Cervical range of movement in relation to neck dimension

Differences in Demographic and Radiographic Characteristics between Patients with Visible and Invisible T1 Slopes on Lateral Cervical Radiographic Images

Introduction: The T1 slope is important for cervical surgical planning, and it may be invisible on radiographic images. The prevalence of T1 invisible cases and the differences in demographic and radiographic characteristics between patients whose T1 slopes are visible or invisible remains unexplored. Methods: This pilot study aimed to evaluate the differences in these characteristics between outpatients whose T1 slopes were visible or invisible on radiographic images. Patients (n = 60) who underwent cervical radiography, whose T1 slope was confirmed clearly, were divided into the visible (V) group and invisible (I) group. The following radiographic parameters were measured: (1) C2-7 sagittal vertical axis (SVA), (2) C2-7 angle in neutral, flexion, and extension positions. Results: Based on the T1 slope visibility, 46.7% of patients were included in group I. The I group had significantly larger C2-7 SVA than the V group for males (p < 0.05). The C2-7 SVA tended to be larger in the I group, without significant difference for females (p = 0.362). Discussion: The mean C2-7 angle in neutral and flexion positions was not significantly different between the V and I groups for either sex. The mean C2-7 angle in the extension position was greater in the V group. The T1 slope was invisible in males with high C2-7 SVA.

Monitoring of neck activity for early warning of cervical spondylosis

Wireless body area networks (WBANs) is a new research hotspot with great development prospects. The non-contact sensing based on radio frequency signal can solve the issues of personal comfort and privacy. Detection of cervical motion range and cervical strain in time are important in diagnosis and prevention of cervical spondylosis. In this paper, channel state information is used to achieve smart perception and monitoring, timely and efficient detection of different postures and abnormal bending of the neck. It provides an efficient way for protecting cervical health, and also some help for doctors to understand the causes of cervical vertebral disease in a timely manner. The classification accuracy of the four activities reached 99.4%, 99.7%, 99.5% and 99.3%, respectively.

Improving the staging of neck injuries using a new index, the Neck Functional Holistic Analysis Score: Clustering approach to determine degrees of impairment

Background

Traumatic cervical spine injuries are amongst the traffic injuries that can cause most harm to a person. Classifying subtypes of clinical presentations has been a method used in other pathologies to diagnose more efficiently and to address the appropriate treatment and the prognosis. The management of patients suffering from cervical injuries could be improved by classifying the severity of the impairment. This will allow clinicians to propose better treatment modalities according to the severity of the injury.

Materials and methods

The present study is a retrospective cohort study performed with the clinical data from 772 patients stored at Fisi-(ON) Health Group. All the patients treated for cervical spine injuries are evaluated using the EBI-5^® system, which is based on inertial measurement unit (IMU) technology. The normalized range of motion of each patient was incorporated into a single index, the Neck Functional Holistic Analysis Score (NFHAS).

Results

Clustering analysis of the patients according to their NFHAS resulted in five groups. The Kruskal-Wallis H test showed that there were statistically relevant differences in the ROM values and NFHAS of the patients depending on the cluster they were assigned to: FE X²(4) = 551.59, p = 0.0005; LB ROM X²(4) = 484.58, p = 0.0005; RT ROM X²(4) = 557.14, p = 0.0005; NFHAS X²(4) = 737.41, p = 0.0005. Effect size with ηp² for the comparison of groups were: FE = 0.76, LB = 0.68, RT = 0.76 and NFHAS = 0.96.

Conclusion

The NFHAS is directly correlated to the available ROM of the patient. The NFHAS serves as a good tool for the classification of cervical injury patients. The degree of impairment shown by the cervical injury can now be staged correctly using this new classification.

Predictive performance of a multivariable difficult intubation model for obese patients

Background

A predictive model of scores of difficult intubation (DI) may help physicians screen for airway difficulty to reduce morbidity and mortality in obese patients. The present study aimed to set up and evaluate the predictive performance of a newly developed, practical, multivariate DI model for obese patients.

Methods

A prospective multi-center study was undertaken on adults with a body mass index (BMI) of 30 kg/m² or more who were undergoing conventional endotracheal intubation. The BMI and 10 preoperative airway tests (namely, malformation of the teeth in the upper jaw, the modified Mallampati test [MMT], the upper lip bite test, neck mobility testing, the neck circumference [NC], the length of the neck, the interincisor gap, the hyomental distance, the thyromental distance [TM] and the sternomental distance) were examined. A DI was defined as one with an intubation difficulty scale (IDS) score ≥ 5.

Results

The 1,015 patients recruited for the study had a mean BMI of 34.2 (standard deviation: 4.3 kg/m²). The proportions for easy intubation, slight DI and DI were 81%, 15.8% and 3.2%, respectively. Drawing on the results of a multivariate analysis, clinically meaningful variables related to obesity (namely, BMI, MMT, and the ratio of NC to TM) were used to build a predictive model for DI. Nevertheless, the best model only had a fair predictive performance. The area under the receiver operating characteristic curve (AUC) was 0.71 (95% confidence interval 0.68–0.84).

Conclusions

The predictive performance of the selected model showed limited benefit for preoperative screening to predict DI among obese patients.

3-Dimensional Cervical Movement Characteristics and the Influence of Thoracic Treatment on a Subgroup of Acute Neck Pain Patients

OBJECTIVE

The purpose of this study was to investigate the influence of thoracic high-velocity low-amplitude thrust (HVLAT) manipulation on quantitative and qualitative 3-dimensional cervical spine kinematic patterns in a subgroup of patients with acute neck pain.

METHODS

Thirty patients with acute neck pain, aged 20 to 59, received a thoracic HVLAT manipulation. Three-dimensional kinematics of the cervical spine were registered pretreatment and posttreatment using an electromagnetic tracking system. Quantitative and qualitative parameters were calculated for axial rotation, lateral bending, and flexion-extension movement. Subjective pain ratings were measured with the visual analogue scale and the Neck Disability Index and were collected pretreatment and posttreatment.

RESULTS

After treatment, the range of motion of the main motion improved significantly for axial rotation (P = .034), lateral bending (P < .001), and flexion-extension (P = .031). Although for axial rotation as the main motion, the smoothness of the flexion-extension movement improved significantly after treatment (P = .036), the reverse was true for flexion-extension as the main motion. Visual analogue scale scores exhibited a statistically (P < .001) and clinically significant reduction of pain sensation. The mean change in Neck Disability Index scores only exhibited a statistically significant improvement 1 week after treatment.

CONCLUSION

Thoracic HVLAT manipulation led to positive changes in quantitative and qualitative aspects of 3-dimensional cervical spine kinematics. Because of the 1-intervention group design, external factors influencing the healing process could not be eliminated.

Feasibility and Preliminary Efficacy of Tailored Yoga in Survivors of Head and Neck Cancer: A Pilot Study

Purpose: Treatment for head and neck cancer (HNC) results in long-term toxicities and increased physical and psychosocial survivor burden. There are a limited number of treatments for these late effects. Yoga postures, breath work, relaxation, and meditation, may improve these late effects. The purpose of this study was to examine the feasibility of a tailored yoga program in HNC survivors and obtain preliminary efficacy data. Methods: This was a randomized wait-list control study of yoga-naive HNC survivors who were >3 months post–cancer treatment. Baseline data were collected. Participants were randomized to either an 8-week hatha yoga intervention group or a wait-list group. Feasibility and efficacy data were collected. At 4 and 8 weeks, patients underwent a repeat assessment of health. Wait-list control group participants were offered the yoga program after data collection. Descriptive statistics evaluated feasibility. Mixed effects general linear models were used to generate estimates of the efficacy outcomes. Results: Seventy-three individuals were screened and 40 were eligible. All eligible individuals consented and enrolled. Five of the intervention group discontinued early and none in the wait-list control group. Feasibility was affirmed as participants were recruited and retained in the study, there were no adverse events, fidelity to protocol was demonstrated, and satisfaction rates were high. Efficacy measures indicated potential benefit for shoulder range of motion (d = 0.57-0.86, P < .05), pain (d = 0.67-0.90, P ≤ .005), and anxiety (d = 0.59, P = .015). Conclusion: A tailored hatha yoga program is feasible and potentially efficacious for HNC survivors. Preliminary data supports further investigation of yoga in this population is needed.

Cervical flexion and extension includes anti-directional cervical joint motion in healthy adults

BACKGROUND CONTEXT

Anti-directional cervical joint motion has previously been demonstrated. However, quantitative studies of anti-directional and pro-directional cervical flexion and extension motions have not been published.

PURPOSE

This study aimed for a quantitative assessment of directional and anti-directional cervical joint motion in healthy subjects.

STUDY DESIGN

An observational study was carried out.

PATIENTS SAMPLE

Eighteen healthy subjects comprised the study sample.

OUTCOME MEASURES

Anti-directional and pro-directional cervical flexion and extension motion from each cervical joint in degrees were the outcome measures.

METHODS

Fluoroscopy videos of cervical flexion and extension motions (from neutral to end-range) were acquired from 18 healthy subjects. The videos were divided into 10% epochs of C0/C7 range of motion (ROM). The pro-directional and anti-directional motions in each 10% epoch were extracted, and the ratios of anti-directional motions with respect to the pro-directional motions (0%=no anti-directional movement) were calculated for joints and 10% epochs.

RESULTS

The flexion and extension ROM for C0/C7 were 51.9°±9.3° and 57.2°±12.2°. The anti-directional motions of flexion and extension ROM constituted 42.8%±9.7% and 41.2%±8.2% of the respective pro-directional movements. For flexion, the first three joints (C0/C1, C1/C2, C2/C3) demonstrated larger ratios compared with the last three joints (C4/C5, C5/C6, C6/C7) (p<.03). For extension, C1/C2 and C2/C3 ratios were larger compared with C0/C1, C4/C5, and C5/C6 (p<.03). Comparisons between flexion and extension motions showed larger C0/C1 ratio but smaller C5/C6 and C6/C7 ratios in extension (p<.05).

CONCLUSIONS

This is the first report of quantified anti-directional cervical flexion and extension motion. The anti-directional motion is approximately 40% of the pro-directional motion. The results document that large proportions of anti-directional cervical flexion and extension motions were normal.

Kinematics of chisel-tooth digging by African mole-rats

Mole-rats are known to use their protruding, chisel-like incisors to dig underground networks of tunnels, but it remains unknown how these incisors are used to break and displace the soil. Theoretically, different excavation strategies can be used. Mole-rats could either use their head depressor muscles to power scooping motions of the upper incisors (by nose-down head rotations) or the lower incisors (by nose-up head rotations), or their jaw adductors to grab and break the soil after penetrating both sets of incisors into the ground, or a combination of these mechanisms. To identify how chisel-tooth digging works, a kinematic analysis of this behaviour was performed based on high-speed videos of 19 individuals from the African mole-rat species Fukomys micklemi placed inside transparent tubes in a laboratory setting. Our analysis showed that the soil is penetrated by both the upper and lower incisors at a relatively high gape angle, generally with the head rotated nose-up. Initially, the upper incisors remain approximately stationary to function as an anchor to allow an upward movement of the lower incisors to grab the soil. Next, a quick, nose-down rotation of the head further detaches the soil and drops the soil below the head. Consequently, both jaw adduction and head depression are jointly used to power tooth-digging in F. micklemi The same mechanism, but with longer digging cycles, and soil being thrown down at smaller gape sizes, was used when digging in harder soil.

Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons

Objective:

To determine within-rater and between-rater reliability of the universal goniometer (UG) for measuring active cervical range of motion (ACROM) in asymptomatic healthy subjects.

Methods:

Nineteen healthy subjects were tested in an identical seated position. Two raters used UG to measure active cervical movements of flexion, extension, right side flexion, left side flexion, right rotation and left rotation. Each motion was measured twice by each of the two raters and was re-measured all over again after one week. Data analysis was performed using the intraclass correlation coefficient (ICC).

Results:

The results demonstrated excellent within-session (ICC2,1 = 0.83 to 0.98) and between-session (ICC2,2 = 0.79 to 0.97) intra-rater reliability and excellent inter-rater reliability (ICC2,2 = 0.79 to 0.92).

Conclusion:

Considering above results it is concluded that UG is a reliable tool for assessing ACROM in a clinical setting for healthy subjects.

Measuring cervical vertebra movements using kinect sensor

The incidence of cervical vertebra spondylosis is increasing with the pace of life while there is no high-efficient measurement method. This study proposed a non-contact, high-efficient, and high-precisionmethod measuring the cervical vertebra activities which obtains the cervical vertebra activities by combining the function of skeletal tracking and face tracking. A comparison study between the proposed and traditional methods has been conducted here. Statistics shows that the efficiency of the proposed measurement method at least is 6 times faster than modified square shaped goniometers that is the represent of traditional measurement, and it's angular error in average is 0.35°. Moreover, the proposed measuring method has been tested in hospital clinical environment and the results show that the proposed method can be used easily and have little interference.

Block-Periodized Training Improves Physiological and Tactically Relevant Performance in Naval Special Warfare Operators

Human performance training and prevention strategies are necessary to promote physical readiness and mitigate musculoskeletal injuries of the Naval Special Warfare (NSW) Operator. The purpose of this study was to measure the effectiveness of 2 training programs when performed during a training evolution of Operators. A total of 85 Operators (experimental: n = 46, age: 29.4 ± 5.5 years, height: 176.7 ± 6.4 cm, mass: 86.7 ± 11.6 kg; control: n = 39, age: 29.0 ± 6.0 years, height: 177.1 ± 6.3 cm, mass: 85.7 ± 12.5 kg) participated in a trial to measure the effectiveness of these programs to improve physical, physiological, and performance characteristics. Operators in the experimental group performed a 12-week block-periodized program, whereas those in the control group performed a nonlinear periodized program. Pretesting/posttesting was performed to assess body composition, aerobic capacity/lactate threshold, muscular strength, flexibility, landing biomechanics, postural stability, and tactically relevant performance. The experimental group demonstrated a significant loss in body fat, fat mass, and body mass compared with the control group, whereas aerobic capacity increased for the both groups. The experimental group demonstrated a significant increase in posterior shoulder flexibility and ankle dorsiflexion, whereas the control group had a significant reduction in shoulder, knee, and ankle flexibility. The experimental group also improved landing strategies and balance. Both groups improved upper and lower muscular power and upper-body muscular endurance, whereas only the experimental group demonstrated significant improvements in agility and total body muscular strength. Implementation of a population-specific training program provides structured and progressive training effectively and promotes physical readiness concurrently with tactical training without overload.

Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life

BACKGROUND

Lymphedema may disrupt local function and affect quality of life (QOL) in patients with head and neck cancer. The purpose of this study was to examine the associations among severity of internal and external lymphedema, symptoms, functional status, and QOL in patients with head and neck cancer.

METHODS

The sample included 103 patients who were ≥ 3 months after head and neck cancer treatment. Variables assessed included severity of internal and external lymphedema, physical/psychological symptoms, functional status, and QOL.

RESULTS

Severity of internal and external lymphedema was associated with physical symptoms and psychological symptoms. Patients with more severe external lymphedema were more likely to have a decrease in neck left/right rotation. The combined effects of external and internal lymphedema severity were associated with hearing impairment and decreased QOL.

CONCLUSIONS

Lymphedema severity correlates with symptom burden, functional status, and QOL in patients after head and neck cancer treatment.

Cervical range of motion and strength in 4,293 young male adults with chronic neck pain

PURPOSE

The correlation of cervical biomechanics and neck pain in young patients has, to date, only been described in terms of small cohorts. This study focuses on the correlation of chronic neck pain and cervical biomechanics.

METHODS

Neck pain, cervical range of motion (CROM) and maximal cervical torque were recorded in 746 patients with conservatively treated chronic neck pain and 3,547 participants of physiotherapy training without chronic neck pain aged 16-32 years.

RESULTS

The "neck pain" group had a highly significant (s < 0.001) higher neck disability index (44.7 vs. 10.4%), longer history of neck pain (3.47 vs. 0.59 years), higher pain intensity (VAS 5.93 vs. 0.93), higher pain frequency (VAS 6.98 vs. 1.09). No differences of CROM and maximal torque in the sagittal, frontal and transverse plane were found.

CONCLUSION

This study describes the largest cohort of biomechanical data of the cervical spine in young adult recorded to date. The findings demonstrate that no correlation was found between neck pain, CROM and maximal torque in the study cohort. On this basis, we conclude that the CROM and maximal cervical torque should not be used as indicators to measure the progress of chronic neck pain in physiotherapy training and sports medicine for the young adult.

Atividade elétrica dos músculos cervicais e amplitude de movimento da coluna cervical em indivíduos com e sem DTM

O objetivo da pesquisa foi avaliar a atividade elétrica e a dor à palpação dos músculos cervicais, a amplitude de movimento (ADM) da coluna cervical e a relação entre atividade elétrica e ADM cervical em indivíduos com e sem desordem temporomandibular (DTM). Participaram do estudo 53 voluntários, sendo 24 com DTM e 29 sem, de ambos os gêneros, com 18 a 32 anos de idade. A DTM foi diagnosticada pelo critério de diagnóstico em pesquisa para DTM (Research Diagnostic Criteria for Temporomandibular Disorders). A eletromiografia dos músculos esternocleidomastoídeo (ECOM) e trapézio superior foi realizada bilateralmente, na situação de repouso, com frequência de 2 KHz e filtro passa-faixa de 10-1000 Hz. As medidas de ADM de flexão, extensão, lateroflexão e rotação foram realizadas com um flexímetro e a comparação entre os grupos contou com o teste de Mann Whitney. O teste de Spearman foi aplicado para a correlação entre as variáveis, com nível de significância de 5%. Não foi verificada nenhuma diferença na ADM cervical entre os grupos. A atividade elétrica demonstrou-se significativamente maior nos músculos ECOM direito (p=0,0130), trapézio superior direito (p=0,0334) e esquerdo (p=0,0335) no grupo DTM em relação ao grupo controle. Não houve correlação significante entre atividade elétrica e ADM cervical. A dor nos músculos cervicais apresentou-se significativamente maior apenas no músculo ECOM direito (p=0,0055). Conclui-se que os grupos estudados registraram diferença na atividade elétrica dos músculos cervicais, sendo esta maior em indivíduos com DTM.

Aesthetic and functional restoration of anterior neck scar contracture using a bipedicled expanded forehead flap

OBJECTIVE

The study aimed to explore a new method to restore functional and cosmetic outcomes for anterior neck burn scar contracture.

METHODS

Tissue expanders were implanted subcutaneously under the muscle of the forehead. Tissue expansion started 1 week postoperatively. When the skin expansion finished, a bilateral pedicled expanded skin flap was created on the basis of the superficial temporal artery and transferred to the anterior neck. Both the range of motion of cervical spine and the mental cervical angle were measured before and after operation. Data were analysed by Statistical Package for Social Sciences (SPSS) 13.0 and t-test.

RESULTS

From September 2006 to May 2010, six male patients were treated by this method. The active range of motion of the neck of patients improved, the postoperative ranges of active flexion, extension, left flexion, right flexion and left and right rotation of cervical spine increased respectively. The mental cervical angle was 152.7±1.9° preoperatively and 90.7±2.2° postoperatively; the physiological angle was recovered. Patients were followed up from 5 months to 3 years, they were satisfied with the results and no recurrence of contracture was found.

CONCLUSION

The bipedicled expanded forehead flap, which provided good blood supply, repaired anterior contracture in the neck and created both aesthetic and functional results; it also diminished donor morbidity.

The influence of age, anthropometrics and range of motion on the morphometry of the synovial folds of the lateral atlanto-axial joints: a pilot study

The purpose of this study was to investigate the effect of age, anthropometrics and cervical range of motion upon synovial fold volume. Ten healthy female subjects aged 20-40 years were included in the study. Age, height, body mass, dimensions of the head and neck and cervical range of motion of each subject were measured. Magnetic resonance (MR) images of the cervical spine were acquired; the volume of the ventral and dorsal synovial folds of the right and the left lateral atlanto-axial joints was measured using seed growing and thresholding methods. Using Spearman's correlation coefficient, it was determined that there was no correlation between synovial fold volume and age. Synovial fold volume was positively correlated with subject height and neck length but negatively correlated with body mass, body mass index and the circumference of the head and neck. The relationship between synovial fold volume and range of cervical motion varied with the plane of movement. The ability to image the synovial folds of the lateral atlanto-axial joints using MR imaging to determine their normal morphology provides the basis for investigating synovial fold pathology in patients with neck pain and headache.