Untersuchungen zu manualmedizinischen Befunden des Krankheitsbildes "Low Back Pain"

Spezifische Tests bilden eine Grundlage der manualmedizinischen Diagnostik und der daraus resultierenden Therapie. Diese Tests werden vor allem hinsichtlich der formellen Testgüte unterschiedlich bewertet. Die Vielfalt von Tests, mangelnde Standardisierung und die unterschiedlichen Anwendungspräferenzen der manualmedizinischen Schulen erschweren eine qualifizierte Aussage zur diagnostischen Wertigkeit der Tests. Insgesamt sind über 36 Tests in Deutschland gebräuchlich und bekannt. Hierbei bleiben die schulinternen Weiterentwicklungen und die Abwandlungen durch einzelne Lehrgruppen ungezählt und spielen für diese Studie keine Rolle. Ohne Daten zur testtheoretischen Nachvollziehbarkeit von diagnostischen Schlüsselmethoden sind keine Aussagen zum therapeutischen Ergebnis der manualmedizinischen Therapie und deren Erfolgskriterien für eventuelle Interventionsstudien möglich. So erscheint die Bestimmung der Testgütekriterien Validität, Reliabilität und Objektivität der verbreiteten manualmedizinischen Tests als Schlüsselproblem dieses Gebietes. Zu diesem Zweck werden die Testgütekriterien der gebräuchlichen manualmedizinischen Untersuchungen bei unterem Kreuzschmerz oder besser „low back pain“ geprüft. Dieses Krankheitsbild ist sowohl in seiner zeitlichen Ausdehnung wie auch in der Intensitätsausprägung als sehr heterogen gekennzeichnet. Es wurde durch strenge Ein- und Ausschlusskriterien eine Studienpopulation gefunden, die repräsentativ hierfür ist

A Pilot Study on the Association of Mitochondrial Oxygen Metabolism and Gas Exchange During Cardiopulmonary Exercise Testing: Is There a Mitochondrial Threshold?

Background: Mitochondria are the key players in aerobic energy generation via oxidative phosphorylation. Consequently, mitochondrial function has implications on physical performance in health and disease ranging from high performance sports to critical illness. The protoporphyrin IX-triplet state lifetime technique (PpIX-TSLT) allows in vivo measurements of mitochondrial oxygen tension (mitoPO 2 ). Hitherto, few data exist on the relation of mitochondrial oxygen metabolism and ergospirometry-derived variables during physical performance. This study investigates the association of mitochondrial oxygen metabolism with gas exchange and blood gas analysis variables assessed during cardiopulmonary exercise testing (CPET) in aerobic and anaerobic metabolic phases. Methods: Seventeen volunteers underwent an exhaustive CPET (graded multistage protocol, 50 W/5 min increase), of which 14 were included in the analysis. At baseline and for every load level PpIX-TSLT-derived mitoPO 2 measurements were performed every 10 s with 1 intermediate dynamic measurement to obtain mitochondrial oxygen consumption and delivery (mito V . O 2 , mito D . O 2 ). In addition, variables of gas exchange and capillary blood gas analyses were obtained to determine ventilatory and lactate thresholds (VT, LT). Metabolic phases were defined in relation to VT1 and VT2 (aerobic

Trainer in a pocket - proof-of-concept of mobile, real-time, foot kinematics feedback for gait pattern normalization in individuals after stroke, incomplete spinal cord injury and elderly patients

Background: Walking disabilities negatively affect inclusion in society and quality of life and increase the risk for secondary complications. It has been shown that external feedback applied by therapists and/or robotic training devices enables individuals with gait abnormalities to consciously normalize their gait pattern. However, little is known about the effects of a technically-assisted over ground feedback therapy. The aim of this study was to assess whether automatic real-time feedback provided by a shoe-mounted inertial-sensor-based gait therapy system is feasible in individuals with gait impairments after incomplete spinal cord injury (iSCI), stroke and in the elderly. Methods: In a non-controlled proof-of-concept study, feedback by tablet computer-generated verbalized instructions was given to individuals with iSCI, stroke and old age for normalization of an individually selected gait parameter (stride length, stance or swing duration, or foot-to-ground angle). The training phase consisted of 3 consecutive visits. Four weeks post training a follow-up visit was performed. Visits started with an initial gait analysis (iGA) without feedback, followed by 5 feedback training sessions of 2–3 min and a gait analysis at the end. A universal evaluation and FB scheme based on equidistant levels of deviations from the mean normal value (1 level = 1 standard deviation (SD) of the physiological reference for the feedback parameter) was used for assessment of gait quality as well as for automated adaptation of training difficulty. Overall changes in level over iGAs were detected using a Friedman’s Test. Post-hoc testing was achieved with paired Wilcoxon Tests. The users’ satisfaction was assessed by a customized questionnaire. Results: Fifteen individuals with iSCI, 11 after stroke and 15 elderly completed the training. The average level at iGA significantly decreased over the visits in all groups (Friedman’s test, p < 0.0001), with the biggest decrease between the first and second training visit (4.78 ± 2.84 to 3.02 ± 2.43, p < 0.0001, paired Wilcoxon test). Overall, users rated the system’s usability and its therapeutic effect as positive. Conclusions: Mobile, real-time, verbalized feedback is feasible and results in a normalization of the feedback gait parameter. The results form a first basis for using real-time feedback in task-specific motor rehabilitation programs. Trial registration: DRKS00011853 , retrospectively registered on 2017/03/23

Feasibility of visual instrumented movement feedback therapy in individuals with motor incomplete spinal cord injury walking on a treadmill

Background: Incomplete spinal cord injury (iSCI) leads to motor and sensory deficits. Even in ambulatory persons with good motor function an impaired proprioception may result in an insecure gait. Limited internal afferent feedback (FB) can be compensated by provision of external FB by therapists or technical systems. Progress in computational power of motion analysis systems allows for implementation of instrumented real-time FB. The aim of this study was to test if individuals with iSCI can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy. Methods: Individuals with chronic iSCI had to complete 6 days (one day per week) of treadmill-based FB training with a 2 weeks pause after 3 days of training. Each day consists of an initial gait analysis followed by 2 blocks with FB/no-FB. During FB the deviation of the mean knee angle during swing from a speed matched reference (norm distance, ND) is visualized as a number. The task consists of lowering the ND, which was updated after every stride. Prior to the tests in patients the in-house developed FB implementation was tested in healthy subjects with an artificial movement task. Results: 4 of 5 study participants benefited from FB in the short and medium term. Decrease of mean ND was highest during the first 3 sessions (from 3.93±1.54 to 2.18±1.04). After the pause mean ND stayed in the same range than before. In the last 3 sessions the mean ND decreased slower (2.40±1.18 to 2.20±0.90). Direct influences of FB ranged from 60% to 15% of reduction in mean ND compared to initial gait analysis and from 20% to 1% compared to no-FB sessions. Conclusions: Instrumented kinematic real-time FB may serve as an effective adjunct to established gait therapies in normalizing the gait pattern after incomplete spinal cord injury. Further studies with larger patient groups need to prove long term learning and the successful transfer of newly acquired skills to activities of daily living

How the Direction of Screws Affects the Primary Stability of a Posterior Malleolus Osteosynthesis under Torsional Loading: A Biomechanical Study

Insufficient fixation of a posterior malleolus fracture (PM) can lead to posttraumatic complications such as osteoarthritis and chronic pain. The purpose of this biomechanical study was to test the hypothesis of whether the direction of PM screw fixation has an impact on the primary stability of osteosynthesis of a PM under torsional loading. PM fractures of 7 pairs human cadaveric lower leg specimens were stabilized with posterior to anterior (p.a.) or anterior to posterior (a.p.) screw fixation. Stability of the osteosynthesis was biomechanically tested using cyclic external torsional loading levels, in 2 Nm steps from 2 Nm up to 12 Nm, under constant monitoring with 3D ultrasonic marker (Zebris). The primary stability does not differ between both stabilizations ( p = 0.378) with a medium effect size (η 2 p = 0.065). The movement of the PM tends to be marginally greater for the osteosynthesis with a.p. screws than with p.a. screws. Whether a.p. screws or the alternative p.a. screw fixation is performed does not seem to have an influence on the primary stability of the osteosynthesis of the PM fixation under torsional loading. Although osteosynthesis from posterior seems to be more stable, the biomechanical results in the torsional test show quite equivalent stabilities. If there is no significant dislocation of the PM, a.p. screw fixation could be a minimally invasive but stable surgical strategy

Metabolomic Profiling in Patients with Heart Failure and Exercise Intolerance: Kynurenine as a Potential Biomarker

Aims: Metabolic and structural perturbations in skeletal muscle have been found in patients with heart failure (HF) both with preserved (HFpEF) and reduced (HFrEF) ejection fraction in association with reduced muscle endurance (RME). We aimed in the current study to create phenotypes for patients with RME and HFpEF compared to RME HFrEF according to their metabolomic profiles and to test the potential of Kynurenine (Kyn) as a marker for RME. Methods: Altogether, 18 HFrEF, 17 HFpEF, and 20 healthy controls (HC) were prospectively included in the current study. The following tests were performed on all participants: isokinetic muscle function tests, echocardiography, spiroergometry, and varied blood tests. Liquid chromatography tandem mass spectrometry was used to quantify metabolites in serum. Results: Except for aromatic and branched amino acids (AA), patients with HF showed reduced AAs compared to HC. Further perturbations were elevated concentrations of Kyn and acylcarnitines (ACs) in HFpEF and HFrEF patients ( p < 0.05). While patients with HFpEF and RME presented with reduced concentrations of ACs (long- and medium-chains), those with HFrEF and RME had distorted AAs metabolism ( p < 0.05). With an area under the curve (AUC) of 0.83, Kyn shows potential as a marker in HF and RME (specificity 70%, sensitivity 83%). In a multiple regression model consisting of short-chain-ACs, spermine, ornithine, glutamate, and Kyn, the latest was an independent predictor for RME (95% CI: −13.01, −3.30, B: −8.2 per 1 µM increase, p = 0.001). Conclusions: RME in patients with HFpEF vs. HFrEF proved to have different metabolomic profiles suggesting varied pathophysiology. Kyn might be a promising biomarker for patients with HF and RME

Physiotherapy for Cervical Dystonia: A Systematic Review of Randomised Controlled Trials

Physiotherapy is mentioned as an adjunctive treatment to improve the symptoms of cervical dystonia in terms of pain, function and quality of life. However, botulinum neurotoxin injection remains the treatment of choice. This systematic review emphasizes physical therapy and evaluates it by including six studies. The methodology is based on a previous systematic review on this topic to provide better comparability and actuality. For this purpose, two databases were searched using the previously published keywords. This time, only randomised controlled trials were evaluated to increase the power. In conclusion, additional physical therapy and active home exercise programs appear to be useful. Further research should focus on the dose–response principle to emphasize physical therapy treatment modalities

Digital-aktiv-assistiertes Therapiekonzept in der gerätegestützten FED-Methode für eine aktive Haltungskorrektur bei Patienten mit idiopathischer Skoliose: Vortrag gehalten auf der Konferenz bionection, Smart Medical Devices and Therapies,, 24. und 25. Oktober 2018, Dresden

Die vorliegende Arbeit wurde mit dem Ziel durchgeführt, die FED-Therapie (Fixation – Elongation – Derotation) durch Gestaltung der Interaktion und des Interfaces zu verbessern. Die folgende Hypothese stand dabei im Vordergrund: „Durch die Implementierung eines digitalen Assistenzsystems in das bisherige Therapiesystem, ist es möglich die aktive Beteiligung der Patienten im FED-Gerät zu erhöhen. Dadurch kann beispielsweise eine Autokorrektur der Körperhaltung in die Therapie integriert werden, welche die Regredienz der idiopathischen Skoliose positiv beeinflusst. “Grundlage der Arbeit ist eine nutzerabhängige Anwenderbefragung von Patienten und Therapeuten, die mit der FED-Therapie arbeiten. Es ließ sich ein deutlicher Entwicklungsbedarf der Mensch-Geräte-Schnittstelle und des Therapieverlaufes feststellen. Das Smart Device besteht sowohl aus einem Ultraschall-Sensor, der die Körperbewegungen der Patienten im FED-Gerät erfasst, als auch einem Benutzerinterface. Kern der Applikation ist die ergonomische Nutzerführung durch die Therapie und eine Integration von leicht nachvollziehbaren Therapieanweisungen. Gleichzeitig sorgt die Applikation für mehr Transparenz und ermöglicht den Patienten erstmals einen Ein- sowie Überblick des Therapiefortschrittes. Durch eine automatische Dokumentation der aufgenommenen Daten und ein verbessertes Patienten-Monitoring erfolgt eine Entlastung der Therapeuten. Dem Patienten soll es erleichtert werden, sich mittels der Gamification-Methode auf ein aktiveres und komplexeres Therapiekonzept einzulassen. In die Applikation ist daher ein Bewegungsspiel integriert. Der Patient kann durch die Erfassung seiner Bewegungen im FED-Gerät das Spiel mit der eigenen Körperhaltung steuern. Als Parameter dient dabei der Input durch die Ultraschall-Sensoren. Unterschiedliche Schwierigkeitsgrade sowie ein Punkte- und Belohnungssystem sind beispielsweise verwendete grundlegende Spielmechanismen. Sie führen zu einer erhöhten Patienten-Motivation, einem aktiveren Mitwirken in der Therapie und einer aktiveren Haltungskorrektur

Fear of Falling Does Not Influence Dual-Task Gait Costs in People with Parkinson&rsquo;s Disease: A Cross-Sectional Study

Cognitive deficits and fear of falling (FOF) can both influence gait patterns in Parkinson&rsquo;s disease (PD). While cognitive deficits contribute to gait changes under dual-task (DT) conditions, it is unclear if FOF also influences changes to gait while performing a cognitive task. Here, we aimed to explore the association between FOF and DT costs in PD, we additionally describe associations between FOF, cognition, and gait parameters under single-task and DT. In 40 PD patients, motor symptoms (MDS-revised version of the Unified Parkinson&rsquo;s Disease Rating Scale, Hoehn and Yahr), FOF (Falls Efficacy Scale International), and Montreal Cognitive Assessment (MoCA) were assessed. Spatiotemporal gait parameters were recorded with a validated mobile gait analysis system with inertial measurement units at each foot while patients walked in a 50 m hallway at their preferred speed under single-task and DT conditions. Under single-task conditions, stride length (&beta; = 0.798) and spatial variability (&beta; = 0.202) were associated with FOF (adjusted R2 = 0.19, p &lt; 0.001) while the MoCA was only weakly associated with temporal variability (adjusted R2 = 0.05, p &lt; 0.001). Under DT conditions, speed, stride length, and cadence decreased, while spatial variability, temporal variability, and stride duration increased with the largest effect size for speed. DT costs of stride length (&beta; = 0.42) and age (&beta; = 0.58) explained 18% of the MoCA variance. However, FOF was not associated with the DT costs of gait parameters. Gait difficulties in PD may exacerbate when cognitive tasks are added during walking. However, FOF does not appear to have a relevant effect on dual-task costs of gait