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Introduction: Residuals of whiplash injury (W.I.) represent one of most common causes of compensation claims in forensic medicine. Until 2012, clinical assessment was deemed sufficient to ascertain the reduction of neck mobility. A new law (n. 27 year 2012/3-ter;3-quarter) has established that in order to assess adamage it is now necessary to demonstrate it both with clinical and instrumental methods. As a consequence, the mere clinical assessment ofW.I. is not anymore accepted by the insurance companies. Sowe need an instrumental evaluationmethod, that should be non invasive, easy to perform, and guarantees a high reproducibility [2]. In forensic medicine there is also another problem: since the assessment of neck mobility has an effect on the economic compensation, the patients may be inclined to demonstrate a deeper damage. So the test should not rely on voluntary actions and should provide some indication of reliability. In our intention this can be achieved by quantifying the passive range of motion (PROM) and by analyzing its variability. Methods: An opto-electronic stereo-photogrammetric system (POSEIDON system BTS, Italy) was employed for obtaining the relative motion between head and upper trunk. Three retroreflective markers were applied to the temples and nasion respectively, and three on acromions and apex of sternum (six markers in total). Only 3-TV camera was sufficient to obtain a reliable acquisition of kinematics at 60 frames/s. While specific physical maneuvers were performed on the subject, the system computed the markers trajectories, the main rotation angles of the head in relation to the trunk (flexion–extension, lateral bending, axial rotation), speed and acceleration. The automatic output was a clinical report that integrates all data related to the morphology and kinematics of the analyzed body segment. Our preliminary study was carried out on 6 healthy, non symptomatic subjects and 6 subjects with history of W.I., whose evaluation was finalized to the insurance assessment. The test was performed in two steps: (1) pure clinical assessment; (2) instrumental assessment. In this second step the subjects were seated on a armchair, in front of the TV-cameras, while the examiner performed the maneuvers to test their PROM inflexion–extension, lateral bending and rotation of the head/neck. Each movement was repeated at least 6 times. The results were compared to age matched control data. Results: Our preliminary data collected on the healthy, asymptomatic subjectsmatched verywellwith data provided in literature [1,3]. Subjects who had residuals ofW.I., exhibited a lower range of motion and some asymmetries that well correlated to the reported symptoms. More interestingly, the standard deviation (SD) of the measured PROM ranged from 1.6◦ to 2.6◦ in the subjects that had no interest in the insurance compensation, and ranged from 3.5◦ to 4.0◦ in symptomatic subjects that were assessed for insurance purposes. In one of them, whose attempt to overstate his reduced mobility was evident clinically, the SD was 8.1. Another interesting observation was that left/right asymmetry for lateral bending and axial rotationwas in the range 0–3◦ in the healthy subjects and 6–21◦ in the W.I. subjects. Discussion: The analysis system adopted allows us to perform an instrumental non invasive, high reliability, easy to use assessment, does not require a large space around the subject and needs only few minutes to produce the written report. When comparing the results of the pure clinical method with results of the instrumental method, the higher resolution of the instrumental method proved to be a clear advantage and allowed us to better understand the clinical condition. It is our impression that this instrumental method offers a major possibility to recognize the simulation. Our aims isnowtocollect a largedatabaseof control subjects, in relation to age and sex, in order to obtain a reference formotion assessment in subjects with history of W.I.

Background Flexed posture commonly increases with age and is related to musculoskeletal impairment and reduced physical performance. The purpose of this clinical study was to systematically compare the effects of a physical activity program that specifically address the flexed posture that marks a certain percentage of elderly individuals with a non specific exercise program for 3 months. Methods Participants were randomly divided into two groups: one followed an Adapted Physical Activity program for flexed posture and the other one completed a non-specific physical activity protocol for the elderly. A multidimensional clinical assessment was performed at baseline and at 3 months including anthropometric data, clinical profile, measures of musculoskeletal impairment and disability. The instrumental assessment of posture was realized using a stereophotogrammetric system and a specific biomechanical model designed to describe the reciprocal position of the body segments on the sagittal plane in a upright posture. Results The Adapted Physical Activity program determined a significant improvement in several key parameters of the multidimensional assessment in comparison to the non-specific protocol: decreased occiput-to-wall distance, greater lower limb range of motion, better flexibility of pectoralis, hamstrings and hip flexor muscles, increased spine extensor muscles strength. Stereophotogrammetric analysis confirmed a reduced protrusion of the head and revealed a reduction in compensative postural adaptations to flexed posture characterized by knee flexion and ankle dorsiflexion in the participants of the specific program. Conclusion The Adapted Physical Activity program for flexed posture significantly improved postural alignment and musculoskeletal impairment of the elderly. The stereophotogrammetric evaluation of posture was useful to measure the global postural alignment and especially to analyse the possible compensatory strategies at lower limbs in flexed posture.

Traditional gait and fluoroscopy analysis of human movement are largely utilised but are still limited in registration, integration, synchronisation and visualisation capabilities. The present work exploits the features of a recently developed software tool based on multimodal display (Data Manager developed within the EU-funded project 'Multimod') in an exemplary clinical case. Standard lower limb gait analysis, comprising segment position, ground reaction force and EMG data collection, and three-dimensional fluoroscopy analysis at the replaced joint were performed in a total knee replacement patient while ascending stairs. Clinical information such as X-rays and standard scores were also available. Data Manager was able to import all this variety of data and to structure these in an original hierarchical tree. Bone and prosthesis component models were registered to corresponding marker position data for effective three-dimensional animations. These were also synchronised with corresponding standard video sequences. Animations, video, time-histories of collected and also processed data were shown in various combinations, according to specific interests of the bioengineering and medical professionals expected to observe and to interpret this large amount of data. This software tool demonstrated to be a valuable means to enhance representation and interpretation of measurements coming from human motion analysis. In a single software, a thorough and effective clinical and biomechanical analysis of human motion was performed.

Rotationplasty of the hip joint is a special surgical technique used for the treatment of malignant tumors of the proximal part of the femur. We report a clinical case and gait analysis results before and after rehabilitation training. Evaluation of joint motion, kinetic moments, and the electromyographic findings enabled us to document progressive adaptation of muscle and joint function to their new role in the motor pattern, demonstrating the exceptional strength of rotationplasty. Active control of two fulcrums in the lower limb, the pseudo hip proximally and the pseudo knee intermedially, makes this type of operation extremely advantageous compared to the alternative of hip disarticulation or hemipelvectomy. Total absence of pain together with the preservation of articular and cutaneous proprioception are important advantages. Rotationplasty is an attractive alternative for treatment of malignant tumors of the proximal part of the femur.