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The effect of the abdominal drawing-in manoeuvre during forward steps
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
viewpoint has been reached with regard to the influence of external loads on scapular movement. Purpose: The objective of this study was to continuously and closely analyze scapular upward rotation and identify the changing “point” (Knot) of the scapular rotatory movement during arm elevation. In addition, the influence of an external load on the Knot was investigated. Methods: The subjects were 35 healthy males (35 shoulders on the dominant-hand side) (mean age: 20.7 ± 1.7 years, mean height: 172 ± 6.4 cm, mean body weight: 65.7 ± 5.8 kg). An external load was applied to the upper limb in a sitting position: The dominant-side upper limb was lifted in the scapular plane with no load or a load using a 1–5-kg dumbbell. The movements of the trunk, scapula, and humerus were measured using a magnetic sensor-based 3-dimensional motion analysis system and analysis software. The measured values were plotted to present the scapular upward rotation as a line graph, and Knot of the movement was determined. Regarding the influence of the external load level on scapular upward rotation, knot was compared between movements under non-loaded (0 kg) and loaded (1–5 kg) conditions using the t-test and Bonferroni’s multiple comparison. A significance level lower than 5% was regarded as significant. Results: Knot position (elevation angle ± SE) under each loading condition was: 0 kg, 83.5 ± 2.9; 1 kg, 81.2 ± 2.9; 2 kg, 81.0 ± 2.9; 3 kg, 76.1 ± 2.9; 4 kg, 73.4 ± 3.1; and 5 kg, 75.8 ± 3.1. On comparison with the non-loaded condition (0 kg), no significant difference was noted under the conditions with 1- and 2-kg loads (p = 0.33 and 0.29, respectively), and Knot angle was constant. In contrast, with 3-, 4-, and 5-kg loads, a significant difference was noted in Knot angle from that under the non-loaded condition (p = 0.002, 0.0002, and 0.004, respectively), showing that a load of 3 kg or greater significantly lowered Knot position. Conclusion(s): It was clarified that a Knot, i.e., changing point, is present in scapular upward rotation. Knot changed due to the influence of the external load level: the arm elevation position shifted downward when the load was 3 kg or greater. Implications: Based on these findings, when a 3-kg or greater force is loaded on the shoulder joint during arm elevation, the scapular movement changes earlier and the importance of the scapular function as a fulcrum of the arm elevation force increases. Keywords: Scapular kinematics; Scapular upward rotation; External load Funding acknowledgements: This study was unfunded. Ethics approval: The Institutional Review Board of Kurume University approved the study protocol (#09078) in the study. http://dx.doi.org/10.1016/j.physio.2015.03.1768
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Research Report Poster Presentation Number: RR-PO-04-17-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 THE EFFECT OF THE ABDOMINAL DRAWING-IN MANOEUVRE DURING FORWARD STEPS S. Madokoro, H. Miaki, T. Yamazaki Kanazawa University, Health Sciences, Kanazawa, Japan Background: A decrease in hip extension has been reported to be a factor in short step width and slow walking speed in older men. Hip motion is related to pelvic and spinal motion, and transversus abdominis (TrA) activation is important for stabilising the pelvis and spine. The abdominal drawing-in manoeuvre (ADIM) can be performed to activate the TrA. Hip extension during ADIM in the prone position improves the relative timing of gluteus maximus activation in relation to the biceps femoris, and decreases anterior pelvic tilt. However, few studies have reported on hip extension during ADIM in the standing position or during walking. In healthy elderly subjects, the reduction in peak hip extension and increased anterior pelvic tilt might be related to trunk stabilisation with TrA activation. Thus, walking with ADIM might increase step width. Purpose: The purpose of this study was to examine the influence of the ADIM on forward steps as a gait exercise. The hypothesis of the present study was that ADIM during forward steps would increase hip extension and reduce pelvic rotation. Methods: The subjects were 20 healthy men (mean age, 20.8 ± 2.4 years). Measurements were performed in the following postures: in neutral standing, in the forward step posture, and in the forward step posture with ADIM. Thicknesses of the lateral abdominal muscles were measured using ultrasound (Mylab 25, Esaote, Indianapolis, IN) at B mode, and kinematics of the hip and pelvis were examined using a three-dimensional motion capture system (Vicon Motion Systems, Oxford, UK). Results: Thicknesses of the TrA and internal oblique increased during forward steps with ADIM. In addition, hip extension increased and pelvic rotation and oblique angles decreased during forward step with ADIM. Conclusion(s): Pelvic oblique and rotation angles decreased and hip extension slightly increased when performing ADIM during forward step. Our results suggest that application of ADIM stabilises the trunk and pelvis by using corset muscles such as TrA in the forward step position. We studied young, healthy, male volunteers who could perform ADIM with accuracy; thus, it is not clear whether comparable results would be obtained in other age groups and in the female sex. Moreover, we measured pelvic and hip angles but did not establish whether step width increased. It will be
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
necessary to measure step width and to confirm the influence of the change in hip extension in a future study. Implications: In rehabilitation, ADIM may increase step width due to an increase in hip extension during walking exercise. Keywords: Transversus abdominis; Abdominal drawingin manoeuvre; Forward steps Funding acknowledgements: The authors express their sincere thanks to acknowledge Dr. Takao Nakagawa’s help with the preparation of this abstract. Ethics approval: This study got approval by Medical Ethics Committee of Kanazawa University.
study, and underwent three experimental sessions on a different day as follows:
http://dx.doi.org/10.1016/j.physio.2015.03.1769
Concentration of oxyhemoglobin of the bilateral biceps brachii muscles (mHbO2 ), reflecting SMBF, was measured throughout all the sessions. In statistical analysis, Dunnett’s test was used to compare a mHbO2 value at the start of each session (baseline) with mHbO2 mean values at 2-minute intervals in each session. Moreover, Student’s t test with Bonferroni correction was used to compare mHbO2 mean values at 2-minute intervals between the NIR-ISG and NIR-ISM sessions. Results: During the NIR-ISG session, mHbO2 showed a rapid increase, and mHbO2 mean values at 2∼4-, 4∼6-, 6∼8-, and 8∼10-minutes were significantly increased compared with the baseline. During the NIR-ISM session, on the other hand, mHbO2 showed a slow increase, and only mHbO2 mean values at 6∼8- and 8∼10-minutes were significantly increased compared with the baseline. However, although mHbO2 mean values at 2∼4- and 4∼6-minutes during the NIR-ISG session were significantly increased compared with those during the NIR-ISM session, there were no significant differences in mHbO2 mean values at 6∼8- and 8∼10-minutes between the two sessions. In contrast to the NIR-ISG and NIR-ISM sessions, mHbO2 was almost unchanged during the control session. Conclusion(s): These results indicate that NIR-ISG can provide the more rapid SMBF increase compared with NIRISM. The rapid mHbO2 increase during NIR-ISG might reflect the rapid inhibition of the SG function due to the effect of NIR. On the other hand, the slow mHbO2 increase during NIR-ISM might reflect gradual vasodilation of the intramuscular arterioles with a gradual muscle temperature increase due to the effect of NIR. Implications: Our findings raise the possibility that both NIR-ISG and NIR-ISM is available for improving decreased SMBF due to immobility during cast immobilization and conditioning before exercise (passive warm up). In order to increase SMBF, NIR-ISM may require longer treatment time compared with NIR-ISG. Keywords: Near infrared; Skeletal muscle; Blood flow Funding acknowledgements: Non funded.
Research Report Poster Presentation Number: RR-PO-03-23-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 DIFFERENCE IN THE INCREASE OF SKELETAL MUSCLE BLOOD FLOW BETWEEN TWO TYPES OF TRANSCUTANEOUS NEAR-INFRARED IRRADIATION METHODS T. Maeda 1,2 , H. Yoshida 3 , K. Hara 4 , S. Terui 2 1 Hirosaki
Memorial Hospital, Department of Rehabilitation, Hirosaki, Japan; 2 Hirosaki University Graduate School of Health Sciences, Division of Comprehensive Rehabilitation Sciences, Hirosaki, Japan; 3 Hirosaki University Graduate School of Health Sciences, Division of Health Sciences, Hirosaki, Japan; 4 Kuroishi General Hospital, Department of Rehabilitation, Kuroishi, Japan Background: Near-infrared (NIR), which has high body permeability, mainly provides a thermal effect to the human body. We previously reported that transcutaneous NIR irradiation around the stellate ganglion (SG), which sends postganglionic sympathetic fibers to the upper body (NIRISG) inhibits sympathetic activity of the upper body, and consequently increases skeletal muscle blood flow (SMBF) of the upper body (WCPT-AWP & ACPT Congress 2013). In the meantime, some researches have reported the possibility that transcutaneous NIR irradiation to the skeletal muscle (NIR-ISM) also increases SMBF. However, little is known about the difference in the SMBF increase between NIR-ISG and NIR-ISM. Purpose: The aim of this study was to investigate the difference in the SMBF increase between NIR-ISG and NIRISM. Methods: We conducted a prospective randomized crossover study. Eight healthy volunteers participated in this
1) “NIR-ISG session”: after 15-minute supine rest (acclimatization), 10-minute NIR (specifically, xenon light) irradiation around the bilateral SGs was performed during supine rest; 2) “NIR-ISM session”: after the acclimatization, 10-minute NIR irradiation to the bilateral biceps brachii muscles was performed during supine rest; and 3) “control session”: after the acclimatization, 10-minute supine rest without NIR-ISG and NIR-ISM was continued.
viewpoint has been reached with regard to the influence of external loads on scapular movement. Purpose: The objective of this study was to continuously and closely analyze scapular upward rotation and identify the changing “point” (Knot) of the scapular rotatory movement during arm elevation. In addition, the influence of an external load on the Knot was investigated. Methods: The subjects were 35 healthy males (35 shoulders on the dominant-hand side) (mean age: 20.7 ± 1.7 years, mean height: 172 ± 6.4 cm, mean body weight: 65.7 ± 5.8 kg). An external load was applied to the upper limb in a sitting position: The dominant-side upper limb was lifted in the scapular plane with no load or a load using a 1–5-kg dumbbell. The movements of the trunk, scapula, and humerus were measured using a magnetic sensor-based 3-dimensional motion analysis system and analysis software. The measured values were plotted to present the scapular upward rotation as a line graph, and Knot of the movement was determined. Regarding the influence of the external load level on scapular upward rotation, knot was compared between movements under non-loaded (0 kg) and loaded (1–5 kg) conditions using the t-test and Bonferroni’s multiple comparison. A significance level lower than 5% was regarded as significant. Results: Knot position (elevation angle ± SE) under each loading condition was: 0 kg, 83.5 ± 2.9; 1 kg, 81.2 ± 2.9; 2 kg, 81.0 ± 2.9; 3 kg, 76.1 ± 2.9; 4 kg, 73.4 ± 3.1; and 5 kg, 75.8 ± 3.1. On comparison with the non-loaded condition (0 kg), no significant difference was noted under the conditions with 1- and 2-kg loads (p = 0.33 and 0.29, respectively), and Knot angle was constant. In contrast, with 3-, 4-, and 5-kg loads, a significant difference was noted in Knot angle from that under the non-loaded condition (p = 0.002, 0.0002, and 0.004, respectively), showing that a load of 3 kg or greater significantly lowered Knot position. Conclusion(s): It was clarified that a Knot, i.e., changing point, is present in scapular upward rotation. Knot changed due to the influence of the external load level: the arm elevation position shifted downward when the load was 3 kg or greater. Implications: Based on these findings, when a 3-kg or greater force is loaded on the shoulder joint during arm elevation, the scapular movement changes earlier and the importance of the scapular function as a fulcrum of the arm elevation force increases. Keywords: Scapular kinematics; Scapular upward rotation; External load Funding acknowledgements: This study was unfunded. Ethics approval: The Institutional Review Board of Kurume University approved the study protocol (#09078) in the study. http://dx.doi.org/10.1016/j.physio.2015.03.1768
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Research Report Poster Presentation Number: RR-PO-04-17-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 THE EFFECT OF THE ABDOMINAL DRAWING-IN MANOEUVRE DURING FORWARD STEPS S. Madokoro, H. Miaki, T. Yamazaki Kanazawa University, Health Sciences, Kanazawa, Japan Background: A decrease in hip extension has been reported to be a factor in short step width and slow walking speed in older men. Hip motion is related to pelvic and spinal motion, and transversus abdominis (TrA) activation is important for stabilising the pelvis and spine. The abdominal drawing-in manoeuvre (ADIM) can be performed to activate the TrA. Hip extension during ADIM in the prone position improves the relative timing of gluteus maximus activation in relation to the biceps femoris, and decreases anterior pelvic tilt. However, few studies have reported on hip extension during ADIM in the standing position or during walking. In healthy elderly subjects, the reduction in peak hip extension and increased anterior pelvic tilt might be related to trunk stabilisation with TrA activation. Thus, walking with ADIM might increase step width. Purpose: The purpose of this study was to examine the influence of the ADIM on forward steps as a gait exercise. The hypothesis of the present study was that ADIM during forward steps would increase hip extension and reduce pelvic rotation. Methods: The subjects were 20 healthy men (mean age, 20.8 ± 2.4 years). Measurements were performed in the following postures: in neutral standing, in the forward step posture, and in the forward step posture with ADIM. Thicknesses of the lateral abdominal muscles were measured using ultrasound (Mylab 25, Esaote, Indianapolis, IN) at B mode, and kinematics of the hip and pelvis were examined using a three-dimensional motion capture system (Vicon Motion Systems, Oxford, UK). Results: Thicknesses of the TrA and internal oblique increased during forward steps with ADIM. In addition, hip extension increased and pelvic rotation and oblique angles decreased during forward step with ADIM. Conclusion(s): Pelvic oblique and rotation angles decreased and hip extension slightly increased when performing ADIM during forward step. Our results suggest that application of ADIM stabilises the trunk and pelvis by using corset muscles such as TrA in the forward step position. We studied young, healthy, male volunteers who could perform ADIM with accuracy; thus, it is not clear whether comparable results would be obtained in other age groups and in the female sex. Moreover, we measured pelvic and hip angles but did not establish whether step width increased. It will be
eS926
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS833–eS1237
necessary to measure step width and to confirm the influence of the change in hip extension in a future study. Implications: In rehabilitation, ADIM may increase step width due to an increase in hip extension during walking exercise. Keywords: Transversus abdominis; Abdominal drawingin manoeuvre; Forward steps Funding acknowledgements: The authors express their sincere thanks to acknowledge Dr. Takao Nakagawa’s help with the preparation of this abstract. Ethics approval: This study got approval by Medical Ethics Committee of Kanazawa University.
study, and underwent three experimental sessions on a different day as follows:
http://dx.doi.org/10.1016/j.physio.2015.03.1769
Concentration of oxyhemoglobin of the bilateral biceps brachii muscles (mHbO2 ), reflecting SMBF, was measured throughout all the sessions. In statistical analysis, Dunnett’s test was used to compare a mHbO2 value at the start of each session (baseline) with mHbO2 mean values at 2-minute intervals in each session. Moreover, Student’s t test with Bonferroni correction was used to compare mHbO2 mean values at 2-minute intervals between the NIR-ISG and NIR-ISM sessions. Results: During the NIR-ISG session, mHbO2 showed a rapid increase, and mHbO2 mean values at 2∼4-, 4∼6-, 6∼8-, and 8∼10-minutes were significantly increased compared with the baseline. During the NIR-ISM session, on the other hand, mHbO2 showed a slow increase, and only mHbO2 mean values at 6∼8- and 8∼10-minutes were significantly increased compared with the baseline. However, although mHbO2 mean values at 2∼4- and 4∼6-minutes during the NIR-ISG session were significantly increased compared with those during the NIR-ISM session, there were no significant differences in mHbO2 mean values at 6∼8- and 8∼10-minutes between the two sessions. In contrast to the NIR-ISG and NIR-ISM sessions, mHbO2 was almost unchanged during the control session. Conclusion(s): These results indicate that NIR-ISG can provide the more rapid SMBF increase compared with NIRISM. The rapid mHbO2 increase during NIR-ISG might reflect the rapid inhibition of the SG function due to the effect of NIR. On the other hand, the slow mHbO2 increase during NIR-ISM might reflect gradual vasodilation of the intramuscular arterioles with a gradual muscle temperature increase due to the effect of NIR. Implications: Our findings raise the possibility that both NIR-ISG and NIR-ISM is available for improving decreased SMBF due to immobility during cast immobilization and conditioning before exercise (passive warm up). In order to increase SMBF, NIR-ISM may require longer treatment time compared with NIR-ISG. Keywords: Near infrared; Skeletal muscle; Blood flow Funding acknowledgements: Non funded.
Research Report Poster Presentation Number: RR-PO-03-23-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 DIFFERENCE IN THE INCREASE OF SKELETAL MUSCLE BLOOD FLOW BETWEEN TWO TYPES OF TRANSCUTANEOUS NEAR-INFRARED IRRADIATION METHODS T. Maeda 1,2 , H. Yoshida 3 , K. Hara 4 , S. Terui 2 1 Hirosaki
Memorial Hospital, Department of Rehabilitation, Hirosaki, Japan; 2 Hirosaki University Graduate School of Health Sciences, Division of Comprehensive Rehabilitation Sciences, Hirosaki, Japan; 3 Hirosaki University Graduate School of Health Sciences, Division of Health Sciences, Hirosaki, Japan; 4 Kuroishi General Hospital, Department of Rehabilitation, Kuroishi, Japan Background: Near-infrared (NIR), which has high body permeability, mainly provides a thermal effect to the human body. We previously reported that transcutaneous NIR irradiation around the stellate ganglion (SG), which sends postganglionic sympathetic fibers to the upper body (NIRISG) inhibits sympathetic activity of the upper body, and consequently increases skeletal muscle blood flow (SMBF) of the upper body (WCPT-AWP & ACPT Congress 2013). In the meantime, some researches have reported the possibility that transcutaneous NIR irradiation to the skeletal muscle (NIR-ISM) also increases SMBF. However, little is known about the difference in the SMBF increase between NIR-ISG and NIR-ISM. Purpose: The aim of this study was to investigate the difference in the SMBF increase between NIR-ISG and NIRISM. Methods: We conducted a prospective randomized crossover study. Eight healthy volunteers participated in this
1) “NIR-ISG session”: after 15-minute supine rest (acclimatization), 10-minute NIR (specifically, xenon light) irradiation around the bilateral SGs was performed during supine rest; 2) “NIR-ISM session”: after the acclimatization, 10-minute NIR irradiation to the bilateral biceps brachii muscles was performed during supine rest; and 3) “control session”: after the acclimatization, 10-minute supine rest without NIR-ISG and NIR-ISM was continued.