- Email: [email protected]
Development of an indirect method for the determination of lumbosacral angle and pelvic tilt by photogrammetry
164
Abstracts from the WFC’s 11th Biennial Congress
Differential tissue strain estimation across strata of tissues under intrinsic motion§ John Triano *, Helene Langevin, Elisa Konofagou *Corresponding author. E-mail address: [email protected]
Introduction: Muscle organs are critical actuators generating tension that may (1) initiate movement, (2) alter multi-joint segment rigidity or (3) attenuate external loads on the body. Pathways of force transmission include myotendinous and epimuscular myofascial networks. Epimuscular pathways are intermuscular, between adjacent muscles, and extramuscular for transmission to nonmuscular structures. Intramuscular transmission may be nonuniform, with motor units and connective tissue components contributing to tension gradients in different proportions when active or stretched. The question is, how significant these mechanical linkages are to health and disease. This study determined whether ultrasound elastography can quantify the relative activity within and between soft tissue structures. Such information is necessary to measure and confirm the relative role of the different tissue strata in transmitting loads during injury, in manual therapy and exercise. Methods: Ten healthy adult male subjects (age = 26.7 1.8 years; Ht = 178.6 5.4 cm; Wt = 76.8 8.9 kg) were recruited. After signing informed consent, each subject was placed supine in the anatomical position. Electromagnetic position of the elbow and myoelectric activity of the biceps and triceps muscles were monitored by surface sensors. Each participant engaged in 5 tasks, bending the elbow to approximately 20 degrees whilst an ultrasound sensor was positioned over the midline biceps; unloaded, 20% maximal voluntary isometric (MVC) MVC concentric no pressure, 20% MVC concentric 1 cm indented, 20% MVC eccentric and 20% MVC concentric with the ultrasound moved distally to the myotendinous confluence. Ultrasound radiofrequency signals (40 MHz, 3 cm depth, 70 frames per second (FPS)) were post processed using speckle tracking with displacement and strain estimation by cross-correlation techniques. The muscle mass was stratified into three bands; skin and subcutaneous, biceps, brachialis. Maximal and cumulative displacement, lateral shear and lateral strain variables, normalized to the duration of movement, were compared across tasks and stratified bands by ANOVA. Results: This report addresses the elastography results alone. All cross-correlations exceeded 0.96. Differences between strata layers were highly significant across all tests (0.0001 < p < 0.045). Unloaded elbow flexion differed from all other test conditions (p < 0.057) with an interaction effect between condition and strata (p < 0.0013). Cumulative displacement of the strata was ordered from superficial to deep while cumulative lateral strain was lowest in the biceps strata (25%; 10%; 34%, respectively). Lateral shear values were 32%, 9%, 23%. Discussion: The motor controlled action of the prime mover (biceps) showed the least variation in strain across all tasks. This would be consistent with the constant displacement under isoinertial load conditions. The subcutaneous tissue and brachialis muscle substance deform in response to lesser activation and, at least for subcutaneous strata, epimuscular force transmission. Conclusion: Layer stratification for both internal tissue displacements and strains during activity can be quantified. Results suggest opportunities to understand how applied and internally generated loads are differentially transmitted. Studies comparing myoelectric activity and strain ratios are underway to better understand active versus passive loading effects. These data will inform studies on load bearing structures during manual therapy. doi: 10.1016/j.clch.2011.09.029
Development of an indirect method for the determination of lumbosacral angle and pelvic tilt by photogrammetry§ Mariana Tonietto Marques *, Marcelo La Torre, Jefferson Fagundes Loss, Juliana Collares Vanassi, Felipe Oso ´rio Marques, Danilo Messa da Silva *Corresponding author. E-mail address: [email protected]
Background: The kinematics of the pelvis result from the synergism between the lumbar spine, inominate bones and sacrum. The evaluation of kinematics is of great value for kinetic functional diagnosis made by health professionals. The lumbopelvic kinematics can be determined directly using radiological examination or by indirect methods, which are usually based on kinemetry. Among the indirect methods that use
Abstracts from the WFC’s 11th Biennial Congress
165
kinemetry, photogrammetry has been often used as a kinetic functional diagnostic tool. This tool can provide information of body segments based on the use of external markers placed on the skin surface. Objective: Implementation of an indirect system to assess lumbosacral angle and pelvic tilt by photogrammetry during different lumbopelvic positions. Methods: Seven healthy subjects of both genders and mean age of 26.7 (3.0 SD) years old participated in this study. The data acquisition was made in two steps: (1) radiographic analysis and (2) photogrammetry. In both steps, skin-surface reflexive markers were used, which contained lead pellets. From radiological images and photographs, algorithms were implemented in the software Mathlab1 7.5 to evaluate lumbosacral angle and pelvic tilt from bony structures in the radiological analysis and from skin-surface markers in the photogrammetry during the neutral position, anteversion and retroversion of the pelvis and during the positions of flexion and extension of lumbar spine. The angles evaluated from bony structures by radiological analysis were used like a gold standard to validate the angle values obtained by photogrammetry. The angle values were submitted to statistical tests in the software SPSS 17.0. First the normality and homogeneity of values obtained were verified, followed by the t test for paired samples and Pearson’s correlation coefficient to verify the difference and the correlation between the methods. The significance level was p < 0.05 and the correlation coefficient was r 0.70. Results: The results showed a strong and significant correlation (r 0.80—0.98) and no statistical differences (p > 0.05) among the methods proposed to measure pelvic tilt during all the different lumbopelvic positions. However, when values of lumbosacral angle obtained by the proposed methods were compared, there was a weak correlation (r 0—0.30) and there was significant difference among the methods (p < 0.05). Conclusion: The results obtained indicate that pelvic tilt can be evaluated from skin-surface markers by photogrammetry during different lumbopelvic positions. The evaluation of lumbosacral angle by photogrammetry was not shown to be appropriate, and further studies are needed to evaluate this. Few changes in the lumbosacral angle obtained by radiological analysis during different pelvic positions were observed, which indicates the possibility that manipulation of the pelvis in the sagittal plane is safe in patients with contraindications to lumbar spine manipulation. doi: 10.1016/j.clch.2011.09.030
Reduced crying time for infants with colic presenting for chiropractic treatment§ Joyce Miller *, Maria Torheim Bjelkarøy, Maria Browning *Corresponding author. E-mail address: [email protected]
Objective: Infant colic or unexplained infant crying is a condition of unknown aetiology affecting approximately 20% of infants. The condition has been found to be highly distressing for both infant and caregivers. Current available evidence has thus far proved inconclusive to support chiropractic manual therapy as efficacious in the treatment of the condition. The aim of this trial was to compare chiropractic manual therapy with placebo (no treatment) in the treatment of infant colic. It further aimed to determine whether any reported change in behaviour in the infant was subject to bias due to the caregiver’s knowledge of treatment. Methods: A double-blinded placebo-controlled randomised trial. Blinding involved caregivers and statistician. One hundred and two subjects with equal distribution of gender, mean age of five weeks, mean gestational age of 39 weeks, and mean birth weight of 3400 g participated in the trial. Subjects were block randomised into three groups including a routine treatment group (A, n = 33), a treatment group with caregivers blinded to treatment (B, n = 35) and an untreated control group with caregivers blinded (C, n = 34). Active treatment involved a modified technique of chiropractic spinal manipulation administered relative to size and age of the infant. Subjects received an average of four visits. The validated gold standard 24-h crying diary 6 was used to detect any change in crying in the subjects. Results: Crying time decreased in all groups. In the period between the first two and last two days, subjects in active treatment group A showed a reduction of 70.2% in total daily crying from 4.6 h to 1.4 h a day. Subjects in blinded treatment group B showed a reduction of 54% in total daily crying from 5.1 h to 2.3 h a day. Subjects in the blinded untreated control group C showed a reduction of 9.4% in total daily crying from
Abstracts from the WFC’s 11th Biennial Congress
Differential tissue strain estimation across strata of tissues under intrinsic motion§ John Triano *, Helene Langevin, Elisa Konofagou *Corresponding author. E-mail address: [email protected]
Introduction: Muscle organs are critical actuators generating tension that may (1) initiate movement, (2) alter multi-joint segment rigidity or (3) attenuate external loads on the body. Pathways of force transmission include myotendinous and epimuscular myofascial networks. Epimuscular pathways are intermuscular, between adjacent muscles, and extramuscular for transmission to nonmuscular structures. Intramuscular transmission may be nonuniform, with motor units and connective tissue components contributing to tension gradients in different proportions when active or stretched. The question is, how significant these mechanical linkages are to health and disease. This study determined whether ultrasound elastography can quantify the relative activity within and between soft tissue structures. Such information is necessary to measure and confirm the relative role of the different tissue strata in transmitting loads during injury, in manual therapy and exercise. Methods: Ten healthy adult male subjects (age = 26.7 1.8 years; Ht = 178.6 5.4 cm; Wt = 76.8 8.9 kg) were recruited. After signing informed consent, each subject was placed supine in the anatomical position. Electromagnetic position of the elbow and myoelectric activity of the biceps and triceps muscles were monitored by surface sensors. Each participant engaged in 5 tasks, bending the elbow to approximately 20 degrees whilst an ultrasound sensor was positioned over the midline biceps; unloaded, 20% maximal voluntary isometric (MVC) MVC concentric no pressure, 20% MVC concentric 1 cm indented, 20% MVC eccentric and 20% MVC concentric with the ultrasound moved distally to the myotendinous confluence. Ultrasound radiofrequency signals (40 MHz, 3 cm depth, 70 frames per second (FPS)) were post processed using speckle tracking with displacement and strain estimation by cross-correlation techniques. The muscle mass was stratified into three bands; skin and subcutaneous, biceps, brachialis. Maximal and cumulative displacement, lateral shear and lateral strain variables, normalized to the duration of movement, were compared across tasks and stratified bands by ANOVA. Results: This report addresses the elastography results alone. All cross-correlations exceeded 0.96. Differences between strata layers were highly significant across all tests (0.0001 < p < 0.045). Unloaded elbow flexion differed from all other test conditions (p < 0.057) with an interaction effect between condition and strata (p < 0.0013). Cumulative displacement of the strata was ordered from superficial to deep while cumulative lateral strain was lowest in the biceps strata (25%; 10%; 34%, respectively). Lateral shear values were 32%, 9%, 23%. Discussion: The motor controlled action of the prime mover (biceps) showed the least variation in strain across all tasks. This would be consistent with the constant displacement under isoinertial load conditions. The subcutaneous tissue and brachialis muscle substance deform in response to lesser activation and, at least for subcutaneous strata, epimuscular force transmission. Conclusion: Layer stratification for both internal tissue displacements and strains during activity can be quantified. Results suggest opportunities to understand how applied and internally generated loads are differentially transmitted. Studies comparing myoelectric activity and strain ratios are underway to better understand active versus passive loading effects. These data will inform studies on load bearing structures during manual therapy. doi: 10.1016/j.clch.2011.09.029
Development of an indirect method for the determination of lumbosacral angle and pelvic tilt by photogrammetry§ Mariana Tonietto Marques *, Marcelo La Torre, Jefferson Fagundes Loss, Juliana Collares Vanassi, Felipe Oso ´rio Marques, Danilo Messa da Silva *Corresponding author. E-mail address: [email protected]
Background: The kinematics of the pelvis result from the synergism between the lumbar spine, inominate bones and sacrum. The evaluation of kinematics is of great value for kinetic functional diagnosis made by health professionals. The lumbopelvic kinematics can be determined directly using radiological examination or by indirect methods, which are usually based on kinemetry. Among the indirect methods that use
Abstracts from the WFC’s 11th Biennial Congress
165
kinemetry, photogrammetry has been often used as a kinetic functional diagnostic tool. This tool can provide information of body segments based on the use of external markers placed on the skin surface. Objective: Implementation of an indirect system to assess lumbosacral angle and pelvic tilt by photogrammetry during different lumbopelvic positions. Methods: Seven healthy subjects of both genders and mean age of 26.7 (3.0 SD) years old participated in this study. The data acquisition was made in two steps: (1) radiographic analysis and (2) photogrammetry. In both steps, skin-surface reflexive markers were used, which contained lead pellets. From radiological images and photographs, algorithms were implemented in the software Mathlab1 7.5 to evaluate lumbosacral angle and pelvic tilt from bony structures in the radiological analysis and from skin-surface markers in the photogrammetry during the neutral position, anteversion and retroversion of the pelvis and during the positions of flexion and extension of lumbar spine. The angles evaluated from bony structures by radiological analysis were used like a gold standard to validate the angle values obtained by photogrammetry. The angle values were submitted to statistical tests in the software SPSS 17.0. First the normality and homogeneity of values obtained were verified, followed by the t test for paired samples and Pearson’s correlation coefficient to verify the difference and the correlation between the methods. The significance level was p < 0.05 and the correlation coefficient was r 0.70. Results: The results showed a strong and significant correlation (r 0.80—0.98) and no statistical differences (p > 0.05) among the methods proposed to measure pelvic tilt during all the different lumbopelvic positions. However, when values of lumbosacral angle obtained by the proposed methods were compared, there was a weak correlation (r 0—0.30) and there was significant difference among the methods (p < 0.05). Conclusion: The results obtained indicate that pelvic tilt can be evaluated from skin-surface markers by photogrammetry during different lumbopelvic positions. The evaluation of lumbosacral angle by photogrammetry was not shown to be appropriate, and further studies are needed to evaluate this. Few changes in the lumbosacral angle obtained by radiological analysis during different pelvic positions were observed, which indicates the possibility that manipulation of the pelvis in the sagittal plane is safe in patients with contraindications to lumbar spine manipulation. doi: 10.1016/j.clch.2011.09.030
Reduced crying time for infants with colic presenting for chiropractic treatment§ Joyce Miller *, Maria Torheim Bjelkarøy, Maria Browning *Corresponding author. E-mail address: [email protected]
Objective: Infant colic or unexplained infant crying is a condition of unknown aetiology affecting approximately 20% of infants. The condition has been found to be highly distressing for both infant and caregivers. Current available evidence has thus far proved inconclusive to support chiropractic manual therapy as efficacious in the treatment of the condition. The aim of this trial was to compare chiropractic manual therapy with placebo (no treatment) in the treatment of infant colic. It further aimed to determine whether any reported change in behaviour in the infant was subject to bias due to the caregiver’s knowledge of treatment. Methods: A double-blinded placebo-controlled randomised trial. Blinding involved caregivers and statistician. One hundred and two subjects with equal distribution of gender, mean age of five weeks, mean gestational age of 39 weeks, and mean birth weight of 3400 g participated in the trial. Subjects were block randomised into three groups including a routine treatment group (A, n = 33), a treatment group with caregivers blinded to treatment (B, n = 35) and an untreated control group with caregivers blinded (C, n = 34). Active treatment involved a modified technique of chiropractic spinal manipulation administered relative to size and age of the infant. Subjects received an average of four visits. The validated gold standard 24-h crying diary 6 was used to detect any change in crying in the subjects. Results: Crying time decreased in all groups. In the period between the first two and last two days, subjects in active treatment group A showed a reduction of 70.2% in total daily crying from 4.6 h to 1.4 h a day. Subjects in blinded treatment group B showed a reduction of 54% in total daily crying from 5.1 h to 2.3 h a day. Subjects in the blinded untreated control group C showed a reduction of 9.4% in total daily crying from