Effect of Physiotherapy on the Promotion of Bone Mineralization in Preterm Infants. A Randomized Controlled Trial.

Preterm infants have a low level of bone mineralization compared to those born at term. The purpose of the present study was to investigate the effect of reflex locomotion therapy (RLT) on bone mineralization and growth in preterm infants and compare its effect against other physiotherapy procedures. 46 preterm infants born at 29-34 weeks were randomized to three groups: One group received RLT (n=17); other group received passive movements with gentle joint compression (n=14); and control group received massage (n=15). All treatments were carried out at the neonatal unit lasting one month. The main outcome measure was the bone mineralization measured with Tibial Speed of Sound (Tibial-SOS). All groups were similar in terms of gestational age (31.8±1.18), birth weight (1,583.41±311.9), and Tibia-SOS (1,604.7±27.9), at the beginning of the intervention. At the end of the study, significant differences were found among groups in Tibial-SOS [F(4,86)=2.77, p=0.049, ηp2 = 0.114] in benefit of RLT group. In conclusion, RLT has been effective in the improvement of Tibial-SOS, and has been more effective than other physical therapy modalities; therefore it could be considered as one of the most effective physiotherapeutic modalities for the prevention and treatment of osteopenia of prematurity.

Development of Wrist Rehabilitation Device Using Extension Type Flexible Pneumatic Actuators with Simple 3D Coordinate Measuring System

Rehabilitation devices have been developed to assist patients recover from physical disabilities by using specific devices to do an exercise, training and therapy. The purpose of this study is to develop a home-based rehabilitation device which is safe to use and without requirement of person-in-charge. In this study, a simple home-based wrist rehabilitation device which can give passive exercise on spherical orbit while patients hold its handles is proposed and tested. The device has two moving handling stage driven by 6 extension type flexible pneumatic actuators (“EFPA” for short) on two hemispherical acrylic domes. The device can give passive exercise for the upper limb by changing the relative position of the patient’s hands. In this paper, the construction and operating principle of the tested device are described. A low-cost 3-dimentional coordinate measuring system using two wire-type linear potentiometers to control the position of the holding stages is also described. In addition, the tracking position control of the holding handles on sphere is carried out. As a result, it can be found that the handling stage of the tested device can trace the desired orbit based on the coordinates measured from 3-dimentional coordinate measuring system. It can be confirmed that the tested wrist rehabilitation device has a possibility to apply passive movements to the wrist along desired orbit while patients hold its handles.

Manual Therapy Interventions for Adhesive Capsulitis: A Review

Adhesive Capsulitis is a debilitating condition which causes the capsule of the Gleno-humeral joint to get thickened and contracted progressively. The prevalence of the disease is much higher in the middle aged and elderly community. It is characterized by pain in the shoulder, and advance towards the restriction of the active and passive glenohumeral motions and thereby obstructing the overall functional activities of the daily living. The effectiveness of various non-operative methods in the treatment of Adhesive Capsulitis has been demonstrated in the literature. Corticosteroid injections and the oral medications are known to be alleviating the pain levels and the inflammatory reactions but not the mobility of the affected joint. Joint mobilization techniques, electrotherapeutic modalities and other manual treatment methods are also found to be effective. In summary, this review focuses on the pathophysiology of the adhesive capsulitis, stages of the condition progress and various manual therapy interventions. Keywords: Gleno-humeral joint, frozen shoulder, rehabilitation, active and passive movements, functional activities.

EXPLORING APPROPRIATE EXERCISES FOR REHABILITATION IN A POST-STROKE PATIENT WITH IHD AND HYPOTHYROIDISM

According to a systemic analysis conducted in 2017, the blunt stroke incidence in various parts of India ranged from 44.29 to 559 per 100,000 people over the previous two decades. Stroke is the sudden loss of any neurological function due to a disturbance of blood flow. The majority of stroke victims suffer from long-term disability. We present the case of a 72-year-old woman who was admitted to the hospital with symptoms of fatigue on the left side of her body and facial palsy on the left side, on further assessment it was found that patient had coronary artery bypass grafting before 10 years with no post-operative complications and also had a history of hypothyroidism, this brings about the suspicion about the correlation between the stroke with the history of IHD and hypothyroidism. To manage these passive movements breathing exercises, bed mobility exercises, strengthening exercises followed by gait training was given which was highly effective to make the patient independent and return to her daily activities

Kinematic Alterations in the Shoulder Complex in Rockwood V Acromioclavicular Injuries During Humerothoracic and Scapulothoracic Movements: A Whole-Cadaver Study

Background: Previous cadaveric kinematic studies on acromioclavicular injuries described mainly rotational differences during humerothoracic movements. Although isolated scapulothoracic movements are also often performed during activities of daily life and can be painful after acromioclavicular injuries, they have not been extensively studied. Further, the analysis of joint translations in kinematic studies has received little attention compared with biomechanical studies. Hypothesis: A kinematic analysis of joint motions in the intact shoulder versus a shoulder with Rockwood V injury would demonstrate a different pattern of kinematic alterations during humerothoracic and scapulothoracic movements. Study design: Descriptive laboratory study. Methods: A kinematic analysis was performed in 14 cadaveric shoulders during 3 humerothoracic passive movements (coronal and sagittal plane elevation and horizontal adduction) and 3 scapulothoracic passive movements (protraction, retraction, and shrug). An optical navigation system registered rotational motions in the sternoclavicular, scapulothoracic, and acromioclavicular joints in the intact and Rockwood V conditions. In the acromioclavicular joint, mediolateral, anteroposterior, and superoinferior translations were also analyzed. Results: In the Rockwood V condition, a significant increase in clavicular elevation in the sternoclavicular joint during both humerothoracic and scapulothoracic movements was demonstrated, whereas a significant decrease in posterior rotation of the clavicle occurred only during humerothoracic movements. In the scapulothoracic joint, the scapular position changed most significantly during protraction. In the acromioclavicular joint, the scapular tilting position was altered significantly during both humerothoracic and scapulothoracic movements, whereas the scapular rotational position changed only during coronal and sagittal plane elevation. The largest significant changes in the scapular protraction position were seen during protraction movement. Further, in the acromioclavicular joint there was a significant inferior translation of the scapula during all motions, a significant anterior translation during protraction and horizontal adduction, and a significant posterior translation during coronal plane elevation. Mediolaterally, the acromial end of the scapula slid further under the distal clavicle during protraction than during horizontal adduction. Conclusion: Large kinematic differences were seen between the intact state and a Rockwood V lesion not only during humerothoracic movements but also during scapulothoracic movements in the cadaveric model. During humerothoracic movements, rotational differences were mainly caused by alterations in the clavicular position. In contrast, during protraction, the alterations in the scapular position were the dominant factor. Clinical Relevance: This study demonstrates that protraction induces larger kinematic alterations than horizontal adduction in acromioclavicular injuries and can therefore be included in both clinical examination and kinematic analyses to identify lesions more clearly.

Increasing Motor Cortex Activation During Grasping Via Novel Robotic Mirror Hand Therapy: A Pilot fNIRS Study

Background: Mirror therapy (MT) has been used for functional recovery of the affected hand by providing the mirrored image of the unaffected hand movement, which induces neural activation of the contralateral cortical hemisphere. Recently, many wearable robots assisting the movement of the hand have been developed, and several studies have proposed robotic mirror therapy (RMT) that provides mirrored movements of the unaffected hand on the affected hand with the robot controlled by electromyography or posture of the unaffected hand. There have been limited evaluations of the cortical activity during RMT compared to MT and robotic therapy (RT) providing passive movements despite the difference in the modality of sensory feedback and the involvement of motor intention, respectively. Methods: This paper analyzes bilateral motor cortex activation in nine healthy subjects and five chronic stroke survivors during a pinching task performed in MT, RT, and RMT conditions using functional near infrared spectroscopy (fNIRS). In the MT condition, the person moved the unaffected hand and observed it in a mirror while the affected hand remained still. In RT condition passive movements were provided to the affected hand with a cable-driven soft robotic glove, while, in RMT condition, the posture of the unaffected hand was measured by a sensing glove and the soft robotic glove mirrored its movement on the affected hand. Results: For both groups, the RMT condition showed the greatest mean cortical activation on the contralateral motor cortex compared to other conditions. Individual results indicate that RMT induces similar or greater neural activation on the motor cortex compared to MT and RT conditions. The interhemispheric activations of both groups were balanced in RMT condition. In MT condition, significantly greater activation was shown on the ipsilateral side for both subject groups, while the contralateral side showed significantly greater activation for healthy in RT condition. Conclusion: The experimental results indicate that combining visual feedback, somatosensory feedback, and motor intention are important for greater stimulation on the contralateral motor cortex of the affected hand. RMT that includes these factors is hypothesized to achieve a more effective functional rehabilitation due to greater and more balanced cortical activation.

Investigation of how accurately individuals with hemiparetic stroke can mirror their forearm positions

Current literature suggests that greater than 50% of survivors of a stroke cannot accurately perceive where their upper extremity is positioned. Our recent work demonstrates that the extent to which this perception is affected can depend on how the task is performed. For example, individuals with stroke who have a deficit in mirroring the position of their passively-placed paretic forearm during a between-arms task may accurately reproduce the position of their actively-controlled paretic forearm during a single-arm task. Moreover, the ability of individuals with various types of unilateral lesions to locate their thumb can depend on whether they reach for their paretic thumb or non-paretic thumb. Consequently, we investigated to what extent the accuracy of individuals post-hemiparetic stroke in mirroring forearm positions on a between-arms task is influenced by various conditions. Eighteen participants with hemiparetic stroke rotated their reference forearm to a target position, and then rotated their opposite forearm to concurrently mirror the position of their reference forearm. This task was performed when participants referenced each forearm (paretic, non-paretic) at two target positions (extension, flexion) for two modes of limb control (passive, active). We quantified for every testing scenario of each participant their position-mirroring error. The number of times for which participants were classified as having a deficit was least when mirroring forearm positions at the flexed position when referencing their non-paretic forearm. Additionally, the difference in the magnitude of errors when participants referenced each arm was greater during active than passive movements. Findings from this study provide further evidence that the accuracy with which individuals post stroke perceive the position of their limbs can depend on how a task is performed. Factors to consider include whether movements are active versus passive, which limb is referenced, and where the limb is positioned.

Numerical Simulation of a Multi-Body System Mimicking Coupled Active and Passive Movements of Fish Swimming

A multi-body system model is proposed for the mimicking of swimming fish with coupled active and passive movements. The relevant algorithms of the kinematics and dynamics of the multi-body system and coupled fluid solver are developed and fully validated. A simplified three-body model is applied for the investigation of the hydrodynamic performance of both an active pitch motion and passive movement. In general, there is an optimal stiffness, under which the model swims with the fastest velocity. The effect of the damper can be drawn only when the stiffness is small. Comparing with the rigid tail, the flexible tail leads to a faster speed when the stiffness and damping coefficients are in a suitable range.

Objective Accuracy Indicators of the Single-Joint Arm Movements Simultaneous Reproduction with Closed Eyes and under Visual Control in Patients with Hemiparesis and Healthy Test Subjects (a New Method for Proprioceptive Sensitivity Objective Assessment)

Aim. We have developed a method for objective assessment of proprioceptive sensitivity (PS) based on determining the accuracy of reproduction with the eyes closed of the tested arm passive single-joint movements by active movements of the other arm during their execution. It was shown that healthy test subjects reproduce the passive movements with high accuracy, while post-stroke patients with hemiparesis reproduce a large proportion of paretic arm test movements with gross qualitative and quantitative errors. To make sure that the reproduction errors are associated with the state of PS but not with the cognitive factor or the functional state of the conditionally healthy arm, it was necessary to find out how accurately these patients are able to reproduce the test-movements under visual control. Materials and Methods. In 11 patients with a lesion in the right and in 9 patients in the left hemispheres of the brain and a control group of 23 healthy subjects, the accuracy of reproduction of the 5 elementary hand movements was studied: flexion-extension in the shoulder, elbow and wrist joints and abduction–adduction in the shoulder and wrist joints. The test person was subjected to a series of passive cyclic movements of the test hand during which he had to copy them with active movements of the other hand. The reproduction procedure for each test movement was performed first under visual control and then with the eyes closed. The angles in the test join and the same joint of the other arm were recorded. Qualitative and quantitative indicators were used to assess the degree of similarity of active and passive movements and to reveal the correspondence of copying accuracy to the previously developed conditional criterion of the norm (CCN) of PS in healthy test subjects. Results. It was shown that in healthy test subjects the accuracy of all movements copying in tests with closed eyes and 98% of movements in tests with opened eyes met the requirements of the CCN. In the group of patients in tests with eyes closed, copying only 61% of movements met this criterion. 20.4% of movements were reproduced with qualitative gross errors, 18.4% were copied qualitatively correctly but differed from CCN in quantitative indicators. In tests with visual tracking of passive movements, reproduction of 98% of movements was qualitatively correct and 83% of movements corresponded to CCN. Conclusions. The vast majority of single-articular movements of the paretic arm are copied by patients with unilateral brain damage under visual control qualitatively correctly and accurately (meeting the CCN). It means that in the course of the study of PS by the proposed method, they, as a rule, understand the motor task and can reproduce the tested movements with their conditionally healthy arm. From this it follows that the main cause of these movements impaired copying in tests with closed eyes is proprioceptive deficit.