Improving Upper Extremity Strength, Function, and Trunk Stability Using Wide-Pulse Functional Electrical Stimulation in Combination With Functional Task-Specific Practice

Objectives: To evaluate upper extremity (UE) function, strength, and dynamic sitting balance in individuals with spinal cord injury (SCI) who received an intensive outpatient therapy program focused on UE training augmented with wide pulse/high frequency functional electrical stimulation (WPHF-FES). Methods: This prospective case series was conducted in an outpatient (OP) clinic in an SCI-specific rehabilitation hospital. Participants were a convenience sample (N = 50) of individuals with tetraplegia receiving OP therapy focused on UE recovery. Individuals participated in 60 minutes of UE functional task-specific practice (FTP) in combination with WPHF-FES 5 times/week for an average of 72 sessions. The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS) and the modified functional reach (MFR). Results: Fifty individuals (13 motor complete; 37 motor incomplete SCI) completed an OP UE training program incorporating WPHF-FES and were included in this analysis. On average, participants demonstrated significant improvements in the total CUE-T score of 14.1 (SD = 10.0, p < .0001) points; significant changes were also noted in UEMS and MFR, improving an average of 4.6 (SD = 5.2, p < .0001) points and 13.6 (SD = 15.8, p < .0001) cm, respectively. Conclusion: Individuals with tetraplegia demonstrated significant improvements in UE strength, function, and dynamic sitting trunk balance after receiving UE training augmented with WPHF-FES. Future comparative effectiveness studies need to be completed to guide efficacious treatment interventions in OP therapy.

Development of a System for Measurement on Asymmetric Sitting Posture

Sitting posture measurement system using the unstable board with accelerometer was developed. And, postural balance was assessed to determine the effect of asymmetry on sitting posture between patients with pelvic asymmetry and healthy subjects. 10 subjects (pelvic asymmetry patients:5, healthy controls:5) were participated in this study. We performed experiment under static and dynamic sitting condition. Angular variation in the anterior-posterior and left-right direction was measured in both two conditions. Also, intra class correlation coefficient was used to evaluate the reliability of the system. The value of angle of pelvic asymmetry patients was more tilted significantly to the left side than right side during static and dynamic sitting. The reliability of the system was excellent. This paper suggested that a system for measurement on asymmetric sitting posture can be utilized to provide useful information about patients with pelvic asymmetry in rehabilitation medicine. Furthermore, results from this study can be used to develop the new clinical quantitative measurement system.

Low Back Pain Exacerbation Is Predictable Through Motif Identification in Center of Pressure Time Series Recorded During Dynamic Sitting

Background: Low back pain (LBP) is a common health problem — sitting on a chair for a prolonged time is considered a significant risk factor. Furthermore, the level of LBP may vary at different times of the day. However, the role of the time-sequence property of sitting behavior in relation to LBP has not been considered. During the dynamic sitting, small changes, such as slight or big sways, have been identified. Therefore, it is possible to identify the motif consisting of such changes, which may be associated with the incidence, exacerbation, or improvement of LBP.Method: Office chairs installed with pressure sensors were provided to a total of 22 office workers (age = 43.4 ± 8.3 years) in Japan. Pressure sensors data were collected during working days and hours (from morning to evening). The participants were asked to answer subjective levels of pain including LBP. Center of pressure (COP) was calculated from the load level, the changes in COP were analyzed by applying the Toeplitz inverse covariance-based clustering (TICC) analysis, COP changes were categorized into several states. Based on the states, common motifs were identified as a recurring sitting behavior pattern combination of different states by motif-aware state assignment (MASA). Finally, the identified motif was tested as a feature to infer the changing levels of LBP within a day. Changes in the levels of LBP from morning to evening were categorized as exacerbated, did not change, or improved based on the survey questions. Here, we present a novel approach based on social spider algorithm (SSA) and probabilistic neural network (PNN) for the prediction of LBP. The specificity and sensitivity of the LBP inference were compared among ten different models, including SSA-PNN.Result: There exists a common motif, consisting of stable sitting and slight sway. When LBP level improved toward the evening, the frequency of motif appearance was higher than when LBP was exacerbated (p < 0.05) or the level did not change. The performance of the SSA-PNN optimization was better than that of the other algorithms. Accuracy, precision, recall, and F1-score were 59.20, 72.46, 40.94, and 63.24%, respectively.Conclusion: A lower frequency of a common motif of the COP dynamic changes characterized by stable sitting and slight sway was found to be associated with the exacerbation of LBP in the evening. LBP exacerbation is predictable by AI-based analysis of COP changes during the sitting behavior of the office workers.

Effectiveness of Combined Stretching and Strengthening Exercise Using Rehabilitation Exercise System with a Linear Actuator and MR Damper on Static and Dynamic Sitting Postural Balance: A Feasibility Study

Postural imbalance induced by prolonged sitting can be improved by exercise therapy. The aim of study was to evaluate the influence of combined stretching and strengthening exercise using rehabilitation exercise system with a linear actuator and MR damper on static and dynamic sitting postural balance. Twelve subjects who sit almost 10 h a day participated in this study. The rehabilitation exercise system with a linear actuator and MR damper was manufactured to provide stretching and strengthening exercise. All subjects were asked to perform an exercise program that was designed to enhance postural balance by stretching the tight muscle and strengthening the weakened muscle. Body pressure distributions were analyzed for mean force and mean pressure using a seat sensor system. Trunk muscle activities were measured by attaching surface electrodes to the thoracic erector spinae, lumbar erector spinae, and lumbar multifidus muscle. All data were divided into two regions (dominant and non-dominant side) under four conditions: no pelvic tilt, lateral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt. Body pressure distributions and trunk muscle activities were compared between before and after performing exercise under static and dynamic sitting conditions. Both in static and dynamic sitting conditions, there were significant differences in body pressure distributions and trunk muscle activities between the DS and NDS before performing the exercise (p < 0.01). After performing exercise, the body pressure distributions increased on the dominant side while those decreased on the non-dominant side significantly (p < 0.01). In addition, the activities of all trunk muscles on the non-predominant side increased significantly (p < 0.01 and p < 0.05). These results showed that postural balance was improved by decreasing the differences in body pressure distribution and trunk muscle activity between the dominant and non-dominant side after performing exercise. From the results of this study, we concluded that the rehabilitation exercise system with a linear actuator and MR damper is suitable for providing combined stretching and strengthening exercise, and it could be helpful to maintain correct posture by enhancing postural balance during sitting.

The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Randomized Controlled Trial

Background: Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) (n = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) (n = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients (n = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention).

Influence of Various Types of Office Desk Chair for Dynamizing the Operation Assessed by Raster Stereography

The current development trend of the operational activities indicates an increase in occupations which last for a few generations and whose primary position is the activity in the sitting position. This trend is directly connected with the technological progress and development of the society within Industry 4.0. However, the workplaces intended for sitting occupations that are designed according to the current standards are unsuitable from several perspectives. The long-term sitting activities at most actual workplaces cause an accumulation of the static load. For this reason, the article deals with dynamizing the activities in the sitting position. The presented research is based on utilizing the knowledge of the sitting posture dynamics and on the information acquired through diagnostics based on the Raster Stereography as an innovative method based on modelling a natural human spin. The article brings the first research results, which points out the fact that probably not all types of dynamic sitting that are nowadays preferred are suitable for long-term working.

The effectiveness of additional core stability exercises in improving dynamic sitting balance, standing balance, lower-limb spasticity, falls and gait in subacute stroke patients (CORE-trial). Study protocol for a Randomized Controlled Trial

BackgroundTrunk impairment produces disorders of motor control, balance, and gait that are correlated with increased risk of falls and reduced mobility in stroke survivors. This creates disability and dependency to perform their activities of daily living. Alterations in body alignment occur, requiring treatment strategies focused on improving the postural control. bearing. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, dynamic sitting, standing balance, and gait. There is some evidence about its effectiveness but it is still necessary to run a large multicenter trial to ratify that existing evidence.MethodsThis is a single-blind multicenter randomized controlled trial. Two parallel groups are compared and both perform the same type of therapy. A control group (CG) (n=110) performs conventional physiotherapy (CP) (1 hour per session) focused on improving balance. An experimental group (EG) (n=110) performs CSE (30 minutes) in addition to CP (30 minutes) (1 hour/session in total). EG is divided in two subgroups, in which only half of patients (n=55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by Spanish-version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at 3 weeks (T1), at 5 weeks -at the end of the intervention (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a 5-week intervention, followed by a 24-week post-intervention). DiscussionThe study will provide useful information on the short and long term effects of a physiotherapy rehabilitation program based on core stability exercises performed in subacute phase.Trial registrationClinicalTrials.gov Identifier NCT03975985. Data registration June 5th, 2019. Retrospectively registered. Date of registration in primary registry: June 5, 2019. Protocol version 1

Trunk Posture Adaptations during Sitting on Dynamic Stool: A Validation Study

Back pain is a complex condition that results from multiple factors including sitting issues such as the chair type and spinal sitting posture. The physiological spinal curvature on the sagittal plane represents a typical feature of good body posture. Sitting postures matching the physiological shape of the spine on the sagittal plane during standing are deemed advantageous from a postural point of view. The aim of this study was to validate a novel dynamic stool by comparing trunk posture adaptations on the sagittal plane during dynamic sitting vs. conventional sitting (standard stool) in healthy people. In total, 100 healthy adults were included. Age, sex and body mass index were recorded. Thoracic kyphosis and lumbar lordosis were measured with the IncliMed® goniometer during standing posture, conventional sitting posture (standard stool) and dynamic sitting posture (novel dynamic stool). Sitting posture was maintained for 2 min before evaluation. Thoracic kyphosis and lumbar lordosis were significantly different between standing vs. sitting (dynamic and conventional) posture (p < 0.001) and between dynamic vs. conventional sitting posture (p < 0.001). Sitting on the novel dynamic stool tested in this study was shown to provide a greater match of thoracic kyphosis and lumbar lordosis with the physiological spinal curvature on the sagittal plane during standing than conventional sitting.