Evaluation of Hindlimb Deformity and Posture in Dogs with Grade 2 Medial Patellar Luxation during Awake Computed Tomography Imaging while Standing

Objective The aim of this study was to determine the degree of bone deformities and hindlimb postural abnormalities in a standing position in awake Toy poodles with and without grade 2 medial patellar luxation (MPL) using high speed 320-row computed tomography (CT). Methods The limbs with grade 2 MPL (MPL-G2 group) and without any orthopaedic disorders (control group) were imaged in a standing position, without sedation or anaesthesia, using CT. In MPL-G2 group, images were obtained when the patella was luxated (G2-L group) and reduced (non-luxation, G2-NL group). Bone morphologies of the femur and tibia were quantified three-dimensionally. Hindlimb standing posture was evaluated by measuring femoral rotation and abduction angles, tibial rotation angle, metatarsal rotation angle, foot rotation angle, angle between the femoral anatomical axis and the mechanical axis of hindlimb and stifle joint line convergence angle. Results There were no significant differences in bone morphologic parameters between the MPL-G2 group (5 limbs) and the control group (6 limbs). In the G2-NL group, there were no significant hindlimb postural abnormalities. In contrast, in the G2-L group, significant hindlimb postural abnormalities including external rotation of femur, internal rotation of tibia and foot, external rotation of tarsal joint, large stifle joint convergence angle, genu varum and toe-in standing were observed. Conclusion Dogs with grade 2 MPL have no bone deformities but show abnormal standing posture when the patella is luxated.

Automated and accurate assessment for postural abnormalities in patients with Parkinson’s disease based on Kinect and machine learning

Background Automated and accurate assessment for postural abnormalities is necessary to monitor the clinical progress of Parkinson’s disease (PD). The combination of depth camera and machine learning makes this purpose possible. Methods Kinect was used to collect the postural images from 70 PD patients. The collected images were processed to extract three-dimensional body joints, which were then converted to two-dimensional body joints to obtain eight quantified coronal and sagittal features (F1-F8) of the trunk. The decision tree classifier was carried out over a data set established by the collected features and the corresponding doctors’ MDS-UPDRS-III 3.13 (the 13th item of the third part of Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale) scores. An objective function was implanted to further improve the human–machine consistency. Results The automated grading of postural abnormalities for PD patients was realized with only six selected features. The intraclass correlation coefficient (ICC) between the machine’s and doctors’ score was 0.940 (95%CI, 0.905–0.962), meaning the machine was highly consistent with the doctors’ judgement. Besides, the decision tree classifier performed outstandingly, reaching 90.0% of accuracy, 95.7% of specificity and 89.1% of sensitivity in rating postural severity. Conclusions We developed an intelligent evaluation system to provide accurate and automated assessment of trunk postural abnormalities in PD patients. This study demonstrates the practicability of our proposed method in the clinical scenario to help making the medical decision about PD.

Prevalence of Upper Cross Syndrome among Students of University of Balochistan, Quetta Pakistan

Objective: To assess the prevalence of upper crossed syndrome among students of Doctor of Physical Therapy (DPT) and Bachelors of Eastern Medicine and Surgery (BEMS) at university of Balochistan Quetta, Pakistan. Background: Upper cross syndrome is characterized as a pattern of tightness or over facilitation of chronically contracted and shortened muscles on one side and weakness or inhibition of chronically lengthened muscles on other side due to the muscle imbalance leading to postural abnormalities including, forward head posture, shoulder protraction, winging of scapula. These changes, in turn, lead to overstress of the cervical cranio-cervical junction, cervical and thoracic spine and shoulders, which can cause neck and/or jaw pain, headaches, and shoulder problems. The purpose of this study was to figure out the number of students of DPT and BEMS suffering from upper crossed syndrome at university of Balochistan Quetta, Pakistan. Methodology: A descriptive cross-sectional study was conducted. A self-constructed questionnaire having two parts, the first part comprised of demographics data while second part comprised of 18 questions and consent form was filled by 340 students both males and females from DPT and BEMS department. The Data was analyzed by Statistical Package for Social Sciences (SPSS) version 16. Results: The study participants had a mean age of ±21.85, most of them were, from 22-25 years n=182 (53.5%) age group, males n=178 (52.4%) and from 3rd semester n=107 (31.5%). The prevalence of upper cross syndrome in the current study was 45.0%. Conclusion: The study concludes that upper cross syndrome has high prevalence in the students of DPT and BEMS in faculty of pharmacy and health sciences, at university of Balochistan Quetta, Pakistan.

Quantitative Analysis of Postural Instability in Patients with Parkinson’s Disease

Introduction. Postural instability is commonly observed in Parkinson’s disease, leading to an increasing risk of falling and worsening as the disease progresses. We found that limit of stability can be applied to reflect the dynamic evolution of postural instability in patients with Parkinson's disease. Methods. Forty-three patients (9 of Hoehn and Yahr stage I, 12 of stage II, 14 of stage III, and 8 of stage IV) met the criteria for the diagnosis of idiopathic Parkinson’s disease and could stand independently for at least 10 minutes. Twelve healthy controls with no sign of parkinsonism were also recruited. Postural instability was assessed by posturography in different directions (forward, backward, right, left, forward-right, forward-left, backward-right, and backward-left). This study trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR1900022715). Results. All participants were able to complete the limit of stability tasks without any complications. Patients in stages II to IV exhibited smaller end point excursion and slower time to complete than controls, suggesting an impaired limit of stability. The patients in stage II exhibited a remarkable decline in most directions compared to controls, except for right and left, and forward and backward decline occurred the earliest. For patients in stage III, right was the only direction with no significant difference from controls. In stage IV patients, the limit of stability declined significantly in all directions ( p < 0.05 ). Conclusions. The postural abnormalities of Parkinson’s disease can occur at early stages, and the pattern of decline is more severe in the forward-backward direction. This trial is registered with ChiCTR1900022715.

Quantitative Evaluation of Upright Posture by X-Ray and 3D Stereophotogrammetry With an Original Marker Placement Protocol in Late Onset Pompe Disease.

Background: Late Onset Pompe Disease (LOPD) is an autosomal recessive muscular disorder characterized by prevailing weakness of trunk and pelvic girdle muscles that causes ventilatory insufficiency and postural abnormalities. The most common myopathy phenotype described clinically in LOPD is the Limb Girdle and Diaphragmatic Pattern; spinal deformities, as hyperlordosis, hyperkyphosis and scoliosis diagnosed by x-Ray exam, have been reported in about a third of LOPD patients. The non-specific clinic onset, the similarity of the LOPD phenotypes with other myopathies, inter-individual heterogeneity and the lack of any disease hallmark, make early diagnosis challenging and, if enzyme replacement therapy does not begin timely, about 60% of patients develops severe motor and ventilatory disabilities.Aim of our study was to quantitatively assess the upright posture in a sibship of LOPD adults by x-Ray(xR) and 3D Stereophotogrammetry (St), considered the gold standard to measure spinal angles and whole-body posture respectively, in order to better identify specific alterations more likely to be present in a homogeneous group.Results: Statistical analysis of St parameters showed a larger ankle, knee, elbow, dorsal, S2-C7, heel-S2-C7, heel-S2-nasion angles and a lower sagittal vertical axis (SVA) than healthy controls. Moreover, xR analysis highlighted a lower occipito-cervical, C2-C7 cervical and Cobb dorsal angles, and a trend to lower lumbar lordosis and SVA compared to normal values. Pearson’s coefficient analysis was carried on in order to evaluate the correlation between xR and St sagittal spino-pelvic parameters and significant correlation was found in dorsal and lumbar angles calculated using xR markers placed on spiny apophysis, xR centre of vertebral bodies, Cobb method and St markers. Conclusions: This is the first study that quantitatively assesses standing whole-body alignment and postural abnormalities in LOPD. These postural alterations are not easily detectable during clinical examination and might be useful to early identify LOPD patients and to facilitate differential diagnosis with other proximal myopathies. Moreover, our St-mks placement protocol showed high reliability to assess any sagittal angles and, being non-invasive as compared to xR, is advisable to investigate and monitor the course of the disease and the response to treatment.