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Bydon M, Qu W, Moinuddin FM, Hunt CL, Garlanger KL, Reeves RK, Windebank AJ, Zhao KD, Jarrah R, Trammell BC, El Sammak S, Michalopoulos GD, Katsos K, Graepel SP, Seidel-Miller KL, Beck LA, Laughlin RS, Dietz AB. Intrathecal delivery of adipose-derived mesenchymal stem cells in traumatic spinal cord injury: Phase I trial. Nat Commun 2024; 15:2201. [PMID: 38561341 PMCID: PMC10984970 DOI: 10.1038/s41467-024-46259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Intrathecal delivery of autologous culture-expanded adipose tissue-derived mesenchymal stem cells (AD-MSC) could be utilized to treat traumatic spinal cord injury (SCI). This Phase I trial (ClinicalTrials.gov: NCT03308565) included 10 patients with American Spinal Injury Association Impairment Scale (AIS) grade A or B at the time of injury. The study's primary outcome was the safety profile, as captured by the nature and frequency of adverse events. Secondary outcomes included changes in sensory and motor scores, imaging, cerebrospinal fluid markers, and somatosensory evoked potentials. The manufacturing and delivery of the regimen were successful for all patients. The most commonly reported adverse events were headache and musculoskeletal pain, observed in 8 patients. No serious AEs were observed. At final follow-up, seven patients demonstrated improvement in AIS grade from the time of injection. In conclusion, the study met the primary endpoint, demonstrating that AD-MSC harvesting and administration were well-tolerated in patients with traumatic SCI.
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Affiliation(s)
- Mohamad Bydon
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Wenchun Qu
- Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL, USA
| | - F M Moinuddin
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald K Reeves
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Ryan Jarrah
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brandon C Trammell
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sally El Sammak
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giorgos D Michalopoulos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos Katsos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lisa A Beck
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Hojo E, Sui Y, Shan X, Zheng K, Rossman P, Manduca A, Powell GM, An KN, Zhao KD, Bauer BA, Ehman RL, Yin Z. MR elastography-based slip interface imaging (SII) for functional assessment of myofascial interfaces: A feasibility study. Magn Reson Med 2024. [PMID: 38523575 DOI: 10.1002/mrm.30087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Abnormal adherence at functional myofascial interfaces is hypothesized as an important phenomenon in myofascial pain syndrome. This study aimed to investigate the feasibility of MR elastography (MRE)-based slip interface imaging (SII) to visualize and assess myofascial mobility in healthy volunteers. METHODS SII was used to assess local shear strain at functional myofascial interfaces in the flexor digitorum profundus (FDP) and thighs. In the FDP, MRE was performed at 90 Hz vibration to each index, middle, ring, and little finger. Two thigh MRE scans were performed at 40 Hz with knees flexed and extended. The normalized octahedral shear strain (NOSS) maps were calculated to visualize myofascial slip interfaces. The entropy of the probability distribution of the gradient NOSS was computed for the two knee positions at the intermuscular interface between vastus lateralis and vastus intermedius, around rectus femoris, and between vastus intermedius and vastus medialis. RESULTS NOSS map depicted distinct functional slip interfaces in the FDP for each finger. Compared to knee flexion, clearer slip interfaces and larger gradient NOSS entropy at the vastus lateralis-vastus intermedius interface were observed during knee extension, where the quadriceps are not passively stretched. This suggests the optimal position for using SII to visualize myofascial slip interface in skeletal muscles is when muscles are not subjected to any additional force. CONCLUSION The study demonstrated that MRE-based SII can visualize and assess myofascial interface mobility in extremities. The results provide a foundation for investigating the hypothesis that myofascial pain syndrome is characterized by changes in the mobility of myofascial interfaces.
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Affiliation(s)
- Emi Hojo
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Yi Sui
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Xiang Shan
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Keni Zheng
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Phillip Rossman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Garret M Powell
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kai-Nan An
- Orthopedics Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kristin D Zhao
- Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Brent A Bauer
- General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Veith DD, Linde MB, Wiggins CC, Zhao KD, Garlanger KL. Intervention Design of High-Intensity Interval Training in Individuals With Spinal Cord Injury: Narrative Review and Future Perspectives. Top Spinal Cord Inj Rehabil 2023; 29:1-15. [PMID: 38076494 PMCID: PMC10704212 DOI: 10.46292/sci22-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Individuals with spinal cord injury (SCI) have lower levels of physical activity compared to the nondisabled population. Exercise guidelines recommend moderate or vigorous exercise to improve cardiovascular health and reduce cardiometabolic risk factors in persons with SCI. High-intensity interval training (HIIT) is a popular exercise choice and encompasses brief periods of vigorous exercise paired with intermittent periods of recovery. Objectives This review describes the available literature on HIIT for individuals with SCI, including differences in protocol design and suggested areas of further investigation. Methods Our institution's library system performed the comprehensive search. The primary keywords and phrases used to search included spinal cord injury, high-intensity interval training, tetraplegia, paraplegia, and several other related terms. Results Initially 62 records were screened, and 36 were deemed outside the scope of this review. Twenty-six studies published between 2001 and 2021 fulfilled the eligibility criteria and were divided among two researchers for review and analysis. All records required persons with SCI and a standardized HIIT intervention. Study design varied widely with respect to mode of exercise, prescribed intensity, duration of performance intervals, and session duration. This variability necessitates further investigation into the specifics of a HIIT prescription and the associated outcomes for persons with SCI. Conclusion Standardization of HIIT protocols may lead to more robust conclusions regarding its effects on cardiorespiratory fitness as well as mitigation of cardiometabolic risk factors. Meta-analyses will eventually be needed on proper dosing and session parameters to improve cardiorespiratory fitness and cardiometabolic risk factors.
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Affiliation(s)
- Daniel D. Veith
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Margaux B. Linde
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Kristin L. Garlanger
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Foley RA, Trentadue TP, Lopez C, Weber NM, Thoreson AR, Holmes DR, Murthy NS, Leng S, Kakar S, Zhao KD. Bilateral lunotriquetral coalition: a dynamic four-dimensional computed tomography technical case report. Skeletal Radiol 2023:10.1007/s00256-023-04490-6. [PMID: 37943305 DOI: 10.1007/s00256-023-04490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
Lunotriquetral coalitions are the most common form of carpal coalition wherein the cartilage between the lunate and triquetrum ossification centers failed to undergo apoptosis. This technical case report examines the arthrokinematics of bilateral lunotriquetral coalitions with dissimilar Minnaar types in one participant with one asymptomatic wrist and one wrist with suspected distal radioulnar joint injury. Static and dynamic (four-dimensional) CT images during pronosupination were captured using a photon-counting detector CT scanner. Interosseous proximity distributions were calculated between the lunotriquetral coalition and adjacent bones in both wrists to quantify arthrokinematics. Interosseous proximity distributions at joints adjacent to the lunotriquetral coalition demonstrate differences in median and minimum interosseous proximities between the asymptomatic and injured wrists during resisted pronosupination. Altered kinematics from lunotriquetral coalitions may be a source of ulnar-sided wrist pain and discomfort, limiting the functional range of motion. This case report highlights potential alterations to wrist arthrokinematics in the setting of lunotriquetral coalitions and possible associations with ulnar-sided wrist pain, highlighting anatomy to examine in radiographic follow-up. Furthermore, this case report demonstrates the technical feasibility of four-dimensional CT using photon-counting detector technology in assessing arthrokinematics in the setting of variant wrist anatomy.
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Affiliation(s)
- Robert A Foley
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Taylor P Trentadue
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Nikkole M Weber
- Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, MN, USA
| | - David R Holmes
- Biomedical Imaging Resource Core Facility, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Shuai Leng
- Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, MN, USA.
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Trentadue TP, Lopez C, Breighner RE, Akbari-Shandiz M, An KN, Leng S, Holmes DR, Moran SL, Kakar S, Smith J, Thoreson A, Zhao KD. Assessing carpal kinematics following scapholunate interosseous ligament injury ex vivo using four-dimensional dynamic computed tomography. Clin Biomech (Bristol, Avon) 2023; 107:106007. [PMID: 37295340 PMCID: PMC10619963 DOI: 10.1016/j.clinbiomech.2023.106007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Scapholunate interosseous ligament injuries are prevalent and often challenging to diagnose radiographically. Four-dimensional CT allows visualization of carpal bones during motion. We present a cadaveric model of sequential ligamentous sectionings ("injuries") to quantify their effects on interosseous proximities at the radioscaphoid joint and scapholunate interval. We hypothesized that injury, wrist position, and their interaction affect carpal arthrokinematics. METHODS Eight cadaveric wrists were moved through flexion-extension and radioulnar deviation after injuries. Dynamic CT images of each motion were acquired in each injury condition using a second-generation dual-source CT scanner. Carpal osteokinematics were used to calculate arthrokinematic interosseous proximity distributions during motion. Median interosseous proximities were normalized and categorized by wrist position. Linear mixed-effects models and marginal means tests were used to compare distributions of median interosseous proximities. FINDINGS The effect of wrist position was significant for both flexion-extension and radioulnar deviation at the radioscaphoid joint; the effect of injury was significant for flexion-extension at the scapholunate interval; and the effect of their interaction was significant for radioulnar deviation at the scapholunate interval. Across wrist positions, radioscaphoid median interosseous proximities were less able to distinguish injury conditions versus scapholunate proximities. Median interosseous proximities at the scapholunate interval are majoritively able to detect differences between less (Geissler I-III) versus more (Geissler IV) severe injuries when the wrist is flexed, extended, and ulnarly-deviated. INTERPRETATION Dynamic CT enhances our understanding of carpal arthrokinematics in a cadaveric model of SLIL injury. Scapholunate median interosseous proximities in flexion, extension, and ulnar deviation best demonstrate ligamentous integrity.
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Affiliation(s)
- Taylor P Trentadue
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America; Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States of America; Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States of America.
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States of America.
| | - Mohsen Akbari-Shandiz
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America
| | - Kai-Nan An
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America.
| | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America; Biomedical Imaging Resource, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Steven L Moran
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN, United States of America.
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN, United States of America; Department of Clinical Anatomy, Mayo Clinic, Rochester, MN, United States of America.
| | - Jay Smith
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Andrew Thoreson
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
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Linde MB, Webb KL, Veith DD, Morkeberg OH, Gill ML, Van Straaten MG, Laskowski ER, Joyner MJ, Beck LA, Zhao KD, Wiggins CC, Garlanger KL. At-Home High-Intensity Interval Training for Individuals with Paraplegia Following Spinal Cord Injury: A Pilot Study. medRxiv 2023:2023.06.21.23291711. [PMID: 37425869 PMCID: PMC10327239 DOI: 10.1101/2023.06.21.23291711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Objective This pilot study aimed to assess the efficacy of a 16-week at-home high-intensity interval training (HIIT) program among individuals with spinal cord injury (SCI). Methods Eight individuals (age: 47±11 (SD) years, 3 females) with SCI below the sixth thoracic vertebrae participated in a 16-week at-home HIIT program using an arm ergometer. Participants completed baseline graded exercise tests to determine target heart rate zones. HIIT was prescribed thrice per week. Each training session consisted of six one-minute bouts with a target heart rate ~80% heart rate reserve (HRR), interspersed with two minutes of recovery at ~30% HRR. A portable heart rate monitor and phone application provided visual feedback during training and allowed for measurements of adherence and compliance. Graded exercise tests were completed after 8 and 16 weeks of HIIT. Surveys were administered to assess participation, self-efficacy, and satisfaction. Results Participants demonstrated a decrease in submaximal cardiac output (P=0.028) and an increase in exercise capacity (peak power output, P=0.027) following HIIT, indicative of improved exercise economy and maximal work capacity. An 87% adherence rate was achieved during the HIIT program. Participants reached a high intensity of 70% HRR or greater during ~80% of intervals. The recovery HRR target was reached during only ~35% of intervals. Self-reported metrics of satisfaction and self-efficacy with at-home HIIT scored moderate to high. Conclusion Participants demonstrated an improvement in exercise economy and maximal work capacity following at-home HIIT. Additionally, participant adherence, compliance, satisfaction, and self-efficacy metrics suggest that at-home HIIT was easily implemented and enjoyable.
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Affiliation(s)
- Margaux B. Linde
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Kevin L. Webb
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Daniel D. Veith
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Olaf H. Morkeberg
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Megan L Gill
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Meegan G. Van Straaten
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Edward R. Laskowski
- Mayo Clinic, Department of Physical Medicine & Rehabilitation and Division of Sports Medicine, Department of Orthopedics, Rochester, MN
| | - Michael J. Joyner
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Lisa A. Beck
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Kristin D. Zhao
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
| | - Chad C. Wiggins
- Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, MN
| | - Kristin L. Garlanger
- Mayo Clinic, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Rochester, MN
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Trentadue TP, Lopez C, Breighner RE, Fautsch K, Leng S, Holmes III DR, Moran SL, Thoreson AR, Kakar S, Zhao KD. Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases. J Wrist Surg 2023; 12:248-260. [PMID: 37223378 PMCID: PMC10202581 DOI: 10.1055/s-0042-1758159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/15/2022] [Indexed: 02/11/2023]
Abstract
Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.
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Affiliation(s)
- Taylor P. Trentadue
- Mayo Clinic Medical Scientist Training Program and Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Ryan E. Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Kalli Fautsch
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Shuai Leng
- Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota
| | - David R. Holmes III
- Biomedical Imaging Resource Division, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew R. Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Fortune E, Cloud-Biebl BA, Madansingh SI, Ngufor CG, Van Straaten MG, Goodwin BM, Murphree DH, Zhao KD, Morrow MM. Estimation of manual wheelchair-based activities in the free-living environment using a neural network model with inertial body-worn sensors. J Electromyogr Kinesiol 2022; 62:102337. [PMID: 31353200 PMCID: PMC6980511 DOI: 10.1016/j.jelekin.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/24/2019] [Accepted: 07/15/2019] [Indexed: 02/03/2023] Open
Abstract
Shoulder pain is common in manual wheelchair (MWC) users. Overuse is thought to be a major cause, but little is known about exposure to activities of daily living (ADLs). The study goal was to develop a method to estimate three conditions in the field: (1) non-propulsion activity, (2) MWC propulsion, and (3) static time using an inertial measurement unit (IMU). Upper arm IMU data were collected as ten MWC users performed lab-based MWC-related ADLs. A neural network model was developed to classify data as non-propulsion activity, propulsion, or static, and validated for the lab-based data collection by video comparison. Six of the participants' free-living IMU data were collected and the lab-based model was applied to estimate daily non-propulsion activity, propulsion, and static time. The neural network model yielded lab-based validity measures ≥0.87 for differentiating non-propulsion activity, propulsion, and static time. A quasi-validation of one participant's field-based data yielded validity measures ≥0.66 for identifying propulsion. Participants' estimated mean daily non-propulsion activity, propulsion, and static time ranged from 158 to 409, 13 to 25, and 367 to 609 min, respectively. The preliminary results suggest the model may be able to accurately identify MWC users' field-based activities. The inclusion of field-based IMU data in the model could further improve field-based classification.
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Affiliation(s)
- Emma Fortune
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Beth A. Cloud-Biebl
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA,Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Stefan I. Madansingh
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Che G. Ngufor
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Biomedical Informatics and Statistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Meegan G. Van Straaten
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Brianna M. Goodwin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dennis H. Murphree
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Biomedical Informatics and Statistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Melissa M. Morrow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
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Mozingo JD, Akbari-Shandiz M, Van Straaten MG, Murthy NS, Schueler BA, Holmes DR, McCollough CH, Zhao KD. Comparison of glenohumeral joint kinematics between manual wheelchair tasks and implications on the subacromial space: A biplane fluoroscopy study. J Electromyogr Kinesiol 2022; 62:102350. [PMID: 31481296 PMCID: PMC7036020 DOI: 10.1016/j.jelekin.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/12/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023] Open
Abstract
Scapula and humerus motion associated with common manual wheelchair tasks is hypothesized to reduce the subacromial space. However, previous work relied on either marker-based motion capture for kinematic measures, which is prone to skin-motion artifact; or ultrasound imaging for arthrokinematic measures, which are 2D and acquired in statically-held positions. The aim of this study was to use a fluoroscopy-based approach to accurately quantify glenohumeral kinematics during manual wheelchair use, and compare tasks for a subset of parameters theorized to be associated with mechanical impingement. Biplane images of the dominant shoulder were acquired during scapular plane elevation, propulsion, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury. A computed tomography scan of the shoulder was obtained, and model-based tracking was used to quantify six-degree-of-freedom glenohumeral kinematics. Axial rotation and superior/inferior and anterior/posterior humeral head positions were characterized for full activity cycles and compared between tasks. The change in the subacromial space was also determined for the period of each task defined by maximal change in the aforementioned parameters. Propulsion, sideways lean, and weight-relief raise, but not scapular plane elevation, were marked by mean internal rotation (8.1°, 10.8°, 14.7°, -49.2° respectively). On average, the humeral head was most superiorly positioned during the weight-relief raise (1.6 ± 0.9 mm), but not significantly different from the sideways lean (0.8 ± 1.1 mm) (p = 0.191), and much of the task was characterized by inferior translation. Scaption was the only task without a defined period of superior translation on average. Pairwise comparisons revealed no significant differences between tasks for anterior/posterior position (task means range: 0.1-1.7 mm), but each task exhibited defined periods of anterior translation. There was not a consistent trend across tasks between internal rotation, superior translation, and anterior translation with reductions in the subacromial space. Further research is warranted to determine the likelihood of mechanical impingement during these tasks based on the measured task kinematics and reductions in the subacromial space.
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Affiliation(s)
- Joseph D. Mozingo
- Biomedical Engineering and Physiology Graduate Program,
Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN,
USA,Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
| | | | | | | | | | - David R. Holmes
- Department of Physiology and Biomedical Engineering, Mayo
Clinic, Rochester, MN, USA
| | | | - Kristin D. Zhao
- Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
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10
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Linde MB, Thoreson AR, Lopez C, Gill ML, Veith DD, Hale RF, Calvert JS, Grahn PJ, Fautsch KJ, Sayenko DG, Zhao KD. Quantitative Assessment of Clinician Assistance During Dynamic Rehabilitation Using Force Sensitive Resistors. Front Rehabilit Sci 2021; 2:757828. [PMID: 36188812 PMCID: PMC9397738 DOI: 10.3389/fresc.2021.757828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
Background: Neuromodulation using epidural electrical stimulation (EES) has shown functional restoration in humans with chronic spinal cord injury (SCI). EES during body weight supported treadmill training (BWSTT) enhanced stepping performance in clinical trial participants with paraplegia. Unfortunately, tools are lacking in availability to quantify clinician assistance during BWSTT with and without EES. Force sensitive resistors (FSRs) have previously quantified clinician assistance during static standing; however, dynamic tasks have not been addressed. Objective: To determine the validity of FSRs in measurements of force and duration to quantify clinician assistance and participant progression during BWSTT with EES in participants with SCI. Design: A feasibility study to determine the effectiveness of EES to restore function in individuals with SCI. Methods: Two male participants with chronic SCI were enrolled in a pilot phase clinical trial. Following implantation of an EES system in the lumbosacral spinal cord, both participants underwent 12 months of BWSTT with EES. At monthly intervals, FSRs were positioned on participants' knees to quantity forces applied by clinicians to achieve appropriate mechanics of stepping during BWSTT. The FSRs were validated on the benchtop using a leg model instrumented with a multiaxial load cell as the gold standard. The outcomes included clinician-applied force duration measured by FSR sensors and changes in applied forces indicating progression over the course of rehabilitation. Results: The force sensitive resistors validation revealed a proportional bias in their output. Loading required for maximal assist training exceeded the active range of the FSRs but were capable of capturing changes in clinician assist levels. The FSRs were also temporally responsive which increased utility for accurately assessing training contact time. The FSRs readings were able to capture independent stance for both participants by study end. There was minimal to no applied force bilaterally for participant 1 and unilaterally for participant 2. Conclusions: Clinician assistance applied at the knees as measured through FSRs during dynamic rehabilitation and EES (both on and off) effectively detected point of contact and duration of forces; however, it lacks accuracy of magnitude assessment. The reduced contact time measured through FSRs related to increased stance duration, which objectively identified independence in stepping during EES-enabled BWSTT following SCI.
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Affiliation(s)
- Margaux B. Linde
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Andrew R. Thoreson
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Megan L. Gill
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Daniel D. Veith
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Rena F. Hale
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Jonathan S. Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Peter J. Grahn
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kalli J. Fautsch
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Hospital, Houston, TX, United States
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Kristin D. Zhao
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11
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Holmes DR, Thoreson AR, Breighner RE, Kakar S, Moran SL, Leng S, Zhao KD. Optimizing Web-Based Viewer of 4D CT Scans for Clinical Assessment of Injured Wrists . Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:2405-2408. [PMID: 34891766 DOI: 10.1109/embc46164.2021.9629999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Wrist injuries pose a unique challenge for patients and providers. Due to the complexity of the wrist, it is difficult to determine if a wrist injury is primarily a bone fracture or soft tissue damage. The scapholunate interosseous ligament (SLIL) is an important ligament in the function of the wrist, and it is also one of the most common soft tissue injuries in the wrist. Wrist arthroscopy is the gold standard for assessing injuries of the scapholunate joint; however, it is an invasive procedure. Recent advances in dynamic imaging with 4D Computed Tomography scans allow for the assessment of SLIL injuries non-invasively. Unfortunately, 4DCT scan data can be difficult to disseminate to clinical practitioners due to the large amount of data generated and the complexity in visualizing the data. A web-based application has been developed to interactively assess 4DCT scans of patients with suspected SLIL injury. Due to the magnitude of data and the diversity of hardware platforms used to visualize the data, the images are preprocessed with a rendering engine and presented in a pseudo-3D visualization paradigm where the user can interactively explore the 3D data without transmitting the entire dataset to the local computer. The technology has been used to assess 27 patients.
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12
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Calvert JS, Gill ML, Linde MB, Veith DD, Thoreson AR, Lopez C, Lee KH, Gerasimenko YP, Edgerton VR, Lavrov IA, Zhao KD, Grahn PJ, Sayenko DG. Voluntary Modulation of Evoked Responses Generated by Epidural and Transcutaneous Spinal Stimulation in Humans with Spinal Cord Injury. J Clin Med 2021; 10:jcm10214898. [PMID: 34768418 PMCID: PMC8584516 DOI: 10.3390/jcm10214898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/29/2022] Open
Abstract
Transcutaneous (TSS) and epidural spinal stimulation (ESS) are electrophysiological techniques that have been used to investigate the interactions between exogenous electrical stimuli and spinal sensorimotor networks that integrate descending motor signals with afferent inputs from the periphery during motor tasks such as standing and stepping. Recently, pilot-phase clinical trials using ESS and TSS have demonstrated restoration of motor functions that were previously lost due to spinal cord injury (SCI). However, the spinal network interactions that occur in response to TSS or ESS pulses with spared descending connections across the site of SCI have yet to be characterized. Therefore, we examined the effects of delivering TSS or ESS pulses to the lumbosacral spinal cord in nine individuals with chronic SCI. During low-frequency stimulation, participants were instructed to relax or attempt maximum voluntary contraction to perform full leg flexion while supine. We observed similar lower-extremity neuromusculature activation during TSS and ESS when performed in the same participants while instructed to relax. Interestingly, when participants were instructed to attempt lower-extremity muscle contractions, both TSS- and ESS-evoked motor responses were significantly inhibited across all muscles. Participants with clinically complete SCI tested with ESS and participants with clinically incomplete SCI tested with TSS demonstrated greater ability to modulate evoked responses than participants with motor complete SCI tested with TSS, although this was not statistically significant due to a low number of subjects in each subgroup. These results suggest that descending commands combined with spinal stimulation may increase activity of inhibitory interneuronal circuitry within spinal sensorimotor networks in individuals with SCI, which may be relevant in the context of regaining functional motor outcomes.
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Affiliation(s)
- Jonathan S. Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN 55905, USA;
| | - Megan L. Gill
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Margaux B. Linde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Daniel D. Veith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Andrew R. Thoreson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Cesar Lopez
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
| | - Kendall H. Lee
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
- Department of Physiology and Biomedical Engineering, Rochester, MN 55905, USA
| | - Yury P. Gerasimenko
- Pavlov Institute of Physiology of Russian Academy of Sciences, 199034 St. Petersburg, Russia;
- Department of Physiology and Biophysics, University of Louisville, Louisville, KY 40292, USA
| | - Victor R. Edgerton
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA 90095, USA;
- Department of Neurobiology, University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari Adscrit a la Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo 2007, Australia
| | - Igor A. Lavrov
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Kristin D. Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
- Department of Physiology and Biomedical Engineering, Rochester, MN 55905, USA
| | - Peter J. Grahn
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA; (M.L.G.); (M.B.L.); (D.D.V.); (A.R.T.); (C.L.); (K.H.L.); (K.D.Z.); (P.J.G.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Dimitry G. Sayenko
- Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-363-7949
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13
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Goodwin BM, Jahanian O, Van Straaten MG, Fortune E, Madansingh SI, Cloud-Biebl BA, Zhao KD, Morrow MM. Application and Reliability of Accelerometer-Based Arm Use Intensities in the Free-Living Environment for Manual Wheelchair Users and Able-Bodied Individuals. Sensors (Basel) 2021; 21:1236. [PMID: 33578639 PMCID: PMC7916413 DOI: 10.3390/s21041236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/31/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022]
Abstract
Arm use in manual wheelchair (MWC) users is characterized by a combination of overuse and a sedentary lifestyle. This study aimed to describe the percentage of daily time MWC users and able-bodied individuals spend in each arm use intensity level utilizing accelerometers. Arm use intensity levels of the upper arms were defined as stationary, low, mid, and high from the signal magnitude area (SMA) of the segment accelerations based on in-lab MWC activities performed by eight MWC users. Accelerometry data were collected in the free-living environments from forty MWC users and 40 sex- and age-matched able-bodied individuals. The SMA intensity levels were applied to the free-living data and the percentage of time spent in each level was calculated. The SMA intensity levels were defined as, stationary: ≤0.67 g, low: 0.671-3.27 g, mid: 3.27-5.87 g, and high: >5.871 g. The dominant arm of both MWC users and able-bodied individuals was stationary for most of the day and less than one percent of the day was spent in high intensity arm activities. Increased MWC user age correlated with increased stationary arm time (R = 0.368, p = 0.019). Five and eight days of data are needed from MWC users and able-bodied individuals, respectively, to achieve reliable representation of their daily arm use intensities.
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Affiliation(s)
- Brianna M. Goodwin
- Health Sciences Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; (B.M.G.); (O.J.); (M.G.V.S.); (E.F.)
| | - Omid Jahanian
- Health Sciences Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; (B.M.G.); (O.J.); (M.G.V.S.); (E.F.)
| | - Meegan G. Van Straaten
- Health Sciences Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; (B.M.G.); (O.J.); (M.G.V.S.); (E.F.)
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55902, USA; (S.I.M.); (K.D.Z.)
| | - Emma Fortune
- Health Sciences Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; (B.M.G.); (O.J.); (M.G.V.S.); (E.F.)
| | - Stefan I. Madansingh
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55902, USA; (S.I.M.); (K.D.Z.)
| | - Beth A. Cloud-Biebl
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Rochester, MN 55902, USA;
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55902, USA; (S.I.M.); (K.D.Z.)
| | - Melissa M. Morrow
- Health Sciences Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; (B.M.G.); (O.J.); (M.G.V.S.); (E.F.)
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14
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Gill ML, Linde MB, Hale RF, Lopez C, Fautsch KJ, Calvert JS, Veith DD, Beck LA, Garlanger KL, Sayenko DG, Lavrov IA, Thoreson AR, Grahn PJ, Zhao KD. Alterations of Spinal Epidural Stimulation-Enabled Stepping by Descending Intentional Motor Commands and Proprioceptive Inputs in Humans With Spinal Cord Injury. Front Syst Neurosci 2021; 14:590231. [PMID: 33584209 PMCID: PMC7875885 DOI: 10.3389/fnsys.2020.590231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Regaining control of movement following a spinal cord injury (SCI) requires utilization and/or functional reorganization of residual descending, and likely ascending, supraspinal sensorimotor pathways, which may be facilitated via task-specific training through body weight supported treadmill (BWST) training. Recently, epidural electrical stimulation (ES) combined with task-specific training demonstrated independence of standing and stepping functions in individuals with clinically complete SCI. The restoration of these functions may be dependent upon variables such as manipulation of proprioceptive input, ES parameter adjustments, and participant intent during step training. However, the impact of each variable on the degree of independence achieved during BWST stepping remains unknown. Objective: To describe the effects of descending intentional commands and proprioceptive inputs, specifically body weight support (BWS), on lower extremity motor activity and vertical ground reaction forces (vGRF) during ES-enabled BWST stepping in humans with chronic sensorimotor complete SCI. Furthermore, we describe perceived changes in the level of assistance provided by clinicians when intent and BWS are modified. Methods: Two individuals with chronic, mid thoracic, clinically complete SCI, enrolled in an IRB and FDA (IDE G150167) approved clinical trial. A 16-contact electrode array was implanted in the epidural space between the T11-L1 vertebral regions. Lower extremity motor output and vertical ground reaction forces were obtained during clinician-assisted ES-enabled treadmill stepping with BWS. Consecutive steps were achieved during various experimentally-controlled conditions, including intentional participation and varied BWS (60% and 20%) while ES parameters remain unchanged. Results: During ES-enabled BWST stepping, the knee extensors exhibited an increase in motor activation during trials in which stepping was passive compared to active or during trials in which 60% BWS was provided compared to 20% BWS. As a result of this increased motor activation, perceived clinician assistance increased during the transition from stance to swing. Intentional participation and 20% BWS resulted in timely and purposeful activation of the lower extremities muscles, which improved independence and decreased clinician assistance. Conclusion: Maximizing participant intention and optimizing proprioceptive inputs through BWS during ES-enabled BWST stepping may facilitate greater independence during BWST stepping for individuals with clinically complete SCI. Clinical Trial Registration:ClinicalTrials.gov identifier: NCT02592668.
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Affiliation(s)
- Megan L Gill
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Margaux B Linde
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Rena F Hale
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kalli J Fautsch
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Jonathan S Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Daniel D Veith
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Lisa A Beck
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kristin L Garlanger
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Hospital, Houston, TX, United States
| | - Igor A Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Andrew R Thoreson
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Peter J Grahn
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States.,Office for Education Diversity, Equity and Inclusion, Mayo Clinic, Rochester, MN, United States
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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15
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Itoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Itoi E, An KN. Bankart repair alone in combined Bankart and superior labral anterior-posterior lesions preserves range of motion without compromising joint stability. JSES Int 2020; 4:63-67. [PMID: 32195465 PMCID: PMC7075760 DOI: 10.1016/j.jseint.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Hypothesis The purpose was to investigate joint stability and range of motion after a Bankart repair without superior labral anterior-posterior (SLAP) repair (termed “Bankart repair”) and after combined Bankart and SLAP repairs (termed “combined repair”). Methods Eight fresh-frozen shoulders were used. Combined Bankart and SLAP lesions were created (10- to 6-o'clock positions). The labrum and capsule were repaired at the 2-o'clock, 3:30 clock-face, and 5-o'clock positions in the Bankart repair group and at the 11-o'clock, 1-o'clock, 2-o'clock, 3:30 clock-face, and 5-o'clock positions in the combined repair group. The internal- and external-rotation ranges of motion were determined with the arm positioned at 0° and 60° of glenohumeral abduction. The rotation angle was defined when a constant torque of 200 N-mm was applied. Joint stability was measured with a custom stability-testing device. The peak translational force in the anterior-posterior direction was measured with the arm at the end range of external rotation. Results External rotation angles were greater at 0° and 60° of abduction in the Bankart repair group than in the combined repair group (0° of abduction, P < .01; 60° of abduction, P < .05). The internal rotation angle was greater at 60° of abduction in the Bankart repair group than in the combined repair group (P < .01). The stability between the 2 groups was not significantly different (P = .60). Conclusion In patients with combined Bankart and SLAP lesions and the need for a wide range of motion, a Bankart repair alone may provide a greater range of motion without compromising the joint stability at the end range compared with a combined repair.
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Affiliation(s)
- Yoshiaki Itoigawa
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA.,Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | | | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kai-Nan An
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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16
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Mozingo JD, Akbari-Shandiz M, Murthy NS, Van Straaten MG, Schueler BA, Holmes DR, McCollough CH, Zhao KD. Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury. Clin Biomech (Bristol, Avon) 2020; 71:221-229. [PMID: 32035338 PMCID: PMC7050284 DOI: 10.1016/j.clinbiomech.2019.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most individuals with spinal cord injury who use manual wheelchairs experience shoulder pain related to wheelchair use, potentially in part from mechanical impingement of soft tissue structures within the subacromial space. There is evidence suggesting that scapula and humerus motion during certain wheelchair tasks occurs in directions that may reduce the subacromial space, but it hasn't been thoroughly characterized in this context. METHODS Shoulder motion was imaged and quantified during scapular plane elevation with/without handheld load, propulsion with/without added resistance, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury using biplane fluoroscopy and computed tomography. For each position, minimum distance between rotator cuff tendon insertions (infraspinatus, subscapularis, supraspinatus) and the coracoacromial arch was determined. Tendon thickness was measured with ultrasound, and impingement risk scores were defined for each task based on frequency and amount of tendon compression. FINDINGS Periods of impingement were identified during scapular plane elevation and propulsion but not during pressure reliefs in most participants. There was a significant effect of activity on impingement risk scores (P < 0.0001), with greatest impingement risk during scapular plane elevation followed by propulsion. Impingement risk scores were not significantly different between scapular plane elevation loading conditions (P = 0.202) or propulsion resistances (P = 0.223). The infraspinatus and supraspinatus tendons were both susceptible to impingement during scapular plane elevation (by acromion), whereas the supraspinatus was most susceptible during propulsion (by acromion and coracoacromial ligament). INTERPRETATION The occurrence of mechanical impingement during certain manual wheelchair tasks, even without increased load/resistance, demonstrates the importance of kinematics inherent to a task as a determinant of impingement. Frequency of and technique used to complete daily tasks should be carefully considered to reduce impingement risk, which may help preserve shoulder health long-term.
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Affiliation(s)
- Joseph D Mozingo
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
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17
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Itoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Itoi E, An KN. The effect of subscapularis muscle contraction on coaptation of anteroinferior glenohumeral ligament-labrum complex after Bankart repair. J Biomech 2019; 85:134-140. [PMID: 30691988 DOI: 10.1016/j.jbiomech.2019.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/29/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022]
Abstract
Facilitation of healing is important for the anteroinferior glenohumeral ligament-labrum complex (AIGHL-LC) after Bankart repair in shoulder dislocation. The purpose of this study was to investigate the effect of subscapularis muscle loading on contact area and contact pressure between the subscapularis and AIGHL-LC and between the glenoid bone and the AIGHL-LC following Bankart repair. Twenty-two fresh-frozen cadaveric shoulders were used. They were attached to a shoulder-positioning device to which a compression force was applied. Loads applied to the supraspinatus, infraspinatus, and teres minor tendons were held constant. The loads applied to the subscapularis tendon were set at 0, 10, 20, and 30 Newton (N). Contact pressure and area between the subscapularis and the AIGHL-LC were measured with the arm at 4 rotational positions: 60° and 30° internal, neutral, and 30° external. After the Bankart lesion was created, the contact area and pressure between the AIGHL-LC and glenoid bone were measured while Bankart repair was performed with or without loading of the subscapularis. The contact area and pressures with 10, 20, and 30 N of subscapularis loadings were significantly greater than with 0 N of subscapularis loading at 60° internal rotation and 30° external rotation (P < .05). After Bankart repair, contact area and pressure with subscapularis loading between the AIGHL-LC and glenoid bone were significantly greater than without subscapularis loading (P < .01). We conclude that isometric contraction exercises of the subscapularis might facilitate healing of the AIGHL-LC after Bankart repair.
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Affiliation(s)
- Yoshiaki Itoigawa
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
| | - Alexander W Hooke
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Scott P Steinmann
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kai-Nan An
- Division of Orthopedic Research, Mayo Clinic, Rochester, MN, United States.
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18
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Calvert JS, Grahn PJ, Zhao KD, Lee KH. Emergence of Epidural Electrical Stimulation to Facilitate Sensorimotor Network Functionality After Spinal Cord Injury. Neuromodulation 2019; 22:244-252. [PMID: 30840354 DOI: 10.1111/ner.12938] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) disrupts signaling pathways between the brain and spinal networks below the level of injury. In cases of severe SCI, permanent loss of sensorimotor and autonomic function can occur. The standard of care for severe SCI uses compensation strategies to maximize independence during activities of daily living while living with chronic SCI-related dysfunctions. Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES). METHODS This review provides a historical account of the translational research efforts that led to the emergence of EES of the spinal cord to enable intentional control of motor functions that were lost after SCI. We also highlight the major limitations associated with EES after SCI and propose future directions of spinal neuromodulation research. RESULTS Multiple, independent studies have demonstrated return of motor function via EES in individuals with chronic SCI. These enabled motor functions include intentional, controlled movement of previously paralyzed extremities, independent standing and stepping, and increased grip strength. In addition, improvements in cardiovascular health, respiratory function, body composition, and urologic function have been reported. CONCLUSIONS EES holds promise to enable functions thought to be permanently lost due to SCI. However, EES is currently restricted to scientific investigation in humans with SCI and requires further validation of factors such as safety and efficacy before clinical translation.
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Affiliation(s)
| | - Peter J Grahn
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Rochester, MN, USA.,Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Rochester, MN, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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19
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Calvert JS, Grahn PJ, Strommen JA, Lavrov IA, Beck LA, Gill ML, Linde MB, Brown DA, Van Straaten MG, Veith DD, Lopez C, Sayenko DG, Gerasimenko YP, Edgerton VR, Zhao KD, Lee KH. Electrophysiological Guidance of Epidural Electrode Array Implantation over the Human Lumbosacral Spinal Cord to Enable Motor Function after Chronic Paralysis. J Neurotrauma 2018; 36:1451-1460. [PMID: 30430902 PMCID: PMC6482916 DOI: 10.1089/neu.2018.5921] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Epidural electrical stimulation (EES) of the spinal cord has been shown to restore function after spinal cord injury (SCI). Characterization of EES-evoked motor responses has provided a basic understanding of spinal sensorimotor network activity related to EES-enabled motor activity of the lower extremities. However, the use of EES-evoked motor responses to guide EES system implantation over the spinal cord and their relation to post-operative EES-enabled function in humans with chronic paralysis attributed to SCI has yet to be described. Herein, we describe the surgical and intraoperative electrophysiological approach used, followed by initial EES-enabled results observed in 2 human subjects with motor complete paralysis who were enrolled in a clinical trial investigating the use of EES to enable motor functions after SCI. The 16-contact electrode array was initially positioned under fluoroscopic guidance. Then, EES-evoked motor responses were recorded from select leg muscles and displayed in real time to determine electrode array proximity to spinal cord regions associated with motor activity of the lower extremities. Acceptable array positioning was determined based on achievement of selective proximal or distal leg muscle activity, as well as bilateral muscle activation. Motor response latencies were not significantly different between intraoperative recordings and post-operative recordings, indicating that array positioning remained stable. Additionally, EES enabled intentional control of step-like activity in both subjects within the first 5 days of testing. These results suggest that the use of EES-evoked motor responses may guide intraoperative positioning of epidural electrodes to target spinal cord circuitry to enable motor functions after SCI.
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Affiliation(s)
- Jonathan S Calvert
- 1 Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota
| | - Peter J Grahn
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey A Strommen
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Igor A Lavrov
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lisa A Beck
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Megan L Gill
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Margaux B Linde
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Desmond A Brown
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Meegan G Van Straaten
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Daniel D Veith
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Cesar Lopez
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota
| | - Dimitry G Sayenko
- 4 Department of Integrative Biology and Physiology University of California Los Angeles, Los Angeles, California.,12 Center for Neuroregeneration, Department of Neurosurgery, Houston Methodist Research Institute, Houston, Texas
| | - Yury P Gerasimenko
- 4 Department of Integrative Biology and Physiology University of California Los Angeles, Los Angeles, California.,5 Pavlov Institute of Physiology, St. Petersburg, Russia
| | - V Reggie Edgerton
- 4 Department of Integrative Biology and Physiology University of California Los Angeles, Los Angeles, California.,6 Department of Neurobiology, University of California Los Angeles, Los Angeles, California.,7 Department of Neurosurgery, University of California Los Angeles, Los Angeles, California.,8 Brain Research Institute, University of California Los Angeles, Los Angeles, California.,9 Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain.,10 Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Kristin D Zhao
- 3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota.,11 Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Kendall H Lee
- 2 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,3 Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota.,11 Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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20
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Godfrey SB, Zhao KD, Theuer A, Catalano MG, Bianchi M, Breighner R, Bhaskaran D, Lennon R, Grioli G, Santello M, Bicchi A, Andrews K. The SoftHand Pro: Functional evaluation of a novel, flexible, and robust myoelectric prosthesis. PLoS One 2018; 13:e0205653. [PMID: 30321204 PMCID: PMC6188862 DOI: 10.1371/journal.pone.0205653] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 09/30/2018] [Indexed: 12/01/2022] Open
Abstract
Roughly one quarter of active upper limb prosthetic technology is rejected by the user, and user surveys have identified key areas requiring improvement: function, comfort, cost, durability, and appearance. Here we present the first systematic, clinical assessment of a novel prosthetic hand, the SoftHand Pro (SHP), in participants with transradial amputation and age-matched, limb-intact participants. The SHP is a robust and functional prosthetic hand that minimizes cost and weight using an underactuated design with a single motor. Participants with limb loss were evaluated on functional clinical measures before and after a 6-8 hour training period with the SHP as well as with their own prosthesis; limb-intact participants were tested only before and after SHP training. Participants with limb loss also evaluated their own prosthesis and the SHP (following training) using subjective questionnaires. Both objective and subjective results were positive and illuminated the strengths and weaknesses of the SHP. In particular, results pre-training show the SHP is easy to use, and significant improvement in the Activities Measure for Upper Limb Amputees in both groups following a 6-8 hour training highlights the ease of learning the unique features of the SHP (median improvement: 4.71 and 3.26 and p = 0.009 and 0.036 for limb loss and limb-intact groups, respectively). Further, we found no difference in performance compared to participant's own commercial devices in several clinical measures and found performance surpassing these devices on two functional tasks, buttoning a shirt and using a cell phone, suggesting a functional prosthetic design. Finally, improvements are needed in the SHP design and/or training in light of poor results in small object manipulation. Taken together, these results show the promise of the SHP, a flexible and adaptive prosthetic hand, and pave a path forward to ensuring higher functionality in future.
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Affiliation(s)
- Sasha Blue Godfrey
- Soft Robotics for Human Collaboration and Rehabilitation Lab, Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, GE, Italy
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States of America
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States of America
| | - Amanda Theuer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America
| | - Manuel G. Catalano
- Soft Robotics for Human Collaboration and Rehabilitation Lab, Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, GE, Italy
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States of America
| | - Matteo Bianchi
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States of America
- Centro di Ricerca E. Piaggio, University of Pisa, Pisa, PI, Italy
| | - Ryan Breighner
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States of America
| | - Divya Bhaskaran
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States of America
| | - Ryan Lennon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Giorgio Grioli
- Soft Robotics for Human Collaboration and Rehabilitation Lab, Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, GE, Italy
| | - Marco Santello
- Neural Control of Movement Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Antonio Bicchi
- Soft Robotics for Human Collaboration and Rehabilitation Lab, Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, GE, Italy
- Centro di Ricerca E. Piaggio, University of Pisa, Pisa, PI, Italy
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Karen Andrews
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America
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21
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Akbari-Shandiz M, Lawrence RL, Ellingson AM, Johnson CP, Zhao KD, Ludewig PM. MRI vs CT-based 2D-3D auto-registration accuracy for quantifying shoulder motion using biplane video-radiography. J Biomech 2018; 82:375-380. [PMID: 30385001 DOI: 10.1016/j.jbiomech.2018.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
Biplane 2D-3D registration approaches have been used for measuring 3D, in vivo glenohumeral (GH) joint kinematics. Computed tomography (CT) has become the gold standard for reconstructing 3D bone models, as it provides high geometric accuracy and similar tissue contrast to video-radiography. Alternatively, magnetic resonance imaging (MRI) would not expose subjects to radiation and provides the ability to add cartilage and other soft tissues to the models. However, the accuracy of MRI-based 2D-3D registration for quantifying glenohumeral kinematics is unknown. We developed an automatic 2D-3D registration program that works with both CT- and MRI-based image volumes for quantifying joint motions. The purpose of this study was to use the proposed 2D-3D auto-registration algorithm to describe the humerus and scapula tracking accuracy of CT- and MRI-based registration relative to radiostereometric analysis (RSA) during dynamic biplanar video-radiography. The GH kinematic accuracy (RMS error) was 0.6-1.0 mm and 0.6-2.2° for the CT-based registration and 1.4-2.2 mm and 1.2-2.6° for MRI-based registration. Higher kinematic accuracy of CT-based registration was expected as MRI provides lower spatial resolution and bone contrast as compared to CT and suffers from spatial distortions. However, the MRI-based registration is within an acceptable accuracy for many clinical research questions.
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Affiliation(s)
- Mohsen Akbari-Shandiz
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA; Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Rebekah L Lawrence
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Arin M Ellingson
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA
| | - Casey P Johnson
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Paula M Ludewig
- Department of Rehabilitation Medicine, Divisions of Rehabilitation Science and Physical Therapy, Medical School, University of Minnesota, MN, USA.
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22
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Gailey AS, Godfrey SB, Breighner RE, Andrews KL, Zhao KD, Bicchi A, Santello M. Grasp Performance of a Soft Synergy-Based Prosthetic Hand: A Pilot Study. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2407-2417. [PMID: 29220323 PMCID: PMC6411533 DOI: 10.1109/tnsre.2017.2737539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Current prosthetic hands are frequently rejected in part due to limited functionality and versatility. We assessed the feasibility of a novel prosthetic hand, the SoftHand Pro (SHP), whose design combines soft robotics and hand postural synergies. Able-bodied subjects ( ) tracked cursor motion by opening and closing the SHP and performed a grasp-lift-hold-release (GLHR) task with a sensorized cylindrical object of variable weight. The SHP control was driven by electromyographic (EMG) signals from two antagonistic muscles. Although the time to perform the GLHR task was longer for the SHP than native hand for the first few trials (10.2 ± 1.4 s and 2.13 ± 0.09 s, respectively), performance was much faster on subsequent trials (~5 s). The SHP steady-state grip force was significantly modulated as a function of object weight ( ). For the native hand, however, peak and steady-state grip forces were modulated to a greater extent (+68% and +91%, respectively). These changes were mediated by the modulation of EMG amplitude and co-contraction. These data suggest that the SHP has a promise for prosthetic applications and point-to-design modifications that could improve the SHP.
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23
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Godfrey SB, Rossi M, Piazza C, Catalano MG, Bianchi M, Grioli G, Zhao KD, Bicchi A. SoftHand at the CYBATHLON: a user's experience. J Neuroeng Rehabil 2017; 14:124. [PMID: 29187203 PMCID: PMC5707829 DOI: 10.1186/s12984-017-0334-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 11/06/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Roughly one-quarter of upper limb prosthesis users reject their prosthesis. Reasons for rejection range from comfort, to cost, aesthetics, function, and more. This paper follows a single user from training with and testing of a novel upper-limb myoelectric prosthesis (the SoftHand Pro) for participation in the CYBATHLON rehearsal to training for and competing in the CYBATHLON 2016 with a figure-of-nine harness controlled powered prosthesis (SoftHand Pro-H) to explore the feasibility and usability of a flexible anthropomorphic prosthetic hand. METHODS The CYBATHLON pilot took part in multiple in-lab training sessions with the SoftHand Pro and SoftHand Pro-H; these sessions focused on basic control and use of the prosthetic devices and direct training of the tasks in the CYBATHLON. He used these devices in competition in the Powered Arm Prosthesis Race in the CYBATHLON rehearsal and 2016 events. RESULTS In training for the CYBATHLON rehearsal, the subject was able to quickly improve performance with the myoelectric SHP despite typically using a body-powered prosthetic hook. The subject improved further with additional training using the figure-of-nine harness-controlled SHPH in preparation for the CYBATHLON. The Pilot placed 3rd (out of 4) in the rehearsal. In the CYBATHLON, he placed 5th (out of 12) and was one of only two pilots who successfully completed all tasks in the competition, having the second-highest score overall. CONCLUSIONS Results with the SoftHand Pro and Pro-H suggest it to be a viable alternative to existing anthropomorphic hands and show that the unique flexibility of the hand is easily learned and exploited.
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Affiliation(s)
- Sasha Blue Godfrey
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Matteo Rossi
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Research Center “Enrico Piaggio”, University of Pisa, Pisa, Italy
| | - Cristina Piazza
- Research Center “Enrico Piaggio”, University of Pisa, Pisa, Italy
| | | | - Matteo Bianchi
- Research Center “Enrico Piaggio”, University of Pisa, Pisa, Italy
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Giorgio Grioli
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, USA
| | - Antonio Bicchi
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Research Center “Enrico Piaggio”, University of Pisa, Pisa, Italy
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24
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Grahn PJ, Lavrov IA, Sayenko DG, Van Straaten MG, Gill ML, Strommen JA, Calvert JS, Drubach DI, Beck LA, Linde MB, Thoreson AR, Lopez C, Mendez AA, Gad PN, Gerasimenko YP, Edgerton VR, Zhao KD, Lee KH. Enabling Task-Specific Volitional Motor Functions via Spinal Cord Neuromodulation in a Human With Paraplegia. Mayo Clin Proc 2017; 92:544-554. [PMID: 28385196 DOI: 10.1016/j.mayocp.2017.02.014] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
We report a case of chronic traumatic paraplegia in which epidural electrical stimulation (EES) of the lumbosacral spinal cord enabled (1) volitional control of task-specific muscle activity, (2) volitional control of rhythmic muscle activity to produce steplike movements while side-lying, (3) independent standing, and (4) while in a vertical position with body weight partially supported, voluntary control of steplike movements and rhythmic muscle activity. This is the first time that the application of EES enabled all of these tasks in the same patient within the first 2 weeks (8 stimulation sessions total) of EES therapy.
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Affiliation(s)
- Peter J Grahn
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Igor A Lavrov
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Dimitry G Sayenko
- Department of Integrative Biology and Physiology, University of California Los Angeles
| | - Meegan G Van Straaten
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Megan L Gill
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Jeffrey A Strommen
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Jonathan S Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN
| | - Dina I Drubach
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Lisa A Beck
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Margaux B Linde
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Andrew R Thoreson
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Cesar Lopez
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Aldo A Mendez
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Parag N Gad
- Department of Integrative Biology and Physiology, University of California Los Angeles
| | - Yury P Gerasimenko
- Department of Integrative Biology and Physiology, University of California Los Angeles; Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg, Russia
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California Los Angeles
| | - Kristin D Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
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25
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Zhao KD, Ben-Abraham EI, Magnuson DJ, Camp JJ, Berglund LJ, An KN, Bronfort G, Gay RE. Effect of Off-Axis Fluoroscopy Imaging on Two-Dimensional Kinematics in the Lumbar Spine: A Dynamic In Vitro Validation Study. J Biomech Eng 2016; 138:054502. [PMID: 26974192 DOI: 10.1115/1.4032995] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Indexed: 01/07/2023]
Abstract
Spine intersegmental motion parameters and the resultant regional patterns may be useful for biomechanical classification of low back pain (LBP) as well as assessing the appropriate intervention strategy. Because of its availability and reasonable cost, two-dimensional (2D) fluoroscopy has great potential as a diagnostic and evaluative tool. However, the technique of quantifying intervertebral motion in the lumbar spine must be validated, and the sensitivity assessed. The purpose of this investigation was to (1) compare synchronous fluoroscopic and optoelectronic measures of intervertebral rotations during dynamic flexion-extension movements in vitro and (2) assess the effect of C-arm rotation to simulate off-axis patient alignment on intervertebral kinematics measures. Six cadaveric lumbar-sacrum specimens were dissected, and active marker optoelectronic sensors were rigidly attached to the bodies of L2-S1. Fluoroscopic sequences and optoelectronic kinematic data (0.15-mm linear, 0.17-0.20 deg rotational, accuracy) were obtained simultaneously. After images were obtained in a true sagittal plane, the image receptor was rotated in 5 deg increments (posterior oblique angulations) from 5 deg to 15 deg. Quantitative motion analysis (qma) software was used to determine the intersegmental rotations from the fluoroscopic images. The mean absolute rotation differences between optoelectronic values and dynamic fluoroscopic values were less than 0.5 deg for all the motion segments at each off-axis fluoroscopic rotation and were not significantly different (P > 0.05) for any of the off-axis rotations of the fluoroscope. Small misalignments of the lumbar spine relative to the fluoroscope did not introduce measurement variation in relative segmental rotations greater than that observed when the spine and fluoroscope were perpendicular to each other, suggesting that fluoroscopic measures of relative segmental rotation during flexion-extension are likely robust, even when patient alignment is not perfect.
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Kakar S, Breighner RE, Leng S, McCollough CH, Moran SL, Berger RA, Zhao KD. The Role of Dynamic (4D) CT in the Detection of Scapholunate Ligament Injury. J Wrist Surg 2016; 5:306-310. [PMID: 27777822 PMCID: PMC5074832 DOI: 10.1055/s-0035-1570463] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
Background Scapholunate (SL) interosseus ligament injuries detected at an early stage could allow the surgeon to prevent progression through the spectrum of injury that leads to instability, and eventually osteoarthritis. We contend that early instability following injury can be detected by visualizing the relative motions and distances between the involved carpal bones (scaphoid and lunate) during wrist movement in vivo. The purpose of this study is to demonstrate the utility of dynamic CT (i.e., 4DCT) in diagnosing SL interosseus ligament injuries in two patients with clinical suspicion of SL interosseus ligament injury during flexion-extension (FE), radial-ulnar (RU) deviation, and dart thrower's (DT) motions. Case Description 4DCT images obtained from two individual cases were analyzed to assess the proximity between the scaphoid and lunate during wrist motion using standard image processing techniques. Proximity maps representing the distances between the scaphoid and lunate bones during each phase of wrist motion were determined. These maps provide insight into the severity of diastasis (large separation) and location of diastasis at the SL joint. The patients' proximity maps indicated dorsal diastasis and subtle uniform diastasis. Literature Review Complex musculoskeletal abnormalities, such as wrist joint instabilities, elude diagnosis during 2D fluoroscopy due to the 3D geometry of the anatomy and the inherent 3D nature of the bony kinematics. Even the most recent advances with MR arthrography lack good correlation with wrist arthroscopy. Wrist arthroscopy remains the gold standard for diagnosis to assess for intercarpal laxity. However, arthroscopy is an invasive procedure subjecting patients to the risk of infection, nerve injury, pain, and stiffness. Clinical Relevance 4DCT allows noninvasive characterization of where ligament injuries likely occur; this may allow for a more selective surgical treatment directed at the specific location of the tear.
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Affiliation(s)
- Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ryan E. Breighner
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kristin D. Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Ellingson AM, Mozingo JD, Magnuson DJ, Pagnano MW, Zhao KD. Characterizing fluoroscopy based kinematic accuracy as a function of pulse width and velocity. J Biomech 2016; 49:3741-3745. [PMID: 27769514 DOI: 10.1016/j.jbiomech.2016.09.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 07/21/2016] [Accepted: 09/16/2016] [Indexed: 12/19/2022]
Abstract
Fluoroscopic imaging has become increasingly popular to investigate total knee arthroplasty kinematics non-invasively - 3D implant models are aligned with 2D image projections, and optimized via an edge-contour alignment technique. Previous studies have quantified the accuracy of this approach, however they do not always adequately address the impact of image collection parameters. A particularly sensitive parameter is the pulse width, or exposure time per frame. At longer pulse widths, more motion is captured in a single frame; this can lead to image blur and subsequent degradation to image edge quality. Therefore, the comparative accuracy of relative joint kinematics as a function of pulse width and joint velocity needs to be defined. A limits of agreement approach was taken to define the mean differences between optoelectric kinematic measures (gold standard) and fluoroscopic methods at various pulse widths (1, 8 and 16ms) and knee velocities (50, 100 and 225°/s). The mean absolute differences between the optoelectric and fluoroscopic methods for 1ms pulse width were less than 1.5° and 0.9mm. Comparable rotational differences (1.3°) were observed for the 8ms pulse width but had larger translational differences (1.4mm). The 16ms pulse width yielded the greatest mean differences (2.0° and 1.6mm), which increased with knee flexion velocity. The importance of pulse width and velocity should not be overlooked for future studies - this parameter has proven to be a sensitive metric in the quantification of joint motion via fluoroscopy and must be identified and reported in future studies.
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Affiliation(s)
- Arin M Ellingson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joseph D Mozingo
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Biomedical Engineering and Physiology Graduate Program, Mayo Graduate School, Rochester, MN, USA
| | | | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Biomedical Engineering and Physiology Graduate Program, Mayo Graduate School, Rochester, MN, USA.
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Itoigawa Y, Hooke AW, Sperling JW, Steinmann SP, Zhao KD, Yamamoto N, Itoi E, An KN. Repairing the Capsule to the Transferred Coracoid Preserves External Rotation in the Modified Latarjet Procedure. J Bone Joint Surg Am 2016; 98:1484-9. [PMID: 27605693 DOI: 10.2106/jbjs.15.01069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is not clear whether the anterior capsule should be repaired to the coracoid process or to the native glenoid during the modified Latarjet procedure. We investigated joint stability and range of motion of the shoulder after the modified Latarjet procedure with both of these methods of capsular repair. METHODS Eighteen fresh-frozen cadaveric shoulders were used. After a Bankart lesion and 6-mm glenoid defect were created, the coracoid process was transferred to the glenoid and fixed with screws. The anterior capsule was repaired either to the coracoid process (coracoid group) or to the native glenoid (glenoid group). The ranges of internal and external axial rotation were measured with the arm at 0° and 60° of glenohumeral abduction. The range of motion was measured with a constant torque of 200 N-mm. Joint stability was measured using a custom stability testing device. The stability ratio in the anterior-posterior direction was measured with the arm at maximal external rotation and neutral rotation. RESULTS The range of external rotation was greater at both 0° and 60° of abduction in the coracoid group compared with the glenoid group (p < 0.05). The range of internal rotation was not significantly different between groups. The end-range stability ratio was not significantly different between groups, but the mid-range stability ratio was significantly greater in the glenoid group. CONCLUSIONS Because the difference in the mid-range stability may not be clinically relevant, we recommend repairing the capsule to the coracoid, as that preserves the range of motion in external rotation. CLINICAL RELEVANCE Repairing the capsule to the transferred coracoid during the modified Latarjet procedure appears to be beneficial to avoid the limited range of motion in external rotation, but the direct contact of the humeral head and the transferred coracoid might confer a risk of osteoarthritis. Long-term consequences in the clinical setting need to be clarified.
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Affiliation(s)
- Yoshiaki Itoigawa
- Department of Orthopedic Surgery (Y.I., A.W.H., J.W.S., S.P.S., and K.-N.A.) and Department of Physical Medicine and Rehabilitation (K.D.Z.), Mayo Clinic, Rochester, Minnesota Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Alexander W Hooke
- Department of Orthopedic Surgery (Y.I., A.W.H., J.W.S., S.P.S., and K.-N.A.) and Department of Physical Medicine and Rehabilitation (K.D.Z.), Mayo Clinic, Rochester, Minnesota
| | - John W Sperling
- Department of Orthopedic Surgery (Y.I., A.W.H., J.W.S., S.P.S., and K.-N.A.) and Department of Physical Medicine and Rehabilitation (K.D.Z.), Mayo Clinic, Rochester, Minnesota
| | - Scott P Steinmann
- Department of Orthopedic Surgery (Y.I., A.W.H., J.W.S., S.P.S., and K.-N.A.) and Department of Physical Medicine and Rehabilitation (K.D.Z.), Mayo Clinic, Rochester, Minnesota
| | - Kristin D Zhao
- Department of Orthopedic Surgery (Y.I., A.W.H., J.W.S., S.P.S., and K.-N.A.) and Department of Physical Medicine and Rehabilitation (K.D.Z.), Mayo Clinic, Rochester, Minnesota
| | | | - Eiji Itoi
- Tohoku University School of Medicine, Sendai, Japan
| | - Kai-Nan An
- Department of Orthopedic Surgery (Y.I., A.W.H., J.W.S., S.P.S., and K.-N.A.) and Department of Physical Medicine and Rehabilitation (K.D.Z.), Mayo Clinic, Rochester, Minnesota
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Zhao KD, Van Straaten MG, Cloud BA, Morrow MM, An KN, Ludewig PM. Scapulothoracic and Glenohumeral Kinematics During Daily Tasks in Users of Manual Wheelchairs. Front Bioeng Biotechnol 2015; 3:183. [PMID: 26636073 PMCID: PMC4653754 DOI: 10.3389/fbioe.2015.00183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/26/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Rates of shoulder pain in individuals who use manual wheelchairs (MWCs) as their primary means of mobility have been reported to be as high as 70% during activities of daily living. Current prevailing thought is that mechanical impingement of the soft tissues that reside within the subacromial space between the humeral head and coracoacromial arch is a major contributor to the shoulder pain in users of MWCs. The subacromial space size is directly related to the kinematics at the shoulder joint. Yet to be answered are questions about which common daily tasks are characterized by the most potentially detrimental kinematics. OBJECTIVE The purpose of this analysis was to quantify and compare potentially detrimental kinematics in three common tasks performed by individuals with spinal cord injury and shoulder pain. These data will add to the body of knowledge and test common assumptions about relative risk of tasks. DESIGN A cross-sectional study of 15 MWC users with shoulder pain. METHODS Electromagnetic surface sensor measures of mean and peak scapulothoracic (ST) internal and downward rotation, anterior tilt, and glenohumeral (GH) internal rotation were compared across propulsion, weight relief, and scapular plane abduction tasks using one-way repeated-measure ANOVA. RESULTS Statistical differences were observed between the tasks for all rotations. Mean ST anterior tilt was greater in weight relief and propulsion than during scapular plane abduction (24°, 23°, and 13° of anterior tilt, respectively). Mean GH axial rotation during weight relief was more internally rotated than during propulsion and scapular plane abduction (9°, 26°, and 51° of external rotation, respectively). LIMITATIONS Surface-based measures of kinematics are subject to skin motion artifact, especially in translation which was not addressed in this study. CONCLUSION Each task presented with specific variables that might contribute to risk of developing shoulder "impingement" and pain. These data may assist therapists in their assessment of movement contributions to shoulder pain in this population, as well as in subsequent treatment planning.
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Affiliation(s)
- Kristin D Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, MN , USA
| | - Meegan G Van Straaten
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic , Rochester, MN , USA
| | - Beth A Cloud
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, MN , USA
| | - Melissa M Morrow
- Department of Health Sciences Research, Mayo Clinic , Rochester, MN , USA
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic , Rochester, MN , USA
| | - Paula M Ludewig
- Program in Rehabilitation Science, Department of Physical Medicine and Rehabilitation, University of Minnesota , Minneapolis, MN , USA
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Wu JZ, Sinsel EW, Zhao KD, An KN, Buczek FL. Analysis of the Constraint Joint Loading in the Thumb During Pipetting. J Biomech Eng 2015; 137:084501. [PMID: 25839321 DOI: 10.1115/1.4030311] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Indexed: 11/08/2022]
Abstract
Dynamic loading on articular joints is essential for the evaluation of the risk of the articulation degeneration associated with occupational activities. In the current study, we analyzed the dynamic constraint loading for the thumb during pipetting. The constraint loading is considered as the loading that has to be carried by the connective tissues of the joints (i.e., the cartilage layer and the ligaments) to maintain the kinematic constraints of the system. The joint loadings are solved using a classic free-body approach, using the external loading and muscle forces, which were obtained in an inverse dynamic approach combined with an optimization procedure in anybody. The constraint forces in the thumb joint obtained in the current study are compared with those obtained in the pinch and grasp tests in a previous study (Cooney and Chao, 1977, "Biomechanical Analysis of Static Forces in the Thumb During Hand Function," J. Bone Joint Surg. Am., 59(1), pp. 27-36). The maximal compression force during pipetting is approximately 83% and 60% greater than those obtained in the tip pinch and key pinch, respectively, while substantially smaller than that obtained during grasping. The maximal lateral shear force is approximately six times, 32 times, and 90% greater than those obtained in the tip pinch, key pinch, and grasp, respectively. The maximal dorsal shear force during pipetting is approximately 3.2 and 1.4 times greater than those obtained in the tip pinch and key pinch, respectively, while substantially smaller than that obtained during grasping. Our analysis indicated that the thumb joints are subjected to repetitive, intensive loading during pipetting, compared to other daily activities.
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Morrow MMB, Van Straaten MG, Murthy NS, Braman JP, Zanella E, Zhao KD. Detailed shoulder MRI findings in manual wheelchair users with shoulder pain. Biomed Res Int 2014; 2014:769649. [PMID: 25180192 PMCID: PMC4142383 DOI: 10.1155/2014/769649] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
Shoulder pain and pathology are common in manual wheelchair (MWC) users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS) guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.
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Affiliation(s)
- Melissa M. B. Morrow
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Meegan G. Van Straaten
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Naveen S. Murthy
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jonathan P. Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Elia Zanella
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kristin D. Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA
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Cloud BA, Zhao KD, Breighner R, Giambini H, An KN. Agreement between fiber optic and optoelectronic systems for quantifying sagittal plane spinal curvature in sitting. Gait Posture 2014; 40:369-74. [PMID: 24909579 PMCID: PMC4099294 DOI: 10.1016/j.gaitpost.2014.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/04/2014] [Accepted: 05/08/2014] [Indexed: 02/02/2023]
Abstract
Spinal posture affects how individuals function from a manual wheelchair. There is a need to directly quantify spinal posture in this population to ultimately improve function. A fiber optic system, comprised of an attached series of sensors, is promising for measuring large regions of the spine in individuals sitting in a wheelchair. The purpose of this study was to determine the agreement between fiber optic and optoelectronic systems for measuring spinal curvature, and describe the range of sagittal plane spinal curvatures in natural sitting. Able-bodied adults (n = 26, 13 male) participated. Each participant assumed three sitting postures: natural, slouched (accentuated kyphosis), and extension (accentuated lordosis) sitting. Fiber optic (ShapeTape) and optoelectronic (Optotrak) systems were applied to the skin over spinous processes from S1 to C7 and used to measure sagittal plane spinal curvature. Regions of kyphosis and lordosis were identified. A Cobb angle-like method was used to quantify lordosis and kyphosis. Generalized linear model and Bland-Altman analyses were used to assess agreement. A strong correlation exists between curvature values obtained with Optotrak and ShapeTape (R(2) = 0.98). The mean difference between Optotrak and ShapeTape for kyphosis in natural, extension, and slouched postures was 4.30° (95% LOA: -3.43 to 12.04°), 3.64° (95% LOA: -1.07 to 8.36°), and 4.02° (95% LOA: -2.80 to 10.84°), respectively. The mean difference for lordosis, when present, in natural and extension postures was 2.86° (95% LOA: -1.18 to 6.90°) and 2.55° (95% LOA: -3.38 to 8.48°), respectively. In natural sitting, the mean ± SD of kyphosis values was 35.07 ± 6.75°. Lordosis was detected in 8/26 participants: 11.72 ± 7.32°. The fiber optic and optoelectronic systems demonstrate acceptable agreement for measuring sagittal plane thoracolumbar spinal curvature.
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Affiliation(s)
- Beth A. Cloud
- Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic 200 First Street SW Rochester, MN 55905 USA
,Mayo Graduate School, Mayo Clinic College of Medicine Center for Clinical and Translational Science Mayo Clinic 200 First Street SW Rochester, MN 55905 USA
| | - Kristin D. Zhao
- Center for Rehabilitation Medicine Research, Department of Physical Medicine and Rehabilitation Mayo Clinic 200 First Street SW Rochester, MN 55905 USA
| | - Ryan Breighner
- Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic 200 First Street SW Rochester, MN 55905 USA
| | - Hugo Giambini
- Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic 200 First Street SW Rochester, MN 55905 USA
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research Mayo Clinic 200 First Street SW Rochester, MN 55905 USA
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Van Straaten MG, Cloud BA, Morrow MM, Ludewig PM, Zhao KD. Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation. Arch Phys Med Rehabil 2014; 95:1810-1817.e2. [PMID: 24887534 DOI: 10.1016/j.apmr.2014.05.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/24/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized. DESIGN A pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk). SETTING Subjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center. PARTICIPANTS A convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination. INTERVENTIONS A 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing. MAIN OUTCOME MEASURES Primary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius. RESULTS Pain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ(2)2=5.10, P=.014), DASH Index (χ(2)2=5.41, P=.012), and SRQ (χ(2)2=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points. CONCLUSIONS A high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.
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Affiliation(s)
- Meegan G Van Straaten
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN
| | - Beth A Cloud
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN; Mayo Graduate School, Mayo Clinic College of Medicine, Center for Clinical and Translational Science, Rochester, MN
| | - Melissa M Morrow
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN
| | - Paula M Ludewig
- Program in Rehabilitation Science, University of Minnesota, Minneapolis, MN
| | - Kristin D Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
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Matsuhashi T, Hooke AW, Zhao KD, Sperling JW, Steinmann SP, An KN. Effect of humeral head rotation on bony glenohumeral stability. Clin Biomech (Bristol, Avon) 2014; 28:961-6. [PMID: 24135199 DOI: 10.1016/j.clinbiomech.2013.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The humeral head and glenoid cavity are not perfectly spherical, nor do they have matching radii of curvature. We hypothesized that glenohumeral stability is dependent on axial humeral rotation. METHODS Seven cadaveric shoulders were investigated. For each test, the humeral head was translated relative to the glenoid in 2 directions (starting from neutral), anterior and anteroinferior. Contact forces and lateral humeral displacement were recorded. Joint stability was quantified using the stability ratio and energy to dislocation. The humerus was set in 60° of abduction for all tests. Testing was performed in neutral rotation and 60° of external rotation. FINDINGS The force displacement curves differed between rotations. In both displacement directions, the peak translational force occurred with less displacement in neutral rotation than in external rotation. The stability ratio and energy to dislocation in the anteroinferior direction were greater than in the anterior direction for both rotation positions. While there were no significant differences in the stability ratio or energy to dislocation between rotation conditions at complete dislocation, the energy required to move the humeral head 10% of the glenoid width was significantly greater with the arm in neutral rotation. INTERPRETATION The energy to dislocation, a new parameter of dislocation risk, and the stability ratio, indicate that the glenohumeral joint is more stable in the anteroinferior direction than the anterior direction. During initial displacement, axial rotation of the humeral head contributes to glenohumeral geometrical stability. However, humeral head rotation does not have a significant effect when looking at complete dislocation.
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Affiliation(s)
- Tomoya Matsuhashi
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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Omi R, Hooke AW, Zhao KD, Matsuhashi T, Goto A, Yamamoto N, Sperling JW, Steinmann SP, Itoi E, An KN. The effect of the remplissage procedure on shoulder range of motion: a cadaveric study. Arthroscopy 2014; 30:178-87. [PMID: 24388452 DOI: 10.1016/j.arthro.2013.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/05/2013] [Accepted: 11/04/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position. METHODS HSLs of 50% and 100% of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°). RESULTS For standard ROMs, the procedure for the 50% HSL maintained complete ROMs, whereas the procedure for the 100% HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50% HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100% HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle. CONCLUSIONS In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position. CLINICAL RELEVANCE The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance.
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Affiliation(s)
- Rei Omi
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Alexander W Hooke
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kristin D Zhao
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Tomoya Matsuhashi
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Akira Goto
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - John W Sperling
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Scott P Steinmann
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kai-Nan An
- Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
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Wu JZ, Sinsel EW, Shroyer JF, Warren CM, Welcome DE, Zhao KD, An KN, Buczek FL. Analysis of the musculoskeletal loading of the thumb during pipetting--a pilot study. J Biomech 2014; 47:392-9. [PMID: 24290720 DOI: 10.1016/j.jbiomech.2013.11.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 11/16/2022]
Abstract
Previous epidemiological studies indicate that the use of thumb-push mechanical pipettes is associated with musculoskeletal disorders (MSDs) in the hand. The goal of the current study was to analyze the loading in the muscle-tendon units in the thumb during pipetting. The hand is modeled as a multi-body linkage system and includes four fingers (index, long, ring, and little finger), a thumb, and a palm segment. Since the current study is focused on the thumb, the model includes only nine muscles attached to the thumb via tendons. The time-histories of joint angles and push force at the pipette plunger during pipetting were determined experimentally and used as model input; whereas forces in the muscle-tendon units in the thumb were calculated via an inverse dynamic approach combined with an optimization procedure. Results indicate that all nine muscles have force outputs during pipetting, and the maximal force was in the abductor pollicis brevis (APB). The ratio of the mean peak muscle force to the mean peak push force during the dispensing cycle was approximately 2.3, which is comparable to values observed in grasping tasks in the literature. The analysis method and results in the current study provide a mechanistic understanding of MSD risk factors associated with pipetting, and may be useful in guiding ergonomic designs for manual pipettes.
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Affiliation(s)
- John Z Wu
- National Institute for Occupational Safety & Health, Morgantown, WV 26505, USA.
| | - Erik W Sinsel
- National Institute for Occupational Safety & Health, Morgantown, WV 26505, USA
| | - Justin F Shroyer
- National Institute for Occupational Safety & Health, Morgantown, WV 26505, USA
| | | | - Daniel E Welcome
- National Institute for Occupational Safety & Health, Morgantown, WV 26505, USA
| | - Kristin D Zhao
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Frank L Buczek
- National Institute for Occupational Safety & Health, Morgantown, WV 26505, USA
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Matsuhashi T, Hooke AW, Zhao KD, Goto A, Sperling JW, Steinmann SP, An KN. Tensile properties of a morphologically split supraspinatus tendon. Clin Anat 2013; 27:702-6. [PMID: 24214830 DOI: 10.1002/ca.22322] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/22/2013] [Accepted: 08/28/2013] [Indexed: 12/11/2022]
Abstract
The supraspinatus tendon consists morphologically of two sub-regions, anterior and posterior. The anterior sub-region is thick and tubular while the posterior is thin and strap-like. The purpose of this study was to compare the structural and mechanical properties of the anterior and posterior sub-regions of the supraspinatus tendon. The supraspinatus tendons from seven human cadaveric shoulders were morphologically divided into the anterior and posterior sub-regions. Length, width, and thickness were measured. A servo-hydraulic testing machine (MTS Systems Corporation, Minneapolis, MN) was used for tensile testing. The maximal load at failure, modulus of elasticity and ultimate tendon stress were calculated. Repeated measures were used for statistical comparisons. The mean anterior tendon cross-sectional area was 47.3 mm(2) and the posterior was 32.1 mm(2) . Failure occurred most often at the insertion site: anterior (5/7) and posterior (6/7). All parameters of the anterior sub-region were significantly greater than those of the posterior sub-region. The moduli of elasticity at the insertion site were 592.4 MPa in the anterior sub-region and 217.7 MPa in the posterior (P = 0.01). The ultimate failure loads were 779.2 N in the anterior sub-region and 335.6 N in the posterior (P = 0.003). The ultimate stresses were 22.1 MPa in the anterior sub-region and 11.6 MPa in the posterior (P = 0.008). We recognized that the anterior and posterior sub-regions of the SSP tendon have significantly different mechanical properties. In a future study, we need to evaluate how best to repair an SSP tendon considering these region-specific properties.
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Affiliation(s)
- Tomoya Matsuhashi
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota
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Wu JZ, Sinsel EW, Shroyer JF, Welcome DE, Zhao KD, An KN, Buczek FL. The musculoskeletal loading profile of the thumb during pipetting based on tendon displacement. Med Eng Phys 2013; 35:1801-10. [PMID: 24018066 DOI: 10.1016/j.medengphy.2013.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/08/2013] [Accepted: 08/11/2013] [Indexed: 11/19/2022]
Abstract
Strong evidence indicates that highly repetitive manual work is associated with the development of upper extremity musculoskeletal disorders (MSDs). One of the occupational activities that involves highly repetitive and forceful hand work is manual pipetting in chemical or biological laboratories. In the current study, we quantified tendon displacement as a parameter to assess the cumulative loading exposure of the musculoskeletal system in the thumb during pipetting. The maximal tendon displacement was found in the flexor pollicis longus (FPL) tendon. Assuming that subjects' pipetting rates were maintained constant during a period of 1 h, the average accumulated tendon displacement in the FPL reached 29 m, which is in the lower range of those observed in other occupational activities, such as typing and nail gun operations. Our results showed that tendon displacement data contain relatively small standard deviations, despite high variances in thumb kinematics, suggesting that the tendon displacements may be useful in evaluating the musculoskeletal loading profile.
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Affiliation(s)
- John Z Wu
- National Institute for Occupational Safety & Health, Morgantown, WV 26505, USA.
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Watanabe K, Kitaoka HB, Fujii T, Crevoisier XM, Berglund LJ, Zhao KD, Kaufman KR, An KN. Posterior tibial tendon dysfunction and flatfoot: analysis with simulated walking. Gait Posture 2013; 37:264-8. [PMID: 22939754 PMCID: PMC3549316 DOI: 10.1016/j.gaitpost.2012.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 07/16/2012] [Accepted: 07/21/2012] [Indexed: 02/02/2023]
Abstract
Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.
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Affiliation(s)
- Kota Watanabe
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A,Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Tadashi Fujii
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | | | | | - Kristin D. Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | | | - Kai-Nan An
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
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Muraki T, Yamamoto N, Zhao KD, Sperling JW, Steinmann SP, Cofield RH, An KN. Effects of posterior capsule tightness on subacromial contact behavior during shoulder motions. J Shoulder Elbow Surg 2012; 21:1160-7. [PMID: 22079765 DOI: 10.1016/j.jse.2011.08.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 07/27/2011] [Accepted: 08/06/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although posterior capsule tightness is believed to cause abnormal contact in the subacromial space, it is not clear whether this tightness changes the contact between the acromion and humeral head. MATERIALS AND METHODS Nine fresh, frozen cadaveric shoulders were used to measure contact pressure on the coracoacromial arch during passive flexion, abduction, and internal and external rotation at 90° of elevation in the scapular plane, as well as horizontal adduction and abduction. The site where the peak contact pressure occurred was also observed. The posterior capsule in the region from 8 to 10 o'clock in the right shoulder was plicated to simulate posterior capsule tightness. RESULTS Peak contact pressure significantly increased with the tightened posterior capsule during flexion. Although peak contact pressure on the coracoacromial ligament during internal rotation significantly increased after capsule tightening, there was no significant increase in pressure when considering the entire coracoacromial arch. The angle where the peak contact pressure occurred during flexion was not significantly far from the end range. The site of the peak contact pressure in 7 of 9 shoulders was on the lesser tuberosity during flexion, regardless of the posterior capsule tightness. CONCLUSIONS Posterior capsule tightness increased contact pressure mainly on the lesser tuberosity during flexion. The peak contact pressure occurred close to the end range of flexion, mainly on the lesser tuberosity. These findings are useful to understand the contribution of posterior capsule tightness to subacromial contact.
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Affiliation(s)
- Takayuki Muraki
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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Arimitsu S, Moritomo H, Kitamura T, Berglund LJ, Zhao KD, An KN, Rizzo M. The stabilizing effect of the distal interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study. J Bone Joint Surg Am 2011; 93:2022-30. [PMID: 22048098 DOI: 10.2106/jbjs.j.00411] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The importance of the stabilizing effect of the distal interosseous membrane on the distal radioulnar joint, especially in patients with a distal oblique bundle, has been described. The purpose of this study was to evaluate the stability of the distal radioulnar joint after an ulnar shortening osteotomy and to quantify longitudinal resistance to ulnar shortening when the osteotomy was proximal or distal to the ulnar attachment of the distal interosseous membrane. These relationships were characterized for forearms with or without a distal oblique bundle. METHODS Ten fresh-frozen cadavers were used. A transverse osteotomy and ulnar shortening was performed proximal (proximal shortening) and distal (distal shortening) to the ulnar attachment of the distal interosseous membrane. Distal radioulnar joint laxity was evaluated as the volar and dorsal displacements of the radius relative to the fixed ulna with 20 N of applied force. Testing was performed under controlled 1-mm increments of ulnar shortening up to 4 mm, with the forearm in neutral alignment, 60° of pronation, and 60° of supination. Resistance to ulnar shortening was quantified as the slope of the load-displacement curve obtained by displacing the distal ulnar segment proximally. RESULTS In proximal shortening, significantly greater stability of the distal radioulnar joint was obtained with even 1 mm of shortening compared with the control, whereas distal shortening demonstrated significant improvement in stability of the distal radioulnar joint only after shortening of ≥4 mm in all rotational positions. Significantly greater stability of the distal radioulnar joint was achieved with proximal shortening than with distal shortening and in specimens with a distal oblique bundle than in those without a distal oblique bundle. The longitudinal resistance to ulnar shortening was significantly greater in proximal shortening than in distal shortening. The stiffness in proximal shortening was not affected by the presence of a distal oblique bundle in the distal interosseous membrane. CONCLUSIONS Ulnar shortening with the osteotomy carried out proximal to the attachment of the distal interosseous membrane had a more favorable effect on stability of the distal radioulnar joint compared with distal osteotomy, especially in the presence of a distal oblique bundle.
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Affiliation(s)
- Sayuri Arimitsu
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
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Wu JZ, Sinsel EW, Gloekler DS, Wimer BM, Zhao KD, An KN, Buczek FL. Inverse dynamic analysis of the biomechanics of the thumb while pipetting: a case study. Med Eng Phys 2011; 34:693-701. [PMID: 22015316 DOI: 10.1016/j.medengphy.2011.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 08/25/2011] [Accepted: 09/15/2011] [Indexed: 11/29/2022]
Abstract
Thumb-push manual pipettes are commonly used tools in many medical, biological, and chemical laboratories. Epidemiological studies indicate that the use of thumb-push mechanical pipettes is associated with musculoskeletal disorders in the hand. The goal of the current study was to evaluate the kinematics and joint loading of the thumb during pipetting. The time-histories of joint angles and the interface contact force between the thumb and plunger during the pipetting action were determined experimentally, and the joint loadings and joint power in the thumb were calculated via an inverse dynamic approach. The moment, power, and energy absorption in each joint of the thumb during the extraction and dispensing actions were analyzed. The results indicate that the majority of the power is generated in the interphalangeal (IP) and carpometacarpal (CMC) joints for the pipetting action. The analysis method and results in the current study will be helpful in exploring the mechanism for musculoskeletal injuries of the hand associated with pipetting, providing a preliminary foundation for ergonomic design of the pipette.
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Affiliation(s)
- John Z Wu
- National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA.
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Kitamura T, Moritomo H, Arimitsu S, Berglund LJ, Zhao KD, An KN, Rizzo M. The biomechanical effect of the distal interosseous membrane on distal radioulnar joint stability: a preliminary anatomic study. J Hand Surg Am 2011; 36:1626-30. [PMID: 21872404 DOI: 10.1016/j.jhsa.2011.07.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 07/21/2011] [Accepted: 07/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The distal interosseous membrane (DIOM) is a secondary stabilizer of the distal radioulnar joint (DRUJ) and has a considerably variable morphology. The purpose of this study was to investigate whether innate DRUJ stability is influenced by the anatomic variation of the DIOM. METHODS Ten fresh-frozen cadaver upper extremities were used in this study. The humerus and the ulna were affixed rigidly to a custom-made apparatus, with the elbow in 90° of flexion. Testing was performed by translating the radius in volar and dorsal directions relative to the ulna, with a 20-N applied force in neutral forearm alignment, 60° pronation, and 60° supination. Total translation of the radius was measured as DRUJ laxity. After the experiment, we investigated anatomic variation of the DIOM, especially regarding the existence of the distal oblique bundle (DOB), which is a notably thick fiber within the DIOM. We compared the DRUJ stability between the groups with and without the DOB. RESULTS The DOB was found in 4 of 10 specimens. The group with a DOB demonstrated a significantly greater DRUJ stability in the neutral position than the group without a DOB. In pronated and supinated forearm positions, no significant difference in DRUJ stability was obtained between the groups with and without a DOB. CONCLUSIONS Innate DRUJ stability in the neutral forearm position was greater in the group with a DOB than in those without a DOB. CLINICAL RELEVANCE This study suggests that considerable variation exists in DRUJ laxity and that it partially depends on anatomical variations of the DIOM.
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Affiliation(s)
- Takashi Kitamura
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55905, USA
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Henderson J, Thoreson A, Yoshii Y, Zhao KD, Amadio PC, An KN. Finite element model of subsynovial connective tissue deformation due to tendon excursion in the human carpal tunnel. J Biomech 2011; 44:150-5. [PMID: 20887993 DOI: 10.1016/j.jbiomech.2010.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 08/13/2010] [Accepted: 09/06/2010] [Indexed: 11/26/2022]
Abstract
Carpal tunnel syndrome (CTS) is a nerve entrapment disease, which has been extensively studied by the engineering and medical community. Although the direct cause is unknown, in vivo and in vitro medical research has shown that tendon excursion creates microtears in the subsynovial connective tissue (SSCT) surrounding the tendon in the carpal tunnel. One proposed mechanism for the SSCT injury is shearing, which is believed to cause fibrosis of the SSCT. Few studies have reported quantitative observations of SSCT response to mechanical loading. Our proposed model is a 2-D section that consists of an FDS tendon, interstitial SSCT and adjacent stationary tendons. We believe that developing this model will allow the most complete quantitative observations of SSCT response to mechanical loading reported thus far. Boundary conditions were applied to the FEA model to simulate single finger flexion. A velocity was applied to the FDS tendon in the model to match loading conditions of the documented cadaver wrist kinematics studies. The cadaveric and FEA displacement results were compared to investigate the magnitude of stiffness required for the SSCT section of the model. The relative motions between the model and cadavers matched more closely than the absolute displacements. Since cadaveric models do not allow identification of the SSCT layers, an FEA model will help determine the displacement and stress experienced by each SSCT layer. Thus, we believe this conceptual model is a first step in understanding how the SSCT layers are recruited during tendon excursion.
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Affiliation(s)
- Jacqueline Henderson
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 1st SW, Rochester, MN 55905, USA
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Abstract
"Convocation of Thanks" is the annual ceremony commemorating the gift of body donation to the Mayo Clinic Bequest program in the Department of Anatomy, College of Medicine, Mayo Clinic in Rochester, MN. For 26 years, this ceremony of gratitude has given students, researchers, faculty, and family members an opportunity to reflect on the immeasurable value of these gifts. The authors describe the significance of ceremonies such as these in historical context and provide abridged transcripts of participants' speeches.
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Affiliation(s)
- Wojciech Pawlina
- Department of Anatomy, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Yoshii Y, Zhao C, Henderson J, Zhao KD, An KN, Amadio PC. Velocity-dependent changes in the relative motion of the subsynovial connective tissue in the human carpal tunnel. J Orthop Res 2011; 29:62-6. [PMID: 20607819 PMCID: PMC2952285 DOI: 10.1002/jor.21181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to measure the rate-dependent changes in the relative motion of subsynovial connective tissue (SSCT) and median nerve in the human carpal tunnel. Using fluoroscopy, we measured the relative motion of middle finger flexor digitorum superficialis tendon, SSCT, and median nerve in eight human cadavers during simulated active finger flexion motions at 2.0, 5.0, 7.5, and 10.0 mm/s. The shear index was defined as the difference in motion between tendon and SSCT or tendon and nerve, expressed as a percentage of tendon excursion. The motion patterns of the SSCT and median nerve relative to tendon excursion were measured at each 10% increment (decile) of maximum tendon excursion. The tendon-SSCT shear index was significantly higher at 10.0 mm/s than at 2.0 mm/s in the single-digit motion. There were corresponding significant decreases in SSCT and median nerve motion for the 10.0 mm/s velocity compared to the 2.0 mm/s velocity. This study demonstrates that the relative motion of the tissues in the carpal tunnel appears to be dependent on tendon velocity, specifically with less nerve and SSCT motion at higher velocity tendon motion. This suggests that SSCT may be predisposed to shear injury from high-velocity tendon motion.
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Affiliation(s)
- Yuichi Yoshii
- Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street South West, Rochester, Minnesota 55905, USA
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Ilharreborde B, Shaw MN, Berglund LJ, Zhao KD, Gay RE, An KN. Biomechanical evaluation of posterior lumbar dynamic stabilization: an in vitro comparison between Universal Clamp and Wallis systems. Eur Spine J 2010; 20:289-96. [PMID: 21132335 DOI: 10.1007/s00586-010-1641-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 10/20/2010] [Accepted: 11/16/2010] [Indexed: 11/28/2022]
Abstract
Treatment of chronic low back pain due to degenerative lumbar spine conditions often involves fusion of the symptomatic level. A known risk of this procedure is accelerated adjacent level degeneration. Motion preservation devices have been designed to provide stabilization to the symptomatic motion segment while preserving some physiologic motion. The aim of this study was to compare the changes in relative range of motion caused as a result of application of two non-fusion, dynamic stabilization devices: the Universal Clamp (UC) and the Wallis device. Nine fresh, frozen human lumbar spines (L1-Sacrum) were tested in flexion-extension, lateral bending, and axial rotation with a custom spine simulator. Specimens were tested in four conditions: (1) intact, (2) the Universal Clamp implanted at L3-4 (UC), (3) the UC with a transverse rod added (UCTR), and (4) the Wallis device implanted at L3-4. Total range of motion at 7.5 N-m was determined for each device and compared to intact condition. The UC device (with or without a transverse rod) restricted motion in all planes more than the Wallis. The greatest restriction was observed in flexion. The neutral position of the L3-4 motion segment shifted toward extension with the UC and UCTR. Motion at the adjacent levels remained similar to that observed in the intact spine for all three constructs. These results suggest that the UC device may be an appropriate dynamic stabilization device for degenerative lumbar disorders.
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Affiliation(s)
- Brice Ilharreborde
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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Muraki T, Yamamoto N, Zhao KD, Sperling JW, Steinmann SP, Cofield RH, An KN. Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med 2010; 38:600-7. [PMID: 19966101 DOI: 10.1177/0363546509350074] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tightness of the posteroinferior capsule is assumed to be the cause of internal rotation loss in baseball pitchers. Although the relationship between posterior capsule and subacromial impingement has been recognized, this relationship during the baseball-pitching motion is unclear. HYPOTHESIS Contact pressure during baseball-pitching motion increases with posterior capsule tightness. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen shoulders were used. The peak contact pressure and area on the coracoacromial arch were measured on a custom-designed shoulder experimental device capable of 6 degrees of freedom motion. Simultaneously, the sites of peak pressure on the coracoacromial arch and humerus were observed from various angles. The posteroinferior capsule tightness was simulated by plicating the capsule in the region from 6 to 8 o'clock. The static testing positions correlated to the early cocking, late cocking, acceleration, deceleration, and follow-through phases of the pitching motion. RESULTS The peak contact pressure during the follow-through phase (0.63 + or - 0.50 MPa) significantly increased with posteroinferior capsule tightness (1.00 + or - 0.65 MPa) (P = .014). Additionally, the contact area on the coracoacromial ligament during the follow-through phase (0.98 + or - 0.67 cm(2)) significantly increased with posteroinferior capsule tightness (1.47 + or - 0.91 cm(2)) (P < .001). The site of the peak contact pressure did not change between the 2 conditions. CONCLUSION Our findings demonstrate that posteroinferior capsule tightness leads to higher contact pressure under the subacromial arch and increased contact area, particularly on the coracoacromial ligament during the follow-through phase. CLINICAL RELEVANCE This tightness may affect risk of injury of the rotator cuff and its surrounding tissues by increasing subacromial contact during pitching.
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Affiliation(s)
- Takayuki Muraki
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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Abstract
BACKGROUND Various tendinopathies occur about the ankle, but there are few publications investigating their etiology or pathoanatomy. The purpose of this investigation was to determine the gliding resistance of the tendons about the posteromedial ankle: the posterior tibial (PT), flexor digitorum longus (FDL), and flexor hallucis longus (FHL) tendons. MATERIALS AND METHODS The gliding abilities of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons at the ankle-hindfoot level were compared, in terms of gliding resistance, with use of a system that was developed in this laboratory. Six cadaveric specimens were used and tested in a dorsiflexed position, then in simulated flatfoot in a dorsiflexed position. RESULTS The gliding resistance was found to be significantly greater in the simulated flatfoot in dorsiflexion compared to the dorsiflexed position with an intact arch for the PT, FDL, and FHL tendons. The gliding resistance was significantly higher in the PT tendon than FDL or FHL tendons in the flatfoot/dorsiflexion condition. There was no significant difference between the FDL and FHL tendons in resistance in either condition. CONCLUSION We concluded that the gliding ability of the PT tendon was inferior to that of the FDL and FHL tendons in a simulated flatfoot model. CLINICAL RELEVANCE The findings of the present study are consistent with the clinical observations that tendinitis and rupture of the PT tendon commonly occurs at the malleolar level, whereas FDL and FHL ruptures do not. A pre-existing flexible flatfoot deformity may be associated with PT tendon dysfunction in the adult due to poor gliding ability of the PT tendon.
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Affiliation(s)
- Tadashi Fujii
- Mayo Clinic, Department of Orthopedics, Rochester, MN 55905, USA
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Hongo M, Gay RE, Zhao KD, Ilharreborde B, Huddleston PM, Berglund LJ, An KN, Zhao C. Junction kinematics between proximal mobile and distal fused lumbar segments: biomechanical analysis of pedicle and hook constructs. Spine J 2009; 9:846-53. [PMID: 19660990 DOI: 10.1016/j.spinee.2009.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 06/04/2009] [Accepted: 06/25/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Biomechanical studies have demonstrated increased motion in motion segments adjacent to instrumentation or arthrodesis. The effects of different configurations of hook and pedicle screw instrumentation on the biomechanical behaviors of adjacent segments have not been well documented. PURPOSE To compare the effect of three different fusion constructs on adjacent segment motion proximal to lumbar arthrodesis. METHODS Seven human cadaver lumbar spines were tested in the following conditions: 1) intact; 2) L4-L5-simulated circumferential fusion (CF); 3) L4-L5-simulated fusion extended to L3 with pedicle screws; and 4) L4-L5-simulated fusion extended to L3 with sublaminar hooks. Rotation data at L2-L3, L3-L4, and L4-L5 were analyzed using both load limit control (+/-7.5N.m) and displacement limit control (truncated to the greatest common angular motion of the segments for each specimen). RESULTS Both the L3-L4 and L2-L3 motion segments above the L4-L5-simulated CF had significantly increased motion in all loading planes compared with the intact spine, but no significant differences were found between L3-L4 and L2-L3 motion. When the L3-L4 segment was stabilized with pedicle screws, its motion was significantly smaller in flexion, lateral bending, and axial rotation than when stabilized with sublaminar hooks. At the same time, L2-L3 motion was significantly larger in flexion, lateral bending, and axial rotation in the pedicle screw model compared with the sublaminar hook construct. CONCLUSIONS The use of sublaminar hooks to stabilize the motion segment above a circumferential lumbar fusion reduced motion at the next cephalad segment compared with a similar construct using pedicle screws. The semiconstrained hook enhancement may be considered if a patient is at a risk of adjacent segment disorders.
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Affiliation(s)
- Michio Hongo
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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