Kinematic measures during a clinical diagnostic technique for human neck disorder: inter- and intraexaminer comparisons.

Diagnoses of human musculoskeletal dysfunction of the cervical spine are indicated by palpable clues of a patient's structural compliance/noncompliance as this body segment responds to diagnostic motion demands applied by a clinician. This process includes assessments of motion range, motion performance, and changes in tissue responses. However, biomechanical quantification of these diagnostic actions and their reproducible components is lacking. As a result, this study sought to use objective kinematic measures to capture aspects of the diagnostic process to compare inter- and intraexaminer motion behaviors when performing a specific clinical diagnostic protocol. Pain-free volunteers and a group determined to be symptomatic based on a psychometric pain score were examined by two clinicians while three-dimensional kinematic data were collected. Intraexaminer diagnostic motion ranges of cervical lateral flexion and secondary rotations were consistent for each examiner and for each subject group. However, interexaminer comparisons for motion range, secondary rotations, and average velocities yielded consistently larger measures for one examiner for both subject groups (P < 0.05). This research demonstrates that fundamental aspects of the clinical diagnostic process for human neck disorders can be identified and measured using kinematic parameters. Further, these objective data have the potential to be linked to clinical decision making.

Differences in human cervical spine kinematics for active and passive motions of symptomatic and asymptomatic subject groups.

Most musculoskeletal disorders of the head and neck regions cannot be identified through imaging techniques; therefore clinician-conducted assessments (passive motions) are used to evaluate the functional ability of these regions. Although active motions do not require interaction with a clinician, these movements can also provide diagnostic indicators of dysfunction. The purpose of this research was to determine whether kinematic measures differed between active and passive movements of participants in symptomatic and asymptomatic groups. Data obtained on cervical lateral flexion range of motion (ROM), coupled axial rotation, and the angular velocity of lateral flexion were statistically analyzed and demonstrated differences between active and passive motions for symptomatic and asymptomatic subjects. Active motions had higher angular velocities (P < .001) and larger ROMs, with greater lateral flexions (P < .05). The asymptomatic group produced a larger average lateral flexion of 7.9° at an average angular velocity of 2 deg/s greater than the symptomatic group. Trends with regard to group assignment were the same for active and passive motions. This work demonstrates the potential for using kinematic measures of active and passive motions to develop an objective standard for diagnoses of cervical dysfunction and supports validity of the clinician-based analysis to distinguish between participant groups.

Blood perfusion and transcutaneous oxygen level characterizations in human skin with changes in normal and shear loads--implications for pressure ulcer formation.

BACKGROUND: Decubitus ulcers (pressure ulcers) are localized areas of tissue breakdown in the skin and the underlying regions. Decubitus ulcers affect approximately 3 million people in the USA every year, including seniors, individuals with diabetes, and those who spend long periods in wheelchairs. Experimental studies demonstrate that static or dynamic normal loads cause blood occlusion in the skin, while prolonged loading conditions can result in skin damage. However, few studies report the effects of 'normal and shear' combined loading on blood perfusion. The goal of this research was to study alterations of transcutaneous oxygen levels and blood perfusion in human skin when both normal and shear loads were applied. METHODS: Fifteen human subjects were evaluated under seven different conditions for changes in transcutaneous oxygen and blood perfusion levels during applications of normal and shear loading on the forearm. Transcutaneous oxygen levels and blood perfusion were continuously measured using a Laser Doppler system, while applied forces were quantified with a multi-axis load cell. FINDINGS: Transcutaneous oxygen and blood perfusion levels decreased when shear loads were applied in addition to normal loads. Further, blood perfusion during recovery periods increased gradually from the first to the last test condition. INTERPRETATION: Results indicate that adding shear loads decreased transcutaneous oxygen and blood perfusion levels in the skin. Based on these findings, shear force may play a role in skin damage, and both shear and normal loads should be considered when trying to prevent ulcer development.

Kinematic measures to objectify head and neck motions in palpatory diagnosis: a pilot study.

CONTEXT: Physicians typically combine the use of palpation and objective measures, as evidence-based medicine dictates, to improve patient diagnosis and care. Practitioners also use palpatory examination in manual medicine to diagnose musculoskeletal impairment; however, there are no commonly accepted objective measures to complement palpatory findings. OBJECTIVE: To evaluate coupled vertebral motion as a parameter to complement palpatory findings from a standard clinical diagnostic test of cervical function. METHODS: Two examiners performed a blind screening of volunteer subjects for the presence of palpable symmetry or asymmetry in motions of the head and neck. In cases of interexaminer agreement, subjects then participated in kinematic assessment of cervical motion patterns. Neck angles were recorded, plotted, and evaluated for amounts of vertebral coupling. RESULTS: Interexaminer agreement was reached with 18 of the 34 subjects screened. Seven subjects with symmetric responses constituted the control group. Experimental subjects consisted of an asymmetric-asymptomatic (pain-free) group (n=6) and an asymmetric-symptomatic (pain) group (n=5). Control subjects exhibited the smallest average linear slope (-0.32) for the least amount of coupled motion. The average linear slopes for asymmetric subjects was -0.42 (asymptomatic) and -0.50 (symptomatic). Data analysis revealed that statistically significant differences among groups will be detected with a larger sample size. CONCLUSIONS: Objective, kinematic parameters can be generated, measured, and evaluated relative to palpatory findings of musculoskeletal impairment by identifying trends in ratios of cervical lateral flexion and axial rotation.

A myoelectric model for thoracic spinal motion dynamics during clinical rotation tests: Part 2. Bilateral segmental motor behaviors.

In part 2 of their report, the authors continue to evaluate myoelectric data obtained from spinal motion dynamics involved in clinical rotation tests. They add to the ipsilateral regional analysis of motor performance as previously presented and analyze the total bilateral myoelectric activity gathered concurrently at individual thoracic vertebral segments during simultaneous rotation left and right motion tests. The authors' hypothetical consideration concerns the nature of composite behaviors at these vertebral segments during active and passive motions and the role that postural dynamics play in movement function. They consider these concepts in the context of the study's experimental design and also within the broader concept of the osteopathic musculoskeletal examination. Results revealed pronounced similarity in individual spinal electromyographic patterns whether motions were volitional or physician induced. Analysis demonstrates the bell-shaped myoelectric behavior pattern originally reported in part 1. The authors also discuss a functional model for this myoelectric activity involving a helical spinal motor pattern with a focal area of transition that is dynamic in response to postural and motion demands.

A myoelectric model for thoracic spinal motion dynamics during clinical rotation tests: Part 1. Ipsilateral regional motor performance.

Osteopathic physicians may use regional diagnostic rotation tests of the spine during physical examinations for patient evaluations. Clinical judgments of these responses relate to symmetry as a criterion for mobility. This first part of a two-part study reports the authors' investigation of regional ipsilateral myoelectric activity during responses to active and passive shoulder and trunk rotations on the left- and right-side muscles with subjects seated. Results indicate symmetry existed in both active and passively induced regional rotation tests. Further, the distribution (profile) of ipsilateral myoelectric activity in the thorax reflected a bell-shaped activity curve that peaked at thoracic levels 6 and 7. This profile element demonstrates remarkable similarity between volitional and physician-induced rotation motions. These myoelectric data justify symmetry and profile as tangible standards for making clinical judgments of regional responses to spinal rotation diagnostic tests.