This study assesses the effectiveness of an innovative shoulder training and rehabilitation device, the Rotr 1. The device uses mechanically created motion to disturb the balance of muscular forces around the shoulder, thereby facilitating dynamic training of the muscles. The hypothesis is that random disturbances provided by the device would potentially in-crease shoulder muscle activation as users try to resist the device’s motion. To test the efficacy of the device, shoulder muscle activation from two groups (ten non-athletes and seven athletes), was assessed in three different shoulder positions and four different exercise conditions (aka configurations). Muscle activation of seven different shoulder muscles was recorded using electromyography (EMG). 3D motion capture was used to ensure repeatability of the positions during testing. ANOVA was done to assess the differences in muscle activation across groups, positions and exercise conditions. This device has the potential to improve performance and rehabilitation of overhead athletes, by increasing the body’s ability to effectively react and protect the shoulder.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18912号 / 人健博第26号 / 新制||人健||2(附属図書館) / 31863 / 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 市橋 則明, 教授 松田 秀一, 教授 木下 彩栄 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Objective: To systematically scope the reported advice and education in physical therapy management of patients with subacromial shoulder pain, and to define key themes of the advice and education. Design: Scoping review. Literature Search: We searched MEDLINE, Scopus, Web of Science, and CINAHL, with publication dates from 2007 to September 2019. Study Selection Criteria: We included quantitative and qualitative research that reported on physical therapy interventions for subacromial shoulder pain. Data Synthesis: We performed a qualitative synthesis that identified items included in patient advice and education. Results: Of 89 original studies included, there were 61 randomized controlled trials; 5 prospective studies; 16 nonrandomized observational intervention studies or case series; and 7 surveys, audits of physical therapy patient records, and focus groups with physical therapists. We identified 7 key themes for advice and education: exercise intensity and pain response, activity modification advice, posture advice, pain self-management advice, pathoanatomical and diagnosis information, behavioral approaches, and pain biology advice. Conclusion: While advice focused predominantly on the local tissue pathology model, 10% of studies included information about pain neuroscience education, psychosocial factors, motor imagery, or behavior change.

BACKGROUND: Clinical investigation of shoulder injuries commonly utilizes visual evaluation of scapular movement to determine if abnormal or asymmetrical movements are related to the injury. To date, the intrarater reliability and diagnostic accuracy of visual evaluation of scapular movement among physical therapists are not known. PURPOSE: The aims of this study were to determine the clinical reliability and diagnostic accuracy of physical therapists visual evaluation of scapulohumeral movements when used to diagnose shoulder impairment. STUDY DESIGN: University based laboratory and an internet based survey. METHODS: Thirty-three physical therapists and 12 patient participants participated in this study. Reliability was measured as percent agreement and using the free marginal kappa statistic (κ) and Cronbach's alpha (α) for interrater and intrarater reliability respectively. Diagnostic accuracy variables such as sensitivity, specificity, likelihood ratios were calculated from contingency table analysis. RESULTS: Visual evaluation yielded the following (95% CI): diagnostic accuracy 49.5%, specificity 60% (56 - 64), and sensitivity 35% (29 - 41), positive and negative likelihood ratios were 0.87 (0.66 - 1.14) and 1.09 (0.92 - 1.27) respectively. Percent agreements of evaluation findings between sessions for static and dynamic symmetry were 69% and 68%, respectively. The alpha statistics for static and dynamic symmetry were both 0.51. Percentage agreement in determining the injured shoulder was 59%, with an alpha statistic of 0.35. CONCLUSION: Visual evaluation of scapular movements, without additional clinical information, demonstrated a poor to fair reliability and poor to fair diagnostic accuracy. CLINICAL RELEVANCE: The clinical utility of the use of isolated visual scapular evaluation is cautioned. More reliable and valid objective measures are needed for diagnosing shoulder impairment. LEVEL OF EVIDENCE: 2b, Exploratory cohort study.

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<p>The purpose of the thesis was to evaluate the neuromuscular control of shoulder muscles when performing concurrent shoulder and hand or elbow efforts in healthy and injured individuals. Of particular interest was the response of the supraspinatus and infraspinatus muscles to performing an additional hand task, such as gripping, while also performing different shoulder actions. Two studies were undertaken to provide the necessary groundwork for the subsequent two studies of this thesis. The first study investigated whether changes to shoulder muscle activity previously seen with gripping where the result of the novelty of using feedback to regulate grip force. This study found that changes in shoulder muscle activity with gripping are not diminished with repetition. The second study provided an improved method of normalizing electromyograms from dynamic contractions and was used in the subsequent studies of this thesis. Studies 3 and 4 of this thesis examined the response of shoulder muscles in healthy individuals during static sub-maximal efforts and maximal dynamic efforts in flexion and scapular planes with neutral and supinated forearm postures. Three conditions were tested in both studies: (i) no additional load, (ii) gripping to 30% of maximum and (iii) contracting the biceps to 30% of maximum. A prevailing theme found during sub-maximal contractions was individuality in neuromuscular recruitment strategies and precluded any significant effects of gripping or biceps contractions. During dynamic contractions, concurrent shoulder efforts with gripping and biceps contractions was found to significantly decrease deltoid, supraspinatus and infraspinatus muscle forces during flexion with supinated forearm posture. This thesis provided a thorough examination of shoulder electromyography in healthy individuals, improving our understanding of the neuromuscular control of the shoulder musculature. A common theme of this thesis was the individuality of neuromuscular strategies of the shoulder.</p> / Doctor of Science (PhD)

A high degree of variability is commonly encountered in biomechanical investigations of the shoulder. Researchers have hypothesized that the variation between individuals explains why only certain workers are injured when performing the same tasks as other individuals. One source for the variability is inter-individual differences in shoulder musculoskeletal geometry. The purpose of this thesis was to use computational modeling to assess the functional roles of the scapulohumeral muscles, compare model-predicted data to the reviewed literature, and quantify the sensitivity of these functional roles to changes in muscle geometry. Muscle moment arms, lines of action, stability ratios, and forces were quantified throughout arm elevation in the scapular plane using a widely investigated upper extremity model. Monte Carlo simulations were performed to iteratively adjust muscle attachment locations in order to reflect potential inter-individual differences in muscle geometry. Model-predicted muscle moment arms agreed well qualitatively with the reviewed literature; however, several muscle lines of action were inconsistent between the model and previous data collected in cadavers available in the literature. Sensitivity of muscle functional roles to attachment changes was muscle-specific, and depended upon the elevation angle as well as outcome measure. Regressions were developed to identify which attachment locations at the clavicle, scapula, and humerus caused the greatest change in muscle functional roles. In general, muscle moment arms were most sensitive to changes of the muscle attachment closest to the joint centre (humeral attachment for rotator cuff muscles; scapular attachment for deltoids). Lines of action were most affected by perturbations in scapular attachment location. Overall, these findings indicate that inter-individual musculoskeletal geometry differences can substantially alter muscle functional roles, which are expected to require altered muscle activity and kinematic coordination patterns between people. These variations in musculoskeletal geometry may differentially affect risk of work-related shoulder musculoskeletal disorders among individuals. / Thesis / Master of Science (MSc)

This study examined changes in task performance during performance of simulated overhead assembly task. The study objectives were to better understand the relationship between fatigue development during overhead work and task performance. This relationship is important, considering that performance changes, or decreases in task quality, have the potential for justifying and driving ergonomic changes that can help to improve worker safety. Sixteen people participated in eight experimental conditions (two levels of duty cycles, two work heights, and two hand positions). Four dependent measures based on endurance, subjective, objective, and physiological fatigue were used to quantify shoulder fatigue and were collected during the experiment. An overhead work task required participants to use a hand tool to strike targets at two reach distances above their head. Task performance was measured as a function of the closeness to the target center and the ability to apply a consistent force throughout the experiment. Data collected in this experiment is intended to provide a research basis for creating design guidelines that will help maximize efficiency and quality while reducing the likelihood of developing shoulder fatigue. / Master of Science