A programme of static positional stretches does not reduce hemiplegic shoulder pain or maintain shoulder range of motion - a randomized controlled trial

Objective: To evaluate the effectiveness of a programme of static positional stretches and positioning of the stroke-affected shoulder for maintaining shoulder external rotation and decreasing hemiplegic shoulder pain. Design: Randomized controlled trial with pretest and posttest design. Setting: Inpatient rehabilitation unit. Subjects: Thirty-two participants ( 17 treatment, 15 comparison) with a first time stroke who were admitted for rehabilitation. Interventions: Treatment participants completed a programme of static positional stretches of the stroke-affected shoulder twice daily and positioned the stroke-affected upper limb in an armrest support at all other times when seated. Main measures: The main outcome measures were pain-free range of motion into external rotation, pain in the stroke-affected shoulder at rest and with movement, motor recovery and functional independence. Results: All participants demonstrated a significant loss of external rotation ( P = 0.005) with no significant group differences. All participants demonstrated a significant improvement in motor recovery ( P < 0.01) and functional independence ( P < 0.01) with no significant group differences. There were no significant effects for pain. The comparison group recorded a decrease in mean pain reported with movement from admission to discharge, and the treatment group recorded an increase. Conclusions: Participation in the management programme did not result in improved outcomes. The results of this study do not support the application of the programme of static positional stretches to maintain range of motion in the shoulder. The effect of increasing pain for the treatment group requires further investigation.

Control of posture and stability of the double-joint (Shoulder/Elbow) arm

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Control of posture and stability of the double-joint (Shoulder/Elbow) arm

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Effects of a resistance and stretching training program on forward head and protracted shoulder posture in physical education classes in students aged 15-17 years old

Purpose: This study aimed to characterize the postural alignment of the head and shoulder in the sagittal plane of Portuguese adolescents, 15-17 years old, and to evaluate the effects of a 32-week resistance and stretching training program applied in Physical Education classes on forward head posture and protracted shoulder posture of Portuguese adolescents. After 32-training weeks the detraining effects after a 16-week period were measured. Methods: This randomized and controlled study was conducted in two secondary schools in Portugal for 48 weeks. Prior the study 275 students aged 15-17 years old were evaluated. Sagittal head, cervical and shoulder angle were measured with photogrammetry and Postural Analysis Software. After this assessment 130 adolescents were considered to have forward head and protracted shoulder posture and were randomly assigned to a control group, an experimental group one or experimental group two. The control group (n=46) only did the Physical Education classes whereas the intervention group one (n=42) and two (n=42) performed a 16-week and 32-week stretching and strengthening program in addition to Physical Education classes, respectively. The postural angles were measured before and after the 16-week and 32-week time intervention period for the three groups and after a 16-week detraining period following the 32-week in intervention group two. Results: 68% of the adolescents studied revealed anteriorization of the head whereas 58% of them had protraction of the shoulder. Significant increases were observed in the cervical and shoulder angle in the experimental group (n=84) following the 16-week and in experimental group two (n=42)after the 32 week-intervention period. After the 16-week detraining period no significant differences were observed in the three postural angles in the intervention group two. Conclusions: Forward head and protracted shoulder are common postural disorders in Portuguese adolescents. The exercise intervention was successful ate decreasing forward head and protracted shoulder in adolescents. Detraining period of 16-week didn´t reduce the overall training effects.

Does an In-Season Detraining Period Affect the Shoulder Rotator Cuff Strength and Balance of Young Swimmers?

Aims: To compare the physical activity, sedentary activity and health-related quality of life (HRQoL) in institutionalized vs. non-institutionalized elderly, and to establish a pattern of relationship and prediction of physical and sedentary activity with physical and mental components of HRQoL. Methods: The sample consisted of 383 elderly with ≥ 75 years old (n=187 institutionalized and n=196 non-institutionalized). Were administered the International Physical Activity Questionnaire (IPAQ) and Short Form 36 Health Survey (SF-36) for evaluated the physical and sedentary activity and HRQoL. Also was used the Mini Mental State Examination (MMSE) as exclusion criteria for cognitive problems in the elderly. Results: Differences between institutionalized and non-institutionalized elderly were found in moderate-intensity activities and walking, a favour of non-institutionalized. The institutionalized elderly remain more minutes in sedentary activity. Also, were observed differences between both groups in physical component of HRQoL, a favour of non-institutionalized elderly. The mental component remained unchanged. The multivariate regression analyses showed that physical activity predicted the physical (8 to 12%) and mental (5 to 8%) components of HRQoL for institutionalized and non-institutionalized elderly. Conclusions: Non-institutionalized elderly were more physically active, spent less time in sedentary activity and showed better perception physical component of HRQoL that institutionalized elderly. An important and encouraging result of this study was that physical activity is a predictor of improved physical and mental component of HRQoL for institutionalized and non-institutionalized elderly.

Shoulder kinematic evaluation in patients with rotator cuff tears using inertial and magnetic sensors.

Questo progetto di tesi fa parte di un più ampio studio clinico condotto all’interno dell’azienda NCS Lab (Carpi,(MO)), in collaborazione con il Dr. Claudio Chillemi (ICOT, Latina (RM)) che mira ad eseguire un confronto tra diverse tecniche chirurgiche per la riparazione della cuffia dei rotatori. Lo studio clinico in questione durerà circa due anni: per questo motivo i dati analizzati in questo progetto di tesi provengono solo dal gruppo di pazienti acquisiti nella fase preoperatoria. Tutti i dati sono stati acquisiti utilizzando i sensori magneto-inerziali WISE (tecnologia proprietaria dell’azienda NCS Lab). Questo lavoro di tesi si propone, quindi, di valutare la ripetibilità del movimento in termini di coefficiente di correlazione multipla e di estrapolare alcuni parametri di interesse clinico come, ad esempio, i range di movimento (ROM) della scapola e dell’omero e il ritmo scapolo-omerale (SHR). Questi parametri sono stati poi caratterizzati da un punto di vista statistico al fine di valutare le differenze tra arto patologico e controlaterale. Sono state calcolate, inoltre, le prediction bands con lo scopo di descrivere le differenze tra arto patologico e controlaterale nella coordinazione scapolo-omerale dei pazienti. Per quanto riguarda la ripetibilità del movimento, i risultati ottenuti in questo lavoro di tesi mostrano che la rotazione medio-laterale è caratterizzata da un eccellente CMC sia per l'arto patologico che per il controlaterale. Inoltre, sono state riscontrate differenze significative dal punto di vista statistico tra le distribuzioni dei range di movimento dell'arto patologico e controlaterale. Tali differenze sono state trovate anche per quanto riguarda il ritmo scapolo-omerale.

A medical imaging-based approach for total shoulder replacement

Ogni anno in Italia, migliaia di protesi convenzionali vengono impiantate con successo in pazienti affetti da artrosi alla spalla, tuttavia è stato dimostrato che questa tipologia di protesi non funziona in quei pazienti che soffrono contemporaneamente anche di grandi lesioni alla cuffia dei rotatori, ricorrendo successivamente a un impianto di protesi di spalla inversa. La scelta sul miglior tipo di protesi da parte del chirurgo è quindi fondamentale e necessaria per evitare futuri stress e operazioni al paziente. Nel corso degli anni si è fatto affidamento a protocolli che non considerano in maniera specifica la componente tissutale ossea. In questa tesi si cerca di dimostrare che attraverso l’utilizzo delle immagini mediche è possibile ricavare dati e grafici specifici sulla componente ossea del paziente per ottimizzare poi la scelta della protesi da parte del chirurgo e la fase pre/intra operatoria.