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Abstract: There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially reinforcing fear-avoidance beliefs underlying pain-related fear. In patients with chronic LBP, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, suggesting a protective response to pain. However, despite short-term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pronociceptive consequences of altered spinal motion, potentially leading to increased loading on lumbar tissues. Yet, it is unknown if similar protective movement strategies already exist in pain-free individuals, which would yield potential insights into the role of fear-avoidance beliefs in motor behavior in the absence of pain. Therefore, the aim of this study is to test whether fear-avoidance beliefs influence spinal motion during lifting in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N = 57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, indicating potential unfavorable interactions between psychological factors and spinal motion during lifting in pain-free subjects. [ABSTRACT FROM AUTHOR]

Generalized joint hypermobility (GJH) is a frequent entity in rheumatology with higher prevalence among women. It is associated with chronic widespread pain, joint dislocations, arthralgia, fibromyalgia and early osteoarthritis. Stair climbing is an important functional task and can induce symptoms in hypermobile persons. The aim of this study was to compare ground reaction forces (GRF) and muscle activity during stair climbing in women with and without GJH. A cross-sectional study of 67 women with normal mobility and 128 hypermobile women was performed. The hypermobile women were further divided into 56 symptomatic and 47 asymptomatic. GRFs were measured by force plates embedded in a six step staircase, as well as surface electromyography (EMG) of six leg muscles. Parameters derived from GRF and EMG were compared between groups using t -test and ANOVA. For GRF no significant differences were found. EMG showed lower activity for the quadriceps during ascent and lower activity for hamstrings and quadriceps during descent in hypermobile women. For symptomatic hypermobile women these differences were even more accentuated. The differences in EMG may point towards an altered movement pattern during stair climbing, aimed at avoiding high muscle activation. However, differences were small, since stair climbing seems to be not demanding. [ABSTRACT FROM AUTHOR]

Non-invasive pulse spectrophotometry to measure indocyanine green (ICG) elimination correlates well with the conventional invasive ICG clearance test. Nevertheless, the precision of this method remains unclear for any application, including small-for-size liver remnants. We therefore measured ICG plasma disappearance rate (PDR) during the anhepatic phase of orthotopic liver transplantation using pulse spectrophotometry. Measurements were done in 24 patients. The median PDR after exclusion of two outliers and two patients with inconstant signal was 1.55%/min (95% confidence interval [CI]=0.8-2.2). No correlation with patient age, gender, body mass, blood loss, administration of fresh frozen plasma, norepinephrine dose, postoperative albumin (serum), or difference in pre and post transplant body weight was detected. In conclusion, we found an ICG-PDR different from zero in the anhepatic phase, an overestimation that may arise in particular from a redistribution into the interstitial space. If ICG pulse spectrophotometry is used to measure functional hepatic reserve, the verified average difference from zero (1.55%/min) determined in our study needs to be taken into account. [ABSTRACT FROM AUTHOR]

Background: Skin marker-based analysis of functional spinal movement is a promising method for quantifying longitudinal effects of treatment interventions in patients with spinal pathologies. However, observed day-to-day changes might not necessarily be due to a treatment intervention, but can result from errors related to soft tissue artifacts, marker placement inaccuracies or biological day-to-day variability.Research Question: How reliable are skin marker-derived three-dimensional spinal kinematics during functional activities between two separate measurement sessions?Methods: Twenty healthy adults (11 females/9 males) were invited to a movement analysis laboratory for two visits separated by 7-10 days. At each visit, they performed various functional activities (i.e. sitting, standing, walking, running, chair rising, box lifting and vertical jumping), while marker trajectories were recorded using a skin marker-based 10-camera optical motion capture system and used to calculate sagittal and frontal plane spinal curvature angles as well as transverse plane segmental rotational angles in the lumbar and thoracic regions. Between-session reliability for continuous data and discrete parameters was determined by analyzing systematic errors using one sample T-tests as well as by calculating intraclass correlation coefficients (ICCs) and minimal detectable changes (MDCs).Results and Significance: The analysis indicated high relative consistency for sagittal plane curvature angles during all activities, but not for frontal and transverse plane angles during walking and running. MDCs were mostly below 15°, with relative values ranging between 10 % and 750 %. This study provides important information that can serve as a basis for researchers and clinicians aiming at investigating longitudinal effects of treatment interventions on spinal motion behavior in patients with spinal pathologies. [ABSTRACT FROM AUTHOR]

Background: Structural leg length discrepancy (LLD) is a common phenomenon. However, its effect on spinal gait kinematics remains unclear.Research Question: How does LLD affect spinal gait kinematics in patients with structural LLD and what is the immediate effect of a shoe lift?.Methods: 10 adolescents with structural LLD (20-60 mm) and 14 healthy controls were included. All of whom were fitted with a trunk marker set and requested to walk barefoot as well as with an orthotic shoe lift (only patients). Data were collected using a 12-camera motion capture system. Group comparisons were conducted using one-dimensional Statistical Parametric Mapping (SPM).Results: Patients with LLD showed statistically significant increased frontal plane lumbar bending angles to the longer side (p = 0.007), increased pelvic drop on the shorter side (p < 0.001) and increased hip adduction angles on the longer leg (p < 0.001) compared to the healthy controls. In the sagittal plane, patients demonstrated changed knee (shorter leg) and ankle joint (longer leg) motion. All gait deviations observed in patients with LLD could immediately be altered by correcting the LLD using a shoe lift.Significance: Due to the LLD, patients showed a lateral pelvic drop on the shorter side, which appeared to be compensated for by a contralateral bending in the lumbar spine and a lateral shift of the pelvis towards the longer side. In addition, the use of an orthotic correction seems to be a suitable option to instantly normalize gait kinematics in patients with mild to moderate LLD. [ABSTRACT FROM AUTHOR]

Introduction: It is important to assess and quantify gait in order to determine the severity of impairments during gait and to evaluate therapeutic interventions. However, laboratory gait assessment is expensive and time consuming and there is a lack of an easily applicable tool for the quantification of gait in clinical practice. The aim of this study was to validate a smartphone-based measurement tool for the quantification of level walking.Methods: Vertical center of mass displacement and step duration of 22 healthy young adults were assessed by a smartphone application and a motion capture system. Intra-session reliability was evaluated by repeated-measures ANOVA, intraclass correlation coefficient (ICC), and standard error of measurement. In order to evaluate the concurrent validity of the smartphone application, smartphone- and motion capture-derived values were compared by Pearson correlation coefficient and Bland-Altman limits of agreement.Results: Six out of eight variables derived by the smartphone application showed an excellent reliability (ICC≥0.75) and all variables correlated significantly with measurements of the motion capture system with moderate to strong correlations ranging from 0.61 to 0.92.Conclusion: The results showed a great potential of the smartphone application to be a user-friendly and valid tool for the assessment of gait in clinical practice. Further research needs to investigate whether the smartphone application is able to detect differences in gait patterns following therapeutic or orthopedic interventions and whether it is valid for the quantification of gait in people with movement disorders. [ABSTRACT FROM AUTHOR]