Thesis (MHSc--Health Science) -- AUT University, 2009. / Includes bibliographical references. Also held in print ( leaves : ill. ; 30 cm.) in the Archive at the City Campus (T 617.572044 HAR)

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban Institute of Technology, 2008. / Purpose Cricket fast bowlers are prone to the development of Myofascial pain syndrome and in particular active myofascial trigger points in their rotator cuff muscles of the shoulder joint (Scott, et al. 2001). This is due to the severe stresses placed upon the muscles, bones and joints of the shoulder as a result of the high velocity throwing action (Bartlett, et al.1996). In muscles containing active myofascial trigger points a decrease in the stretch range of motion as well as the maximal contractile force is noted, these two factors may negatively affect the speed at which a fast bowler deliver the ball (Travell, Simons and Simons, 1999). Dry needling is viewed as the most effective means of deactivating myofascial trigger points leading to in increase in both the contractile force and range of motion of the affected muscle, which could increase the speed at which the bowler delivers the ball (Wilks, 2003). The aim of the study was to determine the immediate effect of dry needling active myofascial trigger points of the rotator cuff on bowling speed in action cricket fast bowlers. Method The study consisted of 40 participants (randomly split into two equal groups of 20) each with shoulder pain of a myofascial origin. Group A (intervention group) received the dry needling intervention in their most tender active myofascial trigger point. While participants in Group B (control group) received no treatment. Bowling speeds were measured both before and after the intervention, to determine its effect on bowling speed. IV Data was entered into MS Exel spreadsheet and imported into SPSS version 15 (SPSS Inc.,Chicago, Iiiinois, USA), which was used for data analysis. Paticipants were evaluated on bowling speed, Algometer readings and Numerical pain rating Scale (NRS) both pre and post intervention. Participants were also asked if they believed the intervention increased, decreased or had no effect on their bowling speeds. Two sample t-test was used to compare baseline values between the groups. A repeated measure ANOVA was used to compare the rate of change of each outcome over time in the two groups. Pearson’s correlation analysis (intra-group) was used to assess the strength and magnitude of correlations of the changes in the outcomes. The McNemar – Bowker test and Weighted Cohen’s kappa statistics were calculated to assess agreement between perceived and actual levels of change. Results A significant treatment effect was observed in the intervention group were an increase in bowling speed, algometer readings as well a decrease in Numerical pain rating scale(NRS) scores was observed. There was also a perceived increase in the speed the participants delivered the ball in the intervention group. No significant changes were observed in the control group. The findings of this study indicate that dry needling as a treatment modality would be beneficial to fast bowlers in not only increasing their speeds but also the pain experienced as a result of active myofascial trigger points.

Os músculos do manguito rotador são os responsáveis pelo movimento de rotação do ombro e representam sítio freqüente de processos patológicos.O desequilíbrio de forças do manguito rotador pode desencadear patologias distintas do ombro ou ser resultado destas. A quantificação da força muscular do manguito rotador com dados precisos, somente é possível com aparelhos de alto custo, longe do alcance da maioria dos profissionais envolvidos com o problema em nosso país. No presente estudo, um aparelho relativamente simples e de baixo custo, capaz de mensurar com precisão a força muscular isométrica de rotação interna e rotação externa do ombro, foi projetado e construído com materiais de fácil obtenção e preço acessível. Ele consiste basicamente de uma plataforma de medição do torque de rotação do ombro acoplada a uma cadeira e adaptável para avaliação bilateral. O aparelho foi projetado para que o indivíduo permaneça sentado durante o teste, com cotovelo fletido a 90 graus e o antebraço apoiado sobre uma superfície plana. Um torquímetro, devidamente calibrado, foi fixado na porção inferior da plataforma, no ponto correspondente ao centro de rotação do ombro. A mudança no comprimento do braço de alavanca foi permitida pela variação na posição de um manípulo para apoio da mão durante os esforços de rotação interna e de rotação externa do ombro. Variações no comprimento do braço de alavanca e na altura da plataforma foram projetadas para adaptarem-se aos braços e antebraços dos indivíduos. O aparelho foi testado em 20 indivíduos saudáveis e demonstrou ser completamente versátil para uso em diversas condições e confiável na produção de informações sobre o torque dos músculos rotadores do ombro. / The rotator cuff muscles are responsible for the rotation movements of the shoulder and frequent site of pathological processes. Rotator cuff muscle power imbalance may unchain or result from distinct shoulder diseases. To date precise quantification of rotator cuff muscle power is only possible with the use of expensive machines, far from the reach of most of the professionals involved with the problem in our country. In the present investigation, a relatively simple and low cost device, able to precisely measuring isometric internal and external rotator muscle power, was developed and built with easily obtainable and low cost materials. It consists basically of a platform for measuring the rotational torque of the shoulder adaptable to both sides of a chair for bilateral evaluation. It was designed for the individual to remain seated while in test, the elbow flexed at 90o and the forearm rested on a flat surface. A properly calibrated torquimeter was adapted to the bottom side of the platform in a point corresponding to the shoulder’s center of rotation. The moving lever was provided with a handle to be grasped by the individual while doing internal or external efforts with the shoulder. Both platform height and moving lever were made adaptable to individual arm and forearm lengths. The device was tested with 20 healthy individuals and demonstrated to be quite versatile for use in many different conditions and reliable in providing information on the torque of the rotator muscle of the shoulder.

This work is about construcion of a manipulator to be used in paper manufacturing. The manipulator is desinged to turn a package of cellulose placed on a roller conveyor. Turning of the package is necessary for unwrapping and cleaness control of cellulose. Design was made based on analytical calculation and was verified using computer simulation. Pneumatic valves and an electric motor were utilized in the manipulator. The manipulator operates automatically.

Background Persistent musculoskeletal pain is a multi-factorial entity, influenced by biological, genetic and psychosocial factors. Psychosocial factors, such as individuals' beliefs and experiences, need to be considered in the management of such pain. While extensive research has explored beliefs of individuals with spinal pain, less is known about individuals' beliefs regarding shoulder pain. Objectives To explore beliefs about the cause of pain in individuals with persistent rotator cuff-related pain, as well as the experiences of the effect of pain on their daily lives. Design A mixed methods design, using semi-structured interviews and validated outcome questionnaires. Method Five men and five women, aged 47–68 years, with shoulder pain for at least three months were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim and analysed using the general inductive approach. Results/findings Four key themes emerged. The cause of pain, ‘Understanding the pain’, was described in terms of anatomical factors within the context of the participants' lives. The pain impacted all areas of life, creating another theme, ‘It affects everything’. Participants responded to their pain by adopting certain, ‘Pain-associated behaviours’ and sought information for diagnosis, general management and exercise prescription, ‘Emotional responses and the future’. Conclusions The participants with rotator cuff-related pain believed the cause of their pain to be local to the shoulder region. However, they also described various stressors in their work-, sports- and family-related lives. Rehabilitation may need to include educating the individual, expanding their understanding regarding pain mechanisms and appropriate interventions, based on individual goal-setting.

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第20400号 / 工博第4337号 / 新制||工||1672(附属図書館) / 京都大学大学院工学研究科高分子化学専攻 / (主査)教授 中條 善樹, 教授 秋吉 一成, 教授 古賀 毅 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DGAM

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24541号 / 人健博第112号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session. Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach. Results: There were two over-arching key themes: firstly, ‘Participants’ Perspectives’ of the session generated four themes: Improved understanding of ‘the whole’; Mindful self-awareness; Taking charge; “The pain is still there”. Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, ‘Participants’ Recommendations’, had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education. Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.

The glenohumeral (GH) joint is the most mobile joint in the human body, but its mobility inherently increases the risk of instability. The humeral head sits in a shallow glenoid in the scapula like a golf ball sitting on a tee. The stability in this joint is provided by the rotator cuff muscles and tendons that actively pull the humerus back into the socket to prevent dislocation, especially during overhead motions. However, the rotator cuff is prone to tears, resulting in pain, loss of mobility, and recreational limitations. Surgical reattachment of the tendon to the bone is challenging due to the mechanical disparity between the two tissues, resulting in stress concentrations and a high risk of retear. Notably, the specialized tissue at the tendon-to-bone attachment, which facilitates stress transfer between tendon and bone in healthy joints, does not regenerate after surgical reattachment and healing, making tendon-to-bone repairs prone to re-tears. A comprehensive understanding of GH joint biomechanics is essential for developing early interventions to prevent rotator cuff injuries. Furthermore, improving tendon-to-bone fixation during rotator cuff repair is critical to improve post-surgery outcomes. In the last decade, bioinspired solutions have shown considerable promise for addressing several biomedical problems. This thesis draws bioinspiration from two animals that have evolved unique mechanical functions: (i) the bat shoulder joint, which facilitates repetitive overhead motions during flight and may offer insights into rotator cuff pathology and (ii) the curvature of python snake teeth, which enables secure grasping of prey without soft tissue tearing. In the first part of the thesis, the bat shoulder was studied for its unique characteristics relative to mice. Overhead motions in humans often lead to shoulder injuries, partly because the bony anatomy of the unstable GH joint places greater stress on the joint's surrounding soft tissues to stabilize these motions. Traditional animal models used to study shoulder pathology are quadrupeds, which lack the capacity for overhead motion. In contrast, bats consistently engage in overhead motion during flight, subjecting their shoulders to substantial loading throughout their relatively long lifespan. Remarkably, the biomechanical demands placed on a bat's shoulder are estimated to exceed those of a competitive swimmer’s by 45-fold, despite sharing similar coracoacromial arch anatomy with humans. We were inspired to study functional adaptations in the shoulders of bats that enable this overhead motion. We performed comparative anatomy studies of the shoulders of bats and mice, similarly-sized quadrupeds. By quantifying the constraints imposed by the bony anatomy, we identified adaptations of the shoulder, including the rotator cuff tendons, that allow bats to sustain overhead motion in a high stress, repeated loading environment, without injury. In the second part of the thesis, python teeth were used as inspiration to develop a repair device optimized to grasp the rotator cuff without tearing. Rotator cuff repair surgeries fail frequently, with 20-94% of the 600,000 repairs performed annually in the United States resulting in retearing of the rotator cuff. The most common cause of failure is sutures tearing through tendons at grasping points. To address this issue, we examined the specialized teeth of snakes of the Pythonoidea superfamily, which effectively grasp soft tissues without tearing. To apply this non-damaging and effective gripping approach to the surgical repair of tendons, we developed and optimized a python-tooth inspired array as an adjunct to current rotator cuff suture repair, and found that it nearly doubled repair strength. Integrated simulations, 3D printing, and ex vivo experiments revealed a relationship between tooth shape and grasping mechanics, and enabled optimization of a tooth array device to enhance rotator cuff repair to distribute stresses and increase tendon-bone contact. The efficacy of the approach was demonstrated via human cadaver tests, suggesting an alternative to traditional suturing paradigms that may reduce tendon re-tearing. Collectively, these studies contribute to a better understanding of the biomechanics of the GH joint and offer novel, bioinspired approaches for rotator cuff repair. The functional adaptations of bats provide insight into developing new approaches to treat GH joint instability, and a clinically relevant python-tooth inspired device can ultimately reduce the high rates of re-rupture currently observed in rotator cuff repair.

Current return-to-drive recommendations for patients following rotator cuff repair (RCR) surgery are not uniform due to a lack of empirical evidence relating driving safety and time-after-surgery. To address the limitations of previous work, Badger et al. (2022) evaluated, on public roads, the driving fitness of patients prior to RCR and at multiple post-operative timepoints. The goal of the Badger, et al. study was to make evidence-based return-to-drive recommendations in an environment with higher fidelity than that of a simulator and not subject to biases inherent to surveys. Badger et al., however, do not fully investigate the driving practices exhibited by subjects, overlooking the potential presence of compensatory driver behaviors. Further investigation of these behaviors through observation of direct driving techniques and practices over time can specifically answer how drivers may modify their behaviors to address a perceived state of impairment. Additionally, the degree of success in vehicle operation by comparing an ideal turn to the path taken by the driver allows for a level of quantification of the effectiveness of the compensatory techniques. Moreover, driver trajectories inferred from the vehicle Controller Area Network (CAN) metrics and from global positioning system (GPS) coordinates are contrasted with the ideal turn to assess minimum requirements for future sensors that are used to make these trajectory comparisons. This investigation leverages pre-existing data collected by the Virginia Tech Transportation Institute (VTTI) and Carilion Clinic as used in the analysis performed by Badger et al. (2022). RCR patients (n=27) executed the same prescribed driving maneuvers and drove the same route in a preoperative state and at 2-, 4-, 6-, and 12-weeks post operation. Behavioral data were annotated to extract key characteristics of interest and related them to relevant vehicle sensor readings. To construct vehicle paths, data was obtained from the on-board data acquisition system (DAS). Behavioral metrics considered the use of ipsilateral vehicle controls, performance of non-primary vehicle tasks, and steering techniques utilized to assess the impact of mobility restrictions due to sling use. Sling use was found to be a significant factor in use of the non-ipsilateral hand associated with the operative extremity (i.e., operative hand) on vehicle functions and, in particular, difficulty with the gear shifting control. Additionally, when considering the performance of non-primary vehicle tasks as assessed through a prescribed visor manipulation, sling use was not a significant factor for the task duration or completion of the task in a fluid motion. Sling use was, however, significant with respect to operative hand position prior to the completion of the visor manipulation: the operative hand was often not on the steering wheel prior to the visor maneuver. In addition, the operative hand was never used to manipulate the visor when the sling was worn. One-handed steering was also more frequent with the presence of the sling. Further behavioral analysis assessed the presence of compensatory behavior exhibited by subjects during periods in which impairment was perceived. Perceived impairment was observed as a function of the different experimental timepoints. Findings indicated a significant decrease in the lateral vehicle jerk during post-operative weeks 6 and 12. Significant differences, however, were not observed in body position alteration to avoid contact with the interior vehicle cabin, in over-the-shoulder checks, and in forward leans during yield and merge maneuvers. Regarding trajectory analysis, sling use did not produce a significant difference in the error metrics between the actual and ideal paths. In completion of turning maneuvers, however, operative extremity was significant for left turns, with greater error against the ideal path observed from those in the left operative cohort compared to those in the right operative cohort. For the right turn, however, operative extremity was not found to be a significant factor. In addition, the GPS data accuracy proved insufficient to support comparison against the ideal path. Overall, findings from this study provide metrics beyond those used in Badger, et al. that can be used in answering when it is safe for rotator cuff repair patients to return-to-drive. With the limited differences observed as a function of study timepoint and sling use, it is recommended that patients are able to safely return-to-drive at two weeks post-operation. If anything, results suggest that overcompensation, as inferred from observation of safer driving behaviors than normal, is present during some experimental timepoints, particularly post-operative week 2. / Master of Science / Current recommendations based on when it is safe for rotator cuff repair patients to return-to-drive are not standard because of a lack of suitable evidence. Previous work and recommendations rely on surveys and simulators which do not create fully realistic conditions and are subject to biases. To address the limitations of previous work, Badger et. al (2022) studied actual rotator cuff repair patients on public roads prior and following operation at multiple timepoints. Badger et al., however, did not consider the potential adaptations in driver behavior due to mobility restrictions and the perception of inferiority due to injury. Additionally, the degree of success of the adaptive driving behaviors based on the error between the actual vehicle path taken and a defined ideal path have not been explored in conjunction with the injury. This investigation is based on the pre-existing data collected by the Virginia Tech Transportation Institute (VTTI) and Carilion Clinic as used in the analysis performed by Badger et al. (2022). RCR patients (n=27) executed identical driving maneuvers and drove the same route before operation and at 2-, 4-, 6-, and 12-weeks post operation. Behavioral observations were recorded and related to relevant vehicle sensor readings. To construct vehicle paths, data was taken from the on-board data acquisition system (DAS). Participants adopted different behaviors, such as using the right hand to use the turn signal when the left arm was in a sling and the left hand to operate the gear shifter when the right arm was on a sling, to assist in combating mobility restrictions. One-handed steering was also more prominent during periods of sling-use. Sling-use, however, did not produce a significant difference in error between the actual vehicle path taken and the ideal path available to the driver. For left-operated participants completing left turns, there was also greater error in comparison to the ideal path than for the group of right-operated patients. However, there was not a difference between left- and right-operated arm participant error in completion of a right turn. The GPS data did not provide a suitable approximation of vehicle trajectory. Overall, findings from this study help to answer when it is safe for rotator cuff repair patients to return-to-drive through evaluation of the effectiveness of compensatory behaviors adopted by participants. With no significant difference in turn execution based on sling use, results suggest that patients can safely return-to-drive at two weeks post-operation. In fact, results suggest that overcompensation towards safer behaviors is present during some experimental timepoints, particularly post-operative week 2.