Trunk motion analysis: a systematic review from a clinical and methodological perspective

INTRODUCTION: This systematic literature review aims to check the current state of affairs of non-gait-related optoelectronic trunk movement analysis; results have been analyzed from a clinical and a methodological perspective. EVIDENCE ACQUISITION: Extensive research was performed on all papers published until December 31st, 2015, dealing with trunk movement analysis assessed by optoelectronic systems, excluding those related to gait. The research was performed on the 14th of January 2016 on three databases: Scopus, Science Direct and Pubmed. A reference search and expert consultation were also performed. EVIDENCE SYNTHESIS: Out of a total number of 8431 papers, 45 were deemed relevant: they included 1334 participants, 57.9% healthy, with age range 8-85. Few studies considered the whole trunk, and none focused on each vertebra independently: the trunk was almost always divided into three segments. Thirteen studies included 20 or more markers. Most of the papers focused mainly on the biomechanics of various movements; the lumbar area and low back pain were the most studied region and pathology respectively. CONCLUSIONS: This study has shown the relative scarcity of current literature focusing on trunk motion analysis. In clinical terms, results were sparse. The only quite well represented group of papers focused on the lumbar spine and pathologies, but the scarcity of individuals evaluated make the results questionable. The use of optoelectronic systems in the evaluation of spine movement is a growing research area. Nevertheless, no standard protocols have been developed so far. Future research is needed to define a precise protocol in terms of number and position of markers along the spine and movements and tasks to be evaluated

Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function.

BACKGROUND: Worsening renal function (WRF), traditionally defined as an increase in serum creatinine levels ≥0.3 mg/dL, is a frequent finding in patients with acute heart failure (AHF) and has been associated with poorer outcomes in some but not all studies. We hypothesized that these discrepancies may be caused by the interaction between WRF and congestion in AHF patients. METHODS AND RESULTS: We measured serum creatinine levels on a daily basis during the hospitalization and assessed the persistence of signs of congestion at discharge in 599 consecutive patients admitted at our institute for AHF. They had a postdischarge mortality and mortality or AHF readmission rates of 13% and 43%, respectively, after 1 year. Patients were subdivided into 4 groups according to the development or not of WRF and the persistence of ≥1 sign of congestion at discharge. Patients with WRF and no congestion had similar outcomes compared with those with no WRF and no congestion, whereas the risk of death or of death or AHF readmission was increased in the patients with persistent congestion alone and in those with both WRF and congestion (hazard ratio, 5.35; 95% confidence interval, 3.0-9.55 at univariable analysis; hazard ratio, 2.44; 95% confidence interval, 1.24-4.18 at multivariable analysis for mortality; hazard ratio, 2.14; 95% confidence interval, 1.39-3.3 at univariable analysis; and hazard ratio, 1.39; 95% confidence interval, 0.88-2.2 at multivariable analysis for mortality and rehospitalizations). CONCLUSIONS: WRF alone, when detected using serial serum creatinine measurements, is not an independent determinant of outcomes in patients with AHF. It has an additive prognostic value when it occurs in patients with persistent signs of congestion

Nonbacterial Thrombotic Endocarditis in Pancreatic Cancer

Nonbacterial thrombotic endocarditis (NBTE), known as marantic endocarditis, is a phenomenon due to hypercoagulability with a complex pathogenesis. Originally described by Ziegler, the lesions of NBTE were considered to be fibrin thrombi deposited on normal or superficially degenerated cardiac valves [1]. Numerous reports have identified the relationship between NBTE and a variety of different inflammatory states, including chronic diseases like malignancy and autoimmune disease [2, 3]. NBTE is a serious manifestation of prothtombotic state that is characterized by the deposition of thrombi on previously undamaged heart valves in the absence of a bloodstream bacterial infection and by the increased frequency of arterial embolic events in patients with chronic debilitating diseases. Although hypercoagulability is often seen in patients with pancreatic cancer, NBTE has rarely been reported antemortem. We report a case of marantic endocarditis in patient with pancreatic cancer, in which neurological symptoms preceded the diagnosis of pancreatic cancer

Paravertebral muscles metabolism changes with age in agreement with EMG particularly at L4-5, less at higher levels : a Near Infrared Spectroscopy (NIRS) evaluation

INTRODUCTION: The metabolic changes that occur over time in paravertebral muscles are not yet well-characterized. The aim of this study was to test a non-invasive method for the evaluation of the paravertebral lumbar muscles since there is evidence of a correlation between highly fatigable back muscles and chronic low back pain.1 METHODS: We recruited a convenience sample of 37 healthy subjects (18-80 yrs) (20 males and 17 females), to have at least 5 participants per age group (15 below 30, 5 aged 30-49, 7 aged 50-59, and 5 aged 60-69 and 70-79). All patients reported no episodes of back pain in the last 5 years. The Biering Sorensen Muscle Test (BSME) was used to cause fatigue: it was repeated three times, to limit adaptation while allowing muscle warm-up. Muscular metabolism of paravertebral muscles was studied checking blood deoxygenation using Near Infrared Spectroscopy (NIRS) 2 at the L2-3, L3-4 and L4-5 levels. According to the literature, we used the only reliable phase of the hemoglobin deoxygenated curve (HHb) that is the rapid one, corresponding to the growth of oxygen consumption before reaching a fully aerobic steady state. We compared all parameters among groups and searched correlations with age, weight, height and BMI. Muscle contraction was studied with surface EMG, particullary Slope Coefficient of Mean Frequency (MNF) was used to analyze EMG Data. RESULTS: We did not find any difference in the results for the examined levels, even if L2-3 showed to be the most reliable (82% of evaluable curves versus L4=76% and L5=71%). We did not find any difference for sex or side neither for NIRS nor for EMG. While EMG slope decreased with age, at the L4-5 level the NIRS angle of slope decreased and in men the time to reach plateau increased. We found a direct correlation between EMG and NIRS slope only, but after averaging the two sides. EMG slope was also directly correlated with height, but only in males. We did not find correlations with weight and BMI. DISCUSSION: With age the growth of EMG signals decreases, and consensually the time to reach an aerobic steady state increases, while the angle of the growth phase consequently decreases. A correlation between metabolic and electromyographic activity has already been demonstrated in low back pain patients, but using a dynamic test and with older, less reliable instruments 3. Even if the phenomena are clearly physiologically linked, there are other factors to be understood that could play a role (like vascularization, oxygen consumption capacity, etc.)4. While L3 is the most used level for NIRS studies, we found correlations only with L4-5 level, where the analysis of rapid phase of the hemoglobin deoxygenated (HHb) was correlated with age, but not to anthropometric parameters

Identification through movement analysis of chronic low back pain pathological spinal movements patterns and their sensibility to change during exercise treatment

INTRODUCTION: Chronic low back pain (CLBP) is a bio-psycho-social syndrome causing disability. While there are multiple imaging systems for the anatomical structures, in vivo movement evaluation has scarcely been performed.1Our aim was to pilot in a CLBP population a movement analysis protocol developed in healthy participants 2, and verify correlations with pain, disability and treatment effects. METHODS: We recruited a convenience sample of 10 CLBP patients who were referred for a group exercise therapy (strengthening, core stability, active stretching and postural re-education)3,4We used a non-invasive optoelectronic full spine evaluation according to a previously developed protocol 2. We analyzed anterior flexion, lateral bending and rotation movements, and collected Numerical Rating (NRS) and Oswestry (ODI) scales before and after treatment. We performed a qualitative analysis to identify possible abnormal movement patterns, that have been quantified through 3 or 4 points Likert scales: their inter-observers repeatability has been checked comparing three operators (1 expert and 2 students). A total score for each movement has then been calculated as well as its variations with treatment, and correlations with ODI and NRS. RESULTS: Comparing normal to pathological patterns (fig 1) we identified the following parameters: for all movements total Range of Motion, fluidity, symmetry, and pelvis center; we also added for lateral bending the lumbopelvic rhythm, for flexion and rotation the arrival overdrive, and for flexion the altered Anticipatory Postural Adjustments. Inter-operators repeatability resulted in a Cohen k 0.21-0.4 in 13% of parameters, 0.41-0.6 in 47%, 0.61-0.8 in 32% and 0.81-1 in 9%. With treatment, ODI and NRS improved and the total score decreased in all movements: flexion (p<0.01), bending (p<0.01) and rotation (p<0.0005). We did not find any correlation with ODI and NRS. DISCUSSION: In this study we have identified some reliable qualitative patterns of pathological movement in CLBP that showed to be sensible to treatment, even if not correlated to subjective scales like ODI and NRS. Future studies should check these preliminary results in wider populations and different treatments, while a quantification of these qualitative parameters is under development

Paravertebral muscles metabolism changes with age in agreement with EMG particularly at L4-5 : a Near Infrared Spectroscopy evaluation (NIRS)

INTRODUCTION: The metabolic changes that occur over time in paravertebral muscles are not yet well-characterized. The aim of this study was to test a non-invasive method for the evaluation of the paravertebral lumbar muscles, since there is evidence of a correlation between highly fatigable back muscles and chronic low back pain.1 METHODS: We recruited a convenience sample of 37 healthy subjects (18-80 yrs) (20 males and 17 females), to have at least 5 participants per age group (15 below 30, 5 aged 30-49, 7 aged 50-59, and 5 aged 60-69 and 70-79). All patients reported no episodes of back pain in the last 5 years. The Biering Sorensen Muscle Test (BSME) was used to cause fatigue: it was repeated three times, to limit adaptation while allowing muscle warm-up. Muscular metabolism of paravertebral muscles was studied checking blood deoxygenation using two Near Infrared Spectroscopy (NIRS)2 at the L2-3, L3-4 and L4-5 levels. According to the literature, we used the only reliable phase of the hemoglobin deoxygenated curve (HHb) that is the rapid one, corresponding to the growth of oxygen consumption before reaching a fully aerobic steady state. We compared all parameters among groups and searched correlations with age, weight, height and BMI. Muscle contraction was studied with surface EMG, particullary Slope Coefficient of Mean Frequency (MNF) was used to analyze EMG Data. RESULTS: We did not find any difference in the results for the examined levels, even if L2-3 showed to be the most reliable (82% of evaluable curves versus L4=76% and L5=71%). We did not find any difference for sex or side neither for NIRS nor for EMG. While EMG slope decreased with age, at the L4-5 level the NIRS angle of slope decreased and in men the time to reach plateau increased. We found a direct correlation between EMG and NIRS slope only, but after averaging the two sides. EMG slope was also directly correlated with height, but only in males. We did not find correlations with weight and BMI. DISCUSSION: With age the growth of EMG signals decreases, and consensually the time to reach an aerobic steady state increases, while the angle of the growth phase consequently decreases. A correlation between metabolic and electromyographic activity has already been demonstrated in low back pain patients, but using a dynamic test and with older, less reliable instruments 3. Even if the phenomena are clearly physiologically linked, there are other factors to be understood that could play a role (like vascularization, oxygen consumption capacity, etc.)4. While L3 is the most used level for NIRS studies, we found correlations only with L4-5 level, where the analysis of rapid phase of the hemoglobin deoxygenated (HHb) was correlated with age, but not to anthropometric parameters

P 159 - Gait in stroke patients is influenced by upper limb functioning: A quantitative analysis correlating QuickDASH with Instrumented TUG and 10MWT

Loss of mobility after stroke is one of the main target of intervention in PRM and physiotherapy as motor impairment affects gait efficacy and upper limb function[1,2]: it is possible to observe a consensual improvement of these latter aspect throughout rehabilitation. Neural connections between upper and lower limb in gait are known[3,4] as well as the fact that modifications of upper limb movement during gait can affect gait parameters[5]. A recent review supports the inclusion of arm activity in addition to leg activity as a component of gait retraining after neurotrauma[6]. To the best of our knowledge, the association between upper limb disability and ability to move and walk in stroke patients has not been quantitatively studied: analysis of correlation between Instrumented TUG/10MWT tests and QuickDASH questionnaire can be a preliminary, easy to perform, and clinically suitable way to assess it. Research Question Do TUG/10MWT temporal and kinematic parameters and QuickDASH score correlate in stroke subjects? Methods A cross sectional study was performed in a tertiary referral sub-acute rehabilitation centre in Northern Italy. 20 stroke inpatients aged 66,53 (\ub17,60) were enrolled. Inclusion criteria were stable clinical conditions and no other neurological or musculoskeletal pathologies. Subjects evaluation consisted of motor and gait skills assessment by performing Timed Up & Go test and 10 Meter Walking Test, and upper limb disability evaluation by administering QuickDASH questionnaire. A wearable BTS G-Sensor IMU (Inertial Measurement Unit) was utilized to obtain a kinematic and temporal analysis of tests[7]. Spearman Correlation was carried out to assess the association between tests parameters and QuickDASH score (p<0.05). Results Correlation between QuickDASH score and TUG time to completion was found as well as for some sub-phases times: forward gait, mid turning and return gait. We also found a correlation with maximum rotation speed in end turning (tab1). With regard to QuickDASH and 10mWT, correlations were found for: time to completion, cadence, speed, gait cycle duration, stride length, % stride length and number of steps (tab2). Discussion The application of IMU wearable sensors to field tests has proven to be a useful, valid and user-friendly mode for assessing motor skills in stroke patients within clinical practice. Valuable correlations were demonstrated between the disability of upper limb and residual motor skills in stroke subjects: the higher the motor disability of the upper limb, the lower the performance in movement tests, and vice versa. These findings may open an alternative way to assess and thinking of the rehabilitation intervention in stroke patients, suggesting the possibility to enforce upper limb rehabilitation not just per-se, but in a wider and comprehensive program of motor skills recovery

Does Gait Kinematic Parameters Change as Functional Outcome Scales in Total Hip Arthroplasty Subjects after Rehabilitation?

Introduction Total hip arthroplasty (THA), is a routine, common surgical intervention;following surgery is usual practice a period of rehabilitation to recover strength, range of motion and walking ability of the operated limb. Many outcome scales (OS) have been developed to assess the improvements of the patients, but gait parameters have not been studied as possible outcome[ Research question For the statistical analysis a Student T and Wilcoxon signed ranks test were performed to test thevariation between T0 and T1. Spearman\u2019s Rho and Pearson\u2019s R were calculated to investigate a possible relationship between BI and MDA, with the gait analysis parameters. Results 12 subjects (4 females, 9 left hips) mean age 68\ub18 were included, the length of recovery was 17\ub16 days. Discussion Both OS and temporal and spatial GA parameters showed meaningful improvements between T0 and T1; these improvements have been clearly detected also with GA, that has rarely been performed before in such an acute phase. The correlation between the OS and the aforementioned GA parameters, may suggest a wider use of GA in this clinical context, as a useful tool to assess the function and improvements of this kind of population. In particular to tailor the rehabilitation treatment

Soil microbial characteristics and mineral nitrogen availability as affected by olive oil waste water applied to cultivated soil.

Waste disposal is an urgent problem in those Italian areas devoted to olive oil production where a large amount of olive oil waste is produced in a short period of time. Given the high organic matter and macronutrient content of olive oil waste water, its use in agriculture could help to solve the disposal problem and, at the same time, to improve the physiochemical characteristics of intensely cultivated soils. However, olive oil waste water contains noteworthy quantities of phenols, which are toxic and have bacteriostatic activity. The effects of repeated spreading of olive oil waste water on alfalfa, on soil microbial properties, and on the availability of mineral nitrogen were determined. Doses of 0, 80, and 160 m3 ha−1 of olive oil waste water (OW) were spread over experimental plots sown with 3rd year alfalfa. Soil samples were collected at various intervals after OW application. The biomass, respiratory activity, metabolic quotient, mineralization index, and the potential nitrification activity (PNA) of the soil were measured. Polyphenol, organic carbon, and mineral nitrogen contents were measured on the same soil samples. In general, the spreading of OW caused slightly positive modifications to the soil microbial biomass and metabolic quotient. These modifications were temporary and disappeared as early as a few months after the treatment. The PNA, as well as the nitrate and nitrite contents, were lower in the treated plots during the vegetative cycle of alfalfa and after the last harvest, and appeared to be negatively correlated with polyphenols. The results of this experiment confirmed that the spreading of olive oil waste water on cultivated soil could be an eco‐compatible practice. Despite their origin, the OW had no toxic effects on the soil microflora, and in fact, stimulated growth and reproduction of cells. Only the PNA proved to be slightly reduced, but the yield was not negatively affected