Prospective Evaluation of Clinical and Ultrasound Findings in Ankle Disease in Juvenile Idiopathic Arthritis: Importance of Ankle Ultrasound

Objective. To prospectively compare clinical examination of the ankle structures with ultrasound (US) findings. Methods. In 42 children with juvenile idiopathic arthritis (JIA; 25 girls, 17 boys, mean age 11.3 yrs, range 2.3–22.3 yrs), a total of 61 swollen/painful ankles were assessed clinically and ultrasonographically. Accurate clinical examination of the entire ankle joint was performed, focusing especially on 3 regions — tibiotalar joint and medial and lateral tendons. Clinical and US findings were both scored 0–3 (normal-severe). Results. US demonstrated no signs of tibiotalar joint effusion in 14 out of 43 ankles considered clinically involved. For the medial tendons, US showed tenosynovitis in 13 ankles out of 31 thought to be clinically normal; and for the lateral tendons, of the 19 deemed to be clinically involved, less than 50% had involvement on US. Very poor agreement was observed comparing the clinical and US scores for the 3 regions: tibiotalar joint, kappa = 0.3; medial tendons, kappa = 0.24; lateral tendons, kappa = 0.25. With regard to other ankle structures, only 39% of the subtalar (talocalcaneal) joints considered clinically involved were deemed abnormal on US. Finally, of the 10 ankles with talonavicular US effusion, only 2 were considered clinically involved. Conclusion. Using US findings as the “gold standard,” clinical examination of the ankle in children with JIA was found to be inadequate in identifying the structures involved. US assessment prior to any glucocorticoid injection should be considered to improve the outcome. A prospective study comparing the outcome following clinical- versus US-guided ankle joint injection should be undertaken, to confirm our findings.

The influence of water motion on the growth rate of the kelp Laminaria digitata

The shallow water kelp Laminaria digitata, abundant in coastal zones of the North Atlantic, is exposed to a range of hydrodynamic environments that makes it ideal for assessing the role of water motion on their growth rate. Here we quantify the growth of L. digitata, as a factor of blade and stipe elongation, at sites adjacent to Strangford Lough, Northern Ireland under different hydrodynamic conditions over a one year period. A modelling approach was used to numerically determine both the temporal and spatial variability of the hydrodynamic environment. Ambient seawater nutrient concentrations, temperature and irradiance were measured as well as the internal nutrient status of the L. digitata populations. Kelp populations growing in the greatest and lowest water motion showed the lowest growth rates. Differences observed in growth rate could not be attributed to seawater nutrient availability, temperature or light. The internal nutrient status also suggested no influence on the observed differences in growth rate. Therefore if there are minimal differences in light, temperature and nutrients between sites, then populations of L. digitata exposed to different water motions are likely to exhibit different growth rates. It is suggested that the growth rate differences observed were a function of water motion with the possibility that, in response to the hydrodynamic forces experienced by the algal cells, L. digitata kelps in the high energy environments were putting more energy into strengthening cell walls rather than blade elongation

Slow and Smooth: A Bayesian Theory for the Combination of Local Motion Signals in Human Vision

In order to estimate the motion of an object, the visual system needs to combine multiple local measurements, each of which carries some degree of ambiguity. We present a model of motion perception whereby measurements from different image regions are combined according to a Bayesian estimator --- the estimated motion maximizes the posterior probability assuming a prior favoring slow and smooth velocities. In reviewing a large number of previously published phenomena we find that the Bayesian estimator predicts a wide range of psychophysical results. This suggests that the seemingly complex set of illusions arise from a single computational strategy that is optimal under reasonable assumptions.

Influence of posture on the range of axial rotation and coupled lateral flexion of the thoracic spine

Objective
This study examines the influence of posture on the range of axial rotation of the thorax and the range and direction of the coupled lateral flexion.

Methods
The ranges of mid thoracic axial rotation and coupled lateral flexion were measured in 52 asymptomatic subjects (aged 18-43 years) using an optical motion analysis system. To examine the influence of posture on primary and coupled motion, we initiated axial rotation from a neutral sitting posture and from end-range thoracic flexion and extension.

Results
There was a significant decrease in the range of thoracic rotation in flexion compared with the neutral and extended postures (P < .001). The mean range of coupled lateral flexion was 8.9% of the axial rotation range in the neutral posture and increased to 14.3% and 23.2% in the extended and flexed postures, respectively. Patterns of coupled motion varied between subjects, but an ipsilateral pattern was more common in the flexed posture, whereas a contralateral pattern was more common in the neutral and extended postures.

Conclusions
The ranges and patterns of coupled motion of the thorax appear to be strongly influenced by the posture from which the movement is initiated. This has important implications in relation to the interpretation of clinical tests of thoracic motion and in consideration of mechanisms of development of thoracic pain disorders.

Functional range of movement of the hand : declination angles to reachable space

 The measurement of the range of hand joint movement is an essential part of clinical practice and rehabilitation. Current methods use three finger joint declination angles of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints. In this paper we propose an alternate form of measurement for the finger movement. Using the notion of reachable space instead of declination angles has significant advantages. Firstly, it provides a visual and quantifiable method that therapists, insurance companies and patients can easily use to understand the functional capabilities of the hand. Secondly, it eliminates the redundant declination angle constraints. Finally, reachable space, defined by a set of reachable fingertip positions, can be measured and constructed by using a modern camera such as Creative Senz3D or built-in hand gesture sensors such as the Leap Motion Controller. Use of cameras or optical-type sensors for this purpose have considerable benefits such as eliminating and minimal involvement of therapist errors, non-contact measurement in addition to valuable time saving for the clinician. A comparison between using declination angles and reachable space were made based on Hume's experiment on functional range of movement to prove the efficiency of this new approach.

Intra-articular pressure profiles of the cadaveric equine fetlock joint in motion

The study of the influence of motion and initial intra-articular pressure (IAP) on intra-articular pressure profiles in equine cadaver metatarsophalangeal (MTP) joints was undertaken as a prelude to in vivo studies, Eleven equine cadaver MTP joints were submitted to 2 motion frequencies of 5 and 10 cycles/min of flexion and extension, simulating the condition of lower and higher (double) rates of passive motion. These frequencies were applied and pressure profiles generated with initial normal intra-articular pressure (-5 mmHg) and subsequently 30 mmHg intra-articular pressure obtained by injection of previously harvested synovial fluid.The 4 trials performed were 1) normal IAP; 5 cyles/min; 2) normal IAP; 10 cycles/min; 3) IAP at 30 mmHg; 5 cycles/min and 4) IAP at 30 mmHg; 10 cycles/min. The range of joint motion applied (mean +/- s.e.) was 67.6 +/- 1.61 degrees with an excursion from 12.2 +/- 1.2 degrees in extension to 56.2 +/- 2.6 degrees in flexion, Mean pressure recorded in mmHg for the first and last min of each trial, respectively, were 1) -5.7 +/- 0.9 and -6.3 +/- 1.1; 2) -5.3 +/- 1.1 and -6.2 +/- 1.1; 3) 58.8 +/- 8.0 and 42.3 +/- 7.2; 4) 56.6 +/- 3.7 and 40.3 +/- 4.6. Statistical analyses showed a trend for difference between the values for the first and last minute in trial 3 (0.05>P<0.1) with P = 0.1 and significant difference (P = 0.02) between the mean IAP of the first and last min in trial 4. The loss of intra-articular pressure associated with time and motion was 10.5, 16.9, 28.1 and 28.9% for trials 1-4, respectively. As initial intraarticular pressure and motion increased, the percent loss of intra-articular pressure increased.The angle of lowest pressure was 12.2 +/- 1.2 (mean +/- s.e.) in extension in trials 1 and 2, In trials 3 and 4, the lowest pressures were obtained in flexion with the joints at 18.5 +/- 2.0 degrees (mean +/- s.e.). This demonstrated that the joint angle of least pressure changed as the initial intra-articular pressure changed and there would not be a single angle of least pressure for a given joint.The volume of synovial fluid recovered from the MTP joints in trial 3 compared to 4 (trials in which fluid was injected to attain IAP of 30 mmHg) was not significantly different, supporting a soft tissue compliance change as a cause for the significant loss of intra-articular pressure during the 15 min of trial 4.The pressure profiles generated correlate well with in vivo values and demonstrated consistent pressure profiles. Our conclusions are summarised as follows:1. Clinically normal equine MTP joints which were frozen and then later thawed were found to have mostly negative baseline intra-articular pressures, as would be expected in living subjects,2. Alternate pressure profiles of the dorsal and plantar pouch at baseline intra-articular pressure document the presence of pressure forces that would support 'back and forth' fluid movement between joint compartments. This should result in movement of joint fluid during motion, assisting in lubrication and nutrition of articular cartilage,3. If joint pressure was initially greater than normal (30 mmHg), as occurs in diseased equine MTP joints, joint motion further increased joint capsule relaxation (compliance) and, therefore, reduced intra-articular pressure.4. Peak intra-articular pressures reached extremely high values (often >100 mmHg) in flexion when initial pressure was 30 mmHg. Joint effusion pressures recorded for clinical MCP joints are frequently 30 mmHg. These IAP values are expected to produce intermittent synovial ischaemia in clinical cases during joint flexion.5, Additional in vivo studies are necessary to confirm our conclusions from this study and to identify the contributions of fluid absorption and the presence of ischaemia in a vascularised joint.

Coordination of spinal motion in the transverse and frontal planes during walking in people with and without recurrent low back pain

STUDY DESIGN. Observational cohort study. OBJECTIVE. To investigate spinal coordination during preferred and fast speed walking in pain-free subjects with and without a history of recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA. Dynamic motion of the spine during walking is compromised in the presence of back pain (LBP), but its analysis often presents some challenges. The coexistence of significant symptoms may change gait because of pain or adaptation of the musculoskeletal structures or both. A history of LBP without the overlay of a current symptomatic episode allows a better model in which to explore the impact on spinal coordination during walking. METHODS. Spinal and lower limb segmental motions were tracked using electromagnetic sensors. Analyses were conducted to explore the synchrony and spatial coordination of the segments and to compare the control and subjects with LBP. RESULTS. We found no apparent differences between the groups for either overall amplitude of motion or most indicators of coordination in the lumbar region; however, there were significant postural differences in the mid-stance phase and other indicators of less phase locking in controls compared with subjects with LBP. The lower thoracic spinal segment was more affected by the history of back pain than the lumbar segment. CONCLUSION. Although small, there were indicators that alterations in spinal movement and coordination in subjects with recurrent LBP were due to adaptive changes rather than the presence of pain. © 2013, Lippincott Williams & Wilkins.

Combining 3D tracking and surgical instrumentation to determine the stiffness of spinal motion segments: a validation study

The spine is a complex structure that provides motion in three directions: flexion and extension, lateral bending and axial rotation. So far, the investigation of the mechanical and kinematic behavior of the basic unit of the spine, a motion segment, is predominantly a domain of in vitro experiments on spinal loading simulators. Most existing approaches to measure spinal stiffness intraoperatively in an in vivo environment use a distractor. However, these concepts usually assume a planar loading and motion. The objective of our study was to develop and validate an apparatus, that allows to perform intraoperative in vivo measurements to determine both the applied force and the resulting motion in three dimensional space. The proposed setup combines force measurement with an instrumented distractor and motion tracking with an optoelectronic system. As the orientation of the applied force and the three dimensional motion is known, not only force-displacement, but also moment-angle relations could be determined. The validation was performed using three cadaveric lumbar ovine spines. The lateral bending stiffness of two motion segments per specimen was determined with the proposed concept and compared with the stiffness acquired on a spinal loading simulator which was considered to be gold standard. The mean values of the stiffness computed with the proposed concept were within a range of ±15% compared to data obtained with the spinal loading simulator under applied loads of less than 5 Nm.

Oscillometric measurement of ankle-brachial index in patients with suspected peripheral disease: comparison with Doppler method

QUESTION UNDER STUDY: Purpose was to validate accuracy and reliability of automated oscillometric ankle-brachial (ABI) measurement prospectively against the current gold standard of Doppler-assisted ABI determination. METHODS: Oscillometric ABI was measured in 50 consecutive patients with peripheral arterial disease (n = 100 limbs, mean age 65 +/- 6 years, 31 men, 19 diabetics) after both high and low ABI had been determined conventionally by Doppler under standardised conditions. Correlation was assessed by linear regression and Pearson product moment correlation. Degree of inter-modality agreement was quantified by use of Bland and Altman method. RESULTS: Oscillometry was performed significantly faster than Doppler-assisted ABI (3.9 +/- 1.3 vs 11.4 +/- 3.8 minutes, P <0.001). Mean readings were 0.62 +/- 0.25, 0.70 +/- 0.22 and 0.63 +/- 0.39 for low, high and oscillometric ABI, respectively. Correlation between oscillometry and Doppler ABI was good overall (r = 0.76 for both low and high ABI) and excellent in oligo-symptomatic, non-diabetic patients (r = 0.81; 0.07 +/- 0.23); it was, however, limited in diabetic patients and in patients with critical limb ischaemia. In general, oscillometric ABI readings were slightly higher (+0.06), but linear regression analysis showed that correlation was sustained over the whole range of measurements. CONCLUSIONS: Results of automated oscillometric ABI determination correlated well with Doppler-assisted measurements and could be obtained in shorter time. Agreement was particularly high in oligo-symptomatic non-diabetic patients.

Abdominal muscle recruitment during a range of voluntary exercises

Various exercises are used to retrain the abdominal muscles in the management of low back pain and other musculoskeletal disorders. However. few studies have directly investigated the activity of all the abdominal muscles or the recruitment of regions of the abdominal muscles during these manoeuvres. This study examined the activity of different regions of transversus abdominis (TrA), obliquus internus (OI) and externus abdominis (OE), and rectus abdominis (RA), and movement of lumbar spine, pelvis and abdomen during inward movement of the lower abdominal wall, abdominal bracing, pelvic tilting, and inward movement of the lower and upper abdominal wall. Inward movement of the lower abdominal wall in supine produced greater activity of TrA compared to OI. OE and RA. During posterior pelvic tilting. middle OI was most active and with abdominal bracing. OE was predominately recruited. Regions of TrA were recruited differentially and in inverse relationship between lumbopelvic motion and TrA electromyography (EMG) was found. This study indicates that inward movement of the abdominal wall in supine produces the most independent activity of TrA relative to the other abdominal muscle, recruitment varies between regions of TrA, and observation of abdominal and lumbopelvic motion may assist in evalation of exercise performance. (c) 2004 Elsevier Ltd. All rights reserved.

Digital storytelling, podcasts, blogs and vlogs : exploring a range of new media texts and forms in English

Curriculum initiatives in Australia emphasise the use of technologies and new media in classrooms. Some English teachers might fear this deployment of technologies because we are not all ‘digital natives’ like our students. If we embrace new media forms such as podcasts, blogs, vodcasts, and digital stories, a whole new world of possibilities open up for literary response and recreative texts, with new audiences and publication spaces. This article encourages English teachers to embrace these new digital forms and how shows we can go about it.

A brush with the real world : the future of inertial motion capture in live performance

3D Motion capture is a medium that plots motion, typically human motion, converting it into a form that can be represented digitally. It is a fast evolving field and recent inertial technology may provide new artistic possibilities for its use in live performance. Although not often used in this context, motion capture has a combination of attributes that can provide unique forms of collaboration with performance arts. The inertial motion capture suit used for this study has orientation sensors placed at strategic points on the body to map body motion. Its portability, real-time performance, ease of use, and its immunity from line-of-sight problems inherent in optical systems suggest it would work well as a live performance technology. Many animation techniques can be used in real-time. This research examines a broad cross-section of these techniques using four practice-led cases to assess the suitability of inertial motion capture to live performance. Although each case explores different visual possibilities, all make use of the performativity of the medium, using either an improvisational format or interactivity among stage, audience and screen that would be difficult to emulate any other way. A real-time environment is not capable of reproducing the depth and sophistication of animation people have come to expect through media. These environments take many hours to render. In time the combination of what can be produced in real-time and the tools available in a 3D environment will no doubt create their own tree of aesthetic directions in live performance. The case study looks at the potential of interactivity that this technology offers.

Enhancing the standard operating range of a placido disk videokeratoscope for corneal surface estimation

Abstract—Corneal topography estimation that is based on the Placido disk principle relies on good quality of precorneal tear film and sufficiently wide eyelid (palpebral) aperture to avoid reflections from eyelashes. However, in practice, these conditions are not always fulfilled resulting in missing regions, smaller corneal coverage, and subsequently poorer estimates of corneal topography. Our aim was to enhance the standard operating range of a Placido disk videokeratoscope to obtain reliable corneal topography estimates in patients with poor tear film quality, such as encountered in those diagnosed with dry eye, and with narrower palpebral apertures as in the case of Asian subjects. This was achieved by incorporating in the instrument’s own topography estimation algorithm an image processing technique that comprises a polar-domain adaptive filter and amorphological closing operator. The experimental results from measurements of test surfaces and real corneas showed that the incorporation of the proposed technique results in better estimates of corneal topography, and, in many cases, to a significant increase in the estimated coverage area making such an enhanced videokeratoscope a better tool for clinicians.

Reading the play : adaptation by prediction of agent motion

An adaptive agent improves its performance by learning from experience. This paper describes an approach to adaptation based on modelling dynamic elements of the environment in order to make predictions of likely future state. This approach is akin to an elite sports player being able to “read the play”, allowing for decisions to be made based on predictions of likely future outcomes. Modelling of the agent‟s likely future state is performed using Markov Chains and a technique called “Motion and Occupancy Grids”. The experiments in this paper compare the performance of the planning system with and without the use of this predictive model. The results of the study demonstrate a surprising decrease in performance when using the predictions of agent occupancy. The results are derived from statistical analysis of the agent‟s performance in a high fidelity simulation of a world leading real robot soccer team.