128 research outputs found
The use of technology in measuring low back function and morphology in low back pain patients
Low back pain (LBP) is a very common symptom experienced by people worldwide. In most cases, however, it is hard to choose the most efficient intervention for the physiotherapist in primary care. Physiological and psychosocial components can play a role in LBP symptoms. In this thesis, the main question was if technology can be used in monitoring/diagnostics for patients with LBP in primary care physiotherapy. The focus was on the physiological components, especially the lumbar multifidus (LM). First, we found that the presentation of the anatomy of LM was inconsistent in literature and anatomical atlases. Second, we presented the LM with a 3D-model of two cadavers and ultrasound images. Third, we tried to measure muscle activity of low back muscles by using surface electromyography. This is a technology that is applied by physiotherapists in primary care. This research showed that this technology made no distinction between muscle activity from several low back muscles. Finally, technologies are used to measure differences between healthy volunteers and patients with LBP. This last research showed that muscle thickness measured by ultrasound, and trunk range of motion measured by a 3D sensor can be used by physiotherapists to monitor patients with LBP. Overall, this thesis contributed to new insights in low back muscles anatomy and technology that can be applied in monitoring biological components in patients with LBP in primary care physiotherapy
Performing a Life Cycle Assessment for Self-service Devices:A Case Study of Self-checkout
Nowadays, self-checkouts are becoming increasingly popular in stores and markets. This is simply because they offer customers the convenience of shopping without having to wait in line and provide store owners with an opportunity to increase sales and improve the customer experience. Meanwhile, the sustainability options of the devices have gained more traction, such as reducing the CO2 emissions of the product and production. However, it is initially unknown how to investigate the sustainability of self-service devices due to insufficient research in this area. To address this issue, the different methodologies have been analyzed based on domain-oriented boundaries. The life cycle assessment (LCA) is chosen to assess the sustainability. Then, the inventory analysis is worked out to gather the relevant raw data. Subsequently, the model of the product's life cycle is established in an LCA software tool. The assessment and interpretation is carried out. A case study of self-checkout is conducted in the industrial company and the results shows that recycled material zincor and using solar energy could lead to a reduction of CO2 emissions of up to 41.8%.</p
Modelling of Multi-Frequency Microwave Backscatter and Emission of Land Surface by a Community Land Active Passive Microwave Radiative Transfer Modelling Platform (CLAP)
Emission and backscattering signals of land surfaces at different frequencies have distinctive responses to soil and vegetation physical states. The use of multi-frequency combined active and passive microwave signals provides complementary information to better understand and interpret the observed signals in relation to surface states and the underlying physical processes. Such a capability also improves our ability to retrieve surface parameters and states such as soil moisture, freeze-thaw dynamics and vegetation biomass and vegetation water content (VWC) for ecosystem monitoring. We present here a prototype Community Land Active Passive Microwave Radiative Transfer Modelling platform (CLAP) for simulating both backscatter (σ0) and emission (TB) signals of land surfaces, in which the CLAP is backboned by an air-to-soil transition model (ATS) (accounting for surface dielectric roughness) integrated with the Advanced Integral Equation Model (AIEM) for modelling soil surface scattering, and the Tor Vergata model for modelling vegetation scattering and the interaction between vegetation and soil parts. The CLAP was used to simulate both ground-based and space-borne multi-frequency microwave measurements collected at the Maqu observatory on the eastern Tibetan plateau. The ground-based systems include a scatterometer system (1–10 GHz) and an L-band microwave radiometer. The space-borne measurements are obtained from the X-band and C-band Advanced Microwave Scanning Radiometer 2 (AMSR2) radiation observations. The impacts of different vegetation properties (i.e., structure, water and temperature dynamics) and soil conditions (i.e., different moisture and temperature profiles) on the microwave signals were investigated by CLAP simulation for understanding factors that can account for diurnal variations of the observed signals. The results show that the dynamic VWC partially accounts for the diurnal variation of the observed signal at the low frequencies (i.e., S- and L-bands), while the diurnal variation of the observed signals at high frequencies (i.e., X- and C-bands) is more due to vegetation temperature changing, which implies the necessity to first disentangle the impact of vegetation temperature for the use of high frequency microwave signals. The model derived vegetation optical depth τ differs in terms of frequencies and different model parameterizations, while its diurnal variation depends on the diurnal variation of VWC regardless of frequency. After normalizing τ at multi-frequency by wavenumber, difference is still observed among different frequencies. This indicates that τ is indeed frequency-dependent, and τ for each frequency is suggested to be applied in the retrieval of soil and vegetation parameters. Moreover, τ at different frequencies (e.g., X-band and L-band) cannot be simply combined for constructing accurate long time series microwave-based vegetation product. To this purpose, it is suggested to investigate the role of the leaf water potential in regulating plant water use and its impact on the normalized τ at multi-frequency. Overall, the CLAP is expected to improve our capability for understanding and applying current and future multi-frequency space-borne microwave systems (e.g. those from ROSE-L and CIMR) for vegetation monitoring.</p
Human oriented performance management: Is there a gap between executives and non-executives?
For organizations it is important to translate the strategy and goals of the organization in tangible targets for the employees. Often, this leads to many Key Performance Indicators (KPI) for the employees. However, the link between their personal KPI’s and the goals of the organization is not always recognised. Therefore, based on previous research into performance management and on theories of organizational behaviour, culture and performance a model was developed to measure human oriented performance management in organizations. Human oriented performance management is all about establishing a direct connection between the objectives and strategy of an organization (or part thereof) and the activities and tasks of the people in the different processes. The research question in this paper is to what extent the dimensions of human oriented performance management do occur within organizations and how these dimensions are perceived by executive and non-executive employees. Using a mixed method approach, survey data was collected among 64 employees of three organizations, and additional eight interviews with executives and eight interviews with non-executives were held to explore and understand the results of the survey. The results show that continues improvement and organizational learning have the highest scores within all of the organizations. The lowest score for all the organizations is Visualization. Executives score slightly higher on most dimensions of human oriented performance management. Especially, the difference between the dimensions Action orientation and Dialogue is notable. The main conclusion is that it\u27s unclear to which extent management and employees really talk about the performance and how to improve it. For many non-executives it is unclear what the organization objectives are and how they perform on these objectives
Inconsistent descriptions of lumbar multifidus morphology:A scoping review
Background Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature. Methods Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system. Results In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings - particularly for levels L4-S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases. Discussion Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas. Conclusions We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology
A guide for standardized interpretation of lumbar multifidus ultrasonography:an observational study
BACKGROUND: Inconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography. METHODS: An observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 μm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1. RESULTS: Based on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images. CONCLUSION: The detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback
Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care
Background: Since the contribution of the lumbar multifidus(LM) is not well understood in relation to nonspecific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. Objectives: This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. Design: Multicenter case control study. Method: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, pvalues< 0.05, with Tukey’s HSD post-hoc test were considered significant. Results: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11–0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10–0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). Conclusions: Trunk ROM and LM thickness show differences between LBP patients and healthy controls
Intramuscular EMG versus Surface EMG of Lumbar Multifidus and Erector Spinae in Healthy Participants
Study Design: Cross-sectional design. Objective: The aim of this study was to investigate the correlation between intramuscular EMG (iEMG) and surface EMG (sEMG) from lumbar multifidus and erector spinae muscles during (submaximal) voluntary contraction tests in healthy participants. Summary of Background Data: Low back muscle function is a key component in the stability of the lumbar spine in which an important role is attributed to the lumbar multifidus (LM). Impairments in this stabilization system are held responsible for (chronic) low back pain. LM function can be measured by iEMG and sEMG; however, in earlier studies, results from iEMG and sEMG were inconsistent. Methods: Fifteen healthy adults were included. The intervention consisted of five clinical tests: resting, submaximal contraction tests of the lower back, abdominal contraction, and a biofeedback test in which LM and erector spinae (ES) activities were compared by iEMG and sEMG. Correlations were calculated with regard to original signal, co-contraction ratio, and cross-talk ratio. Correlation coefficients for each combination of iEMG and sEMG signals were calculated, to identify original signal (i.e., activity of only the targeted muscle) and possible cross-talk. Correlations >0.75 were considered as good concurrent validity. Results: The original signals of LM showed fair to high correlation coefficients (r: 0.3–0.8). Co-contraction of LM and ES was observed during all tests, but iEMG shows more variation in the correlations (r: 0.1–0.8) compared to sEMG (r: 0.3–0.8). Significant cross-talk was observed in all tests, particularly during the biofeedback test of iEMGESversus sEMGLM and iEMGLMversus sEMGES (r = 0.8). Conclusion: Surface EMG of ES and LM are no adequate representation of LM and ES activity measured by iEMG because of moderate/high cross-talk and co-contractions. Clinical tests that aim to assess LM activity do not represent isolated LM activity. This should be taken into account in future clinical studies
Durability of Evoked Compound Action Potential (ECAP)-Controlled, Closed-Loop Spinal Cord Stimulation (SCS) in a Real-World European Chronic Pain Population
Introduction: Closed-loop spinal cord stimulation (CL-SCS) is a recently introduced system that records evoked compound action potentials (ECAPs) from the spinal cord elicited by each stimulation pulse and uses this information to automatically adjust the stimulation strength in real time, known as ECAP-controlled SCS. This innovative system compensates for fluctuations in the distance between the epidural leads and the spinal cord by maintaining the neural response (ECAP) at a predetermined target level. This data collection study was designed to assess the performance of the first CL-SCS system in a real-world setting under normal conditions of use in multiple European centers. The study analyzes and presents clinical outcomes and electrophysiological and device data and compares these findings with those reported in earlier pre-market studies of the same system. Methods: This prospective, multicenter, observational study was conducted in 13 European centers and aimed to gather electrophysiological and device data. The study focused on the real-world application of this system in treating chronic pain affecting the trunk and/or limbs, adhering to standard conditions of use. In addition to collecting and analyzing basic demographic information, the study presents data from the inaugural patient cohort permanently implanted at multiple European centers. Results: A significant decrease in pain intensity was observed for overall back or leg pain scores (verbal numerical rating score [VNRS]) between baseline (mean ± standard error of the mean [SEM]; n = 135; 8.2 ± 0.1), 3 months (n = 93; 2.3 ± 0.2), 6 months (n = 82; 2.5 ± 0.3), and 12 months (n = 76; 2.5 ± 0.3). Comparison of overall pain relief (%) to the AVALON and EVOKE studies showed no significant differences at 3 and 12 months between the real-world data release (RWE; 71.3%; 69.6%) and the AVALON (71.2%; 73.6%) and EVOKE (78.1%; 76.7%) studies. Further investigation was undertaken to objectively characterize the physiological parameters of SCS therapy in this cohort using the metrics of percent time above ECAP threshold (%), dose ratio, and dose accuracy (µV), according to previously described methods. Results showed that a median of 90% (40.7–99.2) of stimuli were above the ECAP threshold, with a dose ratio of 1.3 (1.1–1.4) and dose accuracy of 4.4 µV (0.0–7.1), based on data from 236, 230, and 254 patients, respectively. Thus, across all three metrics, the majority of patients had objective therapy metrics corresponding to the highest levels of pain relief in previously reported studies (usage over threshold > 80%, dose ratio > 1.2, and error < 10 µV). Conclusions: In conclusion, this study provides valuable insights into the real-world application of the ECAP-controlled CL-SCS system, highlighting its potential for maintaining effective pain relief and objective neurophysiological therapy metrics at levels seen in randomized control trials, and potential for quantifying patient burden associated with SCS system use via patient–device interaction metrics. Clinical Trial Registration: In the Netherlands, the study is duly registered on the International Clinical Trials Registry Platform (Trial NL7889). In Germany, the study is duly registered as NCT05272137 and in the United Kingdom as ISCRTN27710516 and has been reviewed by the ethics committee in both countries.</p
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