The design and application of microprocessor based systems for clinical measurement of joint stiffness and grip strength.

The overall aim of the project was to further the research into the objective measurement of the symptoms of arthritic disease. There were three major parts to this study. The first part was to design a measurement system capable of making large scale, objective measurements of the stiffness of the human metacarpophalangeal joint. The second part was to design a new device to measure the grip strength of the human hand objectively. The last part was to use these two measurement systems to conduct research into the clinical manifestations of arthritic disease and study the effects of some therapeutic agents. A new, microcomputer controlled arthrograph system was developed to measure the stiffness of the metacarpophalangeal joint of the index finger. The system proved to be reliable, easy to use and sufficiently accurate to quantify changes in joint stiffness. A new design of grip machine was produced which enabled the forces developed during a power grip to be analysed. Measurement was made of the force contributions of individual digits and the maximum total gripping force. The machine was portable and extremely easy to use. A study of the circadian variation of joint stiffness and grip strength, over a full twenty four hour period, was carried out. Measurements were made every two hour in both healthy and arthritic subjects. A circadian variation of stiffness was observed in the joints of arthritic subjects. Joint stiffness was elevated in the early morning and for some subjects the degree of change was profound. No significant circadian variation was observed in the joint stiffness of healthy subjects. A circadian variation of grip strength was observed in arthritic subjects. Grip strength reached a minimum value between 2.00 and 4.00 a.m. in the majority of subjects. No consistent relationship was found between changes in joint stiffness and changes in grip strength. The effect of several forms of physiotherapy on the joint stiffness of arthritic subjects was studied in both the short and long term. The subjects were measured before, and then immediately after, treatment each time they visited a physiotherapy hand clinic. Only the results of those patients who attended the clinic for a minimum of five weeks were used in any subsequent analysis. Four different treatments were studied: hot wax and ultrasound, hot wax alone, ultrasound alone and exercise. The combination of hot wax baths and ultrasonic therapy effected temporary reductions in all joint stiffness parameters. The reductions in energy dissipation and torque range were highly significant ( p < 0.05 and p < 0.001 respectively ). No significant reductions were found for hot wax, ultrasound alone or exercise. In the long term, no significant change in joint stiffness was found for any of the treatments considered

The Effect of Yoga in Reducing Pain Related to Arthritis: An Integrative Review of the Literature

Research shows that arthritis is the most common cause of disability in the United States (Middleton et al., 2013). The PICOT question for this systematic review of literature is “In adults over the age of 40 years, how do yoga interventions, compared to pharmacological pain relief methods alone, affect arthritic pain intensity and frequency?” This systematic review will discuss the possible benefits of using yoga as treatment for both rheumatoid arthritis and osteoarthritis. The methods for this review included a comprehensive search yielding nineteen credible studies using the databases Search-A-Roo, Google Scholar, and CINAHL Plus for full-text academic journal articles containing studies discussing the use of yoga for adult patients with arthritic conditions

A study of the role of the social worker in the arthritis clinic at Presbyterian Hospital, New York City and her contacts with eighty new patients during the year 1953.

Thesis (M.S.)--Boston Universit

Exercise in Rheumatoid Arthritis

Before 1980, the effects of exercise on people with rheumatoid arthritis was considered negative, even though no research substantiated this belief. Medical professionals prescribed rest and passive exercise as the activity level for people with rheumatoid arthritis. So, the patients rested and developed many of the problems associated with inactivity. This resulted in more disability and less people with rheumatoid arthritis in the work force. This paper is a literature search which examines current research on exercise in rheumatoid arthritis. It attempts to answer many of the questions asked about exercising with rheumatoid arthritis. Discussed are the topics of deconditioning, the effects of inactivity, effects of exercise, how to exercise, and whether exercise causes joint damage. It was concluded that patients with rheumatoid arthritis are severely deconditioned. They can exercise both safely and effectively. Exercise, when completed under controlled conditions, affects an increase in flexibility, strength, cardiovascular endurance, work capacity, mental status and the patients ability to cope with their disease. No joint damage was found as a result of exercise, and evidence exists that exercise can reduce the severity of the disease

Techniques for assessing knee joint pain in arthritis

The assessment of pain is of critical importance for mechanistic studies as well as for the validation of drug targets. This review will focus on knee joint pain associated with arthritis. Different animal models have been developed for the study of knee joint arthritis. Behavioral tests in animal models of knee joint arthritis typically measure knee joint pain rather indirectly. In recent years, however, progress has been made in the development of tests that actually evaluate the sensitivity of the knee joint in arthritis models. They include measurements of the knee extension angle struggle threshold, hind limb withdrawal reflex threshold of knee compression force, and vocalizations in response to stimulation of the knee. A discussion of pain assessment in humans with arthritis pain conditions concludes this review

Thermal and Visual Imaging and Accelerometry Developments to Assist with Arthritis Diagnosis

Juvenile Idiopathic Arthritis (JIA) is a disease that causes pain and inflammation in the joints of children. Its early diagnosis is important to avoid damage to the joints. Joint warmth, redness and movement restriction may be indicators of active arthritis hence accurate objective means to measure temperature, colour and range of movement (ROM) at the joint may assist diagnosis. In this study, three techniques with a potential to assist clinicians in diagnosing JIA were developed. These were based on high-resolution thermal imaging (HRTI), visual imaging and accelerometry. A detailed correlation analysis was performed between the developed methods and the consultant's clinical assessment of JIA diagnosis. Twenty-two patients (age: mean=10.6 years, SD = 2 years) with JIA diagnosis were recruited. 18 participated in the thermal/visual imaging study only, 2 in the accelerometry study only and 2 in both thermal/visual imaging and accelerometry studies. Thermal and visual images of the front and back of the knees and ankles of 20 patients were studied. All ethical approvals from Sheffield Hallam University and the National Health Service (NHS) were duly obtained before commencing the study. The thermal/visual imaging study involved developing image processing techniques to accurately identify and segment the regions of interest (ROIs). A tracking algorithm to accurately locate the ROIs was also implemented. An accelerometry system that is capable of recording movements from 4 channels was developed and its signals were processed by frequency spectrum analysis, short-time Fourier transform and wavelet packet analysis. The thermal imaging results showed a combined 71% correlation (for the front of knees and ankles) with clinical assessment. It may be possible that patients whom their arthritic joint was cooler than their healthy joints may have relied on their healthy leg more extensively for mobility (due to the pain on the arthritic leg) thus increasing its joints temperature. It was also found that JIA may affect the skin colour with a combined 42% correlation between the knees and ankles. The accelerometry results showed a 75% correlation with clinical assessment. The study for the first time brought together the three techniques of thermal imaging, visual imaging and accelerometry to assist with JIA diagnosis. The study demonstrated that the developed techniques have potential in assisting clinicians with JIA diagnosis. Improvements in timely diagnosis allow more effective treatment and can reduce the likelihood of joint damage in rheumatoid arthritis

Arthritic patients' views and perceptions on exercise as an adjunct treatment regime for managing their condition

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science of Medicine in Sports Medicine. Johannesburg, 2016.Introduction: Arthritic disease, presenting with a variety of joint pathologies has a myriad of treatment modalities. Treatment is dependant on various types of medication stemming from the specific diagnosis. Treatment is often supplemented with dietary changes, lifestyle related changes and exercise. Objective: This study aimed to assess the view of arthritic patients towards exercise as an adjunct treatment to medication in managing symptoms of their condition, participant’s knowledge of appropriate exercise regimes in managing their symptoms, whether or not healthcare providers prescribed exercise as a part of treatment, the different healthcare providers exercise prescription habits, the exercise modes and the outcome of the effects of exercise (subjective feeling of pain relief). Methods: A cross-sectional survey study design was used. Patients presenting at two private general practitioners and a biokineticist practices based in the southern suburbs of Johannesburg were invited to participate in this questionnaire-based study. Patients that met the inclusion criteria (those participants diagnosed with any arthritic disease with or without a co-morbid disease not contra-indicating exercise) were included in the study. Questions were developed to determine various aspects of the effect of exercise and participants’ attitudes toward exercise as an additional management tool in arthritic patients. These were all self-reported by the participant using the questionnaire. In addition, information on the type of healthcare providers prescribing exercise, exercise modes and outcomes of exercise were also gathered. Outcomes (improvements in the participants’ arthritic condition, symptoms and activities of daily living with exercise) were used as criteria for improvement. This study did not differentiate between single joint and multi joint arthritis. Results: A total of 67 participants were surveyed of which 25% were male and 73% female. The remaining two percent were unspecified. Age distribution was as follows: 60% >50 years old, 36 % were 30-50 years old and the remaining four percent <30 years of age. Most participants suffered from osteoarthritis (N=29), followed by rheumatoid arthritis (N=27), gout (N=five) and post traumatic arthritis (N=three) while the remaining participants were not specific. Exercise was advised mostly by doctors, followed by physiotherapists then biokineticists. Osteoarthritis and rheumatoid arthritis accounted for the multi-joint involvement arthritic disease. Exercise that was advised by doctors was found to be general (walking-no specifics regarding intensity and time). It was not specific enough and mostly included walking (48%). Exercise alone diminished pain (not statistically significant; p=0.18) and improved activities of daily living by 11%, while medication alone did relieve pain (p=0.034) and improved activities of daily living by 21%. Pain was measured using a numeric pain scale and activities of daily living were self-reported by the participants using the questionnaire. Observations and analysis from the study concludes that medical treatment aided by exercise will improve results in the treatment of participants with arthritic disease. The largest improvement and statistically significant finding in perceived pain relief was noted in the combination of both exercise and medication (p=0.01) with a 32% improvement in activities of daily living. Participants surveyed are of the view that exercise assists them in managing the symptoms of arthritis. Conclusions: Exercise is an important adjunctive treatment modality. Doctors were in fact advising exercise more than other healthcare providers but this advice was very non-specific. Participants were physically active (N=52) and believe that exercise can benefit them. This studies findings suggest that healthcare providers need to prescribe exercise more specific to the patient’s condition and physical capabilities. There is no “one size fits all” exercise prescription. This study adds to the knowledge base of the field in the management of arthritic disease in the southern suburbs of Johannesburg in South Africa. It is consistent with other research done in this field. Future research should be directed toward exploring further these findings and the reasons why healthcare practitioners fail to be specific in their exercise advice.MT201

A Survey of Vocal Characteristics in a Sample of Adult Rheumatoid Arthritics

The normalcy of voicing at the level of the larynx is dependent upon the competency of the cricoarytenoid joints to which the vocal folds are attached. Rheumatoid involvement of this diarthrodial joint could result in reduced mobility or fixation of the fold(s). Medical authors hold differing opinions of the nature and frequency of voice change due to the pathology known as cricoarytenoiditis. The term hoarse has been widely used to describe the characteristic alteration of phonation in a population of rheumatoid arthritics. It was the purpose of this study to survey a sample of adult rheumatoid arthritics in order to describe the acoustic characteristics of their phonation and to relate these findings to arthritic involvement of the cricoarytenoid joints as diagnosed by indirect laryngoscopy. Another purpose of the study was to determine which vocal parameters were most predominant when the voices were perceived as hoarse. The data were collected by means of a questionnaire completed by thirty-one subjects diagnosed with rheumatoid arthritis. Indirect laryngoscopy was performed on all subjects in order to assess the presence or absence of visible evidence of rheumatoid involvement of the cricoarytenoid joints. Voice samples were obtained from each subject and coded independently with the Voice Profile (Starr and Wilson, 1976) by three judges. Results indicated that hoarseness was perceived in 64.5 percent of the sample. This hoarseness was characterized by a lowered pitch and variable amounts of breathiness which was inversely proportional to the amount of hoarseness. While 45 percent of the subjects reported three or more associated laryngeal symptoms, only 12.9 percent were diagnosed with cricoarytenoiditis. Voice analysis in such a limited sample did not permit description of the characteristic voice change associated with cricoarytenoiditis. The transient nature of such voice pathology further hindered the results of this study. In conclusion, it is suggested that more specific research be designed in order to assess the voice pathology at the time voice problems are occurring in subjects already diagnosed with cricoarytenoiditis

Rheumatoid arthritis and its treatment by physiotherapy

The term "Rheumatoid Arthritis" is used, commonly, in two senses - a narrower sense, based on supposed etiology, and a wider, based on pathology. In its narrower sense it is used as suggested by the Nomenclature Sub -committee of the British Committee on Chronic Rheumatic Diseases appointed by the Royal College of Surgeons. This committee suggests that the term be used for two clinical conditions only: - (a) The classical type of Rheumatoid Arthritis of women, usually of the child - bearing age, and (b) Rheumatoid Arthritis in children, including Still's Disease. In its wideresense,the term is used to include most of what the committee includes in its "Rheumatoid Type" when it divides all Chronic Arthritis into this and an Osteo- arthritic Type. This group corresponds largely with what is called in the American literature - on a basis of pathology - Atrophic Arthritis. In this examination into the problem of (Rheumatoid Arthritis and its treatment by Physiotherapy, the wider interpretation is given to the term, and this for several reasons. Even those who divide "classical" or "primary" Rheumatoid Arthritis from the infective or from the climacteric forms of chronic polyarthritis admit that it is very frequently impossible to determine which type a particular case 'belongs to. (van Breemen notes that at a demonstration of patients with chronic rheumatic condition at Prof. Wenckebach's University Clinic in Vienna, the patients having been seen by several authorities on Rheumatism, it was a frequent occurrence that there were four different opinions on one case, or that the names given to the morbid pictures were sharply divergent"). Classifications and groupings varying so widely, an attempt to narrow the term to apply it to only one or two types of case would make it impossible to follow the very extensive researches into the problem being carried on in America, the European continent, and Britain. Perhaps the most valid reason for taking the wider view, is the basis of our present therapy: in the absence of certainty as to etiology - or causerour therapy is necessarily based on disturbed physiology or on pathology - effects or results. It seems right, ¡therefore, that classification or nomenclature should knot assume)or pretend,to,knowledge still lacking, and thus hinder or divert investigation. The patients available for investigation at this institution (The Devonshire Royal Hospital for Rheumatism and Allied Diseases, Buxton), form probably the clinically richest in- patient chronic rheumatic group in the British Isles. With 300 beds - l50 each for male and female patients - the annual admissions (average just over 4,000 for all cases, and 900 in the Rheumatoid Arthritis group. For purposes of stating views based on ,clinical descriptions, results of therapy etc., I have confined myself entirely to patients examined by me ion admission, and under my supervision during their :stay in hospital. For opinions based on figures, necessitating the reviewing of larger groups, I have endeavoured to assure uniformity of diagnosis and groúping by using the case -sheets of patients under the ,supervision of only four out of the ten Honorary Visiting Physicians of the hospital - who are responsible for the diagnostic "labels"