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To evaluate test-retest reliability of trunk kinematics relative to the pelvis during gait in two groups (males and females) of patients with non-specific chronic low back pain (NCLBP) using three-dimensional motion capture system.
A convenience sample of 40 NCLBP participants (20 males and 20 females) was evaluated in two sessions. Participants were asked to walk with self-selected speed and kinematics of thorax and lumbar spine were captured using a 6-infrared-cameras motion-analyzer system. Peak amplitude of displacement and its measurement errors and minimal detectable change (MDC) were then calculated.
Intraclass correlation coefficients (ICCs) were relatively constant but small for certain variables (lower lumbar peak flexion in female: inter-session ICC=0.51 and intra-session ICC=0.68; peak extension in male: inter-session ICC=0.67 and intra-session ICC=0.66). The measurement error remained constant and standard error of measurement (SEM) difference was large between males (generally ≤4.8°) and females (generally ≤5.3°). Standard deviation (SD) was higher in females. In most segments, females exhibited higher MDCs except for lower lumbar sagittal movements.
Although ICCs were sufficiently reliable and constant in both genders during gait, there was difference in SEM due to difference in SD between genders caused by different gait disturbance in chronic low back pain. Due to the increasing tendency of measurement error in other areas of men and women, attention is needed when measuring lumbar motion using the method described in this study.
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To investigate the normal data of pain-related evoked potentials (PREP) elicited with a concentric surface electrode among normal, healthy adults and the relationship between PREP and pain intensity.
Sixty healthy volunteers (22 men and 38 women; aged 36.4±10.7 years; height, 165.4±7.8 cm) were enrolled. Routine nerve conduction study (NCS) was done to measure PREP following electrical stimulation of hands (C7 dermatome) and feet (L5 dermatome). Negative peak (N), positive peak (P) latencies, peak to peak (NP) amplitudes, conduction velocity (CV), and verbal rating scale (VRS) score were obtained. Linear regression analysis tested for significant relevance between variables of PREP and VRS score.
Normal NCS results were obtained in all subjects. N latency of hand PREP was 163.8 ±40.0 ms (right) and 161.0±39.9 ms (left). N latency of foot PREP was 178.0±43.9 ms (right), 180.4±43.4 ms (left). NP amplitude of hands was 20.6±10.6 µV (right) and 21.9±11.6 µV (left). NP amplitude of feet was 18.8±8.3 µV (right) and 19.0±8.4 µV (left). The calculated CV was 13.2±4.7 m/s and VRS score was 3.8±1.0. A highly significant positive correlation was evident between VRS score and NP amplitude (y=0.1069x+1.781, r=0.877, n=60, p<0.0001).
PREP among normal, healthy adults revealed a statistically significant correlation between PREP amplitude and VRS score.
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To evaluate the clinical utility of the electrically calculated quantitative pain degree (QPD) and to correlate it with subjective assessments of pain degree including a visual analogue scale (VAS) and the McGill Pain Questionnaire (MPQ).
We recruited 25 patients with low back pain. Of them, 21 patients suffered from low back pain for more than 3 months. The QPD was calculated using the PainVision (PV, PS-2100; Nipro Co., Osaka, Japan). We applied electrodes to the medial forearm of the subjects and the electrical stimulus was amplified sequentially. Minimum perceived current (MPC) and pain equivalent current (PEC) were defined as minimum electrical stimulation that could be sensed by the subject and electrical stimulation that could trigger actual pain itself. To eliminate individual differences, we defined QPD as the following: QPD=PEC-MPC/MPC. We scored pre-treatment QPD three times at admission and post-treatment QPD once at discharge. The VAS, MPQ, and QPD were evaluated and correlations between the scales were analyzed.
Result showed significant test-retest reliability (ICC=0.967, p<0.001) and the correlation between QDP and MPQ was significant (at admission SRCC=0.619 and p=0.001; at discharge SRCC=0.628, p=0.001). However, the correlation between QPD and VAS was not significant (at admission SRCC=0.240, p=0.248; at discharge SRCC=0.289, p=0.161).
Numerical values measured with PV showed consistent results with repeated calculations. Electrically measured QPD showed an excellent correlation with MPQ but not with VAS. These results demonstrate that PV is a significantly reliable device for quantifying the intensity of low back pain.
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To determine the reliability and validity of hand-held dynamometer (HHD) depending on its fixation in measuring isometric knee extensor strength by comparing the results with an isokinetic dynamometer.
Twenty-seven healthy female volunteers participated in this study. The subjects were tested in seated and supine position using three measurement methods: isometric knee extension by isokinetic dynamometer, non-fixed HHD, and fixed HHD. During the measurement, the knee joints of subjects were fixed at a 35° angle from the extended position. The fixed HHD measurement was conducted with the HHD fixed to distal tibia with a Velcro strap; non-fixed HHD was performed with a hand-held method without Velcro fixation. All the measurements were repeated three times and among them, the maximum values of peak torque were used for the analysis.
The data from the fixed HHD method showed higher validity than the non-fixed method compared with the results of the isokinetic dynamometer. Pearson correlation coefficients (r) between fixed HHD and isokinetic dynamometer method were statistically significant (supine-right: r=0.806, p<0.05; seating-right: r=0.473, p<0.05; supine-left: r=0.524, p<0.05), whereas Pearson correlation coefficients between non-fixed dynamometer and isokinetic dynamometer methods were not statistically significant, except for the result of the supine position of the left leg (r=0.384, p<0.05). Both fixed and non-fixed HHD methods showed excellent inter-rater reliability. However, the fixed HHD method showed a higher reliability than the non-fixed HHD method by considering the intraclass correlation coefficient (fixed HHD, 0.952-0.984; non-fixed HHD, 0.940-0.963).
Fixation of HHD during measurement in the supine position increases the reliability and validity in measuring the quadriceps strength.
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Objective: To investigate the anatomy of the ulnar nerve according to the degree of elbow flexion and to obtain optimal elbow position for ulnar nerve conduction study.
Methods: Eleven elbows in nine cadavers were dissected. We estimated the 10 cm elbow segment to be the distance between 2 points, 4 cm distal and 6 cm proximal to the center of the cubital tunnel, which was determined to be the halfway point between the medial epicondyle and olecranon with elbow position in extension and 45o, 90o, 135o flexion. Anatomical measurements of the actual length of ulnar nerve, distance between medial epicondyle and ulnar nerve, and distance between medial epicondyle and olecranon were obtained in each position. The actual length of the ulnar nerve was measured between two points of the ulnar nerve closest to the landmarks of the estimated 10 cm with flexible ligature.
Results: The actual lengths of ulnar nerve were 10.23 cm, 10.00 cm, 9.44 cm, and 9.08 cm in elbow extension, and 45o, 90o, 135o flexion, respectively. The difference between actual length and estimated lengths were least in 45o elbow flexion (p=0.0001). The distance between medial epicondyle and olecranon increased with increasing elbow flexion (p=0.0001). However, there was no difference in the distance between medial epicondyle and ulnar regardless of the elbow position. As a result, the ulnar nerve seemed to have migrated anteriorly in the cubital tunnel with increasing elbow flexion.
Conclusion: This study suggest that the optimal angle in ulnar nerve conduction study would be 45o flexion, under the condition that the distance measurement is through the halfway point between the medial epicondyle and olecranon.
Objective: To investigate the relationship between the curvature of the cervical spine and various clinical parameters and to identify the validity of new curvature measurement methods.
Method: The cervical spine curvature was assessed on lateral view of plain radiographs by three measurement indices. Index 1 is the ratio of length of line drawn by C2-C7 posteroinferior points and the longest length of vertical line to the posterior curve of C2-C7. Index 2 is the angle formed by three points of index 1. Index 3 is the sum of each distance from line drawn by C2-C7 posteroinferior point to C3-C7 posterior mid-points. The difference of each group and the relationship between pain scale and three indices were statistically analyzed by t-test and Pearson's correlation test.
Results: Sixty-three percent of control group patients showed a straight or kyphotic curvature and younger women group was more likely to have a straight curvature than other age groups. The newly designed measurement methods reflect the diagnostic significance of cervical curvature type measurement. Cervical lordosis did not exactly correlate with pain scale, symptom duration and the difference of clinical diagnosis. But the patients showing interval changes of pain scale were revealed the correlative change of curvature indices with each correlation coefficient of 0.43, 0.69 and 0.55 respectively.
Conclusion: The altered cervical curvature is less valuable for the diagnostic significance and did not relate to the pain scale and duration, but cervical curvature reflect the interval change of the pain scale.
Objective: The aim of the present study was to investigate the pain intensity, quality, and pattern in experimental muscle pain.
Method: Eleven healthy adults and eleven myofascial pain syndrome (MPS) patients participated in this study. Hypertonic saline (5%) was injected into upper trapezius, infraspinatus and tibialis anterior muscles of 11 healthy adults. A continuous recording of ongoing pain intensities of the local pain and referred pain was measured. After pain had subsided, the subjects completed a Korean version of the McGill Pain Questionnaire (MPQ). This study included 11 patients who have trigger point on upper trapezius muscle. Pain pressure thresholds (PPTs) and pain intensity ratings of different pressure stimuli in upper trapezius muscles were compared with experimental group.
Results: In experimental group, local pain became maximal after one minute and referred pain after one and a half minutes. At that time, Visual analogue scale (VAS) score was 3.8 and 1.9 each other. The referred pain of upper trapezius muscle primarily radiated to the posterolateral side of neck. The one of infraspinatus muscle radiated to the shoulder joint and anterolateral side of upper arm area and the one of tibialis anterior muscle radiated to the shin and dorsum of ankle joint. The PPTs were found to be significantly lower in upper trapezius muscle of patients with myofascial pain syndrome (MPS) than in those of experimental group. The slope of VAS to different stimuli showed the linear relationship at both group, and in that of patient groups was found to be significantly steeper than in that of experimental group. The experimental muscle pain group had no difference in pain quality compared with MPS patients except affective subscale.
Conclusion: The present results suggest that intramuscular injection of hypertonic saline can be used a experimental pain model of MPS, and PPTs and pain intensity ratings of different pressure stimulus are valuable tools for quantitative description of chronic and experimental muscle pain.
Objective: The purpose of this study is to analyze the distribution of plantar pressure in six balletpositions and to compare those between the skilled and unskilled ballet dancers.
Methods: Thirty eight feet of healthy ballerina were evaluated by EMED-SF (Novel GMBH Inc. Ger.) system to analyze six positions of ballet. At each position, we estimated the static and dynamic positions. The forefoot was divided into 6 different zones on the basis of head of metatarsal bones. The degree of discipline was assessed by 3 expert ballerina.
Results: In each position, there were significant peak pressure distribution areas. In the skilled ballerina, there was less difference in peak pressure between the static and dynamic positions in comparision with the unskilled ballerina. In the skilled ballerina, more forces are distributed to M6 area in releve position and to M3 and M6 areas in turnout positions.
Conclusion: Six basic ballet positions could be analyzed by plantar pressure measurement. There were some differences in the distribution of planter pressure in some ballet positions between the skilled and unskilled ballet dancers.
임신중 요통은 비교적 증상이 경미하고, 하흉추부·요추부·천장관절부에 흔히 생기는 것으로 알려져 있다. 대부분의 경우는 그 증상이 자연소멸되지만 연구자들은 약 27%의 산모에서는 출산 6개월후에도 요통을 호소하는 것으로 보고되어 있다. 임신중 요통 발생에 관계되는 인자에 대해서는 아직 정확히 밝혀진 바는 없지만 그동안의 연구들에서는 신장과 체중, 임신전 비만정도, 임신중 체중의 증가, 태아 체중, 임신중 활동정도 및 직업 등은 유의한 위험인자가 아니라는 점에 대해서는 대체적으로 동의하고 있으며, 산모의 연령, 다산 및 요통의 과거력 등에 대해서는 아직 의견의 일치를 보지 못하고 있다. 또한 그 원인에 대해서는 여러 가지 의견들이 있지만 대체적으로, 신체역동학적 으로 나타나는 요추부의 과도한 하중 및 혈중 릴랙신이 증가하여 생기는 천장관절의 기능 부전이 주 요인으로 알려져 있다. 따라서 연자들은 한국인에서 임신중 요통의 분포 및 양상이 외국의 보고와 어떻게 다른 지, 통증의 양상의 표현은 어떤지, 임산부의 체형이 요통의 발생과 관련이 있는 지, 요추 후만의 증가가 요통의 발병에 중요한 역할을 하는 지를 알아보고자 1997년 3월부터 9월까지 산전관리를 위하여 성모병원 산부인과를 방문한 202명의 산모를 대상으로 본 연구를 시행하여 다음과 같은 결과를 얻었다.
한국인 산모에서 임신기간에 관계없이 요통의 유병률, 통증이 나타나는 시기 및 통증 부위는 다른 나라 여성들과 유사한 양상을 보였다. 산모의 연령, 출산 횟수, 신장 및 체중 등은 산모의 요통 발생에 큰 영향을 미치지 않는 것으로 보이며, 반면에 요통의 과거력은 산모의 요통을 예측하는 데 도움을 줄 것이라고 판단된다. 또한 요추 후만의 정도는 산모의 요통과 밀접한 관계가 있음을 알 수 있었다.
The purpose of this study was to measure the foot pressure distribution of normal children. Static and dynamic pressure, dynamic pressure-time integral, relative impulse, static pressure distribution between forefoot and heel, and the percentage of contact time in each phase of the gait cycle were measured from 68 normal children by the in-sole pressure measurement system. The measurements were perfomed while standing and walking with their comfortable speed using the in-sole pressure measurement system.
The sites of the greatest static pressure, dynamic pressure-time integral and relative impulse were obtained from the 2nd and the 3rd metatarsal head areas. And the dynamic pressure was obtained from in the lateral heel area. The forefoot to heel load ratio was about 6 to 4 in the static state. The contact time was greatest during the push-off phase., In-sole pressure measurement system, Static pressure, Dynamic pressure,
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