Furthermore no significant within group differences were observed: SNAG (p = 0.842), sham (p = 0.169). Intra- and inter-day reliability of flexion measurements was high (ICC1,1 > 0.82, SEM < 4.0°, SDD<16.3%) indicating acceptable clinical applicability.
Conclusion: While the Zebris proved to be a reliable device for measuring lumbar flexion ROM, SNAG mobilisation did not demonstrate significant differences in flexion ROM when compared to sham mobilisation.
Trial registration
Current Controlled Trials NCT00678093.

BioMed Central (The Open Access Publisher)

Objective To determine the effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of the contralesional M1 on movement kinematics and neural activation within the motor system in the subacute phase after subcortical stroke.
Design Crossover investigation.
Setting A university hospital.
Methods Fifteen right-handed patients with impaired dexterity due to subcortical middle cerebral artery stroke received 1-Hz rTMS for 10 minutes applied to the vertex (control stimulation) and contralesional M1. For behavioral testing, patients performed finger and grasp movements with both hands at 2 baseline conditions, separated by 1 week, and following each rTMS application. For functional magnetic resonance imaging, patients performed hand grip movements with their affected or unaffected hand before and after each rTMS application.
Results Application of rTMS to the contralesional M1 improved the kinematics of finger and grasp movements in the affected hand. At the neural level, rTMS applied to the contralesional M1 reduced overactivity in the contralesional primary and nonprimary motor areas. There was no significant correlation between the rTMS-induced reduction in blood oxygen level–dependent responses within the contralesional M1 and the degree of behavioral improvement of the affected hand. Overactivity of the contralesional dorsal premotor cortex, contralesional parietal operculum, and ipsilesional mesial frontal cortex at baseline predicted improvement of movement kinematics with the affected hand after rTMS of the contralesional M1.
Conclusion The functional magnetic resonance imaging data suggest that rTMS of the contralesional M1 may normalize neural activation within the cortical motor network after subcortical stroke. Identifying patients suitable for rTMS intervention based on individual patterns of cortical activation may help to implement rTMS in motor rehabilitation after stroke.

Archives of Neurology (© Published by American Medical Association)

Köln/Jülich – Die Funktion der nach einem Schlaganfall nur eingeschränkt verwendbaren Hand konnten Wissenschaftler der Neurologischen Klinik der Uniklinik Köln und des Forschungszentrum Jülich mittels einer magnetischen Hirnstimulation verbessern. Die Wissenschaftler berichten von ihren Ergebnissen in den Archives of Neurology (2008; 65: 741 – 747).
Die Neurologen aus Köln und Jülich um Dennis Nowak untersuchten Patienten mit einem erstmaligen Schlaganfall mithilfe einer computerbasierten Bewegungsanalyse und der funktionellen Kernspintomografie. Es zeigte sich, dass die Patienten eine verstärkte Hemmung der motorischen Hirnrinde der vom Schlaganfall betroffenen Hirnhälfte aufweisen. Diese ist für die Steuerung der gelähmten Hand zuständig.
Die Patienten wurden dann mit einer sogenannten magnetischen Hirnstimulation behandelt. Dabei wurden ihnen in einer zehnminütigen Sitzung zwei kreisrunde Spulen am Kopf platziert. Diese senden starke, aber sehr kurze Magnetpulse direkt in bestimmte Hirnregionen. Auf diese Weise erzeugen sie in den neuronalen Schaltkreisen schmerzfrei winzige elektrische Ströme.
Die Wissenschaftler konnten nachweisen, dass die Hemmung der motorischen Hirnrinde der gesunden Hirnhälfte mittels einer magnetischen Hirnstimulation das Zusammenspiel zwischen den beiden Hirnhälften wieder normalisiert und die Funktion der gelähmten Hand sich dadurch verbessert. „Die Methode eröffnet neue Wege in der Behandlung von motorischen und anderen Störungen nach einem Schlaganfall“, hieß es aus der Arbeitsgruppe. © hil/aerzteblatt.de

aerzteblatt.de (© Published by Deutscher Ärzte-Verlag GmbH)

Hypothesis: This study compared the kinematic parameters and activity pattern of muscles around the glenohumeral joint in multidirectional instability (MDI) treated by only physiotherapy and by capsular shift and physiotherapy, before and after treatment, to test the hypothesis that the surgery group would demonstrate better kinematic and muscle activity than the physiotherapy group.
Materials and methods: The study comprised 32 patients with MDI treated with only physiotherapy, 19 patients with MDI treated by capsular shift and physiotherapy, and 50 healthy shoulders as the control group. The investigated kinematic parameters were the range of humeral elevation in the scapular plane, the scapulothoracic and glenohumeral angle, the scapulothoracic and glenohumeral rhythms, and relative displacement between the rotational centers of the humerus and the scapula. The muscle activity was modeled by the on-off pattern of muscles around the shoulder.
Results: Before treatment, increased relative displacement between the rotational centers of the scapula and the humerus and different regression lines were observed in MDI patients. The physiotherapy strengthened the muscles, but regression lines remained monolinear. Capsular shift and physiotherapy resulted in bilinear regression lines and normal relative displacement between the rotation center of scapula and humerus was restored. After surgery and physiotherapy the activity pattern of muscles was almost normal.
Conclusion: The significant alterations in kinematic parameters in MDI patients cannot be completely normalized by physiotherapy only. After the capsular shift and postoperative physiotherapy, the bilinear regression lines (angulation at 60°), the normal relative displacement between the rotational centers of scapula and humerus, and the normal muscular activity pattern were restored to normal ranges and maintained for at least 4 years.

Publisher © 2010 Published by Mosby

The purpose of this study was to investigate the influence of tibial base plate angulation on knee kinematics and kinetics during knee arthroplasty. The amount of quadriceps force required to extend the knee and the anteroposterior displacement of a mobile bearing insert as well as tibiofemoral position were measured during an in vitro simulation of an isokinetic knee extension cycle. Human knee specimens (n = 7, mean age 62, range 52–75 years, all male) were tested in a kinematic knee simulating machine after total knee arthroplasty (TKA) with a mobile bearing insert prosthesis (Interax®, Stryker/Howmedica). During simulation, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 N m about the knee. The quadriceps load was measured using a load cell attached to the quadriceps tendon, the anteroposterior displacement of the mobile bearing insert as well as the relative tibiofemoral position was measured using an ultrasound base motion analysis system (CMS 100®, Zebris). Quadriceps load, insert and tibial displacement were first investigated with the tibial base plate implanted with a neutral tibial base plate orientation, and subsequently after 10° posterior angulation. The quadriceps forces needed to produce a 31 N m knee extension moment after TKA with neutral slope reached levels as high as 1,391 N (SD 82 N). After applying a posterior slope of 10°, maximum quadriceps force was measured to be up to 1,303 N (SD 34 N, P = 0.04). The mobile bearing insert was observed to move up to 0.1 mm (SD 4.2 mm) anteriorly relative to the tibial base plate with neutral tibial slope, and up to 1.0 mm (SD 4.5 mm, P = 0.47) with tibial slope. Femoral position relative to the tibia moved from a posterior position of 13.1 mm (SD 4.0 mm) anteriorly up to 0.5 mm (SD 6.3 mm), and from 16.0 mm (SD 6.4 mm, P = 0.67) to 9.5 mm (SD 9.9 mm, P = 0.33) with a 10° tibial slope. Posterior slope of the tibial base plate resulted in a more physiologic insert movement with a more posterior position of the femur and reduced quadriceps force especially in knee flexion angles above 60° compared to TKA with a neutral slope of the tibial base plate. Thus, the data suggest that the quadriceps lever arm was improved, which might have positive effect in mobilization of patients after TKA.

Publisher © Springer

To find out whether segmental magnetic resonance imaging (MRI) findings such as intervertebral disc degeneration (DD) and facet joint osteoarthritis (FJO) are associated with motion deficiencies as seen in common mobility tests and observed range of motion (ROM). A total of 112 female subjects, nurses and office workers, with and without low back pain, were examined by clinical experts, and lumbar mobility was measured including modified Schober, fingertip-to-floor distance (FTFD) and ZEBRIS motion analysis. An MRI of the lumbar spine was made. Mobility findings were correlated with segmental morphologic changes as seen on MRI at the levels of L1-2 through L5-S1. Only a few statistically significant correlations between MRI findings and the results of the mobility tests could be found. Lateral bending was weakly and negatively correlated to DD and FJO but only on the level of L5-S1. The FTFD showed a weak positive correlation to endplate changes on the level of L4-5. When ROM is observed by clinical experts, there are several significant relationships between MRI findings and the observed motion. There is a highly significant segmental correlation between DD and disc form alteration as seen on MRI on the level of single motion segments. Pain history and current pain level did not moderate any association between MRI and mobility. There is no clear relationship between the structural changes represented by MRI and the measured mobility tests used in this study. Our findings suggest that close observation of spinal motion may provide at least equal information about the influence of spinal structures on motion than the commonly used measured mobility tests do.

Publisher © Springer

Walking is one of the most common human movements. It means to transport the body safely and efficiently across ground level, uphill or downhill. Walking is learned during the first year of life and reaches maturity around the age of seven,remaining at the same level until 60. In old age one's walking performance starts to decline and it gradually slows down.
With the increased life expectancy of the elderly and their more active lifestyle, there is now an emphasis on determining any changes that occur in their gait patterns, in order to indentify diagnostic measures that are usable for monitoring the rehabilitation process after endoprothesis implantation.
The aim of this study is to determine how selected kinematical, kinetic and electromyographical parameters may change as a result of aging. A total of 31 healthy elderly subjects without any history of lower extremity joint pathology were investigated at constant gait speed (three km/h). The gait analysis equipment used consisted of an infinitely adjustable treadmill with force-plates and an ultrasound-based motion analyser with a surface electromyograph. Spatial-temporal, angular, kinetic and electromyographical parameters were recorded for the lower extremities.
The results obtained from the lower limb were compared on both sides as well as with those of 50 healthy young individuals collected from our database. The elderly had a significantly shorter step length and wider step width compared to the results of a young control group. Our results showed that the aged individuals demostrated a statistically lesser range of motion in different joints during walking.
We suggested that neurophysiological changes associated with aging might result in the less certainty of the neuromuscular system in selecting a stable gait.

Fulltext FACTA UNIVERSITATIS

The objective measurement of functional lumbo-pelvical movements enables the evaluation of the quantity and quality of movements referring to functional disorders in dynamic test-situations.
The goal of the present study is the determination of the reproducibility of time-continuous movement analyis of the pelvic region during walking and the determination of possible errors.
The movements of the thoracic (Th12), lumbar and sacrum-region (S1) of 17 healthy subjects (age: 32.1 ± 2.3 years) during walking on a treadmill (4.5 km/h) were investigated twice in an interval of 24 hours by means of a 3D ultrasonic movement analysis system. The ensemble averages of the low-pass filtered and time-normalized angle-time sequences of all anatomical planes and regions showed high test-retest correlations (r ? 0.92, p < 0.01) except fo the lumbar movement in the sagittal plane (r = 0.79, p < 0.01). A paired t-test showed no significant differences for the amplitudes of test and retest measurements except for the thoracolumbar movement in the sagittal plane (p < .05).
The results show that the evaluation of lumbar movement patterns can be regarded as admissible and desirable for clinical movement analysis. The data can be used as a diagnostic tool for the planning and control of therapeutic interventions.

Publisher © Georg Thieme Verlag KG Stuttgart New York

BACKGROUND AND PURPOSE: Measurements of cervical range of motion (CROM) have been extensively reported in the past decade employing simple (goniometers) as well as sophisticated (electro-, magneto- and ultrasonography-based) systems. The recent introduction of the simple, user-friendly and relatively cheap digital inclinometer (DI) has opened a potentially new venue for measurement of this segment's motion. The purpose of the present study was to assess intra-tester reproducibility of DI-based findings as well as its validity in comparison to the ultrasonography-based Zebris CMS 70P (Zebris Medizintechnik Gmbh, Isny, Germany) for measuring CROM in normal subjects.
METHODS: Active CROM of healthy women (n = 15) and men (n = 15) aged 24.2(2.4) years was measured on two sessions, Test 1 and Test 2, spread over 7.2(+/-0.7) days apart. On Test 1, the six primary movements of the neck (flexion, F; extension, E; right and left lateral flexion, RLF and LLF; and right and left rotations, RR and LR) were measured using the DI and the Zebris. On Test 2, the same measurements were performed using the DI only. All measurements were conducted by the same tester, with the subject in the seated position. The only exception was DI measurement of cervical rotation that was performed in the supine position due to the DI gravity-dependence, rendering DI measurements in the transverse plane irrelevant.
RESULTS: No significant differences were revealed between the two instruments with respect to the sagittal and frontal planes, whereas the DI-based CROM in rotation was significantly greater then its Zebris-based counterpart. The inter-device interclass correlation coefficients (ICCs) for the frontal were 0.72 (RLF) and 0.62 (LLF), and 0.77 (F) and 0.83 (E). Poor correlations were indicated for the rotations. The intra-tester reproducibility derived from the test-retest DI measurement indicated good to excellent reproducibility in all planes with ICCs ranging from 0.82 (LLF) to 0.94 (E). The Standard Error of Measurement ranged from 1.6 degrees (RR) to 2.6 degrees (F).
CONCLUSION: DI-based CROM measurements are reproducible and valid for recording sagittal and frontal plane motions in healthy subjects. The higher range in rotations, relative to the Zebris-based findings, is most probably attributable to the test position. Being relatively cheap, portable and convenient for tester and subject alike, the DI seems to be an effective instrument for assessing CROM.

PubMed.gov (© Published by John Wiley & Sons, Ltd.)

Study Design. A comparative study of cervical motion performance in chronic whiplash (CW) patients and healthy subjects.
Objectives. To examine the efficiency of total cervical range of motion (TCROM), which consists of the combined score of all six primary movements and their mean coefficient of variation (MCV), in differentiating CW patients from healthy subjects as well as typical from atypical patients. Additionally to explore in the patients possible relationships between their cervical motion profile and functional and personality traits.
Summary of Background Data. Previous studies revealed that cervical motion was an efficient discriminator between healthy and CW patients. However, none of these studies provided either guidelines regarding cutoff scores or insight as to what should be considered typical compared with atypical patient with respect to cervical motion performance.
Methods. Cervical motion was measured in 75 healthy subjects and 101 CW patients in each of the six primary movements. In addition, patients filled the functional neck disability index (NDI) and personality symptom check list (SCL-R-90) questionnaire.
Results. Total CROM was significantly lower and the MCV was significantly higher in patients compared with healthy subjects. Age and gender affected TCROM significantly in both groups while MCV remained unaffected, respectively. Atypical patients were identified by having a TCROM < 58° and or MCV > 22%, both scores corresponding to 2 SDs below and above group means, respectively. These benchmarks resulted in classifying as atypical 6% of the CW group who also scored drastically higher in the NDI and SCL-R-90 questioners.
Conclusions. Using MCV and TCROM adds new insight regarding what should be considered as atypical cervical motion profile in CW patients. Several aspects of this complex clinical entity are discussed.

SpineJournal (© Published by Lippincott Williams & Wilkins, Inc.)

To find out whether segmental magnetic resonance imaging (MRI) findings such as intervertebral disc degeneration (DD) and facet joint osteoarthritis (FJO) are associated with motion deficiencies as seen in common mobility tests and observed range of motion (ROM). A total of 112 female subjects, nurses and office workers, with and without low back pain, were examined by clinical experts, and lumbar mobility was measured including modified Schober, fingertip-to-floor distance (FTFD) and ZEBRIS motion analysis. An MRI of the lumbar spine was made. Mobility findings were correlated with segmental morphologic changes as seen on MRI at the levels of L1-2 through L5-S1. Only a few statistically significant correlations between MRI findings and the results of the mobility tests could be found. Lateral bending was weakly and negatively correlated to DD and FJO but only on the level of L5-S1. The FTFD showed a weak positive correlation to endplate changes on the level of L4-5. When ROM is observed by clinical experts, there are several significant relationships between MRI findings and the observed motion. There is a highly significant segmental correlation between DD and disc form alteration as seen on MRI on the level of single motion segments. Pain history and current pain level did not moderate any association between MRI and mobility. There is no clear relationship between the structural changes represented by MRI and the measured mobility tests used in this study. Our findings suggest that close observation of spinal motion may provide at least equal information about the influence of spinal structures on motion than the commonly used measured mobility tests do.

Publisher © Springer

The cervical spine exhibits the greatest range of motion among the spinal segments due to the complex interaction of its triplanar components of movement. As a result, measurement of movements of the cervical spine and of the various orthoses used in cervical spine injuries has proved difficult with no one method proving satisfactory. This paper uses the Zebris ultrasonic three-dimensional motion analysis system to measure flexion, extension, range of lateral bending, and range of axial rotation in five similar male and five similar female subjects with no history of neck injuries. The subjects were tested unrestrained and in soft and hard collars, as well as in Philadelphia, Miami J, and Minerva orthoses. Results show that the Minerva is the most stable construct for restriction of movement in all planes in both groups. Looking at these results allows ranking of the measured orthoses in order of their three-dimensional stability. Furthermore, by presenting reproducible data incorporating the composite triplanar movements of the cervical spine, thus allowing comparative analysis of the studied orthoses, they propose the Zebris as a reliable, repeatable, and safe method of measurement of cervical spine motion with low intersubject variability.

PubMed.gov (© Published by Mechanical Engineering Publications For The Institution Of Mechanical Engineers)

Functional imaging has demonstrated the specific involvement of the human middle–temporal complex (hMT/V5+) during processing of moving stimuli. Some studies applied transcranial magnetic stimulation (TMS) to investigate the causal relevance of hMT/V5+ for motion perception. Although the studies used similar visual stimuli and TMS parameters, the critical time point of functionally relevant hMT/V5+ activity differed by 100 ms and more.
The present study aimed to elucidate further the temporal characteristics of motion processing in hMT/V5+ by investigating all critical time windows currently debated in the literature. In contrast to previous studies, we used TMS neuronavigation based on individual fMRI results of five participants to target hMT/V5+, applying single-pulse TMS at 24 different time windows (-50 till +200 ms relative to stimulus onset).
We revealed that TMS significantly impaired motion perception when applied over hMT/V5+ at 40 to 30 ms before as well as 130 to 150 ms after onset of the moving stimuli. While the late effective time window conforms to results from previous experiments, we did not find evidence for an early time window around 0 ms that has been reported in other studies.
Our neuronavigation approach enabled us to quantify the interindividual variance in the exact location of hMT/V5+ and the respective TMS target position on the skull of the participants. Considering that shifting the TMS coil position only by a few millimeters can already lead to a complete loss of TMS effects, our study clearly demonstrates the utility of neuronavigated TMS when investigating specific neuronal effects as in the case of motion processing.

ScienceDirect (© Published by Elsevier Inc.)

Prehensile behavior is a popular task in current research on human motor control. Most studies on reaching used stationary target objects and, therefore, most models do not address the challenges the motor system must respond to when reaching for moving objects. The machines used in earlier studies to produce object motion offered a limited range of trajectories and restricted control over various movement parameters. We have developed a device that allows a great variety of object trajectories along a flat-table surface and gives the experimenter full control over all movement parameters. A linear positioning system is used to move a sled beneath the table surface. Magnetic coupling transfers the sled's movement to the target object on the tabletop. This arrangement allows fast movements of the object (up to 5 m/s) and at the same time protects subjects from any harm due to the moving parts. The system is connected to LC shutter glasses, a 3-D movement registration device, and a switch that detects the onset of hand motion. This allows the selective withdrawal of vision during the reaching task or the introduction of changes in the object motion depending on the subject's reactions.

ScienceDirect (© Published by Elsevier Inc.)

Multisegmentale biomechanische Studien der Lumbalwirbelsäule gewinnen ständig mehr Bedeutung. Nur so werden viele Erkenntnisse bezüglich des physiologischen Verhaltens der gesamten Lumbalwirbelsäule erst möglich. Weiterhin erlauben sie, die Biomechanik der Lumbalwirbelsäule nach Simulation verschiedener Formen von Wirbelsäulenoperationen in vitro zu studieren. Es wurde ein Wirbelsäulensimulator für multisegmentale Mobilitätsuntersuchungen entwickelt. Anhand einer Studie von 19 unfixierten Lendenwirbelsäulenpräparaten wurde eine Funktionalität überprüft. Nach Röntgenkontrolle und Bestimmung der Knochendichte wurden die Präparate mit der automatischen elektromechanischen Lastaufbringung in Flexion/Extension, Seitneigung und Seitdrehung mit bis zu 10 Nm belastet. Die Verschiebungen der beteiligten Wirbelkörper wurden mit einem Bewegungsanalysesystem auf Ultraschallbasis erfaßt.

Publisher © 2009 Walter de Gruyter

Object: Cervical spine disorders have a relatively high annual prevalence and account for numerous visits in musculoskeletal diseases. Objectifiable and non-invasive functional assessments can contribute to the estimation of cervical spine disorders. The reliability of a commercial, meanwhile wide-spread used measuring system for 3-dimensional motion analysis of cervical spine should be investigated.
Methods: 3-D measuring system was the CMS 70P (zebris medical Co., Germany). It is based on the propulsion velocities of ultrasound pulses, which are sent out by two triple markers and transferred to a three-microphone ultrasound receiver. 3-D motion analysis is performed one cycle three times each at five motion planes. Measurement is resulting in totally 30 angles of main and accompanied motion planes. Study included two basic investigations: one group of 126 consecutively recruited cervical spine patients (aged 18 - 84 years), a second group consisted of 50 painfree, healthy volunteers (aged 18 - 30 years). Intra-rater retest-reliability was calculated in the patients' group, inter-rater retest-reliability of two experienced examiners was tested in the volunteers' group. Reliability was valuated by determining the intraclass-correlation-coefficient (ICC) using analysis of variance.
Results: Single direction main motion planes showed ICCs for intra-rater reliability between 0.78 and 0.93. Intra-rater ICCs of range of motion measurements were seen in the same range. ICCs of single direction accompanied motions were found between 0.29 and 0.85. Single direction inter-rater reliability was found negligibly lower than intra-rater with ICCs between 0.69 and 0.88, inter-rater reliability of accompanied motions as well as range of motion measurements were analogous to those of intra-rater retest-reliability.
Conclusion: 3-D cervical motion analyzing system was found to be good to excellent reliable both for one and two examiners. Accompanied motion planes seems to be less reliable in some motion parts, escpecially in accompanied sagittal movements at rotation and lateral bending. This motions should be interpreted carefully in clinical conditions. Results of 3-D cervical spine motion analysis are comparable to other goniometric measuring systems.

Publisher © Georg Thieme Verlag KG Stuttgart New York

Objectives
To evaluate the intra- and inter-examiner reliability of neck active joint position sense measurements in different head movements.
Methods
Participants had to reproduce actively a specific angle-target in all movements (flexion, right/left rotation, right/left side flexion) from two initial positions, sitting and standing by using a 3D ultrasound-based motion analysis device. Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. Absolute error (AE) and variable error (VE) indices were used to assess the repositioning accuracy. Intraclass correlation coefficient (I.C.C.(1,1)), standard error of measurement (S.E.M.), smallest detectable difference (S.D.D.) indices were calculated for the analysis of the results.
Results
Both AE and VE yielded poor to moderate I.C.C.s in any movement and position (-0.01 to 0.50 and 0.01–0.25, respectively). AE presented higher I.C.C.s estimates than the VE but the S.D.D.s were similar for both indices. Regarding the AE, the standing position yielded higher I.C.C. estimates (0.15–0.68) than the sitting position (-0.01 to 0.43) but the S.E.M. (1.2–3.0° and 1.5–3.5°, respectively) and S.D.D. values (123.3–191.8% and 139.9–203.8%, respectively) showed no specific trend in favour of any position. The VE reliability indices showed that standing position was more reliable with less error than sitting. The inter-examiner data showed similar results to the intra-examiner study.
Conclusions
The statistical analysis of the present experiments showed that the method employed for measuring cervical joint position sense is unreliable. However, it needs further research to identify the discriminatory power of these tests or if they are clinically unacceptable.

Journal Gait & Posture (© Published by Elsevier B.V.)

Mismatch negativity (MMN) and its neuromagnetic analog (MMNm) are event-related brain responses elicited by changes in a sequence of auditory events and indexes early cognitive processing. It consistently detects neural processing deficits in schizophrenia. So far MMN is assessed with different methods (electroencephalography, EEG; magnetoencephalography, MEG) and with different paradigms: the "traditional" oddball design with rare deviants (20%) or the "optimum" design with 50% deviants varying in one of five parameters each. These MMN measures may not reflect one unitary mechanism which is equally affected in schizophrenia. We compared both designs in 12 patients with schizophrenia and controls using MEG and EEG. Automated, observer-independent data analysis rendered the procedures suitable for clinical applications. The optimum design was fastest to detect MMN and MEG had the best signal-to-noise ratio. In addition MMN was mostly reduced in schizophrenia if measured with MEG in the optimum paradigm. Optimized paradigms improve sensitivity and speed for the detection of schizophrenia endophenotypes. Dysfunctions in this disorder may lie primarily in the fast and automatic encoding of stimulus features at the auditory cortex.

PubMed.gov (© Published by Elsevier B.V.)

Introduction: Movement analysis with external markers is a non-invasive method used for the study of human movements in sports medicine. The aim of the present study was to assess the reproducibility of ultrasonic movement analysis (Zebris CMS 50) on the kinematics of the thoracic and lumbar spine movements in the sagittal plane.
Methods: Thirty subjects performed five repeated trials of trunk movements executed on 2 consecutive days (test-retest). Three positions were studied seated in a standardized position: neutral (vertical trunk), maximal flexion and extension. Eight external ultrasonic markers were placed corresponding to the contours of the spinous processes (T1, T3, T5, T7, T9, T11, L1, L3). Pearson correlations were used to quantitate between trials and test-retest reliability. A MANOVA was applied to the measurements to reveal differences between all trials and test-retest.
Results Repeated measurements oftrunkflexion and extension on both days of testing demonstrated good to high reliability (Test I: flex. r=0.79-0.94, ext. r=0.72-0.92; p<0.05, Test II: flex. r=0.76-0.92, ext. r=0.77-0.91; p<0.05). The comparison of the test-retest data on consecutive days showed good reliability for trunk flexion (r=0.76-0.93, p<0.05) and extension (r=0.79-0.91, p<0.05) in the sagittal plane. The MANOVA revealed no significant differences (p<0.05) between trials and test-retest.
Conclusion: The study reveals high reproducibility of ultrasonic movement analysis. It is concluded that this method is effective in studying functional spine movement made by therapists trained in the correct use of the ultrasonic movement analysis. The method will assist clinicians in the objective evaluation and reassessment of functional human movements.

Publisher © Georg Thieme Verlag KG Stuttgart New York

PURPOSE: The current study determined the immediate and one year follow-up effects of a multifunctional osteoporosis orthosis, manufactured without rigid elements.
MATERIALS AND METHODS: The study evaluated 54 osteoporosis patients before and after a 12 months time interval. Patients were randomly assigned to two study groups. The participants of the test group were asked to wear the orthosis throughout the one year test period. Patients of the control group carried no specific device. First and second measurements evaluated the thoracic kyphosis as well as the spinal curvature during upright standing. The study also investigated the experienced pain level and the number of falls. During the second examination the spinal posture of twelve randomized selected subjects was evaluated before and after a three hours orthosis wearing period.
RESULTS: The immediate effects, obtained during the first examination, demonstrated a substantial amount of spine straightening facilitated by orthosis wearing. During the orthosis condition the subjects accomplished at least 60% of their maximum active thoracic erection. Almost 80% to 90% of all participants experienced an increase in spinal erection and trunk stability. Subjects were able to maintain the straightened position over extended time periods.
CONCLUSIONS: The results point to a direct use of the examined orthosis. Facilitating sensomotor effects are achieved without rigid elements. The effects induced by air pads improve the relief of pain by gate control mechanisms. Erect posture, pain inhibition, enhanced activity along with improved coordination and more effective physiotherapy should reduce the frequency of falls and the fracture incidence.

Publisher © Georg Thieme Verlag KG Stuttgart · New York

Currently available therapeutic options for the correction of osteoporotic posture changes are not effective. Rigid or semi-rigid orthoses are only applicable in the early phase after vertebral body fractures, and the knowledge about the efficacy of flexible spinal orthoses is limited. Therefore, the present study is aimed at investigating the efficacy of a flexible spinal orthosis without any stabilizing components in terms of posture improvement. Forty women aged (65.9 ± 8.4 years) with a proven osteoporosis (DXA ? -2.5) were randomized to receive either of three treatment regimens: (i) Orthosis (Thämert Osteomed) with paravertebral/lumbosacral air chamber pads (as commercially available); (ii) The same orthosis without air chamber pads; and (iii) Placebo body stocking. Measurements were performed with a 3D real-time ultrasound topometry system (Zebris® CMS 70). The posture correction was substantially and significantly more marked in the first group (38% of the maximally possible intentional erection) as compared to the second (21%) and third group (13%). The orthosis with air chamber pads causes a clinically meaningful trunk support in patients with osteoporotic posture changes. Since the device contains no rigid stabilizing elements, the change in posture is considered to be a result of muscle activation due to sensomotor stimulation by the air chamber pads.

Publisher © Informa Plc.

BACKGROUND: Heavy weight lifting using a squat bar is a commonly used athletic training exercise. Previous in vivo motion studies have concentrated on lifting of everyday objects and not on the vastly increased loads that athletes subject themselves to when performing this exercise.
HYPOTHESIS: Athletes significantly alter their lumbar spinal motion when performing squat lifting at heavy weights. STUDY DESIGN: Controlled laboratory study.
METHODS: Forty-eight athletes (28 men, 20 women) performed 6 lifts at 40% maximum, 4 lifts at 60% maximum, and 2 lifts at 80% maximum. The Zebris 3D motion analysis system was used to measure lumbar spine motion. Exercise was performed as a "free" squat and repeated with a weight lifting support belt. Data obtained were analyzed using SAS.
RESULTS: A significant decrease (P < .05) was seen in flexion in all groups studied when lifting at 40% maximum compared with lifting at 60% and 80% of maximum lift. Flexion from calibrated 0 point ranged from 24.7 degrees (40% group) to 6.8 degrees (80% group). A significant increase (P < .05) was seen in extension when lifting at 40% maximum was compared with lifting at 60% and 80% maximum lift. Extension from calibrated 0 point ranged from -1.5 degrees (40% group) to -20.3 degrees (80% group). No statistically significant difference was found between motion seen when exercise was performed as a free squat or when lifting using a support belt in any of the groups studied.
CONCLUSION: Weight lifting using a squat bar causes athletes to significantly hyperextend their lumbar spines at heavier weights. The use of a weight lifting support belt does not significantly alter spinal motion during lifting.

PubMed.gov (© Published by Sage Publications)

Goniometers and radiographic imaging have been used to measure active or passive cervical range of motion (ROM) in asymptomatic adults. However, the ultrasound-based coordinate measuring system (CMS) can measure continuous neck motion in three dimensions. The aims of this investigation are to evaluate the reliability and validity of ultrasound-based CMS (Zebris, CMS 70P), and to compare the cervical ROM patterns of asymptomatic young and middle-aged adults during continuous neck motions in the three cardinal planes. The ROM reciprocal ratio was defined as the ratio of the ROM from neutral position in one direction versus that in the opposite direction at the same cardinal plane. This study demonstrated the high test–retest reliability and validity of CMS during cervical motion in Chinese participants. Middle-aged adults exhibit reduced ROM ratios in the sagittal and frontal planes. The advantages and limitations of the CMS measurement tool and the potential future applications are documented. The measurement of neck motion pattern by ultrasound-based CMS may provide information on the management of neck dysfunction during functional movements.

Journal Manual Therapy (© Published by Elsevier Ltd.)

AIM OF THE STUDY: Maintaining segmental motion is one of the most reported theoretical advantages of total disc replacement (TDR). Several inlay sizes are available for reconstruction of the physiological disc height. The influence of the implant height on the range of motion (ROM) was investigated in a biomechanical study.
METHODS: A total of 10 human lumbar cadaver spines were subjected to biomechanical testing. Flexion/extension and side-bending moments were applied from 2.5-7.5 Nm on a spine load simulator allowing for all 6 degrees of freedom. Motion under different loads was monitored by the Zebris system in 3 dimensions. Initially intact specimens were tested in 3 load cycles. Then a total disc prothesis was implanted with an 8.5 mm inlay and the cycles were repeated. Finally in 5 cases a 1-mm larger inlay was inserted while in the remaining 5 cases the inlay was exchanged with a 2-mm larger implant. Neutral zone (NZ) and ROM were recorded under the different loads.
RESULTS: The average motion for the various loads showed no significant difference when the intact motion segment was compared to the specimen containing the 8.5-mm inlay. After the larger inlay had been mounted the average reduction of the ROM in flexion/extension was 25% under the load of 7.5 Nm, 26% under a torque of 5.0 Nm and 30% when 2.5 Nm were applied. The NZ was reduced by 37%. For side-bending the ROM was reduced by 21% under a load of 7.5 Nm, by 26% under 5.0 Nm and by 35% under a torque of 2.5 Nm. The NZ was decreased by 27%. The reduction of the ROM was significant (p=0.0057).
CONCLUSION: Segmental lumbar motion is maintained after TDR. The size of the inlay can significantly change the ROM in lumbar spine segments treated by TDR.

Publisher © Georg Thieme Verlag KG Stuttgart New York

This survey focusses on the effects of various claw trimming methods as well as the effect of the different resulting claw shapes on the pressure distribution under the sole.64 bovine claws were trimmed according to 3 different trimming methods, the functional claw trimming method by Toussaint Raven and two other specially modified methods.The alternative methods resulted on the one hand in long and acute-angled claws,on the other hand in a very steep claw profile. The limb samples were attached to the hydraulic plunger of a material testing machine and pressed onto a pressure distribution plate with a predefined load. The pressure distribution pattern was recorded beforeand after trimming. An obvious stress concentration could be observed in the bulbar region of the outer claws. All oftheapplied claw trimming methods induced a redistribution of load onto the inner claws while relieving the bulbar area of the outer claws.The inner claws were the main reason for the enlarged floor contact area caused by the trimming technigues.The results show that all technigues led to an improvement of stress conditions. In some cases, methods 2 and 3 were slightly superior in reducing maximum pressure and enlarging floor contact area.

vetline.de (© Published by Schlütersche Verlagsgesellschaft mbH & Co. KG)