Search Results (409)

After a fracture, patients have reduced willingness to bend and extend their elbow joint due to pain, resulting in muscle atrophy, contracture, and stiffness around the elbow. Moreover, this may lead to progressive atrophy of the muscles around the elbow, resulting in permanent functional loss. Currently, a goniometer is used to measure the range of motion, ROM, to evaluate the recovery of the affected limb. However, the measurement process can cause measurement errors ranging from 4 to 5 degrees due to unskilled operation or inaccurate placement, leading to inaccurate judgments of the recovery of the affected limb. In addition, the current measurement methods do not include an assessment of muscle endurance. In this paper, the proposed device combines image recognition and a myoelectric signal sensor to measure the joint movement angle and muscle endurance. The movement angle of the elbow joint is measured using image recognition. Muscle endurance is measured using the myoelectric signal sensor. The measured data are transmitted to a cloud database via an app we have proposed to help medical staff track a patient’s recovery status. The average error value of static image recognition and verification is up to 0.84 degrees. The average error value of dynamic image recognition and verification is less than 1%. The average error of total harmonic distortion (THD) verified by the myoelectric signal sensor is less than ±3%. It was proven that our system could be applied to measuring elbow joint range of motion. Since this is pilot research, most of the measurement subjects are healthy people without dysfunction in arm movement, and it is difficult to observe differences in the measurement results. In the future, experiments will be conducted on patients with elbow fractures through the IRB. This is expected to achieve the effect of encouraging patients to be actively rehabilitated at home through their measurement data and images of their actions being displayed in real time using our cheap and compact device and app. Full article

Background: The elbow joint is stabilized by complex interactions between bony structures and soft tissues, notably the lateral and medial collateral ligaments. Posterolateral rotatory instability (PLRI), a form of elbow instability, is challenging to diagnose due to overlapping symptoms with other conditions. The radiocapitellar line (RCL) is a radiographic tool for assessing humeroradial alignment and elbow stability, but its diagnostic accuracy remains debated. This study aims to provide normative data on RCL deviations in healthy individuals to improve diagnostic criteria for PLRI. Methods: A prospective study was conducted with 53 healthy individuals (27 males, 26 females) aged 18–45 years. MRI scans of the participants’ elbows were performed in maximum extension and supination to assess radiocapitellar deviations (RCDs). Two orthopedic surgeons independently analyzed the images to evaluate RCDs and assess interobserver reliability. Statistical analyses, including independent t-tests and Pearson correlations, were used to explore the relationship between RCDs, demographic factors, and elbow stability. Results: The average RCD in the cohort was 1.77 mm (SD 1.06 mm). Notably, 62.9% of participants had deviations greater than 1.2 mm, while 12.9% exceeded 3.4 mm, thresholds traditionally used to diagnose PLRI. Gender and age did not significantly influence RCD values. The interobserver reliability was almost good (ICC = 0.87), supporting the consistency of the RCL measurements. Conclusions: Significant RCDs occur even in asymptomatic individuals, challenging the current diagnostic thresholds for PLRI based solely on RCL measurements. A comprehensive assessment that includes clinical, anatomical, and functional evaluations is essential for accurate diagnosis. These findings highlight the need for refined diagnostic criteria and further research into elbow stability. Full article

The main challenges in smart home systems and cyber-physical systems come from not having enough data and unclear interpretation; thus, there is still a lot to be done in this field. In this work, we propose a practical approach called Discrete Human Activity Recognition (DiscHAR) based on prior research to enhance Human Activity Recognition (HAR). Our goal is to generate diverse data to build better models for activity classification. To tackle overfitting, which often occurs with small datasets, we generate data and convert them into discrete forms, improving classification accuracy. Our methodology includes advanced techniques like the R-Frame method for sampling and the Mixed-up approach for data generation. We apply K-means vector quantization to categorize the data, and through the elbow method, we determine the optimal number of clusters. The discrete sequences are converted into one-hot encoded vectors and fed into a CNN model to ensure precise recognition of human activities. Evaluations on the OPP79, PAMAP2, and WISDM datasets show that our approach outperforms existing models, achieving 89% accuracy for OPP79, 93.24% for PAMAP2, and 100% for WISDM. These results demonstrate the model’s effectiveness in identifying complex activities captured by wearable devices. Our work combines theory and practice to address ongoing challenges in this field, aiming to improve the reliability and performance of activity recognition systems in dynamic environments. Full article

Background: The presence of sensorimotor control deficits in adolescent idiopathic scoliosis compared to typically developed adolescents is supported by the literature but lacks reliability studies for assessment in this population. This study aimed to assess the reliability of eight sensorimotor control tests, in terms of static and dynamic balance, joint position sense (JPS) tests of the extremities and the spine, and a functional upper extremity proprioceptive test in adolescent idiopathic scoliosis subjects. Methods: Sixty adolescent idiopathic scoliosis subjects were divided into four groups. Each group underwent two tests by the same examiner, repeated at 15 min intervals. Reliability was measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD). Results: The results showed high reliability for the upper extremity functional proprioception test, for the dynamic and static balance test, and for the spinal lateral flexion joint position sense test in both directions. On the other hand, the shoulder external rotation, knee extension, elbow flexion, and spinal flexion joint position sense tests demonstrated poor reliability in adolescent idiopathic scoliosis subjects. Conclusions: Therapists are recommended to use the functional upper extremity proprioception test, the Fukuda test, the static balance test using a force footplate, and the spinal lateral flexion joint position sense test for assessing treatment progress in this population. Full article

Background: The management of residual elbow instability is a challenging and compelling issue for treating physicians. To overcome inherent drawbacks of dynamic external fixators, the internal joint stabilizer (IJS) has been developed, achieving successful results, but it can sometimes cause local tenderness or anesthetic concerns in the subcutaneous layer. In addition, a bulky anconeus can pull the hardware away from the axis of rotation with an increase in the lever arm and potential issues. To address these issues, an alternative approach has been recently described in which the internal device is covered by the anconeus muscle, becoming submuscular, rather than subcutaneous. The aim of this study was to evaluate the effectiveness of this alternative approach to the IJS application in maintaining a concentric elbow during and after device removal in both acute and chronic scenarios. Methods: Prospective data collection was performed with consecutive patients who had residual elbow instability treated with an IJS (Skeletal Dynamics, Miami, FL) covered by the anconeus from January 2022 and with a minimum follow-up of 12 months. Results: At a medium follow-up of 16 months, the 16 patients selected had a mean arc of flexion–extension of 123° (range: 0–140°) and a mean pronation-supination arc of 150° (range: 80–80°). The mean MEPS and DASH scores were 90.3 ± 6.2 and 6.3 ± 5.3, respectively. At the last follow-up, elbow stability and concentric reduction were confirmed with radiographic and clinical examinations. Conclusions: With a minimum follow-up of 12 months, the present study supports the safety and efficacy of the internal device in a submuscular layer. The clinical outcomes and the rate of recurrent instability are comparable to those achieved with a classic subcutaneous position. Similarly, the complication rate is not affected, and removal surgery is no more aggressive than the classic approach. Full article

Background: Lateral epicondylitis impacts 1–3% of the population. It affects nearly half of all tennis players, primarily due to repetitive forearm muscle use leading to pain at the lateral elbow, particularly at the extensor carpi radialis brevis tendon. While conservative treatments resolve most cases, 4–11% of patients with persistent pain require surgery. Tenotomy is the gold standard for repair, but the research comparing the benefits of specific types of tenotomies (open, arthroscopic, percutaneous, ultrasonically assisted, and Tenex forms) is lacking. Methods: PubMed and Embase searches were conducted for articles focused on four tenotomy techniques. The inclusion criteria allowed for the use of randomized controlled trials (RCTs), prospective cohort studies, and comparative observational studies, while the exclusion criteria excluded meta-analyses. Following the PRISMA guidelines, the initial search resulted in 2327 articles. Once the inclusion and exclusion criteria were applied, 1702 articles underwent abstract screening. Finally, 232 articles proceeded to full-text screening, resulting in 37 articles undergoing data extraction. Results: The primary outcomes included functional improvement, pain relief, overall performance, and postoperative disability. The secondary outcomes included patient-reported satisfaction, return-to-work timeframes, and procedural complications. Conclusions: The tenotomy outcomes were similar, regardless of the method, indicating that discussions with patients about their specific outcome preferences may help guide tenotomy method selection. Full article

Background and Objectives: The objective of this study is to examine the correlation between the active range of motion (ROM) of the affected upper extremity and functional capacity in children with Obstetric Brachial Plexus Palsy (OBPP) who have undergone the modified Hoffer tendon transfer technique. Materials and Methods: The study cohort comprised 52 children with OBPP, aged 4–14 years, who had undergone a shoulder tendon transfer. The ROM was quantified using a goniometer, while functionality was evaluated through the administration of the Brachial Plexus Outcome Measure (BPOM). Results: The study identified significant correlations between the shoulder ROM and the Brachial Plexus Outcome Measure (BPOM). Specifically, shoulder flexion (p = 0.017; r = 0.351) was positively associated with shoulder functionality, while shoulder internal rotation (p = 0.001; r = 0.481) was linked to appearance scores. A significant negative relationship was observed between elbow extension (p < 0.001; r = −0.512) and elbow and forearm activities. Conclusions: The study highlights the necessity of assessing both joint range of motion and body perception for effective treatment and follow-up, to improve the functionality and quality of life for children with OBPP. Full article

In forehand strokes with different grips in tennis, the forearm muscle activities, the distribution and attenuation of the impact loads, and the effects of the muscles on the impact load attenuation exhibited different characteristics. This study aimed to explore these characteristics by analyzing electromyography (EMG) and acceleration data, and comparing the differences between the Eastern and Western grips. Fourteen level II or above tennis players (ten males, aged 22.4 ± 3.6 years; four females, aged 19.8 ± 2.0 years) were recruited and instructed to perform forehand strokes using the Eastern and Western grips, respectively. The EMG of eight forearm muscles and the acceleration data at the ulnar and radial sides of the wrist and elbow were collected. The root mean square (RMS), the peaks of the impact load, the amplitude of impact load attenuation (AC), and the jerk value (Jerk) were calculated. The cross-correlation coefficients and time delays of EMG–EMG, EMG–AC, and EMG–jerk were obtained using the cross-correlation method. The results showed that in the Eastern grip group (group E), the RMS of the flexor carpi ulnaris (FCU) was significantly greater than that in the Western grip group (group W). In group E, the peaks of impact load, AC, and Jerk on the Y axis of the wrist ulnar side were all significantly higher than those in group W. The activity of the extensor digitorum commonis (EDC) had significantly different effects on the amplitude and rate of impact load attenuation at specific locations in different grips, especially at the elbow (p < 0.05). The conclusion indicated that the FCU exhibited higher levels of EMG activity in the Eastern grip. This grip responded to greater impact loads with more substantial and rapid attenuation on the wrist ulnar side. Furthermore, the EDC appeared to contribute more to the amplitude of impact load attenuation in the Western grip and to have a more significant influence on the rate of impact load attenuation in the Eastern grip, especially at the elbow. These results suggest that tennis players and coaches should pay more attention to improving the strength of the EDC and FCU, which can improve sports performance and comfort, as well as prevent sports injuries. Full article

Objectives: This study aimed to assess the impact of a 20-week resistance training program on force–velocity (F-V) parameters using an isokinetic two-point method and comparing one-repetition maximum (1-RM) methods in novice lifters. Methods: Previously untrained individuals completed a supervised, three-session weekly resistance training program involving concentric, eccentric, and isometric phases, repeated every 2 to 4 weeks. Isokinetic dynamometry measured the strength of elbow flexors/extensors at 60°/s and 150°/s, and knee flexors/extensors at 60°/s and 240°/s at Baseline, 3 months, and 5 months. F-V parameters, including maximal theoretical force (F0) and the F-V slope, were calculated. Participants also performed 1-RM tests for the upper and lower limbs. Repeated measures ANOVA with effect size (η² > 0.14 as large) was used to analyze changes in F-V parameters and repeated measures correlation was used to test their association with 1-RM outcomes. Results: Eighteen male participants (22.0 ± 3.4 years) were analyzed. F0 significantly increased for all muscle groups (η² = 0.423 to 0.883) except elbow flexors. F-V slope significantly decreased (steeper) for knee extensors and flexors (η² = 0.348 to 0.695). Knee extensors showed greater F0 gains and steeper F-V slopes than flexors (η² = 0.398 to 0.686). F0 gains were associated with 1-RM changes (r = 0.38 to 0.83), while F-V slope changes correlated only with lower limb 1-RM (r = −0.37 to −0.68). Conclusions: The 20-week resistance training program significantly increased F0 and shifted the F-V profile towards a more “force-oriented” state in knee muscles. These changes correlated with improved 1-RM performance. Future studies should include longer follow-ups and control groups. Full article

This work proposes a new unsupervised method to evaluate the behavior of urban green areas in the presence of heatwave scenarios by analyzing three indices extracted from satellite data: the Normalized Difference Vegetation Index (NDVI), the Normalized Difference Moisture Index (NDMI), and Land Surface Temperature (LST). The aim of this research is to analyze the behavior of urban vegetation types during heatwaves through the analysis of these three indices. To evaluate how these indices characterize urban green areas during heatwaves, an unsupervised classification method of the three indices is proposed that uses the Elbow method to determine the optimal number of classes and the Jenks classification algorithm. Each class is assigned a Gaussian fuzzy set and the green urban areas are classified using zonal statistics operators. The membership degree of the corresponding fuzzy set is calculated to assess the reliability of the classification. Finally, for each type of greenery, the frequencies of types of green areas belonging to NDVI, NDMI, and LST classes are analyzed to evaluate their behavior during heatwaves. The framework was tested in an urban area consisting of the city of Naples (Italy). The results show that some types of greenery, such as deciduous forests and olive groves, are more efficient, in terms of health status and cooling effect, than other types of urban green areas during heatwaves; they are classified with NDVI and NDMI values of mainly High and Medium High, and maximum LST values of Medium Low. Conversely, uncultivated areas show critical behaviors during heatwaves; they are classified with maximum NDVI and NDMI values of Medium Low and maximum LST values of Medium High. The research results represent a support to urban planners and local municipalities in designing effective strategies and nature-based solutions to deal with heat waves in urban settlements. Full article

Background/Objectives: The ulnar nerve’s unique anatomy makes it vulnerable to complex elbow dislocations. Depending on the nature of the injury, the clinical treatment and outcomes related to the nerve may vary. Unfortunately, the current literature provides limited and fragmented information on managing the ulnar nerve and the incidence of neuropathy in complex elbow dislocations. This study aimed to determine the occurrence of ulnar nerve pain and its relationship with transposition. Methods: A retrospective evaluation was conducted on a consecutive series of 44 patients who underwent surgery for complex elbow dislocations. The average follow-up period was 29 months. Patients were categorized based on their condition (trans-olecranon fracture–dislocation, Terrible Triad, Monteggia-like lesions, and injuries not falling into the previous categories). The study assessed whether the ulnar nerve was released from the cubital tunnel and underwent transposition. Additionally, the study examined the number of patients experiencing ulnar pain in the postoperative period and its duration over time. All patients were also evaluated using the Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder, and Hand (DASH) score, and Oxford Elbow Score (OES). Results: Patients who underwent simultaneous ulnar nerve transposition surgery with complex elbow dislocation showed a higher incidence of neuropathy. In these patients, the symptoms were less severe but lasted longer. MEPS, DASH, and OES did not show statistically significant differences between the two groups; however, they were slightly better for the group without ulnar nerve transposition. Conclusions: Surgeons should refrain from routinely transposing the ulnar nerve in complex elbow dislocations. However, further studies involving larger populations are necessary. Full article

Studies on the phenotypic traits and their associations in Chinese cabbage lack precise and objective digital evaluation metrics. Traditional assessment methods often rely on subjective evaluations and experience, compromising accuracy and reliability. This study develops an innovative, comprehensive trait evaluation method based on 3D point cloud technology, with the aim of enhancing the precision, reliability, and standardization of the comprehensive phenotypic traits of Chinese cabbage. By using multi-view image sequences and structure-from-motion algorithms, 3D point clouds of 50 plants from each of the 17 Chinese cabbage varieties were reconstructed. Color-based region growing and 3D convex hull techniques were employed to measure 30 agronomic traits. Comparisons between 3D point cloud-based measurements of the plant spread, plant height, leaf area, and leaf ball volume and traditional methods yielded R² values greater than 0.97, with root mean square errors of 1.27 cm, 1.16 cm, 839.77 cm³, and 59.15 cm², respectively. Based on the plant spread and plant height, a linear regression prediction of Chinese cabbage weights was conducted, yielding an R² value of 0.76. Integrated optimization algorithms were used to test the parameters, reducing the measurement time from 55 min when using traditional methods to 3.2 min. Furthermore, in-depth analyses including variation, correlation, principal component analysis, and clustering analyses were conducted. Variation analysis revealed significant trait variability, with correlation analysis indicating 21 pairs of traits with highly significant positive correlations and 2 pairs with highly significant negative correlations. The top six principal components accounted for 90% of the total variance. Using the elbow method, k-means clustering determined that the optimal number of clusters was four, thus classifying the 17 cabbage varieties into four distinct groups. This study provides new theoretical and methodological insights for exploring phenotypic trait associations in Chinese cabbage and facilitates the breeding and identification of high-quality varieties. Compared with traditional methods, this system provides significant advantages in terms of accuracy, speed, and comprehensiveness, with its low cost and ease of use making it an ideal replacement for manual methods, being particularly suited for large-scale monitoring and high-throughput phenotyping. Full article

Background: Stroke is the third leading cause of disability. Virtual reality (VR) has shown promising results in post-stroke rehabilitation. The VR TRAVEE system was designed for the neuromotor rehabilitation of the upper limb after a stroke and offers the ability to track limb movements by providing auditory feedback and visual augmentation. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), aligned with the International Classification of Functioning, Disability, and Health (ICF) principles, is a valid tool for measuring disability regardless of its cause. This study aimed to investigate the feasibility of the VR TRAVEE system in upper limb rehabilitation for stroke patients. Methods: A total of 14 stroke patients with residual hemiparesis were enrolled in the study. They underwent a 10-day program combining conventional therapy (CnvT) with VR rehabilitation. At baseline (T0), the upper limb was assessed using the Modified Ashworth Scale (MAS), active range of motion (AROM), and the Numeric Rating Scale (NRS) for pain. These assessments were repeated after the 10-day rehabilitation program (T1). Additionally, disability was measured using WHODAS 2.0 at T0 and again 30 days after completing the program. Results: Significant improvements were observed in AROM and MAS scores for the shoulder, elbow, wrist, and metacarpophalangeal joints, as well as in the reduction in shoulder pain (p ˂ 0.001). WHODAS scores decreased across all six domains, with a statistically significant improvement in the Cognition domain (p = 0.011). Conclusions: Combining CnvT with VR as a rehabilitation approach enhances motor function in the upper limb. This method has the potential to reduce disability scores and promote neuroplasticity. Full article

Background/Objectives: To investigate clinical and functional outcomes of patients undergoing reverse total shoulder arthroplasty (RTSA) using a rehabilitation protocol of either 4 or 6 weeks of immobilization. Methods: This comparative study analyzed a consecutive patient cohort that underwent RTSA in a single institute from January 2021–February 2023. Patients were assigned to groups according to the duration of postoperative immobilization and were followed up for a minimum of one year. Patient demographics, range of motion (ROM), functional outcomes using the Simple Shoulder Test (SST) and the American Shoulder and Elbow Score (ASES) as well as postoperative complications were recorded. The minimum clinically important difference (MCID) was used to assess whether the differences between the groups in SST, ASES, SWB, and VAS were clinically relevant. Results: Sixty patients met the inclusion criteria (35 patients in the 6-week immobilization group (6 WG) and 25 patients in the 4-week immobilization group (4 WG)) and were available for the total follow-up period. Similar baseline demographics were observed between the groups. Active ROM significantly improved for both groups, with abduction and forward flexion improving the most. In terms of functional outcomes, significant improvement (p < 0.001) was demonstrated for both groups (ASES, SST, VAS, and SWB). However, patients in the 4 WG reached significantly better results in VAS and SWB at 6 weeks and 3 months, as well as in ASES 3 months postoperatively, whereas both groups leveled off at the end of the follow-up period after 1 year. Taking into account the MCID, these differences for ASES at 3 months, as well as VAS and SWB at 6 weeks and 3 months postoperatively, were significant. Surprisingly, there were no differences between the groups over the entire follow-up period in terms of the SST. Conclusions: The author’s findings suggest faster clinical recovery at 6 weeks and 3 months in patients undergoing postoperative immobilization of 4 weeks compared to 6 weeks following RTSA. However, clinical and functional outcomes were equal for 4 WG and 6 WG at one year follow up. Full article

Background: Lateral epicondylitis of the elbow, commonly known as tennis elbow, is a musculoskeletal disorder characterized by pain and degeneration of the common extensor tendon. Despite various treatments, optimal management remains debated. Objective: This study aimed to compare the effectiveness of focal extracorporeal shockwave therapy (F-ESWT) alone versus a combination of focal and radial pressure waves (F-ESWT+R-PW) in treating chronic lateral epicondylitis. Methods: This retrospective observational study included 45 patients diagnosed with chronic lateral epicondylitis divided into two groups based on the treatment received: group A (F-ESWT, n = 23) and group B (F-ESWT+R-PW, n = 22). Both groups underwent three weekly sessions of their respective treatments. Patients were also given a home exercise protocol. Primary outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Patient-Rated Tennis Elbow Evaluation (PRTEE) for pain and functional impairment at baseline (T0), 4 weeks (T1), 12 weeks (T2), and 24 weeks (T3) post-treatment. Secondary outcomes included grip strength and ultrasonographic measurements of common extensor tendon (CET) thickness and vascularization. Results: Significant improvements in VAS and PRTEE scores were observed in both groups at all follow-up points. Group B showed greater pain reduction at T1 (VAS: 3.0 ± 1.6 vs. 4.43 ± 1.47; p < 0.005) and T2 (VAS: p < 0.030) compared to group A. Functional outcomes (PRTEE) also favored group B at T1 (p < 0.030) and in the pain section at T2 (p < 0.020). Grip strength improved similarly in both groups. CET thickness showed no significant differences at T3. Vascularization decreased significantly in both groups, with a non-significant trend favoring group B. Conclusions: The combined F-ESWT+R-PW therapy proved more effective than F-ESWT alone in the short- to mid-term management of chronic lateral epicondylitis, significantly enhancing pain reduction and functional outcomes. The combination of focal and radial pressure waves offers a superior therapeutic approach, leveraging the distinct mechanisms of each modality for better clinical results. Further research is needed to confirm these findings and establish long-term efficacy. Full article