Comparison of three validated systems to analyse spinal shape and motion

The assessment of spinal shape and mobility is of great importance for long-term therapy evaluation. As frequent radiation should be avoided, especially in children, non-invasive measurements have gained increasing importance. Their comparability between each other however stays elusive. Three non-invasive measurement tools have been compared to each other: Idiag M360, raster stereography and Epionics SPINE. 30 volunteers (15 females/15 males) have each been assessed by each system, investigating lumbar lordosis, thoracic kyphosis and spinal range-of-motion in the sagittal plane. Lumbar lordosis differed significantly (p < 0.001) between measurement devices but correlated significant to each other (Pearson's r 0.5-0.6). Regarding thoracic kyphosis no significant difference and a high correlation (r = 0.8) could be shown between Idiag M360 and raster stereography. For lumbar mobility resulting measurements differed significantly and correlated only moderate between Idiag M360 and Epionics SPINE. Although the different measurement systems are moderate to high correlated to each other, their absolute agreement is limited. This might be explained by differences in their angle definition for lordotic and kyphotic angle, their measurement placement, or their capturing of mobility (static vs. dynamic assessment). Therefore, for long-term evaluation of the back profile, inter-modal comparison of values between different non-invasive devices should be avoided

Video Rasterstereography of the spine and pelvis in eight erect positions : a reliability study

Introduction To investigate the reliability and variability of Video Rasterstereography (VR) measurements of the spine and pelvis, for eight proposed standing postures, in order to help define an optimal standing position for erect pelvis radiography. Methods Surface topography data were collected using the formetic 4D dynamic modelling (Diers) system. 61 healthy participants were recruited; each participant performed eight different standing positions. Four positions were performed with the feet shoulder width apart and parallel, and four positions were performed with the feet shoulder width apart and internally rotated. For the upper extremity, each of the (two sets of) four positions were performed with different arm positions (arms by the sides, arms crossed over the chest, arms 30o flexed and touching the medial end of the clavicle, arms 30o flexed with the hands holding a support). Three sets of surface topography were collected in the eight positions (n=24). The variability was assessed by calculating standard error of the measurement (SEm) and the coefficient of variation (CV). Reliability was assessed using intra-class correlation coefficients (ICC±95%CI). Results No significant differences in the SEm were found between the three paired measurements for all standing positions (P>0.05). ICC values demonstrated excellent reliability for all measurements across the eight standing positions (range 0.879 to 1.00 [95% CI 0.813-1.00]). Conclusion Evaluating eight standing positions radiographically would be unethical as it would involve repeat radiation exposures. Using the formetic 4D dynamic modelling (Diers) system, provides an alternative and has shown that there was only a minimal, non-statistically significant, differences between the eight different standing positions

Technological advancements in the analysis of human motion and posture management through digital devices

Technological development of motion and posture analyses is rapidly progressing, especially in rehabilitation settings and sport biomechanics. Consequently, clear discrimination among different measurement systems is required to diversify their use as needed. This review aims to resume the currently used motion and posture analysis systems, clarify and suggest the appropriate approaches suitable for specific cases or contexts. The currently gold standard systems of motion analysis, widely used in clinical settings, present several limitations related to marker placement or long procedure time. Fully automated and markerless systems are overcoming these drawbacks for conducting biomechanical studies, especially outside laboratories. Similarly, new posture analysis techniques are emerging, often driven by the need for fast and non-invasive methods to obtain high-precision results. These new technologies have also become effective for children or adolescents with non-specific back pain and postural insufficiencies. The evolutions of these methods aim to standardize measurements and provide manageable tools in clinical practice for the early diagnosis of musculoskeletal pathologies and to monitor daily improvements of each patient. Herein, these devices and their uses are described, providing researchers, clinicians, orthopedics, physical therapists, and sports coaches an effective guide to use new technologies in their practice as instruments of diagnosis, therapy, and prevention

Posturalni status i telesni sastav dece školskog uzrasta

Introduction: Contemporary living circumstances offer possibilities of a progress in almost all spheres of life of one child, but there are also some negative aspects such as hypo kinesis, postural disorders, and obesity. Results of previous researches show that postural disorders and state of body composition in a period of an early adolescence represent one of the fastest growing health disorders in this age. In accordance with this, the main goal of this research is to establish the condition and difference of the postural state of the spine and body composition of children of seniour classes of primary school as well as connection and influence of body composition and postural status. Method: The sample of respondents was comprised of 484 children of primary-school age of both genders from the territory of the town Knjazevac. This municipality represents a group of municipalities up to 30 000 inhabitants and such are located on the 49,6% of the territory of Serbia. Instruments used for gathering measured parametres were: anthropometar (SECA model 284; SECA, Hamburg, Germany), an instrument for assessment of body composition Inbody 770, ( Inbody Co, Seoul, Korea) and an instrument for diagnosing of postural status of the spine ( Formetric 4D System, Diers, Germany). For the analysis of the gathered data were used: descriptive and percentage analysis, Hi square test for testing independence with Z test supplement was used to determine differences, ANOVA test was used to determine trend of changes, Eta coefficient was used to determine correlational values, and discriminatory analysis to determine the contribution of parametres of body composition on postural status of the spine. Results: The results have indicated that in the sagittal plane the percentage of postural disorders was present at 69,2% of the respondents (Male =67,5%; Female 71,1%), while that percentage in the frontal plane was 39,5% ( M=32,5; F=47%). Also, a statistically significant difference was observed by gender in the prevalence of the postural disorders and normal posture only in the frontal plane (М=0.000; Ж=0.393) while this was not observed in the sagittal plane of the spine (М=0.000; Ж=0.000). By analyzing the results, only statistically significant difference between genders in the state of postural status of the frontal plane was observed (total=0.001; by classes V=0.053; VI=0.155; VII=0.186; VIII=0.050) while in the postural status of the sagittal plane, a statistically significant difference between genders was not observed (total=0.383; by classes V=0.359; VI=0.596; VII=0.009; VIII=0.257). By ANOVA analysis was determined the presence of a statistically significant trend of changes in all analyzed parametres for the evaluation of body composition except PFM (sig=0.145). Eta coefficient has indicated that there is a statistically significant correlation of the postural status of the spine in the frontal plane and all parametres of body composition, while with the postural status in the sagittal plane variables of body composition that do not correlate are BMFkg (sig=0.072) and PBF (sig=0.070). The results of the discriminatory analysis have indicated to the existence of the statistically significant contribution of the paratmetres of body composition (BFMkg=.875; PBF=859; RSMM=-.730; PFFM=-.658) on the postural status in the sagittal plane of the spine, while the greatest contribution were recorded in the variables (BFMkg=-.638; PBF=-.692; RSMM=.734; PFFM=.615) on the postural status in the frontal plane. Conclusion: It may be concluded that there is high prevalence of the postural disorders of the spine in children of the senior classes in primary school, primarily in the sagittal plane and that there is a gender difference in the prevalence of the spinal deformities in certain regions. Also, in this age period, based on the results of trend analyses, gender differences in body composition parametres are clearly indicated: muscle mass, body fat mass as well as different influence of the parametres of body composition on the state of the postural status of the spine. In accordance with the findings obtained, it is clear that the approach to solving the problem of the current state of the postural disorders on the spine and the parametres of body composition must be different according to gender but also according to age

The development and validation of a movement evaluation system for children with cerebral palsy

The development of objective assessment tools for evaluation in physiotherapy is vital. Currently, the outcomes resulting from an intervention are generated by clinical assessments that are almost exclusively based on subjective criteria which rely upon the assessor’s expertise and consistency. The aim of this project was to develop an objective clinical tool to measure head and trunk postural control in sitting for children with cerebral palsy (CP). It is preferable for any objective measurement tool to be useable with as wide a range of patients and conditions as possible. Ideally, the tool should also be ‘clinically-friendly’ for both therapist and patient. This project took children with CP as a starting point, as representing one of the most challenging groups to assess and to quantify. The project was specifically focused on head-trunk control in sitting because of the importance of this posture for activities of daily living. The Literature Reviews confirmed that head-trunk control status in sitting could be defined by an aligned sitting posture without any external support for the head, trunk and upper limbs. The Method selected was video-based (Dartfish) to meet the requirement of ‘clinically-friendly’ and developed to quantify alignment (and deviations from alignment) of the head and trunk with small errors when compared to a 3D motion capture system (Vicon). The Dartfish method was also used to classify the positions of the upper limbs in comparison with the standard clinical classification; it showed that a simplified representation of the hands and elbows can reflect the clinical judgement. The combination of both these elements enabled the quantification of head/trunk control in children with CP for the first time. The work presented in this thesis makes a new and major contribution to postural assessment. It also provides the basis for the development of a fully automated system for the objective assessment of control using 2D-video recording. This work confirmed that clinical assessments can be objectively replicated, representing a major advance in the validation of physiotherapy interventions

Establishing an evidence-base for erect pelvis radiography : positioning, radiation dose and image quality

Purpose: Pelvic radiography using X-ray imaging has traditionally been used for the identification of hip joint changes, including the identification of pathologies such as osteoarthritis. For patients suffering from hip pain, the supine pelvis X-ray examination is one of the initial diagnostic steps. Despite this, many recent studies have recommended that the position should now be undertaken erect and not supine to reflect the functional appearances of the hip joint. This thesis aims to establish an evidence base for erect pelvis radiography, and it will include assessing radiographic positioning, radiation dose and image quality. Methods: The experimental work described in this thesis was conducted in three phases. Each phase has its own methods with the purpose of achieving a specific set of aims. Phase One was the evaluation of the postural effects of different erect (standing) positions in order to recommend an optimal one for erect pelvic radiography. Eight different erect positions were investigated. A sample group of 67 healthy people participated, and a range of spinal and pelvis measurements were acquired using a 3D video rasterography system (Diers) and an inclinometer.Phase Two was a phantom study evaluating the potential changes to radiation dose and image quality when moving between supine and erect imaging. Phase two was undertaken using three experiments (experiment #1, experiment #2 and experiment #3). Experiment #1 evaluated the impact of increased patient size on the radiation dose and image quality. In this experiment, animal fat was positioned anteriorly on a pelvic anthropomorphic phantom and the thickness increased incrementally in 1cm steps from 1 to 15cm. Image quality was evaluated physically and visually. The effective dose was calculated using Monte Carlo simulation software (PCXMC). During experiment #2, the anterior thicknesses for 109 patients, with a range of BMIs, who were referred for pelvis radiography, was measured in the erect and supine position. Experiment #3 evaluated the potential differences between the positions (supine and erect) in terms of image quality and radiation dose by modelling patient thickness changes between positions using the data obtained in experiment #2. An anthropomorphic phantom was used and modified (by adding additional fat) to simulate tissue changes for both erect and supine X-ray positions. Visual grading analysis was used (VGA) to evaluate image quality. The effective dose and absorbed dose were calculated using PCXMC.During Phase Three, 60 patients were imaged in erect and supine positions. The paired pelvis X-ray images were then compared, taking into account radiation dose and image quality.Results: Phase One demonstrated no statistical differences between the eight-different standing positions for pelvic and spine metrics (P>0.05). Results also demonstrated no significant postural differences between BMIs across all eight standing positions (P>0.05). Also, no differences (P>0.05) were identified in the pelvis and spinal metrics when comparing between males and females .Standing relaxed with feet internally rotated by 20°and the upper arms supported was a recommendation derived from this phase. Results from Phase Two showed an increase in effective dose (E) as the fat thickness increased. Also, all physical and visual image quality metrics decreased as fat thickness increased. Physical and visual image quality measures also decreased for erect images when compared to supine images, and the E also increased. 90kVp, 130/145 SID, using both outer chambers, were the recommended exposure parameters settings for obtaining erect pelvis X-ray images. Results from Phase Three showed that anterior patient thickness was 17% (P<0.001) higher in an erect position .The DAP and absorbed dose were 46% and 45% (P<0.001) greater in the erect position. Also, the effective dose was 67% (P<0.001) higher in the erect position when compared with supine. In regard to the image quality (IQ), that of the erect position decreased by 10% when compared with supine (P<0.001).Conclusion: The eight proposed standing positions could theoretically be suitable for erect pelvis imaging. People in a relaxed standing position, with their feet internally rotated by 20°and their upper arms supported would be recommended. In terms of IQ and radiation dose for erect positions, this position decreases image quality (both physical and visual) and increased radiation dose. Changes were largely due to the effect of gravity on the anterior soft tissue distribution. These issues should be considered and optimised more fully when deciding if to move from supine to erect pelvis imaging