Kinetic Chain Rehabilitation in a Juvenile Idiopathic Arthritis Patient

CASE HISTORY: The patient’s chief complaint was decreasing ROM and pain noticed after conservative orthopedic treatment in the dominant (left) elbow. After extensive evaluation, the patient was diagnosed with juvenile idiopathic arthritis (JIA) at 9 years old. PHYSICAL EXAM: Upon physical therapist examination, it was determined that she had deficits throughout the entire left upper extremity and quadrant. Findings include signs and symptoms of Upper Cross Syndrome including pectoralis muscle group tightness, weakness of deep neck flexors with overuse of sternocleidomastoid and scalenes group, weakness of posterior shoulder and upper back including lower trap, middle trap, and all scapular stabilizing musculature including significant overuse of the upper trapezius and levator scapula complex. This presented as poor scapulothoracic rhythm and scapular dyskinesis with significant scapular winging, forward head and rounded shoulders causing inefficient mechanical function during functional movement patterns. Other specific objective findings included pectoralis minor length difference of right to left of one inch, MMT grade of teres minor and latissimus 3+/5, serratus anterior 3+/5, other rotator cuff reveals 4/5, with subscapularis 4/5. The initial AROM of the elbow revealed a 40° extension lag, excessive supination of 105° with limited pronation of 70°. DIFFERENTIAL DIAGNOSES: Medial epicondylitis, avulsion fracture, rheumatoid arthritis, ankylosing spondylitis. TESTS & RESULTS: X-rays and MRIs were obtained in order to make the JIA diagnosis. Imaging obtained by the patient’s rheumatologist nine months ago showed a slowing of the disease processes, confirmation of the cessation was confirmed on MRI obtained 3 months ago. After failing occupational therapy for ROM and joint sparing techniques, she was referred to physical therapy (PT) to address kinetic chain dysfunction to avoid other joint involvement. FINAL DIAGNOSIS: The final diagnosis was JIA with multiple joint involvement. For the purpose of this case study, Upper Cross Syndrome with associated scapular dyskinesis was addressed in rehabilitation. DISCUSSION: Treatment of JIA is often targeted at the involved joints. It is important for the medical professional to evaluate and address joints that are not currently involved in the disease process. In this case, the patient’s parents advocated for physical therapy. Many cases will go untreated which could affect the long-term functioning of the kinetic chain. Additionally, early intervention can improve functioning of other joints and increase strength of muscles that, when functioning at full capacity, could affect the involved joint. OUTCOME OF THE CASE: After 2 months of PT, objective findings revealed great improvements in pectoralis minor flexibility as demonstrated through measurement of just ½ inch which is symmetrical to the right side; increased postural awareness of downward scapular retraction; appropriate chin tuck posture due to increased deep neck flexor strength; decreased compensation of scalenes and upper trap and levator complex; improved rotator cuff strength and AROM pronation 82°. Most important, she is demonstrating improved awareness of correct downward retracted scapular position with little winging and good head alignment utilizing a chin tuck position. All AROM of the elbow remained the same. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient is navigating all activities of daily living for her age group with a lack in ROM of her elbow. She competes on a shotgun team and plays sports at recess. She will continue with PT once per week for the next 3 months. After revaluation, she may be released with a maintenance program

Monitoring and Damping UMP Due Eccentricity Fault in Induction Machines: A Review

© 2016 IEEE. Three-phase induction machines are reliable and widely used in industrial plants. The efficient condition monitoring can diagnose the inception of fault mechanisms in induction motors thus avoiding failure and expensive repairs. Therefore, there is a strong need to develop a more efficient condition monitoring. The main target is to achieve a relatively low cost and/or non-invasive system which is still powerful in terms of monitoring for online detection of developing faults. This digest adresses rotor eccentricity faults and study of conventional monitoring techniques for induction motor faults. In order to reduce the UMP in case of an eccentric rotor, the eccentricity-generated additional airgap flux waves should be reduced. Additional, the characteristics of UMP in induction machines are addressed. Methods to reduce the side-band flux waves and hence attenuate the UMP will be addressed

Graphics Processing Unit Accelerated Lattice Boltzmann Method Simulations of Dilute Gravity Currents

Lattice Boltzmann method models offer a novel framework for the simulation of high Reynolds number dilute gravity currents. The numerical algorithm is well suited to acceleration via implementation on massively parallel computer architectures. Here we present two lattice Boltzmann method models of lock-exchange dilute gravity currents, in which the largest turbulent length scales are directly resolved. The three-dimensional simulations are accelerated by exporting computations to a graphics processing unit and are validated against experiments and high-resolution simulations for Reynolds numbers up to 30,000. The lattice Boltzmann method models achieve equivalent accuracy to conventional large eddy simulation models in the prediction of key flow properties. A conservative analysis of computational performance relative to conventional methods indicates that the presented framework reduces simulation times by two orders of magnitude. Therefore, it can be used as a foundation for the development of depth-resolving models that capture more of the complexity of environmental gravity currents.Comment: 59 pages, 14 figure

Functional Movement Screen Detected Asymmetry & Normative Values Among College-Aged Students

# Background The Functional Movement Screen (FMS™) is a popular test used by sports medicine professionals to identify dysfunctional movement patterns by analyzing mobility and stability during prescribed movements. Although the FMS™ has been a popular topic of research in recent years, normative data and asymmetries in college-aged students have not been established through research. # Purpose The objective was to determine normative FMS™ scores, report frequency counts for FMS™ asymmetries, and determine if the number of sports seasons and number of different sports an individual participated in during high school varied between university students that showed FMS™ identified asymmetries. # Study Design Cross-sectional Study # Methods One hundred university students completed the FMS™ and an associated survey to determine which sport(s) and for how many seasons they participated in each sport(s) during high school. Total FMS™ scores were assessed as well as identifying the presence of an asymmetry during a FMS™ screen. An asymmetry within the FMS™ was defined as achieving an unequal score on any of the screens that assessed right versus left movements of the body. # Data Analysis Data analysis included descriptive statistics, Pearson correlation was utilized to investigate the relationship between number of sports played and number of sport seasons. Shapiro Wilk test for normality, and Mann Whitney U test was employed to investigate group differences in number of sports played. All analyses were conducted using SPSS software. # Results Statistically significant correlations (r = .286, r^2^ = .08, p < 0.01) were found for both number of sport seasons and number of sports with FMS™ total score. In addition, participants without FMS™-detected asymmetries played significantly more seasons and more sports than their peers that presented asymmetries (U = 946.5, z = -1.98, p = 0.047). Finish with the actual p-value in parenthesis. # Conclusion Participating in multiple sports and multiple sport seasons during high school was associated with higher FMS™ total scores. Results suggest that participating in multiple sports and multiple sport seasons was associated with fewer asymmetries, which may decrease subsequent injury risk. # Level of Evidence 3