15 research outputs found
Orthopädische Biomechanik
Das Buch beschreibt Gedankengänge und Vorgehensweisen der orthopädischen Biomechanik, den Kenntnisstand zu Belastung und Beanspruchung des Haltungs- und Bewegungsapparates sowie die Reaktion der Gewebe auf mechanische Einflßsse exakt, aber mit einem Minimum an mathematischer und physikalischer Argumentation. Es gliedert sich in die Abschnitte
I Grundlagen aus der Mechanik
II Grundlagen aus der Mathematik
III Mechanische Aspekte des Haltungs- und Bewegungsapparates
IV Ăbungsaufgaben mit ausgearbeiteten LĂśsungen
Zahlreiche Abbildungen unterstĂźtzen die anschauliche Darstellung.
Ein Buch fßr Orthopäden, Ingenieure, Naturwissenschaftler, Physiotherapeuten und Orthopädietechniker in den Bereichen Forschung und Entwicklung von Orthopädie und Rehabilitation. <br/
Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance
Background: Physical examination tests of the shoulder (PETS) are clinical examination maneuvers designed to aid
the assessment of shoulder complaints. Despite more than 180 PETS described in the literature, evidence of their
validity and usefulness in diagnosing the shoulder is questioned.
Methods: This meta-analysis aims to use diagnostic odds ratio (DOR) to evaluate how much PETS shift overall
probability and to rank the test performance of single PETS in order to aid the clinicianâs choice of which tests to
use. This study adheres to the principles outlined in the Cochrane guidelines and the PRISMA statement. A fixed
effect model was used to assess the overall diagnostic validity of PETS by pooling DOR for different PETS with
similar biomechanical rationale when possible. Single PETS were assessed and ranked by DOR. Clinical performance
was assessed by sensitivity, specificity, accuracy and likelihood ratio.
Results: Six thousand nine-hundred abstracts and 202 full-text articles were assessed for eligibility; 20 articles were
eligible and data from 11 articles could be included in the meta-analysis. All PETS for SLAP (superior labral
anterior posterior) lesions pooled gave a DOR of 1.38 [1.13, 1.69]. The Supraspinatus test for any full thickness
rotator cuff tear obtained the highest DOR of 9.24 (sensitivity was 0.74, specificity 0.77). Compression-Rotation
test obtained the highest DOR (6.36) among single PETS for SLAP lesions (sensitivity 0.43, specificity 0.89) and
Hawkins test obtained the highest DOR (2.86) for impingement syndrome (sensitivity 0.58, specificity 0.67). No
single PETS showed superior clinical test performance.
Conclusions: The clinical performance of single PETS is limited. However, when the different PETS for SLAP
lesions were pooled, we found a statistical significant change in post-test probability indicating an overall
statistical validity. We suggest that clinicians choose their PETS among those with the highest pooled DOR
and to assess validity to their own specific clinical settings, review the inclusion criteria of the included
primary studies. We further propose that future studies on the validity of PETS use randomized research
designs rather than the accuracy design relying less on well-established gold standard reference tests and
efficient treatment options
Demand, Control and Support at Work Among Sick-Listed Patients with Neck or Back Pain: A Prospective Study
Purpose The main aim of this study was to assess changes in perceived demand, control and support at work of neck and back pain patients over 1 year. We also hypothesised that perceived changes in demand, control and support at work were associated with clinical improvement, reduced fear-avoidance beliefs and successful return to work. Methods Four hundred and five sick-listed patients referred to secondary care with neck or back pain were originally included in an interventional study. Of these, two hundred and twenty-six patients reported perceived psychosocial work factors at both baseline and 1-year follow-up, and they were later included in this prospective study. Changes in demand, control and support dimensions were measured by a total of nine variables. Results At the group level, no significant differences were found among the measured subscales. At the individual level, the regression analyses showed that decreases in fear-avoidance beliefs about work were consistently related to decreases in demand and increases in control, whereas decreases in disability, anxiety and depression were related to increases in support subscales. Conclusions The perception of demand, control and support appear to be stable over 1 year in patients with neck and back pain, despite marked improvement in pain and disability. Disability, anxiety, depression and fear-avoidance beliefs about work were significantly associated with the perception of the work environment, whereas neck and back pain were not.
The published version is available at link.springer.co
Clinical Study Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury
Objective. To study whether values for peak oxygen uptake (VO 2peak ) and work economy (WE) at a standardized workload are different when tested by arm crank ergometry (ACE) and wheelchair ergometry (WCE). Methods. Twelve paraplegic men with spinal cord injury (SCI) in stable neurological condition participated in this cross-sectional repeated-measures study. We determined VO 2peak and peak power output (PO peak ) values during ACE and WCE in a work-matched protocol. Work economy was tested at a standardized workload of 30 Watts (W) for both ACE and WCE. Results. There were no significant differences in VO 2peak (mLâ
kg â1 â
min â1 ) between ACE (27.3 Âą 3.2) and WCE (27.4 Âą 3.8) trials, and a Bland-Altman plot shows that findings are within 95% level of agreement. WE or oxygen consumption at 30 W (VO 2-30W ) was significantly lower during WCE compared to ACE ( < 0.039). Mean (95% CI) PO peak (W) were 130 (111-138) and 100 (83-110) during ACE and WCE, respectively. Conclusion. The findings in the present study support the use of both ACE and WCE for testing peak oxygen uptake. However, WE differed between the two test modalities, meaning that less total energy is used to perform external work of 30 W during wheelchair exercise when using this WCE (VP100 Handisport ergometer). Clinical Trials Protocol Record is NCT00987155/4.2007.2271
Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance
Protein homeostasis in LGMDR9 (LGMD2I) â The role of ubiquitinâproteasome and autophagyâlysosomal system
Aims: Limb-girdle muscular dystrophy R9 (LGMDR9) is an autosomal recessive disorder
caused by mutations in the fukutin-related protein gene (FKRP), encoding a glycosyltransferase involved in Îą-dystroglycan modification. Muscle atrophy, a significant feature of
LGMDR9, occurs by a change in the normal balance between protein synthesis and protein degradation. The ubiquitinâproteasome system (UPS) and autophagyâlysosomal system play a key role in protein degradation in skeletal muscle cells, but their involvement in
the pathology of LGMDR9 is still largely unknown. We have aimed at clarifying whether
proteolysis through the UPS and the autophagyâlysosomal pathway is dysregulated in
LGMDR9 patients.
Methods: Vastus lateralis biopsies from 8 normal controls and 12 LGMDR9 patients harbouring the c.826C>A/c.826C>A FKRP genotype were assessed for protein markers related to UPS, the autophagyâlysosomal system and endoplasmic reticulum (ER) stress/
unfolded protein response (UPR), followed by ultrastructural analysis by transmission
electron microscopy (TEM).
Results: Protein levels of E3 ubiquitin ligases Atrogin-1 and MuRF1 showed a pattern
similar to normal controls. Elevation of the autophagy markers Atg7, LC3B-II, decreased
level of p62 as well as downregulation of the negative autophagy regulator mTORC1, indicated an activation of autophagy in LGMDR9. Mitophagy markers Bnip3 and Parkin were
decreased. TEM analysis demonstrated accumulation of autophagosome-like structures
in LGMDR9 muscle. There was also an increase in the expression of ER stress/UPR markers PDI, peIF2Îą and CHOP and a decrease in IRE1Îą. However, GRP94, Bip and Calnexin
remained unchanged.
Conclusion: Our findings indicate that autophagy and ER stress are induced in LGMDR9
muscle
Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury
Objective. To study whether values for peak oxygen uptake (VO2peak) and work economy (WE) at a standardized workload are different when tested by arm crank ergometry (ACE) and wheelchair ergometry (WCE). Methods. Twelve paraplegic men with spinal cord injury (SCI) in stable neurological condition participated in this cross-sectional repeated-measures study. We determined VO2peak and peak power output (POpeak) values during ACE and WCE in a work-matched protocol. Work economy was tested at a standardized workload of 30 Watts (W) for both ACE and WCE. Results. There were no significant differences in VO2peak (mL¡kgâ1¡minâ1) between ACE (27.3 +/- 3.2) and WCE (27.4 +/- 3.8) trials, and a Bland-Altman plot shows that findings are within 95% level of agreement. WE or oxygen consumption at 30âW (VO2-30W) was significantly lower during WCE compared to ACE (P peak (W) were 130 (111â138) and 100 (83â110) during ACE and WCE, respectively. Conclusion. The findings in the present study support the use of both ACE and WCE for testing peak oxygen uptake. However, WE differed between the two test modalities, meaning that less total energy is used to perform external work of 30âW during wheelchair exercise when using this WCE (VP100 Handisport ergometer). Clinical Trials Protocol Record is NCT00987155/4.2007.2271
Enhanced neural drive after maximal strength training in multiple sclerosis patients
Multiple sclerosis (MS) patients suffer from impaired muscle activation and lower limb strength. Strength training enhances muscle activation and muscle strength, but neural adaptations to strength training remain unexplored in MS patients. The hypothesis was that maximal strength training (MST) using high loads and few repetitions would improve central neural drive and thus strength capacity of MS patients. 14 MS patients staying at a national MS rehabilitation center were randomly assigned to a MST group or a control group (CG). Both groups received âtodayâs treatmentâ. In addition, the MST group trained 4 Ă 4 repetitions of unilateral dynamic leg press and plantar flexion 5 days a week for 3 weeks. Neural adaptations of the soleus muscle were assessed by surface electromyography (EMG) activity, and by superimposed H-reflexes and V-waves obtained during maximum voluntary isometric plantar flexor contractions (MVCs). H-reflexes and V-waves were normalized by the M-wave (H SUP/M SUP, V/M SUP, respectively). In the MST group, MVC increased by 20 Âą 9% (P < 0.05). Soleus EMG activity and V/M SUP ratio increased by 40 and 55%, respectively, in the MST group compared to the CG (P ⤠0.05). The H SUP/M SUP ratio remained unchanged. No change was apparent in the CG. MST group subjects were able to complete all training sessions. No adverse effects were reported. This randomized study provides evidence that MST is effective of augmenting the magnitude of efferent motor output of spinal motor neurons in MS patients, alleviating some neuromuscular symptoms linked to the disease