Finite element shoulder models

Shoulder joint is a complex integration of soft and hard tissues. It plays an important role in performing daily activities and can be considered as a perfect compromise between mobility and stability. However, shoulder is vulnerable to complications such as dislocations and osteoarthritis. Finite element (FE) models have been developed to understand shoulder injury mechanisms, implications of disease on shoulder complex and in assessing the quality of shoulder implants. Further, although few, Finite element shoulder models have also been utilized to answer important clinical questions such as the difference between a normal and osteoarthritic shoulder joint. However, due to the absence of experimental validation, it is questionable whether the constitutive models applied in these FE models are adequate to represent mechanical behaviors of shoulder elements (Cartilages, Ligaments, Muscles etc), therefore the confidence of using current models in answering clinically relevant question. The main objective of this review is to critically evaluate the existing FE shoulder models that have been used to investigate clinical problems. Due concern is given to check the adequacy of representative constitutive models of shoulder elements in drawing clinically relevant conclusion. Suggestions have been given to improve the existing shoulder models by inclusion of adequate constitutive models for shoulder elements to confidently answer clinically relevant questions.

Timed Up and Go Tests in cardiac rehabilitation : reliability and comparison with the 6-minute walk test

PURPOSE: To test the reliability of Timed Up and Go Tests (TUGTs) in cardiac rehabilitation (CR) and compare TUGTs to the 6-Minute Walk Test (6MWT) for outcome measurement. METHODS: Sixty-one of 154 consecutive community-based CR patients were prospectively recruited. Subjects undertook repeated TUGTs and 6MWTs at the start of CR (start-CR), postdischarge from CR (post-CR), and 6 months postdischarge from CR (6 months post-CR). The main outcome measurements were TUGT time (TUGTT) and 6MWT distance (6MWD). RESULTS: Mean (SD) TUGTT1 and TUGTT2 at the 3 assessments were 6.29 (1.30) and 5.94 (1.20); 5.81 (1.22) and 5.53 (1.09); and 5.39 (1.60) and 5.01 (1.28) seconds, respectively. A reduction in TUGTT occurred between each outcome point (P ≤ .002). Repeated TUGTTs were strongly correlated at each assessment, intraclass correlation (95% CI) = 0.85 (0.76–0.91), 0.84 (0.73–0.91), and 0.90 (0.83–0.94), despite a reduction between TUGTT1 and TUGTT2 of 5%, 5%, and 7%, respectively (P ≤ .006). Relative decreases in TUGTT1 (TUGTT2) occurred from start-CR to post-CR and from start-CR to 6 months post-CR of −7.5% (−6.9%) and −14.2% (−15.5%), respectively, while relative increases in 6MWD1 (6MWD2) occurred, 5.1% (7.2%) and 8.4% (10.2%), respectively (P < .001 in all cases). Pearson correlation coefficients for 6MWD1 to TUGTT1 and TUGTT2 across all times were −0.60 and −0.68 (P < .001) and the intraclass correlations (95% CI) for the speeds derived from averaged 6MWDs and TUGTTs were 0.65 (0.54, 0.73) (P < .001). CONCLUSIONS: Similar relative changes occurred for the TUGT and the 6MWT in CR. A significant correlation between the TUGTT and 6MWD was demonstrated, and we suggest that the TUGT may provide a related or a supplementary measurement of functional capacity in CR.

Practice and Procedure : Workers Compensation and Rehabilitation Act 2003 (Qld) ss 131 and 237(1)

In Jacobs v Woolworths Limited [2010] QSC 24 Jones J was required to determine whether a worker who had lodged an application for compensation for an injury outside the time prescribed under the Workers Compensation and Rehabilitation Act 2003 (Qld) (“the Act”) was precluded from seeking common law damages for that injury. This determination depended upon the proper construction of s 131 of the Act, and what was to be understood by the words “worker who has not lodged an application for compensation for the injury” for the purpose of s 237(1)(d).

Rates of attendance at a smoking cessation clinic within a cardiac rehabilitation service

Objectives: Smoking cessation has been shown to be an important intervention for preventing cardiovascular events and improving the health of patients with heart disease. However, unaided quit attempts in these patients often leads to high rates of failure and a return to smoking. Outpatient smoking cessation clinics using face-to-face counseling, ongoing behavioral support, advice on smoking pharmacotherapy and objective monitoring, have been found to be one of the most effective interventions for improving quit smoking rates. An outpatient smoking cessation clinic was trialed within a cardiac rehabilitation service in order to explore its effects on smoking rates for patients with or at risk of heart disease. Attendance rates to the clinic were also monitored. Methods: A descriptive exploratory design was used for this newly developed clinic. Patients who currently smoked tobacco and who had a history of either coronary artery disease, heart failure, atrial fibrillation or those seen under a chest pain assessment service were invited to an outpatient ‘Cardiac Patients Smokers Clinic’. Initially patients were offered up to 10 clinic visits over a 3 month period. Follow-up clinic visits were conducted at 3, 6 and 12 months. A portable carbon monoxide meter was used to objectively measure levels of smoking and validate smoking abstinence. Primary outcomes included rates of attendance. Results: Preliminary findings showed 24 per cent of participants (N = 6) completed all their clinic visits and remained smoke free as measured by their ongoing expired carbon monoxide readings. Clinic attendance rates appeared lowest for those with significant mental health issues such as schizophrenia or substance abuse. However, rates of attendance were improved by having an administration officer make reminder telephone calls prior to clinic visits. Conclusions: Early findings indicate the feasibility of providing a specialist smoking cessation clinic within a cardiac rehabilitation service. Further, that reminder telephone calls prior to appointments improved attendance rates in patients with heart disease to this type of clinic. However, future investigations are warranted.

Reconnection : a contemporary development in cultural landscape theory contributing to rehabilitation strategies for Australian open-cut coal mining landscapes

A value-shift began to influence global political thinking in the late 20th century, characterised by recognition of the need for environmentally, socially and culturally sustainable resource development. This shift entailed a move away from thinking of ‘nature’ and ‘culture’ as separate entities – the former existing to serve the latter – toward the possibility of embracing the intrinsic worth of the nonhuman world. Cultural landscape theory recognises ‘nature’ as at once both ‘natural’, and a ‘cultural’ construct. As such, it may offer a framework through which to progress in the quest for ‘sustainable development’. This study makes a contribution to this quest by asking whether contemporary developments in cultural landscape theory can contribute to rehabilitation strategies for Australian open-cut coal mining landscapes. The answer is ‘yes’. To answer the research question, a flexible, ‘emergent’ methodological approach has been used, resulting in the following outcomes. A thematic historical overview of landscape values and resource development in Australia post-1788, and a review of cultural landscape theory literature, contribute to the formation of a new theoretical framework: Reconnecting the Interrupted Landscape. This framework establishes a positive answer to the research question. It also suggests a method of application within the Australian open-cut coal mining landscape, a highly visible exemplar of the resource development landscape. This method is speculatively tested against the rehabilitation strategy of an operating open-cut coal mine, concluding with positive recommendations to the industry, and to government.

The effect of exercise repetition on the frequency characteristics of motor output force : Implications for Achilles tendinopathy rehabilitation

Objectives: To investigate the frequency characteristics of the ground reaction force (GRF) recorded throughout the eccentric Achilles tendon rehabilitation programme described by Alfredson. Design: Controlled laboratory study, longitudinal. Methods: Nine healthy adult males performed six sets (15 repetitions per set) of eccentric ankle exercise. Ground reaction force was recorded throughout the exercise protocol. For each exercise repetition the frequency power spectrum of the resultant ground reaction force was calculated and normalised to total power. The magnitude of peak relative power within the 8-12 Hz bandwidth and the frequency at which this peak occurred was determined. Results: The magnitude of peak relative power within the 8-12 Hz bandwidth increased with each successive exercise set and following the 4th set (60 repetitions) of exercise the frequency at which peak relative power occurred shifted from 9 to 10 Hz. Conclusions: The increase in magnitude and frequency of ground reaction force vibrations with an increasing number of exercise repetitions is likely connected to changes in muscle activation with fatigue and tendon conditioning. This research illustrates the potential for the number of exercise repetitions performed to influence the tendons' mechanical environment, with implications for tendon remodelling and the clinical efficacy of eccentric rehabilitation programmes for Achilles tendinopathy.

How much is enough? The effect of exercise repetition on the force frequency characteristics of eccentric exercise used for tendinopathy rehabilitation

Introduction: Eccentric exercise (EE) is a commonly used treatment for Achilles tendinopathy. While vibrations in the 8–12 Hz frequency range generated during eccentric muscle actions have been put forward as a potential mechanism for the beneficial effect of EE, optimal loading parameters required to expedite recovery are currently unknown. Alfredson's original protocol employed 90 repetitions of eccentric loading, however abbreviated protocols consisting of fewer repetitions (typically 45) have been developed, albeit with less beneficial effect. Given that 8–12 Hz vibrations generated during isometric muscle actions have been previously shown to increase with fatigue, this research evaluated the effect of exercise repetition on motor output vibrations generated during EE by investigating the frequency characteristics of ground reaction force (GRF) recorded throughout the 90 repetitions of Alfredson's protocol. Methods: Nine healthy adult males performed six sets (15 repetitions per set) of eccentric ankle exercise. GRF was recorded at a frequency of 1000 Hz throughout the exercise protocol. The frequency power spectrum of the resultant GRF was calculated and normalized to total power. Relative spectral power was summed over 1 Hz widows within the frequency rage 7.5–11.5 Hz. The effect of each additional exercise set (15 repetitions) on the relative power within each widow was investigated using a general linear modelling approach. Results: The magnitude of peak relative power within the 7.5–11.5 Hz bandwidth increased across the six exercise sets from 0.03 in exercise set one to 0.12 in exercise set six (P < 0.05). Following the 4th set of exercise the frequency at which peak relative power occurred shifted from 9 to 10 Hz. Discussion: This study has demonstrated that successive repetitions of eccentric loading over six exercise sets results in an increase in the amplitude of motor output vibrations in the 7.5–11.5 Hz bandwidth, with an increase in the frequency of these vibrations occurring after the 4th set (60th repetition). These findings are consistent with findings from previous studies of muscle fatigue. Assuming that the magnitude and frequency of these vibrations represent important stimuli for tendon remodelling as hypothesized within the literature, the findings of this study question the role of abbreviated EE protocols and raise the question; can EE protocols for tendinopathy be optimized by performing eccentric loading to fatigue?

Radiographic projections for acute shoulder trauma: A review of current practice

A review of radiographers was undertaken to determine the specific projections currently performed for patients with acute presentation for shoulder trauma. Radiographers were asked to indicate projections they would perform for specific patient presentations. This poster presents a snapshot of the diversity of projections performed and a review of the current evidence of the most appropriate projections

Non-acute shoulder imaging: Which projections do we really need?

While Magentic Resonance Imaging and Ultrasound are used extensively for non-acute shoulder imaging, plain images are regularly required as a first investigation. This paper presents a snapshot of the diversity of projections performed and a review of the current evidence of the most appropriate projections. The projections recommended are suitable as a first investigation, and also to complement more advanced imaging.

Alternative models of cardiac rehabilitation : a systematic review

The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.

Exercise-based cardiac rehabilitation for the 21st century

Exercise-based cardiac rehabilitation (CR) is efficacious in reducing mortality and hospital admissions; however it remains inaccessible to large proportions of the patient population. Removal of attendance barriers for hospital or centre-based CR has seen the promotion of home-based CR. Delivery of safe and appropriately prescribed exercise in the home was first documented 25 years ago, with the utilisation of fixed land-line telecommunications to monitor ECG. The advent of miniature ECG sensors, in conjunction with smartphones, now enables CR to be delivered with greater flexibility with regard to location, time and format, while retaining the capacity for real-time patient monitoring. A range of new systems allow other signals including speed, location, pulse oximetry, and respiration to be monitored and these may have application in CR. There is compelling evidence that telemonitored-based CR is an effective alternative to traditional CR practice. The long-standing barrier of access to centre-based CR, combined with new delivery platforms, raises the question of when telemonitored-based CR could replace conventional approaches as the standard practice.

The acute response of tendon to loading: implications for rehabilitation

Achilles tendinopathy is a common disorder involving physically active and sedentary individuals alike. Although the processes underlying its development are poorly understood, tendinopathy is widely regarded as an ‘overuse’ injury in which the tendon fails to adapt to prevalent loading conditions. Paradoxically, there is emerging evidence that heavy eccentric loading of the Achilles tendon may be an effective conservative approach for treatment of tendinopathy, with success rates of 60–80% reported. Interestingly, loading exercises involving other forms of muscle action, such as concentric activation, have been shown to be less effective treatment options. However, little is known about the acute response of tendon to exercise at present, and there are few plausible explanatory mechanisms for the observed beneficial effects of eccentric exercise, as opposed to other forms of strain stimuli. This paper presents the findings from a series of experiments undertaken to evaluate the effect of various strain stimuli on the time-dependent response of human Achilles tendon in vivo. It was shown for the first time, that heavy resistive ankle plantarflexion/ dorsiflexion exercises induced an immediate and significant decrease in Achilles tendon thickness (~15%). While thickness returned to pre-exercise levels within 24 hours, the recovery was exponential, with primary recovery occurring in less than 6 hours post-exercise. We proposed that such a diametral strain response with tensile loading reflects collagen realignment, Poison’s effects and radial extrusion of water from the tendon core. With unloading, the recovery of tendon dimensions likely reflects the re-diffusion of water via osmotic and/or inflammatory driven processes. Interestingly, prolonged walking was found to induce a similar diametral strain response. In subsequent studies, we demonstrated that eccentric exercise resulted in a greater reduction (-21%) in Achilles tendon thickness than isolated concentric exercise alone (-5%), despite a similar loading impulse. These novel findings, coupled with observations of a reduced diametral strain response with tendon pathology, highlight the importance of fluid movement to tendon function, nutrition and health. They also provide new insights into potential mechanisms underlying Achilles tendinopathy that impact rehabilitation strategies.

Against Rehabilitation; For Reparitive Justice

The difficulties of re-imagining the possible relationships between crime and justice in capitalist societies, and imagining the possible meanings of democracy in societies characterised by gross inequalities of knowledge, and exclusion of the majority from political decisions are well known. One such difficulty stems from the impossible necessity of maintaining stances of both constant reform and constant critique (see Carlen, 2012). Confronted with economic and cultural inequalities which routinely deny ideals of justice and democracy, there can be a temptation to suppress (or bracket-off) troubling knowledge of criminal justice's and democracy's maligned underbellies and instead talk 'as if' criminal justice's ideal play of governance is always and already realised in its rhetoric. In some senses, this 'as if' talk is aspirational and it is difficult to see how it could be otherwise if more just conceptions of criminal justice and more democratic forms of democracy are to be conceived. However, when, as often happens, aspirational criminal justice concepts become routinised and acted upon as if they can be realised without fundamental social change, they become penal imaginaries, part of a taken-for-granted ideological baggage which, because it is taken-for-granted, obstructs critique (see Carlen, 2008). One such penal imaginary is the concept of rehabilitation, a concept which has a long history of justifying almost every kind of non-lethal response to lawbreaking and which is currently being reborn yet again in theories of criminal desistance and anti-prison campaigns as well as in the more invidious rehabilitation industry with its sales of programmes for cognitive reform.

Hyperelastic constitutive relationship for the strain-rate dependent behavior of shoulder and other joint cartilages

Non-linear finite deformations of articular cartilages under physiological loading conditions can be attributed to hyperelastic behavior. This paper contains experimental results of indentation tests in finite deformation and proposes an empirical based new generalized hyperelastic constitutive model to account for strain-rate dependency for humeral head cartilage tissues. The generalized model is based on existing hyperelastic constitutive relationships that are extensively used to represent biological tissues in biomechanical literature. The experimental results were obtained for three loading velocities, corresponding to low (1x10-3 s-1), moderate and high strain-rates (1x10-1 s-1), which represent physiological loading rates that are experienced in daily activities such as lifting, holding objects and sporting activities. Hyperelastic material parameters were identified by non linear curve fitting procedure. Analysis demonstrated that the material behavior of cartilage can be effectively decoupled into strain-rate independent(elastic) and dependent parts. Further, experiments conducted using different indenters indicated that the parameters obtained are significantly affected by the indenter size, potentially due to structural inhomogeneity of the tissue. The hyperelastic constitutive model developed in this paper opens a new avenue for the exploration of material properties of cartilage tissues.

High risk feet in subacute rehabilitation facilities : how many are there?

Background Australian subacute rehabilitation facilities face significant challenges from the ageing population with increased burden of chronic disease. High risk foot complications are a negative consequence of many chronic diseases. With the rapid expansion of subacute services, it seems imperative to investigate the prevalence of foot complications in this population. The primary aim of this study was to quantify the high risk foot complication prevalence in a subacute rehabilitation population. Methods Eligible participants were all adults admitted overnight, over two 4 week periods, into a large Australian subacute rehabilitation facility. Consenting participants underwent a short non-invasive foot examination by a podiatrist. The standard Queensland Health High Risk Foot Form collected data on age, sex, co-morbidities and foot complications. Descriptive statistics, logistic regression and odds ratios were used to determine the prevalence of foot complications and associations with explanatory variables. Results Overall, 85 of 97 eligible participants consented; mean age 80(9) and 71% were female. At least one foot complication was present in 56.5% participants; including 21.2% defined as high risk and 11.8% current foot ulcer. A previous diagnosis of neuropathy increased the risk of presenting with a high risk foot by 13-fold (OR 13.504, p = 0.001). Conclusion This study highlights the significance of foot complications in the subacute population. It appears that one in every two patients present with a foot complication and one in eight with a foot ulcer. It is suggested all patients admitted to subacute rehabilitation services should be screened for foot complications.