Studying upper-limb kinematics using inertial sensors

AIM: The aim of this study was to analyze scapulohumeral rhythm through nine physical properties that correspond to angular mobility, angular velocity, and acceleration in the three axes of space, obtained by inertial sensors. METHODS: This cross-sectional study recruited healthy young adult subjects. Descriptive and anthropometric independent variables related to age, gender, weight, size, and BMI were included. Nine physical properties were included corresponding to three dependent variables for each of three special axes: mobility angle (degrees), angular speed (degrees/second), and lineal acceleration (meters/seconds2), which were obtained thought the inertial measurement sensors with four inertial sensors (InertiaCube3™ Intersense Inc., Billerica, Massachusetts). Inertial sensors were placed in the right half of the body of each subject located in the middle third of the humerus slightly posterior, in the middle third of the upper spine of the scapula, in the flat part of the sternum, and the distal surface of the ulna and radius. RESULTS: Descriptive graphics of analytical tasks performed were obtained (figure 1). The main difference in mobility between the scapula and humerus was found in pitch axis for abduction ( = 107.6°, SD = 9.3°) and flexion ( = 113.1°, SD = 9.3°). CONCLUSION: This study shows how much each body segment contributes to upper-limb motion, and allows us to obtain grades of mobility provided by the scapula. Also, this study identified movement patterns, and supports inertial sensors as a useful device to analyze upper-limb kinematics. However, further studies with subjects with shoulder pathology should be carried out.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Studying upper-limb kinematic using inertial sensors embedded in smartphones

Background: In recent years, there have been investigations concerning upper-limbs kinematics by various devices. The latest generation of smartphones often includes inertial sensors with subunits which can detect inertial kinematics. The use of smartphones is presented as a convenient and portable analysis method for studying kinematics in terms of angular mobility and linear acceleration Objective: The aim of this study was to study humerus kinematics through six physical properties that correspond to angular mobility and acceleration in the three axes of space, obtained by a smartphone. Methods: This cross-sectional study recruited healthy young adult subjects. Descriptive and anthropometric independent variables related to age, gender, weight, size, and BMI were included. Six physical properties were included corresponding to two dependent variables for each of three special axes: mobility angle (degrees) and lineal acceleration (meters/seconds2), which were obtained thought the inertial measurement sensor embedded in the iPhone4 smartphone equipped with three two elements for the detection of kinematic variables: a gyroscope and an accelerometer. Apple uses an LIS302DL accelerometer in the iPhone4. The application used to obtain kinematic data was xSensor Pro, Crossbow Technology, Inc., available at the Apple AppStore. The iPhone4 has storage capacity of 20MB. The data-sampling rate was set to 32 Hz, and the data for each analytical task was transmitted as email for analysis and postprocessing The iPhone4 was placed in the right half of the body of each subject located in the middle third of the humerus slightly posterior snugly secured by a neoprene fixation belt. Tasks were explained concisely and clearly. The beginning and the end were decided by a verbal order by the researcher. Participants were placed standing, starting from neutral position, performing the following analytical tasks: 180º right shoulder abduction (eight repetitions) and, after a break of about 3 minutes, 180º right shoulder flexion (eight repetitions). Both tasks were performed with the elbow extended, wrist in neutral position and the palmar area of the hand toward the midline at the beginning and end of the movement. Results: A total of 11 subjects (8 men, 3 woman) were measured, whose mean of age was 24.7 years (SD = 4.22 years) and their average BMI was 22.64 Kg/m2 (SD = 2.29 Kg/m2). The mean of angular mobility collected by the smartphone was bigger in pitch axis for flexion (= 157.28°, SD= 12.35°) and abduction (= 151.71°, SD= 9.70°). With regard to acceleration, the highest peak mean value was shown in the Y motion axis during flexion (= 19.5°/s2, SD = 0.8°/s2) and abduction (= 19.4°/s2, SD = 0.8°/s2). Also, descriptive graphics of analytical tasks performed were obtained. Conclusions: This study shows how humerus contributes to upper-limb motion and it identified movement patterns. Therefore, it supports smartphone as a useful device to analyze upper-limb kinematics. Thanks to this study it´s possible to develop a simple application that facilitates the evaluation of the patient.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Differences in Tridimensional Shoulder Kinematics between Asymptomatic Subjects and Subjects Suffering from Rotator Cuff Tears by Means of Inertial Sensors: A Cross-Sectional Study

Background: The aim of this study was to analyze differences in three-dimensional shoulder kinematics between asymptomatic subjects and patients who were diagnosed with rotator cuff tears. Methods: This cross-sectional study recruited 13 symptomatic subjects and 14 asymptomatic subjects. Data were obtained from three inertial sensors placed on the humerus, scapula and sternum. Kinematic data from the glenohumeral, scapulothoracic and thoracohumeral joints were also calculated. The participants performed shoulder abductions and flexions. The principal angles of movements and resultant vectors in each axis were studied. Results: The glenohumeral joint showed differences in abduction (p = 0.001) and flexion (p = 0.000), while differences in the scapulothoracic joint were only significant during flexion (p = 0.001). The asymptomatic group showed higher velocity values in all sensors for both movements, with the differences being significant (p < 0.007). Acceleration differences were found in the scapula during abduction (p = 0.001) and flexion (p = 0.014), as well as in the sternum only during shoulder abduction (p = 0.022). Conclusion: The results showed kinematic differences between the patients and asymptomatic subjects in terms of the mobility, velocity and acceleration variables, with lower values for the patients.This research was partially funded by Chartered of Physiotherapy of Andalusia (Spain) grant number 5369/16P/SG. Partial funding for open access charge: Universidad de Málag

Ultrasonography Assessment Based on Muscle Thickness and Echo Intensity in Post-Polio Patients

There is no specific designed diagnostic test for post-poliomyelitis syndrome. The most important symptoms of this syndrome are new loss of muscle strength and more fatigue. Previous studies have investigated muscle ultrasound parameters to distinguish neuromuscular disease patients from healthy controls. The aim of this study was to investigate if muscle thickness and echo intensity measured by ultrasound can discriminate post-poliomyelitis syndrome patients from healthy controls. A total of 29 post-polio patients and 27 healthy controls participated in this cross-sectional study. Anthropometric measures, muscle thickness, echo intensity using B-mode ultrasound in rectus femoris and biceps brachii muscles, and muscle strength test data were collected. Muscle thickness in rectus femoris was significantly lower in post-poliomyelitis patients than in healthy controls, but not in biceps brachii. Echo intensity in rectus femoris and biceps brachii was higher in post-poliomyelitis syndrome patients than in healthy controls. Correlations were found between muscle thickness and strength in the upper and lower limbs. The results of the present study showed that muscle thickness in rectus femoris and echo intensity in rectus femoris and biceps brachii can discriminate post-poliomyelitis syndrome patients from healthy controls. A better assessment is possible because it can observe differences and relevant parameters in this clinical populationThe study has been co-funded under the OTRI research contract nº 806/87.5076 between the Universidad de Málaga and the Asociación Malagueña de Afectados Polio y Postpolio (AMAPyP). Partial funding for open access charge: Universidad de Málag

Improving adherence physical activity, quality of life and social support for activities in people with intellectual disabilities, through multimodal intervention (education + activity)

Background People with intellectual disabilities (ID) have a poor level of physical activity as they experience many barriers towards doing it (Bodde & Seo, 2009). Physical activity provides many benefits so there are studies to improve adherence to physical activity (Stanish & Frey, 2008). In our study we carried out a multimodal intervention (educational advice + physical activity) to improve adherence to physical activity in people with ID. Method. The sample consisted of 40 people with ID. They all received a multimodal intervention in ASPROMANIS INDUSTRIAL (Malaga, Spain), 2 hours per week for 8 weeks. The outcome measures were: IPAQ (International Physical Activity Questionnaire, WhoQoL Scale to find out about quality of life and SE/SS-AID to know self-efficacy and social support for activity. We measured fitness condition (strength, flexibility, balance and aerobic condition) through a physical fitness test (Functional reach test, single-leg stance with eyes open, single-leg stance with eyes closed, passive knee extension, calf muscle flexibility, anterior hip flexibility, functional shoulder rotation, time-stands test, partial sit-up test, handgrip test, two-minute step test). Results and discussion The results show that with the multimodal intervention, we did not find significant changes in physical activity by measuring with IPAQ (Mets/total) in people with ID. However, we detected an increasing trend [F=0.04(0,84). On the other hand we found significant changes in quality of life [F=4.18(0,04)], professional support[F=40,31(0)] and support for friends [10,09(0)]. Finally, in those with the fitness condition, we found an increasing trend towards flexibility, strength, balance and aerobic condition, and a significant increase in abdominal muscle strength [4.22(0,04)]. Conclussion The conclusion of our study is that a multimodal intervention over 8 weeks in people with ID can improve their quality of life and provide social support for activity, but without significant improvement in physical condition and physical activity. Randomized clinical trials and a higher sample will be needed to confirm this tendency towards improvement.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Correlation between self-efficacy and social support for activity scale and fitness condition

Background: Several factors influence the levels of fitness in people with intellectual disabilities (King et al., 2003) including self-efficacy and social support (Jamieson, Parker, Roberts-Thomson, Lawrence, & Broughton, 2014). The objective of our study is to examine the relationship between fitness and self-efficacy and social support for activity in people with intellectual disabilities. Our hypothesis is that self-efficacy and social support will have a mild relationship to fitness. Methods: An observational cross-sectional study was conducted. We used the self efficacy and social support for activity scale for people with intellectual disabilities (SE/SS-AID). To measure the correlations we used physical fitness tests (Functional reach test, Single-leg stance with eyes open-, Single-leg stance with eyes closed, passive knee extension, calf muscle flexibility, anterior hip flexibility, functional shoulder rotation, Time-stands test, Partial sit-up test, Handgrip test, two-minute step test). The physical fitness tests was separated into four categories to provide greater specificity (strength, balance, flexibility and aerobic condition). Data from the SE/SS-AID and physical fitness tests were measured in 131 adults with ID. Results and discussion. We found important correlations between the physical fitness tests and the SE/SS-AID (Calf Muscle Flexibility = 0.26 Anterior Hip Flexibility = 0.23 Abdominal Strength= 0, 21). To our knowledge, this is the first study to examine the correlations between fitness, self-efficacy and social support for activities. Other studies have measured fitness condition and social support and self efficacy for activity with regard to the SE/SS-AID scale for people with intellectual disabilities (Skowronski, Horvat, Nocera, Roswal, & Croce, 2009) but we can not know the correlations between these Conclusion: The main conclusion of our studywas that we found a low correlation between some physical fitness tests and the Self Efficacy and Social Support scales for activities. References Jamieson, L. M., Parker, E. J., Roberts-Thomson, K. F., Lawrence, H. P., & Broughton, J. (2014). Self-efficacy and self-rated oral health among pregnant aboriginal Australian women. BMC Oral Health, 14(1), 29. doi:10.1186/1472-6831-14-29 King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M. K., & Young, N. L. (2003). A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Physical & Occupational Therapy in Pediatrics, 23(1), 63-90. Skowronski, W., Horvat, M., Nocera, J., Roswal, G., & Croce, R. (2009). Eurofit special: European fitness battery score variation among individuals with intellectual disabilities. Adapted Physical Activity Quarterly: APAQ, 26(1), 54-67.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Effect of obesity in Independence and balance in people with intelectual disability

Background People with obesity often have problems with postural control. Some studies show that people with intellectual disabilities (ID) have a higher likelihood of having falls than the general population, with a prevalence in adults of between 29% and 70% (Cox et al., 2010). Currently, there are no studies that show the effects of obesity on independence and balance in people with ID. The objective of our study is analyse, in people with ID, the degree of influence that obesity has on independence with regard to activities of daily living, static and semi-static balance. Therefore, we can compare two groups: obese people and non-obese people. Our hypothesis is that obesity will exercise a negative influence on static and semi-static balance as well as on independence and the development of the activities of daily living. Method In a cross-sectional study, we compared static and semi-static balance in two groups of people with ID: the obese and the non-obese. All those in the sample had a low ID (IQ: 70-50) to mild ID (IQ 50-35). To measure balance we used a single leg balance test (SLBT) with opened eyes and closed eyes, and a functional reach test (FRT). In order to measure levels of dependence we used a Barthel index. The outcome variables were: time in balance in SLBT open eyes/closed eyes), maximum range of FRT and Barthel index. Results and Discussion We found significant differences in all outcome variables between two groups. To our knowledge, this is the first study to analyze how obesity affects independence, static balance and semi-static balance in people with ID. However, other studies have analyzed the effects of obesity on the general population (Singh et al., 2009). In both studies (General population: Singh et al. 2009 and people with ID in this study) we observed that obesity can be a determinant of negatively static balance and semi-static balance. Conclussion The main conclusion of this study is that obesity has a negative effect on independence, static balance and semi-static balance in people with ID. These results would have been carried out when we carry out an intervention on people with ID to prevent falls. References - Cox CR, Clemson L, Stancliffe RJ, Durvasula S, Sherrington C. Incidence of and risk factors for falls among adults with an intellectual disability. J Intellect Disabil Res. 2010 Dec;54(12):1045-57. doi: 10.1111/j.1365-2788.2010.01333.x. - Enkelaar L, Smulders E, van Schrojenstein Lantman-de Valk H, Weerdesteyn V, Geurts AC. Clinical measures are feasible and sensitive to assess balance and gait capacities in older persons with mild to moderate Intellectual Disabilities. Res Dev Disabil. 2013 Jan;34(1):276-85. doi: 10.1016/j.ridd.2012.08.014. - Singh D, Park W, Levy MS, Jung ES. The effects of obesity and standing time on postural sway during prolonged quiet standing. Ergonomics. 2009 Aug;52(8):977-86.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Effect of Supervised over Self-Performed Eccentric Exercise on Lateral Elbow Tendinopathy: A Pilot Study

Background: The efficacy of eccentric exercise self-performed by the patient has not been proved in the treatment of lateral elbow tendinopathy (LET). The aim of this study was to compare the effects of a programme of eccentric exercises applied by a physiotherapist to patients with LET through a structured manual programme compared to its self-performance, guided by an illustrated brochure. Method: A single-blind, pilot, randomised, controlled trial was conducted. Twenty patients were randomised. The intervention group carried out eccentric exercises applied directly by a physiotherapist (10 sessions). The control group carried out eccentric exercises that were self-performed by the patient (10 sessions). Both groups received simulated ultrasounds. Pain (visual analogue scale (VAS)), function (DASH questionnaire) and satisfaction (with a Likert scale) were measured at the beginning of the intervention, immediately after the intervention and 3 months after the intervention. Results: The mean age was 53.17 and 54.25 years old. The experimental group presented a greater tendency to improve function (DASH −15.91) and reduce pain (VAS −2.88) compared to the control group, although these differences were not significant (p > 0.05). Conclusion: Eccentric exercise, both performed by the physiotherapist and self-performed by the patient, improved function and pain in the patients with LET.Partial funding for open access charge: Universidad de Málag

Kinematic Parameters That Can Discriminate in Levels of Functionality in the Six-Minute Walk Test in Patients with Heart Failure with a Preserved Ejection Fraction

It is a challenge to manage and assess heart failure with preserved left ventricular ejection fraction (HFpEF) patients. Six-Minute Walk Test (6MWT) is used in this clinical population as a functional test. The objective of the study was to assess gait and kinematic parameters in HFpEF patients during the 6MWT with an inertial sensor and to discriminate patients according to their performance in the 6MWT: (1) walk more or less than 300 m, (2) finish or stop the test, (3) women or men and (4) fallen or did not fall in the last year. A cross-sectional study was performed in patients with HFpEF older than 70 years. 6MWT was carried out in a closed corridor larger than 30 m. Two Shimmer3 inertial sensors were used in the chest and lumbar region. Pure kinematic parameters analysed were angular velocity and linear acceleration in the three axes. Using these data, an algorithm calculated gait kinematic parameters: total distance, lap time, gait speed and step and stride variables. Two analyses were done according to the performance. Student’s t-test measured differences between groups and receiver operating characteristic assessed discriminant ability. Seventy patients performed the 6MWT. Step time, step symmetry, stride time and stride symmetry in both analyses showed high AUC values (>0.75). More significant differences in velocity and acceleration in the maximum Y axis or vertical movements. Three pure kinematic parameters obtained good discriminant capacity (AUC > 0.75). The new methodology proved differences in gait and pure kinematic parameters that can distinguish two groups according to the performance in the 6MWT and they had discriminant capacity.This work was supported by the Spanish Foundation of Internal Medicine, through the call “Prof. Dr. Miguel Vilardell 2019 research project”, grant number: FEMI-PB-PI-MV-2019. Partial funding for open access charge: Universidad de Málaga

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: A nationwide study in Spain

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. Participants This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. Interventions An exploratory factorial analysis was performed to select the most relevant variables of the sample. Primary and secondary outcome measures Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. Results Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10 5 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade =3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10 5 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. Conclusions Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10 5 people/week) was a statistically independent predictor of mortality. Trial registration number CEIM 20/217