Reverse shoulder prosthesis in patients with rheumatoid arthritis: a systematic review

PURPOSE: To obtain detailed information on the outcomes of patients with rheumatoid arthritis (RA) undergoing reverse shoulder arthroplasty (RSA) METHODS: A literature search was conducted for studies reporting on the use of RSA in RA patients from 1990 to 2014. The inclusion criteria were a report of sufficient information on pre-operative status and surgical outcome allowing evaluation of the therapeutic potential of RSA in RA. The literature search resulted in 586 hits, but only five studies that met the inclusion criteria were assessed. RESULTS: There were 100 shoulders that had been operated on, of which 87 were followed for a mean of 55.4 months, the longest follow-up being 11.9 years Most patients had glenohumeral erosive lesions of Larsen Grade III or IV. The Delta III prosthesis was implanted in most cases and in three studies bone graft was used for severe glenoid lesions. The main outcome measures employed were the Constant score (Cs) and ASES questionnaire. The mean increase in Cs and ASES score after surgery was 42.4 and 54 points, respectively. The mean post-operative forward elevation was 120.6°, the average increment being 51° and the mean increase of abduction was 58.5°. The mean prevalence of scapular notching was 35.4 %. The rate of adverse events was 31 %, but the vast majority were of minor severity. Eight prostheses underwent revision, due to infection in four. CONCLUSIONS: RSA implanted in RA patients would appear to give similar results to those obtained in massive cuff tears with or without arthropathy

Parkinson’s disease: new system to improve quality of life

Parkinson’s disease (PD) is the most common neurodegenerative movement disorder, affecting 0.3% of the general population(1). Postural instability is a loss of balance and it is a common feature of PD(2). Individuals with PD commonly experience gait and postural stability impairments, which may lead to falls, mobility loss, and reduced independence. Human Body Posturizer (HBP) is a fully articulated orthosis, light and able to adapt to the physical characteristics of each individual. Our aim has been to evaluate the role of HBP as an innovative tool for the conservative treatment of gait and postural stability impairments in patients affected by PD. This study analyzed 20 subjects (10 male and 10 female) affected by PD and a control group of age-matched healthy subjects (10 male and 10 female). A bipodal platform (Prokin, Tecnobody) was used to evaluate static balance. To describe the functional characteristics of the PD sample, a clinical assessment was carried out at the beginning of the study. The Berg Balance Scale and the Parkinson’s Disease Rating Scale (UPDRS) were administrated before the experimental session. All patients were firstly evaluated without HBP and wearing normal clothes; then, patients were asked to wear HBP and, after 40 mins, a second acquisition with HBP was performed. For the static evaluation, the patients performed a stabilometric test, 30 sec with eyes open and then 30 sec with eyes closed; perimeter sway, area of the center of pressure (CoP), anterior- posterior velocity (VA-P), and medial-lateral velocity (VM-L) have been evaluated. Our results showed a marked improvement of all analyzed parameters; in particular, a significant reduction in VA-P (p<0.05) was present when patients wear HBP in both open and closed eyes. Moreover, a significant reduction (p<0.05) of the CoP area was observed in closed eyes. This variable reflects the ability of balance system to achieve body stability. In conclusion, our data suggest a stabilizing effect of HBP in patients with PD with a role in improving quality of life

Effects of a new system of postural realignment (HBP): evaluation through the sensorizer

Orthosis are external aids designed for different postural problems and represent the most commonly used conservative treatment (Noonan K et al., 1996). In this analysis, a modular exoskeleton named Human Body Posturizer (HBP) has been tested to evaluate parameters related to the gait cycle and thus any positive effects on balance A sample of 20 normal subjects, 10 male and 10 female (age: 24.8±1.83) who had no previous or current diseases of the bones, joints and muscles have been considered. They wore the HBP for thirty days, three times a week for 30 minutes and then performed a motor task final. The Sensorizer C1-S has been used to analyse their motor task before and after the use of HBP. Regularity of the step, the step symmetry and regularity of the double step were the parameters analyzed in this study. In normal subjects, all three parameters analyzed statistically with the t-test showed a significant change after wearing the HBP resulting in a positive effect on the balance. The results of this study suggested a general improvement of the balance during walking. Symmetry and regularity of the step parameters are fundamental and predictive of the risk of falls (Tura et al. 2010). An improvement of these parameters is associated with a better balance, since low values may be associated with postural imbalances and asymmetries in the way. Further studies will be performed in order to demonstrate the efficacy of this device on elder patients

Evaluation of the Human Body Posturizer in postural diseases and its impact on of the fall risk in the elderly

Introduction: Orthosis are external aids designed for different postural problems and represent the most commonly used conservative treatment (Noonan K et al., 1996). In this analysis, a modular exoskeleton named Human Body Posturizer (HBP) has been tested to evaluate the morphological variations due to it’s prolonged use and its effects on the fall risk in the elderly. Methods: a sample of 20 normal male subjects (age: 23.4±4.3) have worn the HBP 3 days for week for 6 months. Subject were examined by baropodometry, Surfacer system and SF-36 questionary. Furthermore, 150 subjects with mild fall risk met inclusion criteria (64.85±2.75) were enrolled. A test battery of physiological parameters related to balance and falls (Tinetti Gait and Balance test, Short Physical Performance Battery, Numeric Pain Rating Scale) has been used in order to determine fall risk in elderly people (Shimada H et al., 2011). Results: in normal subjects, a general increasing of the bilateral symmetry associated to a structural reorganization of the dorsal and lumbar regions. In elderly subjects, a significant improvements in Short Physical Performance Battery, Tinetti Scale and Pain Numeric Rating Scale (p < 0.05) have been showed after treatment with HBP. A significant reduction in fall risk was shown in HBP treated subjects. Discussions: the results of this study suggested a general improvement of the postural assessment due to the increasing of the structural symmetry of the back. The use of Human Body Posturizer seems to be a new significant device for prevention of fall in elder patients. The use of the HBP could represent an integrative therapy for different postural diseases. Further studies will be performed in order to demonstrate the efficacy of this device on elder patients

The morphological look of the plantar surface in the young soccer players

Introduction. The plantar support and its modifications are widely studied because of their bearing on posture (Eils E et al., 2004). In particular, past studies have focused on the support modification during specific athletic tasks to highlight the eventual correlations between foot type and the most frequent sport injuries, due to intrinsic and extrinsic components that involve the structural and functional dynamics that act on the plantar vault during static and dynamic condition. These studies have been conducted by analyzing the morphological variation of the footprint during the performance (Bruner E et al., in press). Methods. In the present study the variation in shape of the baropodometrical footprint of young soccer players, has been analyzed using geometric morphometrics (Adams et al., 2004). This approach permits a quantification of the morphological variation of the subjects using Cartesian coordinates placed at specific points on the footprint outline, and to correlate them with physical variables. Results.In the present study the young soccer players displayed a narrowing of the footprint due to a transversal variation on the isthmus, when compared to children of the same age who did not play soccer. These results suggest a physiological and biomechanical organization of the foot type in soccer due to the specific athletic tasks involved. Discussions. As the foot type, in sport, is strictly associated to recurrent injuries, the result obtained in this study should be considered as indicative for future analysis. In fact, a clear and univocal knowledge of this phenomenon would be useful in the planning of a training protocol to reduce the incidence of sport related injuries

Effects of the HBP passive exoskeleton on brain functions: Application on multiple sclerosis patients

Human exoskeletons are used for enhancing people’s strength, endurance and speed in many activities, and they have recently been shown to improve the quality of life in people with disabilities (Rahman et al., 2007). In present study we report the benefits of a passive and fully articulated exoskeleton on multiple sclerosis patients by means of behavioral and electrophysiological measures, paying particular attention to the prefrontal cortex activity. Multiple sclerosis is a neurological condition characterized by lesions of the myelin sheaths that encapsulate the neurons of the brain, spine and optic nerve, and it causes transient or progressive symptoms and impairments in gait and posture. Up to 50% of multiple sclerosis patients require walking aids and 10% are wheelchair-bound 15 years following the initial diagnosis. We tested the ability of a new orthosis, the “Human Body Posturizer”, to improve the structural and functional symmetry of the body through proprioception in multiple sclerosis patients. The results showed that a single Human Body Posturizer application improved mobility and ambulation in all tested patients. Most importantly, we associated these effects and brain measurements, particularly prefrontal cortex activity

Morphology of spine and footprint in athletes from different sports: an integrate approach to evaluate posture

Posture is a complex process determined by the interaction of several body structures. In the past years, different direct and indirect procedures have been proposed to understand how these anatomical structures could be modified by forces exerted during sport practice (Queen et al, 2007). A particular attention has been focused on the variations in athletes from different sports to highlight eventual correlations between morpho-functional modifications, postural diseases and injuries (Cain et al, 2007). The aim of this work is to study the morphological aspects of the footprint and the spine in different athletes by an integrate approach. 115 subjects were tested and divided accordingly to the specific sport activity (control, basketball, volleyball, football, gymnastics); only subjects without previous or current diseases of the bones, joints and muscles have been considered. The electronic baropodometry has been used to measure the pressure distribution exerted on each foot during static and dynamic conditions; the Surfacer has been used to record the position of chosen points on the back. Our results indicated that, in comparison with controls, athletes from different sports displayed specific and significant modifications in foot type and in the back morphology; in particular, statistical analysis showed that in basketball and gymnastics athletes, significant changing in foot type and in the back morphology were present; moreover, in volleyball athletes, significant changing were found in foot type. Therefore, our results suggest that each sport could determinate specific postural changes during sport practice. Our data could be useful to develop specific training protocols aimed to prevent alterations in spine morphology and foot type that are associated with sport practice and could determine injuries or other postural diseases. Reference

Human Body Posturizer (H.B.P.): new orthosis for improving postural dynamics

Introduction. Posture is the result of many complex processes involving the entire body in relationship with different environmental changes (Penha P.J.,2005). Interaction between the different anatomical districts occurs at different levels and it is influenced by different initial conditions. Alterations in imbalances and associated diseases produce a structural and physiologic reorganization of the anatomical structures to improve postural dynamics (Kasim et al., 2010). Generally, these modifications can be divided into para-mophisms and dis-morphisms of the spine. Currently postural diseases are treated by passive (brace and orthosis) and active (gymnastic) methods according with the severity of imbalance (LeBauer et al., 2008; Ugwonali et al., 2004). Purpose of this study is to validate a new type of orthosis named Human Body Posturizer (H.B.P). It is a modular flexible structure composed of different modules which act on the cervical, thoracic and lumbar traits of the back, and an inferior module which acts on the inferior limbs. Materials and methods. The present study considers a sample of 20 male subjects with age spanning from 19 to 35 years (mean age 23,4 ± 4,3). Subjects underwent 4 weeks of H.B.P. treatment consisting of 30 minutes, two times for week. The sample was analyzed by using the Surfacer System (Diagnostic Support), which permits to capture the external geometry of the back. Each subject was sampled before and after the treatment and differences between pre and post treatment were analyzed trough geometric morphometric approach (Slice 2000). Results. The results of this study showed a reorganization of the bilateral structures of the back after treatment. In particular an increased degree of symmetry was observed both in trunk and lumbar regions of the back. Conclusions. The preliminary results of the present study suggest that the HBP, acts on the spatial organization of the back, rectifying the position of the anatomical components associated to the early postural diseases. Nevertheless these results should be considered as preliminary and need of further researches