Browsing by Subject "Weight-Bearing"
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Item Estimate of Muscle Contribution to Spinal Loads During Continuous Passive Motion for Low Back Pain(2005-05-11) Diederich, Jennifer Marie; Triano, John J.This research is a first approximation model for determining the active loads in the lumbar spine during continuous passive motion (CPM) in the prone position. The study consisted of two groups' five healthy subjects and four subjects with the diagnosis of mechanical low back pain (LBP) at L4/L5/S1. Solutions to the issues in this investigation were sought in three stages. First was the introduction and synchronization of a number of sensors for making valid, time-linked observations of kinematic variables during CPM. Second, a root mean square myoelectric signal (RMS-MES) model was needed to calibrate muscle activation levels during feasible standardized tasks to be performed by low back pain patients. Such a model must be able to partition passive and active load components acting on the lumbar spine and to estimate equivalent muscle loads from activity observed during CPM. Finally, biomechanical models are necessary for estimating the passive, active and total loads transmitted through the trunk during CPM. Testing consisted of three calibration stances: upright, weighted holding 3lb weights in hands extended 90?? the shoulder and CPM at intermediate speed 11.5 degrees, fast speed 11.5 degrees, and intermediate speed at 20 degrees. Measurements recorded: 8 myoelectric signals (MES) of paired muscles (latissimus dorsi, multifidus, gluteus maximus, and hamstring femoris), 4 Polhemus Fastrak electromagnetic positioning sensors (lumbar, sacrum, 10cm posterior to center of knee, and table), linear accelerometer, uniaxial load cell, and modified treatment table with AMTI force plate. Results demonstrate consistent repeatable measurements from the instrumented treatment table. The active loads created during CPM are minimal in comparison to the passive loads for both groups and therefore the muscle loads are not counteracting the implied therapy.Item Weightbearing and Activity Restriction Treatments and Quality of Life in Patients with Perthes Disease(2021-05-01T05:00:00.000Z) Do, Dang-Huy; Kim, Harry K. W.; Huo, Michael; Wells, JoelBACKGROUND: Weightbearing and activity restrictions are commonly prescribed during the active stages of Perthes disease. These restrictions, ranging from cast or brace treatment with nonweightbearing to full weightbearing with activity restrictions, may have a substantial influence on the physical, mental, and social health of a child. However, their impact on the patient's quality of life is not well-described. OBJECTIVES: After controlling for confounding variables, are restrictions on weightbearing and activity associated with physical health measures (as expressed by the Patient-Reported Outcome Measurement Information System [PROMIS] mobility, PROMIS pain interference, and PROMIS fatigue), mental health measures (PROMIS depressive symptoms and PROMIS anxiety), and social health measures (PROMIS peer relationships)? METHODS: Between 2013 and 2020, 211 patients with Perthes disease at a single institution were assigned six PROMIS measures to assess physical, mental, and social health. Patients who met the following eligibility criteria were analyzed: age 8 to 14 years old, completion of six PROMIS measures, English-speaking, and active stage of Perthes disease (Waldenstrom Stage I, II, or III). Weightbearing and activity restrictions were clinically recommended to patients in the initial through early reossification stages of Perthes disease when patients had increasing pain, loss of hip motion, loss of hip containment, progression of femoral head deformity, increased hip synovitis, and femoral head involvement on magnetic resonance imaging (MRI), or as a postoperative regimen. Patients were categorized into four intervention groups based on weightbearing and activity regimen. We excluded 111 patients who did not meet the inclusion criteria. The following six pediatric self-report PROMIS measures were assessed: mobility, pain interference, fatigue, depressive symptoms, anxiety, and peer relationships. Analysis of variance (ANOVA) was used to compare differences between the mean PROMIS T-scores of these weightbearing/activity regimens. Results were assessed with a significance of p < 0.05 and adjusted for Waldenstrom stage, gender, age of diagnosis, and history of major surgery using multivariate regression analysis. RESULTS: After controlling for confounding variables, the mild- (β regression coefficient -15 [95% CI -19 to -10]; p < 0.001), moderate- (β -19 [95% CI -24 to -14]; p < 0.001), and severe- (β -25 [95% CI -30 to -19]; p < 0.001) restriction groups were associated with worse mobility T-scores compared with the no-restriction group, but no association was detected for the pain interference or fatigue measures. Weightbearing and activity restrictions were not associated with mental health measures (depressive symptoms and anxiety). Weightbearing and activity restrictions were not associated with social health measures (peer relationships). Earlier Waldenstrom stage was associated with worse pain interference (β 10 [95% CI 2 to 17]; p = 0.01) and peer relationships scores (β -8 [95% CI -15 to -1]; p = 0.03); female gender was linked with worse depressive symptoms (β 7 [95% CI 2 to 12]; p = 0.005) and peer relationships scores (β -6 [95% CI -12 to 0]; p = 0.04); and earlier age at diagnosis was associated with worse peer relationships scores (β 1 [95% CI 0 to 2]; p = 0.03). History of major surgery had no connection to any of the six PROMIS measures. CONCLUSION: We found that weightbearing and activity restriction treatments are associated with poorer patient-reported mobility in the active stages of Perthes disease after controlling for confounding variables, but not pain interference, fatigue, depressive symptoms, anxiety, or peer relationships. Understanding how these treatments are associated with Perthes disease patients' quality of life can aid in decision-making for providers, help set expectations for patients and their parents, and provide opportunities for better education and preparation. Because of the chronic nature of Perthes disease, future studies may focus on longitudinal trends in patient-reported outcomes to better understand the overall impact of this disease and its treatment.