Forced posture of neurology residents in daily routine on the ward in Germany

Background The aim of this pilot study was to analyze the work of neurologists regarding static posture (> 4 s) and to identify awkward postures. Methods A total of 9 neurologists (assistant physicians; 3 male, 6 female) participated in this study. Kinematic data were collected using the computer-assisted acquisition and long-term analysis of musculoskeletal loads (CUELA; IFA, Sankt Augustin, Germany) system. Daily work (“office work,” “measures on patients,” and “other activities”) was analyzed with a computer-based task analysis. Results During ”measures on patients,” more than 80% of the total percentage of non-neutral posture was assumed with a flexed position of the head and entire back, both during “blood collection” (4.7% of the time) and while “placing intravenous catheters” (8.3% of the time). In contrast, long static postures (> 30 s) in the head and neck area, including the thoracic spine, were adopted during “office work.” Despite the increased total percentage of non-neutral attitudes during measures on patients, the time share of 3.4% of the total working time is so small that the risk for developing musculoskeletal disorders (MSD) is negligible. In contrast, office work, which comprises 50.8% of the total working time and longer static postures, has a potential risk for the development of MSD. Conclusion The present study is the first kinematic pilot analysis in the field of in-patient neurological assistants. Non-neutral as well as static postures in everyday work could be identified. Potential MSD can be reduced by optimizing the working height and by taking regular breaks to loosen the musculoskeletal system.

Automatic Measurement of Neutral Foot Posture Using Three-Dimensional Scanning

The Rearfoot Angle (RFA) is the most commonly method used for foot posture assessment, and it is also a method for evaluating the subtalar joint neutral foot posture. However, orthopedists and researchers often meet trouble for the measurements of the RFA and neutral foot posture due to lacking measurement with automation and objectivity. In general, the RFA was measured using a goniometer to align with manual markers on the foot. The purpose of this study implements the automatic computing of leg angle, foot angle, and RFA by the foot model using Three-Dimensional (3D) scanning. This study contributes to the algorithms to The purpose of this study implement the automatic and objective computing of leg angle, foot angle, and RFA by the foot model using 3D scanning. The automatic calculation on leg angle, foot angle, and neutral foot posture has been created, test, and validated completely in this study. There are two algorithm methods proposed to determine the midpoint on the leg or foot outline. The midline has been computed by linear regression through five midpoints. The leg and foot angles are calculated by the tibial and calcaneal midlines, respectively. Through the subject standing on eversion foot platforms, the neutral posture of the foot can be computed by the leg and foot angles determined by the 3D model scanned of the foot with various tilt angles. The determinations of the midpoint and midline have been demonstrated algorithm by MATLAB. Based on comparing with the goniometer measured, selecting the midpoint algorithm of the limit points and the lowest point methods to determine the tibial and calcaneal midlines respectively would carry out better results. The foot 3D scanning measurement proposed in this study has been tested and validated from the goniometer. This study can determine the leg angle, foot angle, and neutral foot postures for a subject with normal weight status, but be not suitable for that with obese weight status. In the future, this study can provide guidance for foot posture assessment and personal insoles design.

Analysis of Foot-Ankle-Leg Injuries in Various Under-Foot Impact Loading Environments with a Human Active Lower Limb (HALL) Model

Lower limb injuries caused by under-foot impacts often appear in sport landing, automobile collision, and anti-vehicular landmine blasts. The purpose of the present study was to evaluate a foot-ankle-leg model of the Human Active Lower Limb (HALL) model, and used it to investigate lower leg injury responses in different under-foot loading environments to provide a theoretical basis for the design of physical dummies adapted to multiple loading conditions. The model was first validated in allowable rotation loading conditions, like dorsiflexion, inversion/eversion, and external rotation. Then, its sensitivity to loading rates and initial postures was further verified through experimental data concerning both biomechanical stiffness and injury locations. Finally, the model was used to investigate the biomechanical responses of the foot-ankle-leg region in different under-foot loading conditions covering the loading rate from sport landing to blast impact. The results showed that from -15° plantarflexion to 30° dorsiflexion, the neutral posture always showed the largest tolerance, and more than 1.5 times tolerance gap was achieved between neutral posture and dorsiflexion 30°. Under-foot impacts from 2 m/s to 14 m/s, the peak tibia force increased at least 1.9 times in all postures. Thus, we consider that it is necessary to include initial posture and loading rate factors in the definition of the foot-ankle-leg injury tolerance for under-foot impact loading.

Influence of Foot Progression Angle on Center of Pressure During Stair Ascending in Subjects With Chronic Ankle Instability

The purpose of this study was to identify changes in the center of pressure during stair ascending in subjects with chronic ankle instability while different angles of foot are applied. The subjects of this study were 20 male and female adults with chronic ankle instability were selected from among the employees of D Hospital in Daegu Metropolitan City. The criteria for selection of subjects with chronic ankle instability were those who felt wobbling in the ankle joint and scored not higher than 24 points in a test using the Cumberland Ankle Instability Tool (CAIT). The subjects carried out stair ascending in neutral, toe-in and toe-out postures, respectively, and changes in the center of pressure (COP) were compared and analyzed. The results of this study, no statistically significant difference appeared in the comparison between the toe-in posture and neutral posture or between the neutral posture and the toe-out posture but medial/lateral movements of the center of pressure showed significant differences between the toe-in and toe-out postures. In addition, the total travel range and the moving range of the center of pressure, the average velocity, and the anterior/posterior movements of the center of pressure showed no statistically significant difference among all three postures. As a result, it could be seen that when adults with chronic ankle instability climb the stairs, the toe-in posture reduce the medial/lateral movements of the center of pressure thereby increasing the stability of the ankle and effectively preventing re-injuries.

Dimensional Characterization of the Human Lumbar Interlaminar Space as a Guide for Safe Application of Minimally Invasive Dilators

BACKGROUND The risk of interlaminar passage of a dilator into the lumbar spinal canal in minimally invasive approaches is currently unknown. Among anthropometric data reported in the medical literature, there is no cadaveric report of the interlaminar dimensions of the lumbar spine. OBJECTIVE To report the lumbar interlaminar dimensions in neutral, flexion, and extension postures. METHODS A total of 8 spines were sectioned into lumbar segments. Digitized coordinate data defining the locations and movements of chosen anatomic points on the laminar edges at a given spinal level were used to measure changes in the opening dimensions during static neutral posture and flexion-extension movements. Interlaminar dimensions were averaged and categorized for each vertebral level and spinal posture. RESULTS The mean interlaminar distance increased from neutral posture to flexion across all vertebral levels. The mean interlaminar distances in the neutral posture ranged from 12.21 mm (L5-S1) to 14.88 mm (L1-L2). In flexion, the range was from 17.15 mm (L5-S1) to 18.50 mm (L4-L5). These measurements are greater than the first several diameters of dilators in all minimally invasive dilator sets. CONCLUSION The precise measurements of the lumbar interlaminar space are valuable to minimally invasive spine surgeons for the dilatation phase of the operation. The risk of interlaminar passage of a minimally invasive dilator is greatest in flexion with dilators that have a diameter of 16 mm or less. There is considerably less risk of interlaminar passage in patients positioned on an extended Jackson table.

Changes in Musculoskeletal Discomfort and Postural Alignment According to the Height of the Worktable When VDT Activities were Performed by Patients in a Wheelchair with C6 and T6 Spinal Cord Injuries

Purpose: This purpose of the study was to identify the effects of computer worktable heights on musculoskeletal changes in the neck and upper extremities and postural alignment in patients with C6 and T6 level spinal cord injuries. Materials and Methods: The participants in the present study were patients diagnosed with AIS A. The level of the worktable was set 5 cm below the elbow, at elbow level, and 5 cm above elbow level. Subjective musculoskeletal discomfort (Borg-RPE) was measured at the end of the experiment. To compare the side posture for the wheelchair axle, patients with C6 and the T6 injuries were selected to measure the angle of the centerline for the axle, the tip of the chin, and the postural change for the tragus of the ear. Results: First, in the patient with C6 injuries, the Borg-RPE scores decreased when the worktable height was 5 cm above the elbow, whereas, in the patient with T6 injuries, the Borg-RPE scores decreased when the worktable height was decreased. Second, in the patient with C6 injuries, the chin tip and tragus of the ear were close to the center of the wheelchair when the height of the worktable was 5 cm above the elbow in the lateral position. In the patient with T6 injuries, there was no difference in lateral posture according to the height of the worktable. Conclusion: To reduce musculoskeletal system discomfort in patients during video display terminal (VDT) work, it is necessary to set the worktable height higher than the elbow standard for patients with C6 injuries and lower than elbow height for patients with T6 injuries. In the case of posture change, in the patient with C6 injuries, the higher the worktable height, the more the neck and head changed from forward flexion to a neutral posture.

Using bodily postures to reduce anxiety and improve interoception: A comparison between powerful and neutral poses

Background Previous research has shown that anxiety syndromes are highly prevalent among university students. Effective treatments are needed to reduce the burden of anxiety in this population. Powerful postures have been found to impact affective states, as well as interoception (i.e. the ability to perceive inner bodily signals). However, no previous study has compared the effects of powerful- and neutral postures in regards to anxiety and interoceptive ability. Methods The first part of the study measured the single-session effect of adopting powerful- vs. neutral postures on students' (n = 57) interoceptive ability and state anxiety. The second part of the study measured the effect of adopting powerful or neutral postures twice daily for two weeks, on individuals' interoceptive ability and trait anxiety. Results State anxiety decreased in both conditions whereas interoceptive accuracy only increased in the power posing condition after a single session. Interoceptive accuracy increased in both groups after two weeks of training. Limitations The study included no comparison to a condition where individuals adopted their natural (i.e. usual) bodily posture. Conclusions Embodiment interventions that include elements of adopting an open or expansive bodily posture whilst maintaining a self-focus, can help to reduce state anxiety and improve interoceptive accuracy in student populations. Power posing does not seem to be superior to holding a neutral posture to improve interoceptive accuracy or anxiety. One reason therefore could be that both conditions include the manipulation of self-focus and a postural change that diverges from individuals' normal posture.

Effect of Increased Lumbar Lordosis on Lumbar Multifidus and Longissimus Thoracis Activation During Quadruped Exercise in Patients With Chronic Low Back Pain: An EMG Study

The objective was to investigate the electromyographic activity of the lumbar multifidus (MF) muscle and longissimus thoracis muscle, along with their activity ratio (MF longissimus thoracis ratio), during quadruped stabilization exercise performed with neutral posture and with increased lumbar lordosis in patients with chronic low back pain (CLBP). A total of 23 patients with CLBP (12 females and 11 males) were recruited based on inclusion and exclusion criterion. Each patient performed 4 exercises in random order, with surface electromyography electrodes and an electrogoniometer attached. A cross-sectional study design was used to measure the amplitude of muscle activation (as a percentage of maximum voluntary contraction) in each patient across the 2 muscles (MF and longissimus thoracis) during quadruped stabilization exercise with neutral posture and with increased lumbar lordosis. A 2-way analysis of variance was conducted, which demonstrated a statistically significant increase in the recruitment of MF with increased lumbar lordosis in patients with CLBP during quadruped exercise. An increase of 9.7% and 16.9% maximum voluntary contraction in MF electromyographic activity was observed in lumbar lordosis posture during the quadruped leg raise and quadruped leg-arm raise exercise, respectively (P < .01), when compared to the neutral posture. The increased recruitment of MF with lumbar lordosis in the quadruped position has strong implications in the assessment and management of patients with CLBP.

Co-Design to Support the Development of Inclusive eHealth Tools for Caregivers of Functionally Dependent Older Persons: Social Justice Design

Background eHealth can help reduce social health inequalities (SHIs) as much as it can exacerbate them. Taking a co-design approach to the development of eHealth tools has the potential to ensure that these tools are inclusive. Although the importance of involving future users in the development of eHealth tools to reduce SHIs is highlighted in the scientific literature, the challenges associated with their participation question the benefits of this involvement as co-designers in a real-world context. Objective On the basis of Amartya Sen’s theoretical framework of social justice, the aim of this study is to explore how co-design can support the development of an inclusive eHealth tool for caregivers of functionally dependent older persons. Methods This study is based on a social justice design and participant observation as part of a large-scale research project funded by the Ministry of Families as part of the Age-Friendly Quebec Program (Québec Ami des Aînés). The analysis was based on the method developed by Miles and Huberman and on Paillé’s analytical questioning method. Results A total of 78 people participated in 11 co-design sessions in 11 Quebec regions. A total of 24 preparatory meetings and 11 debriefing sessions were required to complete this process. Co-designers participated in the creation of a prototype to support the search for formal services for caregivers. The majority of participants (except for 2) significantly contributed to the tool’s designing. They also incorporated conversion factors to ensure the inclusiveness of the eHealth tool, such as an adequate level of digital literacy and respect for the caregiver’s help-seeking process. In the course of the experiment, the research team’s position regarding its role in co-design evolved from a neutral posture and promoting co-designer participation to one that was more pragmatic. Conclusions The use of co-design involving participants at risk of SHIs does not guarantee innovation, but it does guarantee that the tool developed will comply with their process of help-seeking and their literacy level. Time issues interfere with efforts to carry out a democratic process in its ideal form. It would be useful to single out some key issues to guide researchers on what should be addressed in co-design discussions and what can be left out to make optimal use of this approach in a real-world context.