Method: Ten healthy adult volunteers were included. We attached surface markers at the corresponding skin surface of each lumbar vertebral bodies and measured lumbar segmental ROM in flexion-extension, right bending, left bending, axial rotation with 3-D motion analysis. We compared some of the results with radiologic segmental ROM measurements.
Results: In 3-D motion analysis, segmental ROM of flexion and extension, right bending, left bending, right rotation, left rotation were, respectively: 10.1o, 45o, 3.5o, 1.7o and 1.9o (L1-L2); 17.9o, 6.2o, 5.1o, 1.4o and 1.1o (L2-L3); 15.0o, 7.2o, 4.9o, 2.1o and 1.1o (L3-L4); 14.9o, 5.8o, 4.6o, 1.7° and 1.6° (L4-L5); 10.6o, 4.9o, 3.8°, 2.6° and 0.8° (L5-S1). There was no statistically significant difference in segmental ROM between 3-D motion analysis measurements and radiologic measurements except L5-S1 right bending, L2-L3 and L5-S1 left bending. No statistical significant difference in lumbar flexion and bending ROM was found between two methods.
Conclusion: 3-D motion analysis is a useful method when measuring the lumbar segmental range of motion and it has an advantage to analyze segmental lumbar motion with three directions simultaneously. (J Korean Acad Rehab Med 2003; 27: 424-432)
Methods: Thirty nine patients who underwent cervical decompression and fusion for cervical myelopathy were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated with Nurick classification, Functional Independence measure (FIM) score and gait analysis using three dimensional motion analyzer before surgery, 1 week and 3 months after surgery.
Results: In the Nurick classification there was statistically significant change but no significant change in FIM score after surgery. In the gait analysis there were statistically significant improvements in all the linear parameters, kinetic (ankle plantarflexion moment) and kinematic (knee range of motion in swing phase) parameters (p＜0.05).
Conclusion: This study suggests that gait analysis can be used as a quantitative tools of postoperative gait improvement in patient with cervical myelopathy. (J Korean Acad Rehab Med 2003; 27: 58-62)
Objective: This study is aimed to evaluate a sit-to-stand (STS) pattern in the children with spastic diplegic cerebral palsy in comparison with the normal children.
Method: Fifteen young children with spastic diplegic cerebral palsy and 21 normally developed children were recruited as subjects. A motion analysis system using a Motion analyzer (Vicon 370 M.A. with 6 infrared cameras) was used to examine the STS task. The changes in joint angle, moment, and power of each joints in lower limbs, total duration of STS transfer and each transitional points were assessed.
Results: Total duration of STS in patients was 2.44 sec, which was significantly prolonged in comparing with 1.10 sec in normal control. The major prolongation of STS occurred in the phase of vertical movement of center of mass (CoM). Cerebral palsied children showed more anterior pelvic tilting and hip flexion throughout STS transfer than normal control. Asymmetries in initial angle of ankle and maximal momentum of knee extension were shown in spastic diplegic children with cerebral palsy, but not in normal control. Less extension momentum and power of knee joint and more plantar flexion momentaum of ankle joint were observed in cerebral palsy in comparing with those of normal children.
Conclusion: This study showed that STS pattern in spastic diplegic cerebral palsy was quite different from that of normal children. The characteristics of STS pattern in these children was slowness of speed; mainly from slowness of vertical displacement of CoM, and more anterior
pelvic tilt, hip flexion and earlier abrupt change of knee extension. As well, the major moments required for this task in these patients occurred at hip and ankle joints instead of knee joint.
Objective: Rising from a sitting position is a very common, yet essential activity in daily life. The activity to perform the sit-to-stand (STS) transfer is a prerequisite for upright mobility. This study aims to provide fundamental data concerning the execution of the STS, and in particularly the followings: 1) how do the angles of the lower limbs change throughout the process of rising from a chair; 2) how much motion torque and power in each joint are required per kilogram of body weight to complete the STS transfer?
Method: Twenty-one children who have developed normally and could understand the command requested are involved as subjects. Their age ranged from 3 to 5 years old. Motion analysis of STS transfer were assessed with the Vicon 370 M.A (Oxford Metrics Limited, United Kingdom). The changes in joint angle, maximal moment and power in lower limb were calculated throughout the STS transfer.
Results: A series of transition points was observed in the angles of the hip, knee and ankle joints throughout the sit-to-stand movements, which was classified into five stages. The first stage is trunk and hip flexion phase; second stage, buttock take-off; third stage, ankle dorsiflexion and knee extension; forth stage, just-standing; fifth stage, stabilizing phase. The extension moment of each joint is 0.65 Nm/kg on right, 0.71 Nm/kg on left in hip, 0.41 Nm/kg on right, 0.38 Nm/kg on left in knee and 0.21 Nm/kg on right, 0.22 Nm/kg on left in ankle joint. The extension power is 0.60 watt/kg on right, 0.68 watt/kg on left in hip, 0.59 watt/kg on right, 0.50 watt/kg on left in knee and 0.15 watt/kg on right, 0.15 watt/kg on left in ankle joint.
Conclusion: A consistent pattern was observed throughout the sit-to-stand transfer and six transition points were observed in the angles of the hip, knee and ankle joints throughout the STS transfer. By these 6 points, the movement of the STS transfer was classified into 5 stages. Major changes in angle, moment, and power of each joint were observed in sagittal plane. There were no side to side difference during the STS transfer.
Currently the evaluations of upper extremity motion have relied on a task-oriented approach to gain an accurate clinical picture of the functional capacities. As it is, an adequate and objective system to estimate upper extremity function is yet to be developed.
Authors used the virtual reality motion analysis system(VRMAS) which was developed by us for the purpose of investigating the kinematics of upper extremity motion during drinking a cup of water. Four healthy male adult subjects were recruited from the hospital personnels. After each subject sat down on a chair resting against the backrest in a neutral position, in front of a table he was instructed to drink the content of the cup from the table.
The data was analized and showed the following results. While drinking, the hand movements were smooth and linear. There were six distinct stages during drinking a cup of water; a reaching for the cup(stage 1), picking up the cup and carrying the cup to the mouth(stage 2), extending neck and drinking from the cup(stage 3), flexing neck(stage 4), replacing the cup to the table(stage 5), and returning to the start position(stage 6). During the stage 1 and 2, of all joint motions, the shoulder adduction and elbow flexion were most prominent. The stage 3 showed the most complex movements in shoulder flexion, forearm pronation, and wrist extension which were simultaneous. Remaining stages were the reversal of the first three stages. We could observe the ranges of motion of neck, shoulder, elbow, and wrist joint as well as the relationships of these joints at the same time.
In conclusion, VRMAS could be a very useful evaluation tool for the upper extremity motion and for obtaining the kinematic data from the upper extremity motion analysis.
The pendulum test, recognized as a reliable measure of spasticity, has been replaced in this study by a video-based two dimensional motion analysis system. Using twenty five patients with spasticity(21 males, 4 females; mean age 46.6 year-old) in their lower legs due to lesions affecting the central nervous system and twenty two persons without any evidence of hypertonia(all males; mean age 23.4 year-old), five parameters such as relaxation index(RI), amplitude ratio(AR), torque at maximal acceleration velocity, number of swing and swing time were obtained for the purpose of documenting the reliability of the video-based two dimensional motion analysis system for the evaluation of spasticity.
The values of RI(P＜0.05), AR(P＜0.01), and swing time(P＜0.05) in patients with spasticity were significantly lower than control, whereas the value of torque in patients was significantly higher than control(P＜0.01). Spearman's correlation coefficients of the RI(r=0.70894, P＜0.001), AR(r=0.71832, P＜0.001), number of swing(r=0.59037, P＜0.05) and swing time(r=0.59648, P＜0.01) showed a statistically significant negative correlation with the modified Ashworth scale, whereas that of torque(r=0.59037, P＜0.01) showed a significant positive correlation.
In conclusion, a pendulum test using a video-based two dimensional motion analysis system is a simple, and a reliable method for the quantitative evaluation of spasticity.
Measurement of spinal range of motion(ROM) can be effectively used in guiding the direction of therapy, determining the patient's response to rehabilitation treatment and functional assessment. However for a method of measurement to be commonly used in clinical and research settings, it must be easy to perform, rapid and highly reliable. The purpose of this study was to determine the possibility of clinical application of 2-dimensional motion analysis system to measure spinal ROM in patients with low back pain(LBP).
Subjects included 10 healthy males and 10 patients with LBP. Using Electronic Digital Inclinometer (EDI 320) and 2-dimensional motion analysis system, thoracic, lumbar and pelvic ROMs were measured for trunkal flexion, extension, lateral flexion and rotation. Also proportions of decreased ROMs in LBP patients relative to healthy subjects and movement patterns of each spinal segment according to time sequence were investigated.
LBP patients compared to normal subjects showed significantly low spinal ROM(P＜0.05) except thoracic and pelvic ROM for extension. When looking at the change of each spinal ROM in respect to time with motion analysis system, normal subjects showed synchronized and sigmoid motion curve time from the initiation to the end of motion in all areas of spine during 4 motions. LBP patients took longer time from the initiation to the end of each motion, and showed smaller initial change and fluctuation in spinal ROM during each motion compared to normal subjects.
The results of this preliminary study suggest that 2-dimensional motion analysis system can be effectively used for measuring spinal ROM in patients with LBP.
Isotonic exercise occurs when the tension or torque generated by a muscle is constant throughout the movement. In practice it is very difficult to maintain the tension constant. Evaluation of isotonic exercise should include the works of concentric and eccentric contraction and the changes in tension and torque during joint motion. However, optimal evaluation tools for isotonic exercise has yet to be developed.
We authors, used virtual reality motion analysis system(VRMAS) which was codeveloped by us and EMG system(Cardwell Excel). Healthy male adult subjects(n=10) were recruited from hospital personnel. After dominant upper arm and trunk of each subject was fixed with velcro, he was instructed to repeat flexion and extension of his dominant elbow grasping dumbell (9 kg) in hand with maximal velocity as possible as can until the point of exhaustion. We measured the elbow angle, the angular velocity, torque, power, total work and the work of concentric and eccentric contraction during exercise.
The results were as follows: there were four distinct elbow flexor muscle contractions during flexion and extension of the elbow with the first and the second contractions during concentric contraction and the third and the fourth contractions during eccentric contraction. Between the peaks of contraction, motion was maintained due to the momentum that was generated. Of the ten subjects, seven had higher concentric work than eccentric work with the eccentric work being higher in the remaining three. But there was no statistic significance between the works of concentric contraction and eccentric contraction(p>0.05). The biggest work was observed in the fourth contraction, while the third contraction showed the least work(p<0.05).
In conclusion, there were four distinct muscle contractions during elbow isotonic exercise and the works of each muscle contraction were different. This result is contrary to the definition of isotonic exercise. This study also shows that the VRMAS could be a very useful evaluation tool for several types of isotonic exercise.
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