Normative pelvic floor parameters in children assessed by transabdominal ultrasound.

PURPOSE: Successful management of dysfunctional voiding in children hinges on retraining inappropriate pelvic floor muscle recruitment. Recently dynamic pelvic floor muscle activity was visualized in adults using transabdominal ultrasound. We evaluated transabdominal ultrasound for visualizing and measuring pelvic floor muscle activity in normative children. MATERIALS AND METHODS: A total of 21 volunteers, including 10 boys and 11 girls 7 to 16 years old (mean age 11.6) who were free of bladder disorders consented to participate in the study. Subjects were screened and demonstrated normative bladder emptying before being imaged while supine and standing using a sagittal curved linear array 2 to 5 MHz transducer over the suprapubic region. After pelvic floor muscle contraction was explained 4 parameters were measured 3 times each, including the direction of movement/displacement from freeze-frame ultrasound images, and endurance and coordination from ultrasound movie loops. The methodology for digitizing movie data were developed, tested and found to be reliable. New variables of endurance as a percent of maximum coordination amplitude and coordination as the amplitude between maximum and minimum effort were created. RESULTS: Overall 66% and 71% of subjects demonstrated anterior displacement of the pelvic floor during voluntary contraction while lying and standing, respectively, with no significant difference in lying vs standing. However, coordination displacement was greater while lying than standing. During 20-second contractions pelvic floor muscle activity attained peak amplitude at 5.5 seconds, followed by a marked decay with 1 or more cycles of muscular re-recruitment. It was observed that fatigue led to repeat recruitment of the rectus and oblique abdominal muscles. CONCLUSIONS: In children free of voiding dysfunction pelvic floor displacement and coordination are highly variable. Noninvasive ultrasound of the pelvic floor provided visual assessment of muscular activity, a biofeedback component for the patient and measurement potential for the therapist.

The position of the spine in the recovery position--an experimental comparison between the lateral recovery position and the modified HAINES position.

UNLABELLED: The lateral recovery position is widely used for the positioning of unconscious patients. Ideally, in the setting of trauma it is avoided because of concerns about spinal cord injury. However, unconscious individuals with unsuspected trauma or trauma victims attended by partially trained first-aiders may be placed in the recovery position, potentially endangering the cord. Excessive movement of the spine in the recovery position may increase the risk of spinal cord injury in these situations. A new recovery position, termed the modified HAINES position, is described and the position of the spine in this position is compared with the lateral recovery position. HYPOTHESIS: That the modified HAINES position results in less distortion of the position of the spine than the lateral recovery position. METHODS: Thirty-eight healthy volunteers were imaged in the two different positions. Measurements of rotation, flexion and lateral flexion of the cervical and thoraco-lumbar spine were made. Two tailed paired t-tests were employed to compare measurements of the two positions and a McNemar test was used to compare the subjects' subjective experiences. RESULTS: The modified HAINES position resulted in 13.0 degrees (99% CI: 7.5-18.5) less lateral flexion and 12.6 degrees (99% CI: 9.4-15.9) less extension of the cervical spine while the position of the thoraco-lumbar spine was similar in both positions. Nineteen of 28 subjects found the modified HAINES position more comfortable (not significant). CONCLUSION: The modified HAINES position results in a more neutral position of the spine making it preferable to the lateral recovery position in the management of patients when trauma may have occurred. Further research is required to ensure that the recovery positions in use today are the best possible.

The role of weightbearing in the clinical assessment of knee joint position sense.

Knee joint position sense was assessed by active tests with active limb matching responses in supine lying and in unilateral weightbearing (WB) stance using (re)positioning of the whole limb whilst focusing on the knee, and in supine lying using (re)positioning confined to the knee. Following five tests at approximately 45 degrees knee flexion in all three test conditions, position sense was found to be significantly more accurate and reliable following the WB procedure. Possible explanations are, first, that during WB the subjects were more able to assist identification of the test positions using cues obtained during movement of the knee to and from these positions. Second, a larger volume of proprioceptive afferent information may have been derived from sources outside the examined knee, and even outside the examined limb. Whilst WB joint position sense assessments are more functional, the obtained results may not characterise the capacity of the proprioceptors in and around the examined (knee) joint. Since the WB and NWB results were not correlated, one procedure cannot be used to predict results from the others. Also, predominantly unilateral WB stance is often impractical for subjects with limited balance or WB pain.

Aftereffects of resisted muscle contractions on the accuracy of joint position sense in elite male athletes.

OBJECTIVE: To examine the effects of quadriceps and hamstring muscle strength testing on the results of subsequent knee joint position sense tests. DESIGN: A case-control study of 40 elite male athletes divided equally into two groups, experimental and control. METHODS: Both groups underwent position sense tests of both knees, with eyes closed, with isometric maintenance of the knee in each test position, return of the limb to the starting position, then active replication of the perceived test position using the same limb. In the experimental group, joint sense testing commenced 5 to 25 min after strength testing of quadriceps and hamstring muscle strength in both legs using maximum isokinetic contractions at plateau speeds of 60 degrees/sec and 120 degrees/sec. The control group did not undergo pretest muscle strength testing. RESULTS: The difference in the mean absolute (signless) and relative (signed) position sense errors between the experimental and control groups was 0.8 degrees and 1.4 degrees, respectively. The difference between the standard deviation of the relative errors was 1.2 degrees. These results were not statistically significant (analysis of variance p = .24, .12, and .13, respectively). CONCLUSION: In elite male athletes knee joint position sense is unaffected by nonfatiguing strength tests conducted 5 to 25 min before position sense testing.

Computer-aided video analysis of vertebrofemoral motion during toe touching in healthy subjects.

OBJECTIVE: Despite widespread use of the toe touch test, the relative contribution from vertebral and hip movements has not been clearly established, largely because of unsatisfactory measurement techniques. This study aimed to reinvestigate the kinematics of toe touching by combining computerized videotape analysis with a new model of reference marker placement. METHOD: Twenty-two subjects were videotaped during active toe touching from upright standing. Computer software was then used to derive the sagittal thoracic, lumbar, and hip angles at .02-sec intervals throughout the movement. RESULTS: Hip flexion was directly proportional to toe touch distance (TTD) (r2 = .71) but not lumbar flexion (r2 = .17) or thoracic (r2 = .20) excursion. On average there was .8 degree of thoracolumbar flexion for every 1 degree of hip flexion; however, there were wide variations between subjects. In 19 of 22 subjects the thoracic spine flexed and extended relatively equal amounts during the test resulting in a small total thoracic excursion of 4.8 degrees flexion in unsuccessful toe touchers and 4.0 degrees extension in successful toe touchers. CONCLUSION: The separate contributions of hip, lumbar, and thoracic mobility to toe touching or any other vertebrofemoral motion can only be accurately determined by a measurement strategy that uses the plane of the pelvis to separate vertebral from hip motion and uses tangents at the limits of the thoracic and lumbar regions to separate lumbar from thoracic motion. Using this model the authors found that TTD is not a reliable indicator of either vertebral or hip mobility.

How should an unconscious person with a suspected neck injury be positioned?

INTRODUCTION: Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the "lateral recovery position," coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance. HYPOTHESIS: It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the "HAINES modified recovery position." HAINES is an acronym for High Arm IN Endangered Spine. METHODS: Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position. RESULTS: For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each). CONCLUSION: An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.

ASSESSMENT PICTOGRAPHY: A Pictographic Assessment and Treatment Record.

The author's intention in developing assessment pictography (ASPI) was to provide a fully diagrammatic and freehand recording system with wide application in physiotherapy. In its present form ASPI allows recording of the results from five basic aspects of assessment and the recording of one area of treatment, as follows: Active Movement Test Movement tested. Starting position. Range of movement and estimated normal range. Pain during movement. Passive Movement Test Movement tested. Starting position. Range of movement and estimated normal range. Pain during movement. Abnormal resistance during movement. Muscle Strength Grading, Isometric Test "Movement" tested. Starting position. Intensity of muscle contraction. Pain during test. Functional Ability Test Activity tested. Level of ability. Passive Treatment Techniques Type of technique. Manner of delivery. Movement treated.

VIBRATORY MOTOR STIMULATION: A Preliminary Report.

At the annual meeting of the Australian Association of Neurologists in 1964, J. W. Lance-from the Division of Neurology, Prince Henry Hospital, Sydney, and the School of Medicine, University of New South Wales-made one of the earliest reports on the effects of low amplitude, high frequency, sinusoidal stretch on human skeletal muscle (Lance, 1965). This effect consists of an involuntary asynchronous motor unit contraction in the muscle subjected to the mechanical vibration, with reciprocal relaxation of the prime antagonists. Hagbarth and Eklund (1966a) termed this response the tonic vibration reflex (TVR). This author has coined the term vibratory motor stimulation (VMS) to describe the use of mechanical vibration for the purpose of eliciting the TVR or its correlates.

Physiology of pregnancy.

Pregnancy commences with the fertilization of an ovum, and terminates thirty-eight weeks later with the commencement of parturition. Once a month, approximately fourteen days before commencement of menstruation, an ovum is liberated from a mature graafian follicle. Fertilization usually occurs just before or soon after the ovum enters a fallopian tube. The zygote (fertilized ovum) takes approximately four days to pass down the tube, and on reaching the uterus it has divided several times to form the blastocyst. The blastocyst remains free in the uterus a further two to three days before being embedded in the endometrium (endothelial lining of the uterus). After ovulation the graafian follicle develops into the corpus luteum, a specialized endocrine structure.

The activation or de-activation of receptors for the purpose of developing somatic, autonomic, and mental functions: introduction. Part I - philosophy.

At the present time there appears to be a growing interest in the work of Miss Rood - Professor and Chairman, Physical Therapy Department, University of Southern California, U.S.A. Her approach deals with the activation or de-activation of receptors for the purpose of developing somatic, autonomic, and mental functions. The work is based upon what is presently known or believed in the field of physiology, and upon a re-evaluation of normal human ontogenesis.

Some aspects of the theory, performance, and interpretation of the strength duration test.

The strength duration test was first used for clinical purposes by Adrian (1916), and later developed by Ritchie (1944). The classical galvanic-faradic test, first used about 1859 by Baierlacher (Licht, 1961), was considered by Hickock in 1961 to be the most commonly used electro-diagnostic procedure. Today this test has been almost completely superseded by the strength duration test.

A discussion on the use of muscle stretch in re-education.

Application of the physiological principles of muscle stretch for facilitatory and inhibitory purposes has formed a major part of the proprioceptive neuromuscular facilitation techniques of Dr. Herman Kabat and Margaret Knott (Kabat, 1947; Knott and Voss, 1956), and is also used by many other workers. One of the most accurate interpretations of this physiological knowledge has been made by Professor Margaret S. Rood, of the University of Southern California (Rood, 1964), and in this paper I will describe her work along with certain other fundamental considerations.